2. Divining an undivine future
Protest photo: UNAIDS
As
the United Nations struggles to raise $10 billion for what it describes
as a bare minimum program of AIDS prevention and treatment, the numbers
show nothing but disaster, especially for the hard-hit nations of Africa.
When asked about the future, AIDS experts tend to stress the positive. This is not an airborne infection that is spread by sneezing. Most individuals can control whether they get infected. Behavior change works.
It's true: Prevention programs can save lives. In Brazil, Uganda, Senegal and Thailand, climbing infection rates have been reversed by prompt, practical government action. In Uganda, HIV prevalence in pregnant women has fallen to 12 percent from 30 percent in 1992. Much of the credit goes to an education program that, much earlier than other African countries, confronted the sexual transmission of AIDS. In Brazil, anti-AIDS efforts prevented 234,000 hospitalizations between 1996 and 2000.
The big dying continues
Those statistics are all the more impressive against
a gloomy backdrop. With an AIDS vaccine a distant dream, and most nations
squandering the opportunity to prevent an epidemic from getting started,
it's a good bet that the future will be an extension of the present. Current
trends, in other words, will continue.
Looking a few years down the line offers little cause for optimism. Even without new infections, the prohibitive cost of anti-AIDS medicines will doom most of the 40 million who are now infected.
AIDS has more than a foothold in South Africa. In a decade, the epidemic
will cause a 17-fold increase in deaths among people aged 15 to 34!
UNAIDS 2002 "Barcelona" report,
p. 46.
But the general fecklessness of prevention programs ensures more infections. In Guyana (South America), where "only" 2.7 percent of adults are infected, UNAIDS, the United Nations AIDS program, estimates that 19 percent of today's 15-year-olds will be infected by age 50.
In the 45 countries with the worst epidemic, UNAIDS estimates that 68 million people will die early by 2020 from AIDS. So five times as many will die in the second 20-year phase of the epidemic as in the first 20 years.
Fifty-five million of these will die in sub-Saharan Africa.
These numbers may be grim, but epidemics are more than a simple body count. They also have social and economic effects. And long after the funerals are over, the historic effects may remain.
How
is the AIDS epidemic affecting society? Just look at the July, 2002, "Report
on the global HIV/AIDS Epidemic" (see bibliography):
In Botswana's cities, 45 percent of pregnant women carry HIV; in Zimbabwe,
35 percent. Without good (read: expensive) medicine, these women will
die - often after infecting their children. (The continued increase in
these rates has confounded experts who had hoped to see a leveling of
infection rates.)
Families also will die, as children are born with deadly
infection from their mothers or are sent to relatives for care. In Zambia,
65 percent of households dissolved after the mother died of AIDS.
About 14 million living children have lost one
or both parents to the disease.
Orphans tend to get less education than children
from intact families. Girls in particular are pulled from school when
AIDS ravages families.
The disease is also killing teachers. In one location
in Zimbabwe, 19 percent of male and 29 percent of female teachers are
infected.
Coping with AIDS is expensive. In two-thirds of
Zambian families, after the father died, income fell by at least 80 percent.
In Tanzania, 29 percent of the average family's savings were used to cope
with a single illness. In hard-hit Botswana, the average income-earner
in the poorest quarter of the population is caring for four relatives
who are ill or orphaned by the epidemic.
Health-care systems are sagging. AIDS patients' need for hospital beds
will exceed the entire national supply in Namibia and Swaziland by 2005.
In all of sub-Saharan Africa, 25 to 40 percent more doctors and nurses
may need training by 2010 to compensate for increased demand and for AIDS
deaths among health-care workers. And the direct medical costs of primitive
AIDS treatment (not including pricey but life-sustaining drugs) in Africa
is estimated at $30 per patient, more than three times the per-capita
health budget in many countries.
Bad for the economy
AIDS also damages economies. In Thailand, 41 percent
of families have sold land to pay for AIDS expenses. In Burkina Faso,
AIDS reduced agricultural output among 20 percent of rural households.
AIDS-affected households in Ethiopia spent half as much time farming.
Since the vast majority of deaths occur at prime working age - from 15 to 49 - the effect on employment is severe. According to UNAIDS, the epidemic "hits productivity mainly through absenteeism, organizational disruption and the loss of 'institutional memory.'"
"How (do you) keep schools functioning, or transport systems functioning, or water supplies functioning, or police services functioning when 20-30 percent of the people you have trained are, in fact, dying of HIV/AIDS?" asked economist Desmond Cohen of the International Labor Office in a press briefing this July.
In countries with at least 20 percent infection rates, the disease is cutting overall economic growth by 2 to 4 percent. By 2010, economic output in South Africa, the engine of the regional economy, will be 17 percent lower than otherwise.
These countries (in red) are mentioned in connection
with the AIDS epidemic.
Adding it up
While these statistics largely reflect sub-Saharan
Africa, this region
is simply where the disease is most established. Many argue that it represents
not the worst case but a global future if prevention efforts continue
to fail. Thus complacency about the plight of Africa is not only callous, but wrongheaded.
If AIDS continues to march unchecked across Asia, it's logical expect more of the same in that densely populated continent.
India alone already has 4 million infections. In China, an unknown number of rural people were infected by a frightening policy of pooling donated blood and returning it to donors.
As we've seen, AIDS is not just about deaths, but also about damage to education, families, and health-care systems. It's about lower life expectancy, fewer skilled workers, higher business costs and the horror of burying so many children and young adults.
This is the only AIDS referral facility in Haiti.
U.S.
Senator Michael DeWine.
The synergistic effects of the epidemic could thus harm every level of society, culture and the economy.
Will the social dislocations fuel the gruesome civil wars that have wracked countries like Mozambique, Angola and Congo in recent years? Perhaps. At the very least, it's hard to imagine the destruction fostering stability.
Will we see more refugees in a continent already wracked by refugees? It's certainly possible to anticipate more "disaster zones" like Sudan, where the civil war has dragged on for more than two decades.
Will we see more famine, like those that have struck Ethiopia and the border of the Sahara Desert in recent decades? Can't rule it out. Famine does not simply reflect the absence of rain, but also the inability of government and society to cope with a drought-prone climate.
Distrust predictions? Maybe we can understand the future by looking back at past waves of disease.
Does AIDS resemble historic epidemics?
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©2002, University of Wisconsin, Board of Regents.