Africa: Poverty and the AIDS virus

Last year, South African President Thabo Mbeki came under sustained attack from both the scientific community and his allies concerning his response to the AIDS epidemic. Of course, the world media had a field day reporting it.

President Mbeki was accused of sowing confusion over AIDS when he insisted that AIDS was linked to poverty.

In his speech to the 13th International AIDS Conference in Durban last July, he said: ‘What I heard was that extreme poverty is the world’s biggest killer and the greatest cause of ill health and suffering across the globe. I heard stories being told about malaria, tuberculosis, hepatitis B, HIV-AIDS and other diseases.’

‘As I listened even longer to this tale of human woe, I heard the name recur with frightening frequency – Africa, Africa, Africa,’ he added.

‘In the end, I came to the conclusion that as Africans, we are confronted by a health crisis of enormous proportions. One of the consequences of this crisis is the deeply disturbing phenomenon of the collapse of immune systems among millions of our people, such that their bodies have no natural defence against attack by many viruses and bacteria,’ he said.

‘As I listened and heard the whole story told about our own country, it seemed to me that we could not blame everything on a single virus,’ he continued.

‘The world’s biggest killer and the greatest cause of ill health and suffering across the globe, including South Africa, is extreme poverty’.

Thabo Mbeki was not alone when he said this. Years earlier, the late Jonathan Mann (who became the founding director of the WHO’s Global Programme on AIDS) had made the link between deprived social and economic conditions and vulnerability to AIDS in his pioneering work on the AIDS epidemic in Africa.

‘Those people who were marginalized, stigmatized and discriminated against – before HIV/AIDS arrived – have later become, over time, those at highest risk of HIV infection,’ he wrote.

As a result of his AIDS research from 1984-1986 in Zaire, he warned that AIDS was not merely another infectious disease. ‘It seemed to flourish in and reinforce conditions of poverty, oppression, urban migration and social violence’.

According to a Washington Post article dated 5 July 2000, just before his death in a plane crash on 3 September 1998, Mann said, ‘discrimination isn’t just an effect, its actually a root cause of the epidemic itself’.

These conditions have prevailed in Africa ever since it was called upon to follow the prescriptions dished out by the World Bank and the International Monetary Fund.

Over the past four decades, the collapse in commodity prices, debt repayments and structural adjustment programmes and conditionalities have consigned Africa to the margins of the global economy, and virtual collapse.

African countries are worse off today than they were during their independence in the 1960s. This was stated in a report in July last year, prepared jointly by the World Bank and its partners, entitled ‘Can Africa Claim the 21st Century,’ which makes grim reading.

In the early 1960s, African nations were widely considered to be more advanced than East Asian nations. But between that time and the end of the 1990s, Africa retreated in real economic terms.

Over the past 30 years, it has lost market shares in global trade even in primary goods. ‘Africa accounts for barely 1 percent of global GDP and only 2 percent of world trade,’ says the report. ‘Its share of global manufactured exports is almost zero’.

Nearly half the continent’s people live below the poverty line. Less than one in five Africans have access to electricity; two-thirds of rural people lack adequate water supplies; and three quarters live without proper sanitation.

Infectious diseases like malaria and AIDS take more of a toll now than at any time since the early part of the 20th century.

The UN Economic Commission for Africa had stated that the World Bank’s structural adjustment policies have increased poverty and unemployment.

‘Debt servicing obligations have become unbearable … starvation and malnutrition, abject poverty and external dependence have worsened, while other structural weaknesses and deficiencies of the African economies have intensified,’ it noted in a 1989 report.

According to UNDP’s 1999 Human Development Report, the debt burden has undermined growth, health and education.

These colonial legacies have looted and reduced the continent to a state of poverty, conflict, chaos, criminality and disease. Many African nations have ceased to exist; law and order have all but disintegrated, plunging countries into bottomless pits of inter-ethnic genocide, wars, mayhem and murder; while natural disasters, death and ruin are unprecedented.

Poverty and conflict feed on each other. Clare Short, Britain’s International Development Secretary, said at a London Conference on 26th March that ‘Africa will not escape a cycle of poverty and decay without peace and stability’. Peace and stability can only come about when there are resources available to secure social and economic stability.

By the end of 1998, the total debt burden had reached 65.5 percent of the GDP; and some countries spend 40 percent of their national budget on debt servicing. The debt service obligations of African countries is a major obstacle to social and economic development.

This was implicitly acknowledged by the head of UNAIDS, Peter Piot, at the Durban AIDS Conference, when he called for the cancellation of the entire foreign debt of the African countries to enable them to develop public health capacities to fight the pandemic. Developing countries that carry some 95 percent of the AIDS burden have a debt of more than $2 trillion. The $15 billion or more in interests payments per year that poor countries have to pay can be used instead for social and economic development.

So far, attempts by the industrialised creditor nations to relieve (not cancel) these countries of their debt burdens have turned out to be public relations stunts with rock stars in tow.

Even the WB-IMF's highly touted debt relief plan, the Highly Indebted Poor Countries (HIPC) Initiative, has been found to be a sham, benefiting the creditors rather than the debtors.

