"It is the most interesting book I have ever read and inspires me to do something immediate to save our civilization." —Hanh Lien, translator for the Vietnamese edition of World on the Edge
The recent International AIDS conference in Durban, South Africa, reminds us that Africa is dying. The HIV epidemic that is raging across Africa is now taking some 6,030 lives each day, the equivalent of 15 fully loaded jumbo jets crashing — with no survivors. This number, climbing higher each year, is expected to double during this decade.
Public attention has initially focused on the dramatic rise in adult mortality and the precipitous drop in life expectancy. But we need now to look at the longer term economic consequences — falling food production, deteriorating health care, and disintegrating educational systems. Effectively dealing with this epidemic and the heavy loss of adults will make the rebuilding of Europe after World War II seem like child’s play by comparison.
While industrial countries have held the HIV infection rate among the adult population to less than 1 percent, in some 16 African countries it is over 10 percent. In South Africa, it is 20 percent. In Zimbabwe and Swaziland, it is 25 percent. And in Botswana, which has the highest infection rate, 36 percent of adults are HIV positive. Barring a medical miracle, these latter countries will lose one fifth to one third of their adults by the end of this decade.
Attention in Durban focused on the high cost of treating those already ill, but the virus is continuing to spread. Unless its spread is curbed soon, it will take more lives in Africa than World War II claimed worldwide.
As deaths multiply, life expectancy falls. Without AIDS, countries with high infection rates, like Botswana, Zimbabwe, and South Africa would have a life expectancy of some 70 years or more. With the virus continuing to spread, life expectancy could drop to 30 — more like a medieval than a modern life span.
Whereas infectious diseases typically take their heaviest toll among the eldest and the very young who have weaker immune systems, HIV claims mostly adults, depriving countries of their most productive workers. In the epidemic’s early stages, the virus typically spreads most rapidly among the better educated, more socially mobile segment of society. It takes the agronomists, engineers, and teachers on whom economic development depends.
The HIV epidemic is affecting every segment of society, every sector of the economy, and every facet of life. For example, close to half of Zimbabwe’s health care budget is used to treat AIDS patients. In some hospitals in Burundi and South Africa, AIDS patients occupy 60 percent of the beds. Health care workers are worked to exhaustion.
This epidemic, now producing thousands of orphans each day, could easily produce 20 million orphans by 2010, a number that could overwhelm the resources of extended families.
Education is also suffering. In Zambia, the number of teachers dying with AIDS each year approaches the number of new teachers being trained. In the Central African Republic, a shortage of teachers closed 107 primary schools, leaving only 66 open. At the college level, the damage is equally devastating. At the University of Durban-Westville in South Africa, 25 percent of the student body is HIV positive.
In addition to the continuing handicaps of a lack of infrastructure and trained personnel, Africa must now contend with the adverse economic effects of the epidemic. AIDS dramatically increases the dependency ratio, the number of young and elderly who depend on productive adults. This in turn makes it much more difficult for a society to save. Reduced savings means reduced investment and slower economic growth or even decline.
At the corporate level, firms in countries with high infection rates are seeing their employee health care insurance costs double, triple, or quadruple. Companies that were until recently comfortably in the black now find themselves in the red. Under these circumstances, investment inflows from abroad are declining and could dry up entirely.
In a largely rural society, food security declines as the epidemic progresses. At the family level, food supplies drop precipitously when the first adult develops full-blown AIDS. This deprives the family not only of this worker in the fields, but also of the work time of the adult caring for the AIDS victim. A survey in Tanzania found that a woman whose husband was sick with AIDS spent 60 percent less time tending the crops.
Food production declines from the epidemic have been reported in Burkina Faso, Côte d’Ivoire, and Zimbabwe. In pastoral economies, such as Namibia, the loss of the male head of household is often followed by the loss of cattle, the family’s livelihood.
Sub-Saharan Africa, a region of 600 million people, is moving into uncharted territory. There are historical precedents for epidemics on this scale, such as the smallpox epidemic that decimated New World Indian populations in the 16th century or the bubonic plague in Europe in the 14th century, but there is no precedent for such a concentrated loss of adults.
The good news is that some countries are halting the spread of the virus. The key is strong leadership from the top. In Uganda, where the epidemic first took root, the active personal leadership of President Yoweri Museveni over the last dozen years has succeeded in reducing the share of adults infected with the virus from a peak of 14 percent to 8 percent. In effect, the number of new infections has dropped well below the number of deaths from AIDS.
Senegal, alone in Africa, responded early to the threat from the virus. As a result, it prevented the epidemic from gaining momentum and held the infection rate to 2 percent of its adults, a number only slightly higher than that of the industrial countries.
Saving Africa depends on a Marshall Plan-scale effort on two fronts: one to curb the spread of the virus and the other to restore economic progress. Winning the former depends directly on Africa’s national political leaders. Unless they personally lead, the effort will fail.
Once the leader outlines the behavioral changes needed to contain the virus — such as young people delaying first intercourse, reducing the number of sexual partners, and using condoms — then others can contribute. This includes the medical establishment within the country, NGOs working in this area, and international health and family planning agencies.
To compensate for the “missing generation,” countries will need assistance across the board in education. This is an area where the U.S. Peace Corps and its equivalents in Europe can play a central role, particularly in supplying the teachers needed to keep schools open. Social workers are needed to work with orphans. A program of financial assistance is necessary for the extended families trying to absorb the millions of orphans projected by 2010.
Given the high cost of doing business in an AIDS-ridden society, special incentives in the form of tax relief are needed to attract corporate investors, incentives that could be underwritten by international development agencies. And it goes without saying, debt relief is essential to the rebuilding of Africa.
It is not possible to outline a detailed rescue effort here. The bottom line is that there is no precedent in international development for the challenge the world now faces in Africa. The question is not whether we can respond to this challenge. We can. We have the resources to do so. If we fail to respond to Africa’s pain, we will forfeit the right to call ourselves a civilized society.
Copyright © 2000 Earth Policy Institute