POSTED JULY 26, 2002

2. Divining an undivine future

3. Past plagues

This African girl was orphaned by AIDS and infected by HIV. USAID.

Anything except a pandemic that's still spinning out of control. (An epidemic is an outbreak of infectious disease; a pandemic is an epidemic that's spread over a wide geographic region.)

No such luck. The 2002 AIDS conference in Barcelona confirmed, if we had any doubt, that the epidemic is still spreading, leaving existing hotbeds in Africa and North America to become a truly global problem. "AIDS epidemic still in early phase and not leveling off in worst-affected countries," the world's AIDS-fighters summarized.

We summarize:

20 million have died

40 million-plus carry HIV, the AIDS virus.

5 million become infected each year

3 million die each year.

Adult infection rates are above 10 percent in 20 African countries.

HIV is gaining new ground in Asia. Four million are infected in India alone.

The future is grim. AIDS drugs are unaffordable to most potential patients in developing countries. Fewer than 4 percent of those patients, mainly in Brazil, are getting them. So most people will die within 10 years of infection. That means more orphans and funerals, but fewer workers, teachers and doctors.

Here's the grim situation as of last year. Note numbers in sub-Saharan Africa, South Asia and North America. UNAIDS 2002 "Barcelona" report

Two years ago, a report from the U.S. Census Bureau (see "The AIDS Pandemic..." in the bibliography), reported that life expectancy would plunge to around 30 years in six African countries, including Botswana, Namibia and Swaziland. That amounts to erasing a century of public-health progress.

Africa: Only the first?
It's easy to anticipate that fragile societies and economies might collapse under the strain. Would that mean large flows of refugees heading for the developed world? Would those states-in-name-only become breeding grounds for terror, disease or environmental catastrophe? Could countries like Indonesia or China, where democracy is more dream than a reality, turn yet more authoritarian as they try to cope with the spreading epidemic?

We Why Filers are no way wise enough to answer these questions, but we will observe that past epidemics have changed history:

Some experts think the Roman Empire was hollowed out by epidemics that peaked between 165 and 266 AD.. Losses of population, taxes and the ability to raise armies led to chaos and finally the dissolution of the empire.

The first wave of the black death killed roughly a third of Europeans during 1346 to 1350. Some historians credit the epidemic with helping jump-start the Renaissance, the rise of science, culture and new political forms that ended the miserable Middle Ages.

Smallpox, measles, and other viruses killed as many as 90 percent of Native Americans after the Spanish conquerors arrived on the heels of Columbus. This decimation allowed a few shiploads of bloodthirsty Spaniards to defeat millions of Indians.

Source: UN Department of Economic and Social Affairs (2002) World Population Prospects, the 2000 Revision
The AIDS epidemic is really starting to pinch in southern Africa, where it's wiping out a century's gains in life expectancy. Average life expectancy in sub-Saharan Africa is 47 years; it would be 62 without the epidemic. Fifty-five million extra deaths are predicted for this region by 2020. UNAIDS 2002 "Barcelona" report, p. 45

AIDS, to date, has not caused anywhere near the destruction of smallpox or black death. And as a slow-acting, blood-borne illness that's invisible almost to the end, it obeys different epidemiological rules than most previous killers.

Still, the concern about the future course of the AIDS epidemic arises quite starkly from today's statistics -- and tomorrow's projections.

Where is the AIDS epidemic going?

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Terry Devitt, editor; Pamela Jackson, project assistant; S.V. Medaris, designer/illustrator; David Tenenbaum, feature writer; Amy Toburen, content development executive

©2002, University of Wisconsin, Board of Regents.