HIV and AIDS pathogenesis and epidemiology

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CHAPTER TWO: LITERATURE REVIEW

Introduction

The previous chapter dealt with the introduction, aim, research objectives, methodology, literature review and relevant background information on HIV and AIDS in Manicaland. This chapter undertakes a review of the literature. It acknowledges the extensive body of research in the area of HIV and AIDS that has been undertaken both globally and nationally. Gaps in current knowledge will be identified and then one of the gaps related to the roles of culture and the Church regarding HIV and AIDS will be highlighted. Hence, the literature review will explore relevant research articles and books and highlight areas that require further attention. Further, my approach to the review of the literature inserting my own life history as a Catholic woman religious who has first-hand experience of Manyika culture. Uchem (2001: 24) argues:
Since gender roles are socially and culturally constructed, and learned from generation to generation through the process of socialization, they can also be unlearned. Already, things are beginning to change, though only slowly. No doubt, such a phenomenon as domination and subordination, which took centuries to construct, will also probably take as long to dismantle. For further change to happen we need to look at the attitude of Jesus in the gospels.
I have personally seen the ways in which gender roles are socially constructed. For example, in my own Manyika culture if a woman is married and gives birth to a baby boy, people say “Agara pamusha”, meaning that she fully belongs to that family into which she has married. The also say, “Rudzi rwakura” meaning that the lineage has increased. But when a woman gives birth to a baby girl, nothing positive is said, except to the mother of the child, who is told, “you now have someone to gossip with”. Another example is the sad story of my late mother who used to be beaten by my father for no apparent reason, or for small things such as putting too much salt in the vegetables or when she differed from him in any way. I am told that there were many occasions when my mother’s brothers, especially Uncle Evaristo, came to our home wanting to take her back. But, thinking of her children, she would refuse. I am told that one time she was beaten up and was left almost half dead and was taken to the hospital by some well-wishers. It is reported that when she was discharged from the hospital her brothers came and took her to their home. There they forbad her to go back to her husband, saying, “Enough is enough, you will not go!!!” So my mother had to escape. The main reason for her running away from the place of “safety” to a “dangerous” place of injustice and inequality was her concern for her children. Were it not for the resilience and commitment of most women, about three-quarters of our families would have broken up in Africa and beyond. Perhaps most of the well off people whom we now see around us would not be holding those positions if their mothers had not chosen to suffer for them and rather than taking the easy and comfortable way out. Consequently, I humbly 22 admit that my mother was one of those women who were totally dedicated to their family. If she were one of those women who throw their babies into toilets, she would not have endured the pain of forcing herself back to the family where her “enemy” was. It was through her resilience and love of her children that she finally manged to convert my father, who eventually become a staunch Catholic. This life of brutality and misery was the fate of most of the women in my village. It is true that this sort of an attitude is changing slowly owing to many different activists who are fighting for gender equality. I believe that education rooted in the gospel mandate is also contributing to this small change, as mentioned by Uchem (2001). In addition, the outstanding works by African theologians have contributed to reducing the cases of violence against women in homes. This literature review will be presented in the following thematic order: HIV and AIDS pathogenesis and epidemiology, HIV and the Catholic Church, and HIV and culture.

