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AFRICA IS DYING-IT NEEDS HELP
Lester R. Brown
July 18, 2000
Worldwatch Issue Alert
2000 - 5
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 million 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.
Additional information and data can be found at the Issue
Alerts page at
http://www.worldwatch.org/chairman
COPYRIGHT: 2000 Worldwatch Institute
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