Chapter 5. Our Socially Divided World: The Effects of the HIV Epidemic
Since the human immunodeficiency virus was identified in 1981, this infection has spread worldwide. By 1990, an estimated 10 million people were infected with the virus. By the end of 2002, the number had climbed to 68 million. Of this total, 26 million have died; 42 million are living with the virus. Twenty-nine million HIV-positive people today live in sub-Saharan Africa, but only 30,000 are being treated with anti-retroviral drugs; 6 million live in South Asia, with nearly 4 million of them in India.7
Infection rates are climbing. In the absence of effective treatment, the parts of sub-Saharan Africa with the highest infection rates face a staggering loss of life. Adding the heavy mortality from the epidemic to the normal mortality of older adults means that countries like Botswana and Zimbabwe will lose half of their adult populations within a decade.8
There is no recent historical example of an infectious disease taking such a heavy toll. To find a precedent for such a potentially devastating loss of life from such a disease, we have to go back to the decimation of New World Indian communities by the introduction of smallpox in the sixteenth century or to the bubonic plague that claimed roughly a fourth of Europe's population during the fourteenth century. HIV should be seen for what it is—an epidemic of epic proportions that, if not checked soon, could claim more lives during the early part of this century than were claimed by all the wars during the last century.9
The HIV epidemic is not an isolated health care phenomenon. It is affecting every facet of life, every sector of the economy. Food production, already lagging behind population growth in most countries in sub-Saharan Africa, is now falling fast as the number of field workers shrinks. As food production falls, hunger intensifies among the dependent groups of children and elderly. Malnutrition weakens the immune systems of some, the virus weakens the immune systems of others, and some have immune systems weakened by both. The downward spiral in family welfare typically begins when the first adult falls victim to the illness—a development that is doubly disruptive because for each person who is sick and unable to work, others must devote at least part of their time caring for that family member.10
Expenditures for health care and medicine in families with falling incomes and shrinking food supplies further exacerbate the dire situation. As savings disappear, productive assets must be sold, including livestock and farm implements. Medical and funeral costs for parents often leave children in debt. Hunger leaves those with the virus more vulnerable to infectious diseases.11
While the economic fallout from the massive loss of young adults is still poorly understood, the epidemic is already beginning to cut into economic activity. Rising worker health insurance costs are shrinking or even eliminating company profit margins, forcing some firms into the red. In addition, companies are facing increasing sick leave, decreased productivity, and the burden of recruiting and training replacements when employees die.12
In these circumstances, companies become less competitive in world markets. Incoming capital flows begin to shrink, and economic growth slows or even turns into economic decline. Both exports and imports are reduced, savings decline, and more countries face the prospect of defaulting on their international debt.13
Education is also affected. The ranks of teachers are being decimated by the virus. In some countries, such as Zambia, teachers are dying faster than they can be replaced. When one or both parents die, more children stay home simply because there is not enough money to buy books and support them in school. They must fend for themselves. Universities are also feeling the effects. At the University of Durbin in South Africa, 25 percent of the student body is HIV-positive.14
The effects on health care are equally devastating. In many hospitals in eastern and southern Africa, a majority of the beds are now occupied by AIDS victims, leaving less space for those who need care for traditional illnesses. Doctors and nurses are often stretched to the breaking point. With health care systems now unable to provide even basic care, the toll of traditional disease is also rising. Life expectancy is dropping not only due to the lives lost to AIDS, but also due to those lost because of the deterioration in health care.15
The epidemic is leaving millions of orphans in its wake. Sub-Saharan Africa is expected to have 20 million "AIDS orphans" by 2010—children who have lost at least one parent to the disease. There is no precedent for millions of street children in Africa. But the extended family, once capable of absorbing these numbers, is now itself being decimated by the loss of adults, leaving children, often small ones, to fend for themselves. For some girls, the only option is what has come to be known as "survival sex." Michael Grunwald of the Washington Post writes from Swaziland, "In the countryside, teenage Swazi girls are selling sex—and spreading HIV—for $5 an encounter, exactly what it costs to hire oxen for a day of plowing."16
The HIV epidemic in Africa is now a development problem, a matter of whether a society can continue to function as needed to support its people. It is a food security problem. It is a national security problem. It is an educational system problem. And it is a foreign investment problem. Stephen Lewis, the U.N. Special Envoy for HIV/AIDS in Africa, says that the epidemic can be curbed and the infection trends can be reversed, but it will take help from the international community. The failure to fully fund the Global Fund to Fight AIDS, Tuberculosis and Malaria is "mass murder" by complacency. He says, "The pandemic cannot be allowed to continue, and those who watch it unfold with a kind of pathological equanimity must be held to account."17
Writing in the New York Times, Alex de Waal, an adviser to the U.N. Economic Commission for Africa and to UNICEF, sums up the effects of the epidemic well: "Just as HIV destroys the body's immune system, the epidemic of HIV and AIDS has disabled the body politic. As a result of HIV, the worst hit African countries have undergone a social breakdown that is now reaching a new level: African societies' capacity to resist famine is fast eroding. Hunger and disease have begun reinforcing each other. As daunting as the prospect is, we will have to fight them together, or we will succeed against neither."18
7. Latest regional and world statistics in UNAIDS, AIDS Epidemic Update (Geneva: December 2002), p. 6; total deaths and historical estimates calculated using UNAIDS statistics in Worldwatch Institute, Signposts 2002, CD-Rom (Washington, DC: 2002); anti-retroviral treatment from UNAIDS, op. cit. note 5, pp. 22-23.
8. UNAIDS, op. cit. note 5.
9. More deaths from AIDS than wars from Lawrence K. Altman, "U.N. Forecasts Big Increase in AIDS Death Toll," New York Times, 3 July 2002.
10. AIDS and food security in UNAIDS, op. cit. note 5, pp. 49-50; U.N. Food and Agriculture Organization (FAO), The Impact of HIV/AIDS on Food Security, 27th Session of the Committee on World Food Security, Rome, 28 May-1 June 2001.
11. UNAIDS, op. cit. note 5, pp. 49-50; FAO, op. cit. note 10.
12. "Strategic Caring: Firms Strategize About AIDS," The Economist, 5 October 2002; UNAIDS, op. cit. note 5.
13. UNAIDS, op. cit. note 5.
14. UNAIDS, Report on the Global HIV/AIDS Epidemic (Geneva: June 2000), p. 29; Prega Govender, "Shock AIDS Test Result at Varsity," (Johannesburg) Sunday Times, 25 April 1999; "South Africa: University Finds 25 Percent of Students Infected," Kaiser Daily HIV/AIDS Report, 27 April 1999.
15. UNAIDS, op. cit. note 14.
16. Mark Dennis, Julia Ross, and Shelley Smith, eds., Children on the Brink 2002: A Joint Report on Orphan Estimates and Program Strategies (Washington, DC: UNAIDS, UNICEF, and U.S. Agency for International Development, July 2002), p. 6; Michael Grunwald, "Sowing Harvests of Hunger in Africa," Washington Post, 17 November 2002.
17. Stephen Lewis, press briefing (New York: 8 January 2003); Edith M. Lederer, "Lack of Funding for HIV/AIDS is Mass Murder by Complacency, Says U.N. Envoy," Associated Press, 9 January 2003.
18. Alex de Waal, "What AIDS Means in a Famine," New York Times, 19 November 2002.
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