AIDS in Africa

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  • by Anup Shah
  • This Page Last Updated Sunday, February 17, 2008

One conflict in Africa that has taken a long time to get appropriate media attention, with regards to its severity, is that of the conflict of ordinary African people against HIV and AIDS.

The Impact of AIDS in Africa

Between 1999 and 2000 more people died of AIDS in Africa than in all the wars on the continent, as mentioned by the UN Secretary General, Kofi Annan.

The death toll is expected to have a severe impact on many economies in the region. In some nations, it is already being felt. Life expectencies in some nations is already decreasing rapidly, while mortality rates are increasing.

[2000] began with 24 million Africans infected with the virus. In the absence of a medical miracle, nearly all will die before 2010. Each day, 6,000 Africans die from AIDS. Each day, an additional 11,000 are infected.

— Lester R. Brown, HIV Epidemic Restructuring Africa’s Population, World Watch Issue Alert, 31 October 2000

UNAIDS estimates for 2007 that there were roughly:

  • 32.8 million living with HIV
  • 2.5 million new infections of HIV
  • 2 million deaths from AIDS

Over two-thirds of HIV cases, and some 80% of deaths, were in Sub-Saharan Africa.

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Lack of Action by Some African Leaders

As many African countries have moved towards democratization, they have been rewarded with the debts of their previously unaccounted dictators, most of whom embezzled billions of dollars from their own country into private savings. Obstruction by some major pharmaceutical companies (detailed further below) has also contributed to the hampered responses of many governments. The current and future generations are thus paying for this with their own lives.

While poverty is undoubtedly a crucial factor as to why health problems are so severe in Africa (also detailed further below), political will of national governments is paramount, despite disheartening odds. Constraints such as social norms and taboos, or lack of decisive or effective institutions have all contributed to the situation getting worse.

In South Africa, a relatively wealthy African nation, President Thabo Mbeki had long denied AIDS resulting from HIV. Only through public outrage and international pressure was he forced to admit that there is a problem.

However, other nations in Africa have shown a more proactive response to the crisis.

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Action by other African Leaders

Some nations in Africa have shown a more proactive response to the crisis. Though it is one of the world’s poorest countries, Senegal has been a success story when it comes to fighting HIV/AIDS. Reasons are many, including that

  • Problems were recognized early;
  • Resources were poured into fighting HIV/AIDS; and
  • Courageous steps were taken to deal with the religious and cultural taboos head on, using mass media to raise awareness effectively.
  • Both prevention strategies and reactive approaches such as condom use have also been promoted.
  • Universal access to anti-retroviral drugs was found to be more effective than user fees, for example and by monitoring and responding, they were able to increase health coverage and access to essential medicines, as USAIDS reported in its World Report 2004

UNAIDS, reporting years earlier on Senegal’s success did, however, admit that

there was much in the social structure of Senegal as well as in the structure of its health services even before the advent of AIDS that favored a response once the threat of an HIV epidemic became clear. But it was the determined use of those existing advantages to generate a national response early on that can be credited with the fact that, at the end of the 1990s, Senegal has one of the lowest rates of HIV infection in sub-Saharan Africa.

— Acting early to prevent AIDS: The case of Senegal, UNAIDS, June 1999, p.23

Uganda has also been another success story in fighting AIDS. UNAIDS warns that even when there are successes, complacency must not seep in, as there are signs that in Uganda young people today may be less knowledgeable about AIDS than their counterparts in the 1990s.

A variety of additional approaches observed include

  • Governments working with NGOs and their own people to deal with gender issues;
  • Recognizing the role of grandparents in high cases of orphaned children;
  • Using the mainstream media to raise awareness;
  • Providing universal health access in many cases;
  • Improving children’s access to education.

Botswana, Ethiopia, Tanzania, Senegal, and Zambia, have also tried to provide free HIV treatment as user fees have prevented people from receiving health services. Some of these free treatments are funded by a combination of government resources and donor contributions, showing partnerships at work.

