No 66 June 2005.4
South of Sahara
25 million people affected by AIDS
25 million Africans south of Sahara have AIDS. Workers, teachers, nurses, soldiers die to-day by the tens of thousands: a situation that is destroying already fragile societies.
Eight years, ten at the most: this is the time that remains to be lived for one who has contracted the AIDS virus and has no way to receive treatment. This is the destiny to-day for 92% of the 25 million Africans, AIDS victims, South of Sahara at the end of 2003 (3.6% of the black population of the continent) out of 38 millions of infected people in the world, according to average estimates of the United Nations. It is still in the South of Sahara that the pandemic does propagate most: 3 million new infections in 2003 out of a total of 4.8 millions, against 1.1 million in Asia five times more populated. The continent is finally last in accessibility to treatments: 8% of needs are covered against 65% in Latin America. It is in Africa that AIDS kills most, and much ahead: only for 2003, 2.2 millions dead from AIDS, that is more than four out of five deaths in the whole world.
This epidemic is obliterating the most outstanding progress of life expectancy registered in the last three decades in poor countries. This life expectancy is now regressing in some thirty countries in Africa. In the seven most affected countries, with over 20% of the adult population affected with AIDS – South Africa, Botswana, Lesotho, Namibia, Swaziland, Zambia and Zimbabwe – it has come down in some ten years to levels before the sixties. A South African born in 2005 will live an average 45 years, against 63 for one born in 1990. In Botswana, this has passed from 65 years to 40 years; in Zambia, Zimbabwe and Swaziland from 55 years to 35. In those countries of Southern Africa, the most affected region of the continent, the population increase should even decrease within the next decade. If the demographic impact of AIDS in Africa is such, it is because the epidemic is affecting women more than anywhere else.
In Ethiopia women number a little more than half of the 1.4 million adults with AIDS. On the whole of Africa they represent 57% of infected adults and, a more dramatic situation, 75% of infections affect young people. These infected women will bear fewer children.
South Africa first to be concerned
Why does this epidemic strike the black continent to such an extent? There is no one cause: many have tried to find it in cultural and sexual characteristics. In reality there are a multiplicity of factors on all continents, North and South, the amplitude and combining of which can form in such or such a region a mortal cocktail.
“In South Africa, the country that numbers most people with AIDS in the world (5.3 millions, a little more than in India which is twenty-five times more populated), three elements are particularly important to explain the new progression of the sickness, explains Didier Fassin, doctor and anthropologist: the socio-economical situation, violence and migrations.” Extreme poverty for example makes easier what researchers call “survival sex”: relations between man and women where the economic dependence rests on the marketing of the body. Another factor: sexual violence. It is not a South African specificity, but with more than one rape a minute registered by police, it has attained unheard-of proportions in relation with the violence in this country for more than a century. Migrations are equally at play. “They have considerably been amplified since the end of apartheid with the abolition of passes that allowed movements outside townships and homelands only to those who had a work permit”, continues Didier Fassin. Men go to towns or mines, leaving wife and children back at the village for long periods. Then on their work place they take a second, even a third wife, before returning to their village where they contaminate their wife. Those migrations are a general phenomenon and they are very important in southern Africa - notably because of the importance of the mining sector – and are linked to the impoverishment of rural society in all developing countries. The limited access to education, especially for women, helps the propagation of the epidemic. Education is the only way for women to strengthen their influence in their families and society, particularly their economic power and therefore their negotiation margins with their husbands in regards to sexuality.
Sickness aggravates poverty
AIDS proliferates on and increases poverty. In affected homes the incapacity for work of one or several persons leads to a loss of revenues and a reduction of savings while expenses for the care of the sick or for funerals increase. This is one more weight for women, making their domestic work heavier to the detriment of productive activities, all the more so since it is on them that the care of AIDS orphans rests essentially; in Africa the number of those orphans is estimated at 12 millions (on 15 millions in the world) and will exceed 20 millions in five years. To compensate resources losses families are forced to rely more on the economic contribution of children, and girls are the first to abandon school.
