Plague of our times

THE HIV/AIDS SCOURGE HAS not begun to level off in Africa. Estimates published last year by the Joint United Nations Programme on HIV/AIDS (UNAIDS) are overwhelming: nearly 29.4 million adults in sub-Saharan Africa are infected. The disease has orphaned nearly eleven million African children. Without a marked improvement in prevention, treatment and vaccine research, an estimated fifty five million Africans will have died by 2020. The bad news is that AIDS appears to be apocalyptic. The good news is that the pandemic is the most profound reason to stop doing business as usual.

The urge to stress the immensity of the crisis is driven by more than a concern for the moral implications of the AIDS holocaust. The fact is that estimates of its impact represent new realities that will affect economic, political and cultural processes. Important questions are raised about long-term stability, among which, how will the pandemic affect the economic and political security of Africa?

State stability

In 1990, the US Central Intelligence Agency added AIDS to its hot-button list of variables for assessing the long-term stability of states. Alex de Waal, Programme Director for the Commission for HIV/AIDS and Governance in Africa at the United Nations' Economic Commission for Africa, foresees that the pandemic will transform populations, societies and states. While there is no direct causal connection between AIDS and insecurity, there is a direct link between the pandemic and the conditions for destabilisation: aggravated economic degradation, breakdown in social cohesion, and rapid degeneration of civil, military and political institutions.

Of those infected, about ten million are between the ages of fifteen and twenty four. These are working adults; the most productive members of the continent's developing countries. Without adequate intervention, AIDS will reduce the availability of skilled labour. It will also decrease life expectancy, increase the number of child-headed households, and worsen child and infant mortality.

AIDS by itself does not cause insecurity. Instead, it will contribute to heightened impoverishment, resource constraints and social inequalities - with long-term implications for security. This is a security issue but of a type not seen before, which requires more strategic consideration of new forms of complex emergencies and crises.

Economic fallout

The economic fallout poses major questions for strategic planning and economic development. Short-term consequences are first felt at the local level. AIDS places tremendous economic strain on families and communities. To provide treatment, care and support for patients, households must divert money away from school fees, savings, food, and income-generating investments such as agricultural seeds, tools and veterinary medicines.

Simultaneously, Africa's most traditional social safety net - the extended family - exhausts its financial and human capital to cover increased healthcare costs, funeral expenses and to support young orphans. In both formal and informal economies, firms lose revenue to increased costs in absenteeism, training and remuneration. Overall agricultural productivity is also adversely affected.

In September last year, the US National Intelligence Council reported that countries heavily affected by HIV/AIDS could lose up to one percent of gross domestic product (GDP) per year. In Africa, the cumulative effects will not only create more dependency on foreign aid, but will also exacerbate poverty and inequality in three important respects.

First, the purging of assets and other lost opportunities to increase household earnings will undermine the development of a strong middle class. Family coping strategies often require the sale of goods and property. Access to affordable treatment is rare, and as a result families lose income to expensive medical costs.

Second, without developed industries and a strong labour force, African economies will continue to depend on extractive industries such as mining. Already portrayed as the continent of war, disease and poverty, AIDS has only heightened Africa's negative image. Critically important industries for earning foreign exchange - such as tourism - will fail to grow. Without increased investment and trade, countries will continue to struggle on the margins of the global economy.

Third, because rural areas are heavily affected by AIDS but do not have access to treatment and support, agricultural productivity will go on falling. Food production and supply are compromised, straining the livelihood of millions. In southern Africa, where the average prevalence rate for the infection is thirty percent, the illness and death of agricultural workers, teachers and health professionals contributed to the food crisis of 2001/2002.

Deadly mistake

At the April 2001 summit convened by the Organization of African Unity in Abuja, Nigeria, African leaders recognised the state of emergency created by the pandemic and committed themselves to fighting it. States resolved to increase health spending to at least fifteen percent of GDP. Governments subsequently pledged nearly $13 million of their scarce resources to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

However, the amounts promised are both unrealistic and a drop in the ocean; governments can barely cover the costs of an effective response to HIV/AIDS. While the continent's health infrastructure is variable, in the least developed countries annual spending is frequently under $20 per person. The World Bank has estimated the annual average cost of hospital care for HIV/AIDS in Africa at about $218 without antiretroviral treatment. More resources will be required. Failure to respond to the pandemic may become more than a moral lapse: it could translate into a deadly political mistake in terms of social cohesion and good governance.

Pressure on already tight budgets could intensify the struggle for scarce resources. In military and governmental sectors, elites with power and opportunity maybe more likely to funnel funds to private bank accounts for treatment and care as well as to save and invest for an uncertain future. Increased corruption and patronage can lead to competition for powerful positions and discourage the equitable distribution of leadership opportunities. As a result, political and middle class elites may struggle for power and resources.

The perception of government inefficiency in addressing the health crisis is apolitical consideration. If governments and the ruling elite are thought to be diverting resources away from HIV/AIDS, the distance between the governed and the governing will grow. Increased conflict over health resources and other competing interests in the midst of weak democratisation will help to polarise marginal political positions, and contribute to tensions between opposition and ruling parties.

