The poor often do not have access to information. Most AIDS activists agree that preventing the spread of HIV/AIDS requires education and information for behavioural change. Yet many of the health and HIV/AIDS education and information campaign appear in media and forms that are not accessible to the poor and the communities in which they live.
The poorest of the poor often live in remote areas and have no access to even the mass media, including radio. There also tends to be a correlation between high illiteracy and poverty, creating more of a challenge for the crafting of messages and information on basic health and HIV/AIDS for the poor. When poor women are further burdened by the demands of care-giving, they have no time to access information they need about prevention, treatment and care.
Even where prevention messages physically reach people, they may not be accepted or acted upon especially where these messages are not related to
Poverty leads to behaviours that expose people to the risk of HIV infection:
Many HIV/AIDS information and communication campaigns emphasize “safer sex” as a means of protection. When women and young girls are engaged in sex work to earn money for basic needs, “safer sex” becomes an option that is hard for them to negotiate due to their impoverished status.
Marriage for poor women in patriarchal societies also is seen as the most reliable way for women to survive.
In most provincial towns in Sierra Leone, about half of the women are married by the age of 18, and of these, the largest percentage is in a polygamous marriage.
Women within these marriages are economically dependent on their husbands, and because of this dependency, they often silently risk unfaithfulness and do not dare to discuss the issue of safer sex for fear of violence and likely being thrown out of the “economic security” provided by the marriage. The fact that women cannot practice safer sex within marriage has become a central but often hidden feature of the spread of HIV/AIDS. If a woman is forced to leave the home, because she has married young, often without basic education and skills, she may resort to sex work to survive, thus continuing the vicious cycle of inequality, social disempowerment and poverty.
Labour migration, which becomes the route through which women and youth seek to escape poverty, puts young women particularly at risk of sexual exploitation. It also creates unequal ratios of men and women, increasing the possibility of HIV transmission through shared partners or sex work.
Often prevention messages that advocate the use of condoms and safer sex, do not consider the situation of the poor. Also condoms, if not distributed for free by public health and other structures, may be unaffordable for the poor (even when the cheapest is Le200), and, distribution may not reach remote areas.
Living conditions of the poor weaken their resistance to illness: Poor people often live in unhealthy situations.
A larger percentage of provincial people and an alarming number of people living in Freetown, (Sierra Leone’s capital) do not have access to clean water in their homes, and one in four does not have electricity. Very poor people are not able to get enough food, or enough good food. Many people live in informal settlements in provincial towns and villages and inner city slums, where sanitation and refuse removal are poor.
Diseases like cholera, pneumonia and diarrhea to mention a few spread rapidly when people live under these kinds of conditions. Poor people living with HIV/AIDS are more likely to become ill sooner from these opportunistic infections.
Because the poor often go without food, and when food is available it tends not be nutritious, they are constantly in a state of malnutrition which weakens resistance.
Coupled with the lack of clean and safe drinking water, and the lack of decent housing, all of these factors compromise the health of the poor.
Once infected with HIV/AIDS, the body of the poor in such a weakened state is unable to fight the opportunistic diseases that take their toll faster.
Treatment and medical care are often beyond the reach of the poor, even though the government of Sierra Leone says the treatment is free, but every thing boils down again to the access to the information and the sad fact that there are hundreds of towns and villages that are over 10 miles away from a health care facility.
The cost, as well as access to treatment and care, determines who survives with HIV/AIDS.
Little wonder that Kabala one of the poorest district in the country has the highest cases of HIV/AIDS. By Mohamed Fofanah