In a letter to the Financial Times dated 29 September 2000, Kevin Watkins of Oxfam said that eight countries – including Mozambique, Malawi and Senegal spend more than 15 percent of revenue on debt servicing, with this rising to 40 percent in Zambia. In Tanzania, post-HIPC debt servicing amounted to $177 million, while current spending on primary education and health was $136 million.

According to the Southern African Research and Documentation Centre (SARDC), 22 of the 41 HIPC on the debt relief scheme will still have to pay $2 billion a year to creditors, thus spending more on debt than on education and health.

‘For every $1 that rich countries lend to the developing countries, $8 comes straight back in the form of repayment on debts owed to the rich countries,’ says Archbishop Njongokulu Ndungane of Cape Town. ‘Wealth is actually pouring from the South to the North,’ he added.

The UN estimates that 19,000 children die each day as a result of the social impact of the debt. The UNDP estimates that seven million children’s lives in sub-Saharan Africa could be saved each year, if the money currently spent on debt servicing was put to health and education.

Many of the HIPC are facing a devastating AIDS crisis. At the Durban AIDS Conference last July, Karen Stanecki of the US Bureau of Census revealed figures that sent shock waves around the world.

According to her estimates, people in four African countries, namely Zimbabwe, Namibia, Swaziland and Botswana, will have an average life span of only 29-33 years; whilst in many other African countries, average life spans will be below 40 years.

By 2003, some African countries, including South Africa, will have negative population growth, she said.

According to her, 20 percent or more of the adult population in Botswana, Lesotho, Namibia, South Africa, Swaziland, Zambia and Zimbabwe are infected with AIDS.

The World Bank economist for Africa, Alan Gelb, says that AIDS has been even more devastating than the numbers suggest, as the disease is most likely to infect young adults entering the most productive period of their lives. He said this at the launch of the World Bank Report in July 2000.

AIDS, in turn, will have a devastating impact on the economies of countries. According to Gelb, in the worst-affected African countries, labour markets have been crippled, national savings rates have declined, and economists are forecasting severe shortages of skilled manpower, as an entire generation is depleted by the epidemic.

And AIDS is spreading at a rate that was unimaginable five years ago. There are now 25 million AIDS cases in Africa. More than 8 million African children have become ‘AIDS orphans’.

The social and health crises unfolding in Africa is linked to the debt crisis (and growing poverty) afflicting the continent.

The ongoing immiserisation of Africa and the systemic crises that confronts the continent, resulting in the collapse of social and public health and delivery systems, the ensuing social dislocation and unrest, is a leading factor in the AIDS pandemic.

These are ideal conditions for the spread of ill health, diseases, death and epidemics. It is little wonder that AIDS has exploded in Africa, killing almost two and a half million people last year, whereas 200,000 Africans died in wars in 1998.

According to UNAIDS, the disease is intensifying in Russia, Eastern Europe, India and Latin America – areas that are under enormous social and economic stress and instability where state welfare (and health) systems have collapsed.

Can the exponential leap in the AIDS epidemic worldwide be attributed mainly to sexual behaviour, as it is claimed that AIDS is largely a sexually transmitted disease?

In the light of the impending catastrophe that awaits Africa – drastically shortened lifespans and negative population growth due to severe escalating death rates from AIDS, and economic collapse - the US and the industrialised nations spend less than one percent of their overseas development budgets on AIDS.

This was revealed in a UN study in 1999, which showed that the rich countries spend $350 million to fight AIDS but their spending was not in keeping with the spread of the disease.

According to a press report dated 23 April 1999, the UNAIDS Director was quoted as saying: ‘Twenty years into the epidemic … AIDS is expanding three times faster than the funding to control it. Weighed against the global catastrophe of the AIDS epidemic, level of spending for HIV is minimal.’

‘Donor nations must realize that their substantial investments towards improving conditions in developing nations will be effectively obliterated unless more is invested in fighting AIDS – the single greatest threat to global development today,’ he warned.

UNAIDS says that AIDS funding in Africa alone will require more than $3 billion per year and only a fraction of this amount is available. It realises that one of the major obstacles in the battle against AIDS is the lack of funds.

Kofi Annan, the UN Secretary-General, last February made an appeal to the UN member states to mobilize resources to reverse the AIDS pandemic.

It is still yet to be seen how the rich countries will respond to the AIDS pandemic.

A Special Session of the UN General Assembly is planned for June to devise a Global Action Plan against AIDS. The meeting aims to secure political and social commitments to fight the epidemic and includes focusing on international funding, debt relief, and the pharmaceutical industry, among others.

However, WB-IMF policies are still in place that continue to exact strict conditionalities and force poor countries to go on paying their debts.

Drug companies still insist that Third World countries must pay world market prices for anti-AIDS drugs, otherwise they will be faced with trade sanctions.

And South Africa is being sued by the drug corporations and their Northern proxies for making anti-AIDS drugs affordable to AIDS patients.

If this is any indication, the view is hardly rose-coloured.