The moral and political schism that has developed between former South African President Nelson Mandela and his successor Thabo Mbeki on the government's AIDS policies is an example of the politics of the pandemic.

The activist organisation Treatment for Action Campaign threatened to reinstate a radical civil disobedience campaign in advance of South Africa's April 2004 general elections to increase pressure on the South African government to implement a treatment plan. The pressure worked and the government has formally committed itself to implementing a national scheme. However, the two sides remain divided, and the campaign will continue to be vigilant.

As more and more people are vulnerable to AIDS, the pressure on governments will increase. The problem, of course, will be the lack of resources. Governments will have to decide between the urgent need for treatment while negotiating debt repayment, building social service infrastructure, bolstering defence, and addressing other pressing development issues.

There may also be adverse effects on the consolidation of full political participation and governance. Because the disease kills the most productive members of society, the cumulative effect may be a reduction in the pool of upcoming political leaders both for government and civil society. Women, who are the primary caregivers for infected family members and are more biologically, epidemiologically and socially vulnerable, are particularly affected and their political involvement may be reduced.

Armed and infected

The military and police in affected countries present a unique security challenge. African militaries have significantly higher rates of infection than civilian populations and the same seems to apply to civilian police forces. Military personnel, peacekeepers and peace observers consistently rank among the groups most affected. A 1998 UN report, AIDS and the Military, noted that soldiers are generally at two to five times greater risk of contracting sexually transmitted diseases than the civilian population; during conflict that can rise to fifty times. Estimates of HIV prevalence among military personnel in the Democratic Republic of the Congo are as high as sixty percent. In 2000, the Panos Institute estimated that AIDS might kill between twenty five and fifty percent of the Malawi military by 2005.

African militaries vary widely in their institutional capacity, deployment patterns and relationship to civilian authority. The effects of infection will also vary. However, because military and police are particularly vulnerable, the pandemic will have serious implications for institutional capacity, national security and conflict management.

Stefan Elbe, a lecturer at the University of Warwick, recently wrote that while high HIV/AIDS rates cannot be causally linked to increases in armed conflict, in the long term the pandemic could adversely affect operational efficiency. In addition to diminished institutional capacity, national forces will suffer from reduced troop capability and combat readiness. More resources will have to be committed to treatment and care. Military staffing and personnel will be a further problem because people between fifteen and twenty four are the most vulnerable to the illness. In fact, the professionalisation of many of Africa's militaries will be slowed because of the expense of training and building institutional capacity.

National insecurity may be compounded by police operational ineffectiveness. A reduction in numbers of officers could translate into a weakened ability to respond to or prevent crime. In turn, a diminished or handicapped military may leave a security vacuum which police or informal non-state security forces may fill ineffectively.

A related worry, if civilian police forces are weakened, concerns the expanding youth population and the large numbers of AIDS orphans. In an economically depressed environment, larger youthful populations could contribute to increased communal violence. Cohorts of orphaned males are particularly vulnerable to criminal activity. Simultaneously, orphaned girls are sexually vulnerable and could be forced to engage in commercial sex - which might also increase HIV transmission.

Security and civil-military relations are further complicated if sexually active military units with high, untreated, undiagnosed HIV/AIDS rates are deployed in conflict zones. In Africa, where there is a proliferation of disorder, state and non-state combatants, as well as the civilian population, are at particular risk of exposure to infection.

Conflicts bring dislocation: the forced movement of refugees and internally displaced people; lack of social and health services; and observable increases in rape and prostitution. State and non-state combatants are highly mobile and powerful. They are deployed at borders and in the midst of powerless and desperate civilian populations. In conflicts, women, who are more vulnerable to HIV, often resort to exchanging sex for money, food and protection. Commercialised sex, coupled with the loneliness, boredom and stress of combatants, encourages the rapid spread of infection.

Domino effect

South Africa's catastrophe alone has tragic consequences; its rate of infection remains one of the world s highest at about twenty percent. Potentially dominant in the region, it is critical to the overall stability of sub-Saharan Africa because of its relative wealth, power, size and status. A reduction or compromise in Pretoria's own security would therefore have a domino effect on wider regional stability.

Simultaneously, Africa will have to find its own troops to contribute to under-committed international or UN peacekeeping missions. Thus, HIV/AIDS poses a major problem for Africa's peacekeepers; and has implications for South Africa's role in the Great Lakes region and the Economic Community of West Africa's forces in West Africa.

One step forward, two steps back

Nearly twenty one years into the pandemic, evidence of its destabilising effects is becoming clearer. The disease does not cause insecurity by itself; instead, the great plague of our age could lead to increased resource competition, social unravelling, and the degradation of civil and military institutions. The combination of HIV/AIDS with these destabilising forces will produce new types of complex emergencies and crises.

Even more worrying, for every step African nations take toward development, democratisation and peace, they will take two steps back. Historians will assess AIDS' role in transforming economic, political and social processes, and will wonder whether these transformations, with their positive and negative results, were anticipated by this century's leaders. While a world without AIDS may be decades away, its consequences will have enormous implications for the next century and beyond.