In Zambia the average consumption of calories has passed in twenty years from 2273 to 1934 calories a day according to the United Nations Conference on Commerce and Development (UNCCD), a drop imputable in great part to AIDS: an under-nourishment that accelerates the moment when AIDS people, weakened, topple over into sickness. For a long time the macroeconomic impact of those dramas has been considered relatively weak because AIDS hits mostly poor families whose contribution to the GDP (gross domestic product) is proportionally smaller. Furthermore those families are in majority employed in the informal sector that statistics do not take into account. In addition to that, the idea that developing countries had near inexhaustible pools of labour available has prevailed for a long time. Such an analysis, that does not take into account the cost of training the human resources in agriculture and informal urban economy, is contradicted by observations in most affected countries. A study published last year by the FAO (Food and Agriculture Organization) on twelve African countries indicates a reduction of 2.3% (Mozambique) to 12.8% (Uganda) of the number of agricultural assets in the year 2000 compared with the year 1985. In 2020, without generalized access to anti-retrovirals, those net losses will vary between 10.7% (Cameroon) and 26% (Namibia), and in the end there will be less production and an increase of food insecurity.
In the industrial sector, employers see diminishing results with the death of trained employees and ever increasing absences of personnel due to sickness or funerals. The World Bank estimated to 14% in 2005 the losses in business turnover of six big Kenyan firms, against 6% in 1994.
Education, health: ravaged sectors
Affecting 95% of the people old enough to work (between 15 and 49 years), AIDS does not only break the economic growth (a loss of one growth point a year in sub-Sahara Africa in the 1990s), it weakens States whose resources diminish with the general impoverishment of the population and with administrations, decimated by the epidemic, less and less capable to fulfill their mission and in particular in two vital sectors for economic and social development, education and health. In South Africa, 200,000 teachers in 1999, that is 9.4% of their numbers, will have disappeared by 2010: it is a workforce costly to train and States do not have the means to replace it. In Malawi, 58% of the jobs in national education are now vacant. In Tanzania, with 100 deaths each month, there will be next year a shortage of 45,000 teachers. In Swaziland, the estimated cost to replace teachers in 2015 is 253 million dollars, more than the present budget of the State. Besides children opting out of schools because their families are affected, those continuing going to school find themselves in overcrowded classrooms with teaching quality inexorably dropping.
As for health care, there is an explosive demand. In Ivory Coast and in Zimbabwe more than half of hospital beds are taken by AIDS patients. This sickness takes two thirds of the health budget in Rwanda, a quarter in Zimbabwe. To the restriction of resources is added the loss of medical staff. In Zambia the death rate of nurses multiplied four times between 1986 and 1991 and reaches 3% of their numbers each year. Botswana has lost 17% of its medical personnel since 1999. In all sectors, these deaths carry a loss of institutional memory, a rupture of the chain of accumulated knowledge during their professional career, for which cannot account this gloomy numbering of deaths or costs of training new personnel, and which adds to the destabilizing factors in most affected countries. The latter could even be affected in their ruling functions: interior and international security. The infection rate in armed forces of many African countries reach hallucinating proportions: 50% in Angola, in the Democratic Republic of Congo, in Swaziland, even more in Zimbabwe and in Zambia. Civil wars that have ravaged the continent, in Liberia, in Congo, now in Darfour, are strong factors in the spreading of the epidemic in the armed forces and civil populations. Systematic rapes, with the overt intention of contaminating the victims, are a strategy of terror and of well-proven destruction. Robert Ostergard, American political analyst, observes that the rate of contamination within the armed forces of democratic countries makes them less capable of assuming their mission of security and peace that the international community entrusts to them.
AIDS and poverty walk hand in hand. This trite remark, politicized excessively, may lead to minimize, even to deny the necessity of strong policies advocating access to anti-retroviral remedies. This was up to 2003 the unacceptable position, heavy with consequences, of the South African President Thabo Mbeki; it caused the greatest scandal in the history of AIDS. To minimize the weight of social injustice in the analysis of this plague and therefore not to draw the political conclusions is as much unjustifiable as the opposite position.
Michel Fortin, M.Afr.
N.B.: This text is taken from an article by Antoine De Ravignon in Alternatives Internationales
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