There is still a long way to go, as prevention programs reach fewer than 1 in 5 in Africa, for example, as the UNAIDS World Report 2004 mentioned above notes (p.70). Despite the incredibly difficult challenge still facing most countries, there are important reasons to be optimistic.

The Center for Global Development think tank notes a number of conclusions in Saving Millions:

  1. Major health interventions have worked even in the poorest of countries;
  2. Donor funding has saved lives;
  3. Saving lives saves money;
  4. Partnerships between governments, NGOs, and private companies can be powerful;
  5. National governments can get the job done;
  6. Health behaviors can be changed; and
  7. Successful programs take many forms.

This has required a number of elements:

  • Predictable, adequate funding from both international and local sources;
  • Political leadership and champions;
  • Technical innovation within an effective delivery system, at a sustainable price;
  • Technical consensus about the appropriate biomedical or public health approach;
  • Good management on the ground; and
  • Effective use of information.

UNAIDS’s strategy is a three-pronged approach:

  1. Decreasing the risk of infection to slow down the spread;
  2. Decreasing vulnerability to reduce risk and impact; and
  3. Reducing risk to decrease vulnerability.

Furthermore,

This is a problem with a solution. As our report indicates, we know what works—successful approaches are evolving locally, nationally and globally. They are being helped by the growing momentum of international political leadership, by business workplace programs, and by the dynamic mobilization of affected communities themselves—a key element that remains at the heart of our global response.

— UNAIDS 2004 Report on the global AIDS epidemic, p.8

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Belated International/Western Media Attention to AIDS in Africa

Noted earlier, the importance of aid donations to helping fight AIDS is high. However, while AIDS in Africa is now on the agenda in many first world countries, and often received reasonable media attention, it has taken a long time to report on the crisis and reflect the concerns of citizens in those countries to help address this problem.

By 1990, the sense of urgency about AIDS in wealthy nations had also started to dissipate. “In the '90s it became clear we were not going to have a major heterosexual epidemic in the States,” said Michael Merson, who would succeed Mann at the WHO program. AIDS “was no longer a threat to the West.”

Foege, the former [US federal Centers for Disease Control and Prevention] CDC director, now teaches at Emory University. He has a maxim for his public health students: “Tie the needs of the poor with the fears of the rich. When the rich lose their fear, they are not willing to invest in the problems of the poor.”

— Barton Gellman, The Belated Global Response to AIDS in Africa, Washington Post, July 5, 2000

What is also disturbing is how the situation in Sub-Saharan Africa only become real western mainstream media news headlines around the time HIV and AIDS was declared a national security threat to the United States. While it it understandable that a media may reflect concerns in its own nation, it is another example of the mainstream coverage and their priorities, especially when there is a lot to report in terms of western economic policies seen through the various international institutions that have increased poverty, an important factor in the spread of AIDS.

Major western media outlets also claim to be the best sources of world news, yet the items covered seem driven by the agenda of rich nations, not of the actual events around the world. (See this site’s section on mainstream media for more on that angle.)

Western politicians were concerned about the plight of Kosovars leading up to the Kosovo crisis, but there was not a similar concern for people on the continent of Africa, where far more have died from AIDS (already in the millions—approximately 11 million people around the beginning of 1999—by the time concern for Kosovo was raised. This is not to belittle the situation in Kosovo, but to help put it in perspective).

Now that it is a direct concern for some western countries as well, there is increased reporting on the situation in Africa as well. Could the same interest in African affairs earlier helped raise awareness and the urgency for help earlier?

When Brown and Hall first proposed to study the phenomenon in 1987, they could not obtain CIA approval for use of personnel and computer modeling resources. Internal critics declared global AIDS an unfit subject of intelligence, or said the impact on U.S. interests would be benign.

Speaking of one military colleague at the National Intelligence Council, Brown said, “His penetrating analysis was, ‘Oh, it will be good, because Africa is overpopulated anyway.’ Others were saying, ‘It may be big, but what are you going to do about it?’” Still others, Brown recalled, discounted the likelihood of damage to allied militaries. If officers began dying of the disease, they said, “That boosts morale, because there’s more room for advancement.”

