AIDS in Africa: Dying by the Numbers
By: John Christensen
“We used to think of AIDS as a health
issue; we were wrong”
In coming to grips with AIDS, the worst health
calamity since the Middle Ages and one likely to be the worst ever,
consideration inevitably turns to the numbers.
According to estimates from UNAIDS, an umbrella group for five U.N.
agencies, the World Bank and the World Health Organization, 34.3
million people in the world have AIDS -- 24.5 million of them in
sub-Saharan Africa. Nearly 19 million have died from AIDS, 3.8
million of them children under the age of 15.
Among the other statistics:
· 5.4 million new AIDS infections in 1999, 4 million of them in
Africa.
· 2.8 million dead of AIDS in 1999, 85 percent of them in Africa.
· 13.2 million children orphaned by AIDS, 12.1 million of them in
sub-Saharan Africa.
· Reduced life expectancy in sub-Saharan Africa from 59 years to 45
between 2005 and 2010, and in Zimbabwe from 61 to 33.
· More than 500,000 babies infected in 1999 by their mothers --
most of them in sub-Saharan Africa.
Finally, this: The bubonic plague is reckoned to have killed about
30 million people in medieval Europe. The U.S. Census Bureau
projects that AIDS deaths and the loss of future population from the
deaths of women of child-bearing age means that by 2010, sub-Saharan
Africa will have 71 million fewer people than it would otherwise.
The numbers are staggering, but they do not begin to encompass the
suffering and the dramas that put faces on the epidemic.
We think we are animals
One face belonged to Gugu Dlamini, a South African woman who
admitted on television on World AIDS Day that she had AIDS. When she
returned to her home, she was beaten to death by fellow villagers.
Another belongs to a Ugandan girl named Kevina who lost both parents
and her aunts and uncles to AIDS. Although just 14, Kevina must care
for four younger brothers, three younger sisters and her blind,
84-year-old grandfather. They have no money, food, health care or
transportation. Their roof leaks and other villagers sometimes steal
their firewood.
“The teacher calls us orphans,” Kevina writes in a letter published
by the United Nations Development Program, “but I don’t want that
name. Even other children don’t want that name. We think we are
animals.”
Increasingly sophisticated treatments have cut the death AIDS death
rate in the industrialized countries, but elsewhere the epidemic is
gathering momentum.
Infections in the former Soviet Union have doubled in the past two
years. Journalist Patricia Thomas, author of a forthcoming book on
the search for an AIDS vaccine called “Big Shot,” says that “... in
India and China, the world’s most populous nations, their epidemics
have just gotten off the ground.”
The focus at the moment, however, is on sub-Saharan Africa, where 10
of the 11 infections that take place each minute occur, where in
some countries teachers, doctors and nurses are dying faster than
they can be replaced, and where treatment ranges from inadequate to
non-existent.
AIDS - A loaded word
AIDS was first identified in 1959 in what was then the Belgian
Congo. Frank Vogl of Transparency International, says that until the
late 1980s “many African nations were in total denial. They thought
we in the West were trying to fool them. They said, “That’s your
problem. We’ve got other things to worry about.” I don’t hear that
rhetoric much any more.”
Although governments are mobilizing -- including Botswana, Zimbabwe,
Namibia and Swaziland where AIDS is the worst -- they sometimes take
their own approach to the problem.
“We know the government will intervene, and massively,” says Dr.
Robert Shell of the Population Research Unit at Rhodes University in
Grahamstown, South Africa, “but the pandemic marches forward. Every
day we get 1,700 new cases.”
Most men are not tested
Many men leave their rural homes to work in mines and on
construction projects. This mobile work force and rapid urbanization
has contributed to cities in which 40 to 50 percent of the
population has AIDS.
In a document prepared for the U.N. Development Program, researcher
Desmond Cohen writes that a 40 to 50 percent infection rate was once
thought “wholly improbable.”
Wars have also contributed to the problem.
Like migrant workers, truck drivers and young men, soldiers often
visit “commercial sex workers,” or prostitutes, 90 percent of whom
are believed to have AIDS. Nigerian soldiers with the ECOMOG forces
in Sierra Leone and Finnish soldiers serving as peacekeepers in
Namibia took AIDS with them when they returned home.
The AIDS rate among women is much higher than among men, but as
Shell points out “most men are not being tested.”
Meanwhile, they unknowingly may be passing on the infection to
African women. Compounding the problem, according to a U.N. study,
is that 30 percent of young African women believe if a man looks
healthy, he could not have AIDS.
Strangling businesses
Given the variables and incomplete reporting on the epidemic, it is
difficult to assess its economic impact with any precision. But
there have been estimates that the per capita income in most
sub-Saharan countries has declined by 20 percent.
The American Foundation for AIDS Research noted in a research paper
late in 1999 that 80 percent of those dying are workers between the
ages of 20 and 50 -- workers in their prime.
“AIDS is slowly strangling many businesses and economies,” the
report said, “and in a global market everyone eventually suffers.”
Many companies hire and train two and even three people to do the
job of one person because AIDS is certain to fell some of them.
The epidemic is also responsible for the quadrupling of life
insurance premiums in Zimbabwe, escalating health costs to Botswana
companies by 500 percent and driving the health costs of a large
Zambian company so high that they exceeded profits.
In Zimbabwe and Botswana, where roughly one of every four people
have AIDS, the disease has cut sharply into population growth with
negative consequences.
“The zero growth is coming because people are dying in their young
adult years, not after leading full lives and then dying,” says
Karen Stanecki, chief of health studies for the U.S. Census Bureau.
People are dying in the years when they’re supposed to be most
productive, and they won’t be there to raise the next generation.
Which means you’ll have all these orphans and no one to raise them.
The danger of global consequences
One of the most alarming speculations is that by the year 2010 there
will be 40 million AIDS orphans in Africa, most of whom will have
grown up with little or no social structure.
As much as humanitarianism, it is this vision of lawlessness and
chaos and their potential to destabilize the global economy that has
fueled worldwide concern.
“If we don’t work with the Africans themselves to address these
problems,” U.S. Ambassador to the United Nations Richard Holbrooke
said in January 2000, “we will have to deal with them later when
they will get more dangerous and more expensive.”
Researchers are working on an AIDS vaccine, but such a medicine is
still years away. In the meantime aggressive prevention programs
can, and do, help.
But African nations spend only $165 million a year to combat AIDS,
and it all comes from the industrialized nations. James Wolfensohn,
president of the World Bank, told the U.N. Security Council in
January 2000 that an effective and comprehensive prevention program
for sub-Saharan Africa would cost $2.3 billion a year.
To be effective prevention must be paired with investment that will
create jobs, invigorate the educational system and pull the poor out
of the “here and now” mentality that makes them susceptible to AIDS.
“Many of us used to think of AIDS as a health issue,” Wolfensohn
told the Security Council. “We were wrong. AIDS can no longer be
confined to the health or social sector portfolios. AIDS is turning
back the clock on development.”
Says Vogl: “These countries have to make their economies grow.
People who are trapped in poverty aren’t going to do much about
health care. If everything else in the country is falling to pieces,
it is not going to have much effect.”
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