The African AIDS Crisis and the Death of Nations

Today's Los Angeles Times has a powerfully disturbing photo-essay on the HIV/AIDS crisis in Africa, "The Orphans of AIDS." Here's the brief opening essay:

In 1990, nine years after the AIDS virus was identified, the map showing the worldwide spread of the disease displayed most of Africa in the palest pink. The infection rate among adults was less than 1%. Since then, the colors have deepened faster here than anywhere else on Earth. Southern Africa now is colored a bloody crimson. The infection rate is more than 15%.

The statistics have been repeated so often they cease to shock, even as they soar: 25 million people have died worldwide. Forty million are living with HIV, the virus that causes acquired immune deficiency syndrome, and as many as 14.5 million children have been orphaned by the disease, according to UNAIDS.

The United Nations Development Program said last year that AIDS had caused the biggest reversal in human development ever recorded.Just as African countries were beginning to make headway on improving quality of life and decreasing mortality in the 1990s, the rising pandemic started to erase many of their gains.

In fact, so sweeping are the repercussions of AIDS that some have asked whether the smaller states in southern Africa might simply collapse under the strain.

If all that is difficult to measure, the cost to families and individuals is incalculable.

Funerals have replaced weddings as the main family ceremony. People struggle to buy medicine. They borrow to pay for funerals. Breadwinners die and families plunge into poverty and hunger. Many families are made up of orphans and grandparents.

Unprotected orphans are exploited sexually or economically, often by their relatives. A myth persists in parts of Africa that sex with a virgin can cure AIDS, a factor in the upsurge of rapes of babies and girls. No one can calculate the cost. Southern Africa can only try to endure the successive waves of infection, illness and death.

Be sure to view the full photographic slide show.

Laurie Garrett, in a 2005 Foreign Affairs essay, suggested that HIV/AIDS is the most complex disease ever faced by the international community:

Unlike the massive pandemics of the past, such as the Black Death or the influenza outbreak of 1918-19, HIV/AIDS inflicts death very slowly. For three decades, the current pandemic has created waves of infection, followed years later by waves of acute disease, and years after that by waves of death and family disruption. In the prior two megaplagues, the periods between infection, illness, and death and family disruption were days to weeks. Entire societies experienced the shock simultaneously, grieved in unison, and witnessed the impact on the society and state as one.

In the case of HIV/AIDS, however, the intervals between these waves have lasted up to 14 years, and the waves themselves have been staggered, with the progression of infection and illness varying from person to person and region to region. Successive high-amplitude waves have swept over sub-Saharan Africa for up to four human generations. On the other hand, low-amplitude waves have gone almost unnoticed for ten years or more in India, Indonesia, Russia, Southeast Asia, and Ukraine. Only now are these areas experiencing large-scale infection. Illness, death, and the mass creation of orphans are still ahead.

Even within Africa, the timing of HIV/AIDS and its impact have varied. The Great Lakes region has been suffering for 35 years now, long enough that every facet of society there has been reshaped. On the other hand, Botswana, Malawi, Swaziland, and most of western Africa are now in a third generation of low-amplitude waves. South Africa, Namibia, and Angola have yet to experience the full death tolls of their first, rapidly rising wave of infection....

The long shock waves caused by AIDS, moreover, are washing over many countries that are simultaneously being swamped by other diseases -- malaria, tuberculosis, childhood dysentery, gonorrhea, antibiotic-resistant bacterial infections, and newly emerging infections such as severe acute respiratory syndrome (SARS) and the Marburg virus. Many of these countries also suffer from other problems that impede economic development and cause social disruption, such as military conflict and social unrest. It is therefore extremely difficult to predict how HIV/AIDS will affect these states and their societies, economies, cultures, and politics. The full impact may not be known for a generation, and the results will vary around the planet. The Joint UN Programme on HIV/AIDS and the Shell Corporation have attempted to model the pandemic's future, and their forecasts are gloomy. And even these predictions depend on government actions that may not be taken.

Politicians are usually shortsighted, and those making HIV/AIDS policy have proved to be no exception. To date, no HIV/AIDS policy enacted by any government or by the UN addresses more than one HIV/AIDS wave's worth of activity, and most epidemic policies have only been implemented in reaction to specific instances of public outcry. Few political leaders and officials recognize that current anti-HIV/AIDS drugs are not curative and, to fend off death, must be taken daily for the rest of a patient's life. The World Health Organization, in a program funded by rich nations, intends by year's end to equip a modest three million people in poor countries with antiretroviral drugs. But to be effective, the program must last for many years rather than be a one-time expense. If wealthy donors cut off their assistance, few poor countries will be able to pick up the treatment costs on their own. A massive wave of death would ensue, as the rich world turned off the life support system of all three million people.

Of all the political science subjects in which I study and lecture, I'm still perplexed by the challenge of development and survival in Sub-Saharan Africa. Fortunately, as this Boston Globe article points out, President Bush's Africa AIDS program is having a substantial and positive impact on the crisis. Billions of dollars have been sent to stressed nations to make available powerful antiretroviral drugs and other treatments. The story notes, of course, that global AIDS activists are reluctant to give the administration any credit for the hopeful progress occurring on the continent.