Another security official, recalling those debates, said critics reasoned that Africa’s limitless pool of unemployed men left armies with plenty of reinforcements. “If you have one 18-year-old with a Kalashnikov [rifle] and he dies, you find another 18-year-old,” he said. “The cold truth was that the impact on military stability was minimal.”

— Barton Gellman, The Belated Global Response to AIDS in Africa, Washington Post, July 5, 2000

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Western Pharmaceutical Companies’ Reaction to AIDS in Africa

AIDS policy is now a key world commodity—right up there with shiploads of computers, crude oil and wheat.

— Patricia Nell Warren, AIDS and the World Bank: Global Blackmail?, A&U Magazine, June 27, 2000

Accompanying the concern of the belated western media attention is the action of the multinational pharmaceutical companies and their lobbying efforts in first world countries and international forums, which reveal they are more worried for their profits than the plight of African nations, for they have resisted African nations’ attempts to use generic versions of their expensive drugs or pursue other related policies.

Currently, treatments, which Medicines Sans Frontiers describe as having “transformed HIV/AIDS from a death sentence to a chronic disease in developed countries”, are expensive and affordable by mainly the wealthier people in western countries. However, poor people—including those in industrialized nations—are the major victims of HIV and AIDS.

On July 19, 2000, the Export-Import Bank of the United States offered $1 billion per year for five years in loans to Sub-Saharan Africa to finance the purchase of U.S. HIV/AIDS medications and related equipment and services from U.S. pharmaceutical firms. However, three southern African countries, Namibia, South Africa and Zimbabwe rejected the offer because the loans would further the dependency and debt of African countries, while American pharmaceutical corporations would benefit. Another criticism such motions have received is that this ends up benefitting those companies who, in effect, get a free subsidy. In this way, U.S. corporate interests are advanced.

Oxfam went as far as accusing some corporations of contributing to human rights violations by trying to prevent access to the needed drugs:

Oxfam believes that 39 of the world’s biggest drug companies are contributing to a gross breach of human rights in South Africa and has today called on the United Nations to investigate.

— Drug giants set to cause violation of human rights, Oxfam Press Release, April 11, 2001

Numerous pharmaceutical companies took South Africa to court at the beginning of March 2001, over language in the Medicines Act which would allow for generic production and parallel importing of affordable AIDS drugs.

However, the public outrage around the world that resulted from these companies trying to do such a thing while people were dying led to them drop their case in April, 2001.

That was only part of the battle that South Africa won, and at some cost:

People concerned by globalisation frequently invoke the spectre of the growing might of corporations, which are seen as claiming ever greater chunks of influence in global policy setting. Rarely has this picture been drawn as clearly as in a recent court case in South Africa, in which the government of the country with more people living with HIV/AIDS than any other was locked into a fierce struggle with an industry doing everything possible to preserve its profits.

Happily, this David-and-Goliath story ended well when the 39 pharmaceutical companies suing the government decided to unconditionally drop their case against the Medicines and Related Substances Control Amendment Act, No. 90 of 1997, albeit after having tied it up in court for more than three years. Thus the final victory must be tempered by its high costs: during these three years, more than 400,000 South Africans have died of HIV/AIDS. Additionally, it is important to recognize that the legal victory alone will not automatically translate into improved care for people with HIV/AIDS; further steps are necessary before the hopes raised by this case—particularly for access to life-saving anti-retroviral medications—can be realized.

— Toby Kasper, Developing Countries Must Stand Firm on People Over Patents, South Centre Bulletin 11, 30 April 2001 (Emphasis Added)

Furthermore, while pharmaceutical companies pour research into cures, and the way that they are doing it is raising appropriate criticisms and concerns, this attention also diverts the much needed emphasis on prevention as summarized by the following:

What might be overlooked, however, as life-sustaining drugs become available, is the fact that prevention is still by far the more compassionate and more cost-effective answer. Prevention does not replace treatment, but it does reduce the number of people whose lives will depend on expensive drugs with significant side effects.

...

