AIDS running amok
Protest photo: UNAIDS
How bad can it get?
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
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.
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
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.
Adding it up
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.
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?
©2002, University of Wisconsin, Board of Regents.