**1. Introduction**

248 Social and Psychological Aspects of HIV/AIDS and Their Ramifications

Walker N, Schwartländer B, Bryce J. (Ed). (2002). Meeting international goals in child

Zaba B, Marston M, Floyd S. (2003). The effect of HIV on child mortality trends in sub-

Population Division, September 2003. UN/POP/MORT/2003/13.

Saharan Africa. Paper presented at a Workshop held at the United Nations

survival and HIV/AIDS. *The Lancet*, 360(9329): 284 – 289.

More than 42 million people around the world are currently infected with the Human Immunodeficiency Virus (HIV), which causes the Acquired Immunodeficiency Syndrome (AIDS) (Ojukwu, 2004). Although new cases of HIV/AIDS infections have declined in most developed countries, the virus has spread rapidly through much of the developing world. In some areas of sub-Saharan Africa, one in four adults is infected with the virus (Saloner, 2002). Acquired Immunodeficiency Syndrome (AIDS) comprises a collection of symptoms and infections, which result from specific damage to the immune system as a result of HIV. Latter stages of the condition leave individuals susceptible to opportunistic infections and tumours (Arnett 2001; UNAIDS, 2004).

Most European researchers believe that HIV originated from sub-Saharan Africa. Although this allegation may appear to be libellous, sub-Saharan Africa has become one of the worst affected regions (UNAIDS, 2003). An estimated 38.6 million people currently live with the disease worldwide (Nunn, Baggaley, Melby & Thomas, 2004). According to the joint United Nations Program on HIV/AIDS (UNAIDS, 2006), HIV/AIDS has killed more than 25 million people since it was first recognized in 1981, which makes it one of the most destructive epidemics in recorded history. HIV/AIDS has claimed an estimated 2.4-3.3 million lives, of which more than 570,000 were children in 2005 (WHO, 2006). Almost one third of the deaths accruing to HIV/AIDS, occurred in sub-Saharan Africa. This development has adversely impacted on economic growth and human capital development within this region.

Antiretroviral treatment reduces both mortality and morbidity regarding HIV infection, however, routine access to antiretroviral medication is not available in all countries (WHO, 2003). HIV/AIDS stigma is more severe than that associated with other life-threatening conditions and extends beyond affected individuals, care providers and even volunteers who are involved with caring for people who live with the disease (Salati, 2004).

Evidently, the physical size of a country, its population and its national income level per head, are important determinants of economic potential- a major factor, which differentiates one country from another. A country's potential for economic growth is influenced by its

HIV/AIDS and the Productivity of Selected Sub-Saharan African Regions 251

First and foremost, there should be laboratory evidence of infection with the HIV, which is usually achieved by demonstrating the presence of antibodies, to the virus. In the absence of antibodies a diagnosis may be made by viral isolation or viral antigen detection by means of serological tests (International AIDS Society, 2000). If possible, laboratory evidence of deficient cell mediated immunity should be demonstrated. The following tests should be conducted: total lymphocyte count, T cell subset, delayed hypersensitivity skin testing by using a number of antigens and lymphocyte proliferative studies, which uses various mitogens (Daka & Loha, 2008). In addition, there should be clinical evidence, which is either definitive or presumptive of opportunistic infections, certain cancers or direct central

Retroviruses have a unique method of reproducing, which allows the virus to copy its genetic information into a form that can be integrated into the host cells' own genetic code. Each time the host cell divides, viral copies are produced along with more host cells. The HIV attacks and gradually depletes a specialized group of lymphocytes, T helper or T4 cells. T cells normally play a key role in setting the immune system's responses in motion (McMichael, 2000). They send out chemical signals that stimulate production of antibodies and trigger maturation of other types of cells within the immune systems (B cell, macrophages and nerve cells). HIV not only depletes T helper cells, but also prevents remaining cells from functioning properly. B-cells become defective in an ability to produce immunoglobulin in response to appropriate stimuli. Loss of immunity is selective and affects primarily parts of the immune system that are involved in defenses against parasites, viral and fungal organisms, hence people who have AIDS, develop certain unusual life

> Diagrammatic illustration of stages of HIV Infection ↓ Development of antibodies (seroconversion)

> > ↓ Asymptomatic carrier state ↓ AIDS related complex (Non-life threatening conditions)

↓ Continuing asymptomatic state -------- recovery ------ continuing illness

> ↓ AIDS and other life threatening conditions

> > ↓ Death

nervous system involvement owing to virus infection of the brain (AVERT, 2009).

**3. Pathophysiology** 

infections (ibid).

Source: Ukpere, 2007.

endowment of physical resources (land, minerals and raw materials), in addition to its endowment of human resources (the number of people in a country and their skill level) (Dhar, 1995). However, the latter seems to have been demoted by the scourge of the HIV/AIDS pandemic within regions that are most affected. That HIV/AIDS epidemic has been ravishing the world for the past three decades, is a given fact and, therefore, calls for urgent action both individually and collectively. This paper attempts to ascertain the possibility of a relationship between HIV/AIDS and productivity of worst affected regions pursuant to broadening knowledge regarding HIV/AIDs as it affects the global economy. The following hypothesis is proposed:


#### **2. Diagnoses of HIV/AIDS**

Since its inception, several definitions have been developed for epidemiological surveillance such as the Bangui definition and the 1994 expanded World Health Organization AIDS case definition. However, clinical staging of patients was not an intended use for these systems as they are neither sensitive nor specific. In developing countries, the World Health Organization's staging system for HIV infection and disease relied on clinical and laboratory data (UNAIDS, 2004). In 1990, the World Health Organization (WHO) grouped these infections and conditions by introducing a staging for patients infected with HIV-1, which was updated in September 2005 (WHO 2006). Most of these conditions are opportunistic infections that are easily treatable in healthy people.


Previously, the Centre for Disease Control and Prevention (CDCP) did not have an official name for the disease, and had often referred to it by other diseases that were associated with it, for example, lymphadenopathy, a disease after which the discoverers of HIV originally named the virus. They also used Kaposi Sarcoma, an opportunistic infection, and named a task force after this, which was set up in 1981. In the general press, the term GRID, which abbreviated Gay-Related Immune Deficiency, was also coined (Goldstein, 1983). However, after determining that AIDS was not confined to the homosexual community, the term GRID became misleading, therefore, AIDS was adopted at a meeting in July 1982 (Altman, 1984). By September 1982, the CDCP began to use the name AIDS to include all HIV positive people with a CD4+T cell count below 200 per μl of blood. However, 14% of all cases in developed countries use either this definition or the pre-1993 CDCP definition.

AIDS diagnosis still applies even if, after treatment, the CD4+T cell count rises to above 200 per μl of blood, and even if other AIDS-defining illnesses are cured (Black, 1986, Nomcebo, 2005). The following criteria should be satisfied before a diagnosis of AIDS can be made: First and foremost, there should be laboratory evidence of infection with the HIV, which is usually achieved by demonstrating the presence of antibodies, to the virus. In the absence of antibodies a diagnosis may be made by viral isolation or viral antigen detection by means of serological tests (International AIDS Society, 2000). If possible, laboratory evidence of deficient cell mediated immunity should be demonstrated. The following tests should be conducted: total lymphocyte count, T cell subset, delayed hypersensitivity skin testing by using a number of antigens and lymphocyte proliferative studies, which uses various mitogens (Daka & Loha, 2008). In addition, there should be clinical evidence, which is either definitive or presumptive of opportunistic infections, certain cancers or direct central nervous system involvement owing to virus infection of the brain (AVERT, 2009).