Attending to broader health concerns is not as expensive, or as hopeless, as it might seem. There are also serious weaknesses in a prevention plan that relies exclusively on provision of condoms, even with health education. It does not address women’s lack of power in sexual relationships, nor the irrelevance of condoms to most people after a few beers. Strengthening immune systems will help to protect people from some of the consequences of unsafe sex and from other infectious diseases as well. What it will take to prevent HIV transmission and to treat people with HIV/AIDS is no less, but no more, than what has been needed all along in sub-Saharan Africa and other poor regions. It would have been cheaper to provide the infrastructure, the nutrition, the education and the medicines before HIV/AIDS, but it is still a bargain calculated in both compassionate and cost-effective terms.

— Eileen Stillwaggon, AIDS and the Poverty in Africa, The Nation Magazine, May 21 2001

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Impact of Poverty on AIDS in Africa

The following quote reveals a lot:

Although there are numerous factors in the spread of HIV/AIDS, it is largely recognised as a disease of poverty, hitting hardest where people are marginalised and suffering economic hardship. IMF designed Structural Adjustment Programmes (SAPs), adopted by debtor countries as a condition of debt relief, are hurting, not working. By pushing poor people even deeper into poverty, SAPs may be increasing their vulnerability to HIV infection, and reinforcing conditions where the scourge of HIV/AIDS can flourish.

— Deadly Conditions? Examining the relationship between debt relief policies and HIV/AIDS, Medact and the World Development Movement, September 1999

Africa Action, an organization looking into political, economic and social justice for Africa looked at the impacts of IMF and World Bank structural adjustments and its impacts on health in Africa, and is worth quoting at length:

Health status is influenced by socioeconomic factors as well as by the state of health care delivery systems. The policies prescribed by the World Bank and IMF have increased poverty in African countries and mandated cutbacks in the health sector. Combined, this has caused a massive deterioration in the continent’s health status.

The health care systems inherited by most African states after the colonial era were unevenly weighted toward privileged elites and urban centers. In the 1960s and 1970s, substantial progress was made in improving the reach of health care services in many African countries. Most African governments increased spending on the health sector during this period. They endeavored to extend primary health care and to emphasize the development of a public health system to redress the inequalities of the colonial era. The World Health Organization (WHO) emphasized the importance of primary healthcare at the historic Alma Ata Conference in 1978. The Declaration of Alma Ata focused on a community-based approach to health care and resolved that comprehensive health care was a basic right and a responsibility of government.

These efforts undertaken by African governments after independence were quite successful....

While the progress across the African continent was uneven, it was significant, not only because of its positive effects on the health of African populations. It also illustrated a commitment by African leaders to the principle of building and developing their health care systems.

With the economic crisis of the 1980s, much of Africa’s economic and social progress over the previous two decades began to come undone. As African governments became clients of the World Bank and IMF, they forfeited control over their domestic spending priorities. The loan conditions of these institutions forced contraction in government spending on health and other social services....

The relationship between poverty and ill-health is well established. The economic austerity policies attached to World Bank and IMF loans led to intensified poverty in many African countries in the 1980s and 1990s. This increased the vulnerability of African populations to the spread of diseases and to other health problems....

The deepening poverty across the continent has created fertile ground for the spread of infectious diseases. Declining living conditions and reduced access to basic services have led to decreased health status. In Africa today, almost half of the population lacks access to safe water and adequate sanitation services. As immune systems have become weakened, the susceptibility of Africa’s people to infectious diseases has greatly increased....

Even as government spending on health was cut back, the amounts being paid by African governments to foreign creditors continued to increase. By the 1990s, most African countries were spending more repaying foreign debts than on health or education for their people. Health care services in African countries disintegrated, while desperately needed resources were siphoned off by foreign creditors. It was estimated in 1997 that sub-Saharan African governments were transferring to Northern creditors four times what they were spending on the health of their people. In 1998, Senegal spent five times as much repaying foreign debts as on health. Across Africa, debt repayments compete directly with spending on Africa’s health care services.

The erosion of Africa’s health care infrastructure has left many countries unable to cope with the impact of HIV/AIDS and other diseases. Efforts to address the health crisis have been undermined by the lack of available resources and the breakdown in health care delivery systems. The privatization of basic health care has further impeded the response to the health crisis....