HIV and AIDS pathogenesis and epidemiology

Although the main theme of this study is the impact of culture and the Catholic Church on HIV and AIDS among Manyika women, it is necessary to highlight relevant information about the epidemic. This is important as the scientific facts will enable one to appreciate the impact of sociocultural, gender and economic variables on women’s vulnerability to HIV and AIDS. HIV is a condition in which an individual has contracted the human immunodeficiency virus (Musingafi et al., 2012: 3). This virus destroys the body’s immune system and makes the individual susceptible to opportunistic diseases and infections. This disease can be spread through having unprotected sex, sharing instruments such syringes with infected individuals, during pregnancy, childbirth and breastfeeding and through blood transfusions. Myths, such as the one that if an infected man has unprotected sex with a young woman (virgin) he will be cured of this disease (AVERT, 2016) have accelerated the spread of the disease in many communities.
White blood cells (CD4) plus T helper cells (CD4-T lymphocytes) play an essential role in helping people to fight off a wide array of infections, but are destroyed by HIV. CD4-T cells send signals to other types of immune cells, including CD8 killer cells. CD8 cells are lymphocytes that comprise transmembrane glycoprotein and serve as co-receptors that are found on the surface of cytotoxic T-cells. Cytotoxic T-cells are needed to kill the rapidly multiplying cancer cells. CD4+ T-cells are needed to help the autoimmune system to overpower infectious pathogens (AIDS gov, 2016).
CD8+ T-cells are critical agents in cellular immune responses, especially for controlling viral infections. During HIV infection, CD8+ T-cells can recognise infected cells and cover them with secretions of perforin and granzymes (Gulzar and Copeland, 2004). The cytotoxic T-lymphocytes can also eliminate virally infected cells by engaging death receptors on the surface of the infected cells. Furthermore, the CD8+ cytotoxic T-lymphocytes suppress viral binding and transcription, respectively (Gulzar and Copeland, 2004). HIV has adopted many strategies to withstand CD8+ T-cell responses to fighting pathogens. For example, HIV often mutates in order to escape CD8+ T-cell recognition or they disrupt proper CD8+ T-cell signalling. Consequently, improper T-cell receptor stimulation “creates an anergic state in these cells” (Gulzar and Copeland, 2004). By disrupting the CD4+ T-cells and the antigen-presenting cells that are required for the proper maturation of CD8+ T-cells, HIV is able to decrease the circulating pool of effector and memory CD8+ T-cells that are able to combat viral infection. The final result is the destruction of the CD8+ T-cell function (Gulzar and Copeland, 2004). Hence, when the virus attacks the CD4 T cells, it is able to multiply within infected cells. Blood samples that measure the number of CD4 cells (the CD4 count) are needed to detect the presence of the HIV (AIDS gov, 2017).
The disease forms when the virus has destroyed the body’s immune system, weakening it. This reduces individuals’ ability to resist other diseases, making them vulnerable to a variety of illnesses:
AIDS is the medical term used for a set of symptoms and opportunistic infections that arise from the HIV. The transition from HIV infection to full-blown AIDS generally proceeds as follows (Musingafi et al., 2012: 5– 6):
a. A “window” period between infections with HIV and before the body responds by producing antibodies. The person is free from symptoms, appears negative when tested, but is capable of passing the virus to other persons. The window period lasts between 3 to 6 months;
b. A “dormant” period when a person is HIV positive but the virus is still sleeping or inactive). Therefore, no signs of illness appear. However, the person will test HIV positive if tested;
c. An AIDS-related complex stage that marks the beginning of the clinical illness with non-specific symptoms/signs. Such symptoms may include swelling of lymph nodes, nausea, chronic diarrhoea, weight loss, fever and fatigue;
d. The full-blown AIDS stage when a patient presents obvious symptoms and signs of AIDS: this represents the final stage of HIV infection. Without treatment, AIDS patients at this stage are likely to die after a short time. However, the era of ART has changed the situation dramatically.