The World Bank has recommended several forms of privatization in the health sector.... Throughout Africa, the privatization of health care has reduced access to necessary services. The introduction of market principles into health care delivery has transformed health care from a public service to a private commodity. The outcome has been the denial of access to the poor, who cannot afford to pay for private care.... For example ... user fees have actually succeeded in driving the poor away from health care [while] the promotion of insurance schemes as a means to defray the costs of private health care ... is inherently flawed in the African context. Less than 10% of Africa’s labor force is employed in the formal job sector.

Beyond the issue of affordability, private health care is also inappropriate in responding to Africa’s particular health needs. When infectious diseases constitute the greatest challenge to health in Africa, public health services are essential. Private health care cannot make the necessary interventions at the community level. Private care is less effective at prevention, and is less able to cope with epidemic situations. Successfully responding to the spread of HIV/AIDS and other diseases in Africa requires strong public health care services.

The privatization of health care in Africa has created a two-tier system which reinforces economic and social inequalities. As health care has become an expensive privilege, the poor have been unable to pay for essential services. The result has been reduced access and increased rates of illness and mortality. Despite these devastating consequences, the World Bank and IMF have continued to push for the privatization of public health services.

— Ann-Louise Colgan, Hazardous to Health: The World Bank and IMF in Africa, Africa Action, April 18, 2002

The article also comments on recent increases in funds to tackle HIV/AIDS and other problems and concludes that because some underlying causes and issues are not addressed, these steps may not have much effective impact:

The World Bank has also increased its funding for health, and for HIV/AIDS programs in particular. While the shift in focus towards prioritizing social development and poverty eradication is welcome, fundamental problems remain. New lending for health and education can achieve little when the debt burden of most African countries is already unsustainable. Debt cancellation should be the first step in enabling African countries to tackle their social development challenges. Additional resources to support health and education programs should be conceived as public investment, not new loans. The new spin on the World Bank and IMF priorities fails to change the basic agenda and operations of these institutions. Indeed, it appears to be largely an exercise in public relations. The conditions attached to World Bank and IMF loans still reflect the same orientation prescribed over the past two decades. The recent moves towards promoting poverty reduction have actually permitted these institutions to increase the scope of their loan conditions to include social sector reforms and governance aspects. This allows an even greater intrusion into the domestic policies of African countries. It is highly inappropriate that external creditors should have such control over the priorities of African governments. And it is disingenuous for such creditors to proclaim concern with poverty reduction when they continue to drain desperately needed resources from the poorest countries....

The free market fundamentalism of the World Bank and IMF has had a disastrous impact on Africa’s health. The all-out pursuit of market-led growth has undermined health and health care in African countries. It has forced governments to sacrifice social needs to meet macroeconomic goals.

This approach to development is fundamentally flawed. The failure to prioritize public health denies its significance in promoting long-term economic growth. As the WHO Commission on Macroeconomics and Health recently concluded, health is more than an outcome of development, it is a crucial means to achieving development.

— Ann-Louise Colgan, Hazardous to Health: The World Bank and IMF in Africa, Africa Action, April 18, 2002

There is also the phenomenon of “brain drain” whereby the poor countries educate some of their population to key jobs such as medical areas and other professions only to find that some rich countries try to attract them away. The prestigious British Medical Journal (BMJ) sums this up in the title of an article: “Developed world is robbing African countries of health staff” (Rebecca Coombes, BMJ, Volume 230, p.923, April 23, 2005.) Some countries are left with just 500 doctors each with large areas without any health workers of any kind. One third of practicing doctors in UK are from overseas as the BBC notes.

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Author and Page Information

  • by Anup Shah
  • Created: Saturday, July 01, 2000
  • Last Updated: Sunday, February 17, 2008

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Document Revision History

DateReason
February 17, 2008Updated the AIDS statistics (replacing the 2006 statistics)
December 3, 2006Updated the AIDS statistics
January 27, 2006Update to AIDS impact, the effects of brain drain, and addition of a few success stories. Else, remainder remains untouched from May 15, 2002.

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