Epidemiology of HIV and AIDS

Epidemiology is “the study of the distribution and determinants of health-related states or events (including diseases), and the application of this study to the control of diseases and other health problems” (WHO, 2017). The challenges of preventing, containing the spread of, and clinically managing HIV and AIDS are a problem worldwide. Nonetheless, the characteristic patterns of opportunistic HIV infections vary in major regions in different parts of the world. There is no vaccine to date, although scientists continue to work on finding a cure (Musingafi et al., 2012).An understanding of epidemiology is needed for the reader to have a clear picture of the distribution and determinants of HIV and AIDS. This allows the reader to look at HIV and AIDS infection in women and men. It is by only after having enough knowledge about an issue or issues that one sees the need to take action. Haacker and Claeson (2009) underscore the importance of identifying epidemiological patterns surrounding HIV and AIDS, and learning lessons that may help to contain the HIV and AIDS pandemic. Zimbabwean leaders, policymakers, and Manyika women and men in the Eastern Highlands in particular should also learn from global HIV and AIDS epidemiological patterns in order to apply these studies to controlling the spread of HIV and AIDS among Manyika communities.
Every small action makes a difference. Mbuy-Beya (2001) invites us all to give a hand, and to “stand up and walk”, meaning that although HIV and AIDS has “crippled” us, we still have the potential to fight this disease and win the battle against us. Green (2011) points out that the incidence of HIV and AIDS is decreasing in some African countries, such as Zimbabwe. It could be argued that even though there is a noticeable decrease in HIV and AIDS infection rates, there is still much to be done, as many women are infected and affected by it.
According to Mbonu et al. (2009), many people living with HIV and AIDS (PLWHA) in sub-Saharan Africa face a combination of severe medical problems associated with the disease. Furthermore, the stigmatisation of those identified as being HIV positive serves to reinforce barriers to reaching others who are at risk or infected with HIV. Such negative social attitudes enhance secrecy and denial, and thus serve as catalysts for fostering HIV transmission. Furthermore, the stigma and humiliation associated with HIV and AIDS discourage many people from seeking HIV testing, support and treatment.
Social stigmas about HIV and AIDS negatively impact on the quality of patient care after a diagnosis of HIV and the perception and treatment of sub-Saharan African PLWHA and their partners by their communities and families (Mbonu et al., 2009). The women’s movement and activists writing on HIV and AIDS indicate that young women living with HIV have been left out from the global networking opportunities by their counterparts. “But powerful women in government and influential NGOs did not always represent all women, especially poor women” (Mbali, 2013: 94). It is due to the lack of support that many women are bearing the brunt of suffering.
Parsons (2012: 92) expresses his shock at the level of secrecy he witnessed amongst the Manyika: “before all else, to a degree that frequently shocked me, HIV infection is lived as an intense secret, often even within domestic spaces where its existence is all known.’’ Accordingly, it might be difficult for the Manyika to discuss openly how processes related to HIV and AIDS impact on their lives. Owusu-Ansah (2016) indicates that education is needed in such situations. Women need education to know that it is important to report incidents of threat and assaults against them so that the perpetrators can be punished. Some women do not report their husbands because they are the breadwinners and if they end up in prison their children would not be catered for. Oduyoye wonders how love can be manifested in destruction (personal communication, 11 June 2005).
Kapstein and Busby (2013) emphasise that it is the basic human right of everyone infected by HIV and AIDS to get treatment. PLWHA need counselling. Women’s issues that are detrimental to their rights should be solved. Kanyoro (2001: 163) thinks that a solution to women’s plight in the face of HIV and AIDS could start with incorporating “discussions on culture in our African communities so that women find it safe to speak about issues that harm their well-being”. This study aims to facilitate dialogue that will lead to breaking down Manyika taboos and fostering open and honest approaches to living with HIV and AIDS among Manyika women. The use of counselling in the process of HIV and AIDS interventions should not be overlooked. According to Van Dyk (2005) HIV pastoral care and counselling is a form of spiritual counselling. This kind of counselling accommodates everyone despite their religion, gender, colour, race or ethnic group. HIV pastoral counselling is not selective. It is meant for everyone. Van Dyk (2005: 249) notes, however, that “many clergy find it difficult to counsel HIV positive people properly because they are themselves ignorant about the disease and its ramifications”.
Although the Government of Zimbabwe is to be applauded for its contributions towards HIV and AIDS interventions, which include introducing policies to reduce new infections, there is still a need to provide ART to those infected, although targeted goals were met by 2012 in most of the key prevention services. Furthermore, when the Zimbabwean government adopted the 2013 WHO guidelines there was an increase in the number of people receiving ART services and challenging the culture of silence around the disease (UNICEF 1990, Zimbabwe National Statistics Agency, 2015).
The Zimbabwe National AIDS Policy has successfully guided medium-term interventions on HIV and AIDS. The use of ARVs and other methods has helped more people to live longer with HIV and AIDS. Nevertheless Zimbabwe still needs to have a long-term policy aimed at eradicating HIV and AIDS among the entire population.

Chapter 1: Overview 
1.0 Introduction
1.1 Aim
1.2 Objectives
1.3 The context of the research
1.3.1 Background information
1.4 Challenges in the church response to HIV and AIDS
1.5 Mutare in Manicaland
1.6 HIV and AIDS prevalence in Manicaland
1.7 Churches in Manicaland
1.8 Research questions
1.9 Rationale
1.10 Research methodology
1.11 Literature review
1.12 Structure of the thesis
Chapter Two: Literature Review 
2.0 Introduction
2.1 HIV and AIDS pathogenesis and epidemiology
2.2 Epidemiology of HIV and AIDS
2.3 HIV and women in Africa
2.4 The Catholic Church and HIV and AIDS
2.5 African theological responses to HIV and AIDS
2.6 Catholic religious responses to HIV and AIDS
2.7 The problem of faith healing
2.8 The churches in Manicaland organisation and HIV/AIDS
2.9 Culture and HIV and AIDS
2.10 Churches’ leaders in relation to culture, women and HIV and AIDS
2.11 Review on literature on churches, culture, women and HIV
2.12 Conclusion
Chapter 3: Research Methodology 
3.0 Introduction
3.1 Qualitative research
3.2 Methods
3.3 Research design
3.4 Sampling
3.5 Data collection method
3.6 Ethical considerations
3.7 Conclusion
Chapter 4: Research Findings
4.0 Introduction
4.1. Selection of study area
4.2 Interviews
4.3 Focus group discussions
4.4 Findings
4.6 Conclusion
Chapter 5: Analysis, Recommendations and Conclusion
5.0 Introduction
5.1 Research questions and findings
5.2 Personal impact of the study on the researcher
5.3 Conclusion
References
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