in sub-Saharan Africa is a plague of biblical proportions.
AIDS in sub-Saharan
Africa, notes The United Nations, is the “worst infectious disease catastrophe
since the bubonic plague.” Deaths due to AIDS in the region will soon
surpass the 20 million people in Europe who died in the plague of 1347
and the more than 20 million people worldwide who died in the influenza
epidemic of 1917. Over the next
decade, AIDS will kill more people in sub-Saharan Africa than the total
number of casualties lost in all wars of the 20th century combined.
Africa accounts for only one-tenth of the global population, it currently
carries the burden of more than 80% of AIDS deaths worldwide:
- In the past decade,
12 million people in sub-Saharan Africa have died of AIDS – one-quarter
of them children – and each day AIDS buries another 5,500 men, women
- In 1998, AIDS
was the largest killer and accounted for 1.8 million deaths in sub-Saharan
Africa, nearly double the 1 million deaths from malaria and eight times
the 209,000 deaths from tuberculosis.
- By 2005, the daily
death toll will reach 13,000 people with, nearly 5 million AIDS deaths
in that year alone.
yet, the pandemic rages on:
- In sub-Saharan
Africa, more than 22 million adults and 1 million children are currently
living with HIV.
- Every day, 11,000
additional people are infected – one every 8 seconds.
- Since the Administration
launched this effort on World AIDS Day (December 1, 1998), more than
2.5 million people in sub-Saharan Africa have been infected with HIV,
368,000 in South Africa alone.
- Half of all new
infections in southern Africa, and 10% of new infections worldwide,
occur in South Africa, now experiencing the fastest growing AIDS disaster.
in Selected African Countries
Fragile health care
systems are already buckling beneath the weight of the rapidly growing
number of people with AIDS and the growing loss of health personnel as
a result of AIDS. For example, The World
Bank estimates that in Zimbabwe, Zambia, and Cote d'Ivoire, people
with AIDS already occupy 50-80% of all beds in urban hospitals. In addition,
the escalating incidence of tuberculosis (TB), the most common opportunistic
infection associated with AIDS, now accounts for between one-third and
one-half of all AIDS deaths in Africa.
in sub-Saharan Africa is stalking women and young people, shattering families,
and placing extraordinary burdens on the extended family and village systems
that have been the backbone of African child-rearing tradition.
While AIDS in sub-Saharan
Africa is an equal opportunity killer, women, children, and young people
are increasingly caught in the path of this relentless pandemic.
All too often, cultural
norms place women at heightened risk of HIV.
In many parts of sub-Saharan Africa, and around the world, discrimination
against women begins early and continues throughout life.
Girls are far less likely to have access to education, information,
and skill training. And in turn,
women are far less likely to have access to essential health care and
income generating opportunities. These
realities increase their vulnerability to both poverty and HIV.
The low status of
women in sub-Saharan Africa severely restricts their power to make informed
and safe choices. As a result, more than half of all new HIV infections
in sub-Saharan Africa are among women and 80% of the 14 million HIV-positive
women of childbearing age worldwide reside in sub-Saharan Africa.
In many areas throughout the region, pregnant women have astronomically
high rates of HIV infection including 73% in Beit Bridge, Zimbabwe and
43% in Francistown, Botswana. Nine
out of every ten infants infected with HIV at birth and through breastfeeding
live in sub-Saharan Africa – with nearly 600,000 new infections each year
There are many places
throughout the region where up to one-quarter of all children are already
living with an HIV-positive parent. And
in nine sub-Saharan African countries, between one-fifth and one-third
of all children will be orphaned by AIDS by the end of this year. In human
terms, the AIDS orphan emergency is causing unprecedented threats to child
welfare. This vulnerability includes decreased access to life-sustaining
food, education, health care, housing, and clothing, and increased psychosocial
distress brought on by the death of a parent, isolation, and stigma. These
children are also at extraordinary risk of physical and sexual abuse as
well as child labor exploitation. And while most of these orphans were born HIV-negative
– this vulnerability leaves them at seriously increased risk of becoming
HIV infected themselves.
Tragically, the worst
is yet to come. During the next decade, more than 40 million
children will be orphaned by AIDS, and this "slow burn disaster"
is not expected to peak until at least 2O3O.
According to UNICEF, the AIDS pandemic in sub-Saharan Africa is
having and will continue to have a more significant impact on child survival
and maternal mortality than all other emergencies on the continent combined. Without a doubt, AIDS has placed an entire
generation of Africa's children in jeopardy.
9 sub-Saharan African countries,
one-fifth to one-third of all children
under the age of 15 will be orphaned by the year 2000
is wiping out decades of progress on a host of development objectives.
After hundreds of millions of dollars of donor investment and well-documented
results, AIDS is now turning back the development clock to the 1960s.
In the coming decade in many areas of sub-Saharan Africa, infant mortality
(those less than one year old) will double and child mortality (those
under age five) will triple. In addition, despite steady advances in access
to education, a rapidly increasing number of children (particularly girls)
are now dropping out of school to act as substitute labor or as caregivers
for their dying parents. Far too few are finding their way back to school.
Finally, according to the US Census Bureau, AIDS has already reduced life
expectancy in Zimbabwe by 25 years and in Zambia from 56 years old to
37. In the next few years, AIDS
will reduce life expectancy in South Africa by a third, from 60 years
old to 40.
Under-5 Mortality Rates
in 2010 for Selected African Countries
is not only causing unfathomable human suffering, it is jeopardizing economic
growth, political stability, and civil society in many sub-Saharan African
is a trade and investment issue. The Blueprint for a US/Africa Partnership for the 21st Century,
adopted at the US/Africa Ministerial Meeting states: “African-US economic
ties continue to grow. For example,
US exports to Africa grew more rapidly in 1998 than did US exports to most
other regions and are now 45% greater than its exports to all countries
of the former Soviet Union combined. As
a source of crude oil, Africa is as important to the United States as the
Persian Gulf. On a balance of payment
basis, American private investment consistently produces a higher rate of
return in Africa than in any other region.”
According to Professor
Jeffrey Sachs, Director of the Harvard Institute for International Development,
"a frontal attack on AIDS in Africa may now be the single most important
strategy for economic development." This is true because as the Southern
Africa AIDS Information Dissemination Service estimates, over the next
20 years AIDS will reduce by a fourth the economies of sub-Saharan Africa.
In fact, this AIDS related economic impact has already begun. According to the Economist, a recent study in Namibia estimated that AIDS costs the
country almost 8% of GNP in 1996 and by 2005, Kenya's GNP will be 14.5%
smaller than it would have been without AIDS. In Tanzania, The World Bank
predicts that GNP will be 15-25% lower as a result of AIDS. The South
African government estimates that AIDS costs the country 2% of GNP each
AIDS has hit professionals
hard in sub-Saharan Africa, particularly civil servants, engineers, teachers,
miners, and military personnel. In Malawi and Zambia, 30% of teachers
are HIV-positive, and in Zambia, 1,500 teachers died of AIDS in 1998 alone. In South Africa, 1 in 5 miners is currently infected with HIV.
Uganda Railways has already lost 5,600 employees (10% of its workforce)
to AIDS and now has an AIDS-related labor turnover rate of 15% annually.
And in Zimbabwe, a major transportation company employing 12,000
workers found that by 1996 more than one-third were already HIV positive.
According to a World Bank study in Kigali, Rwanda, 34% of people with
post-secondary education were HIV positive, compared to 18% of those with
primary education, and civil servants were more than three times more
likely to be HIV-positive than farmers.
and training costs, and the disruption to regular production due to sick
and bereavement leave, are seriously affecting both the private and public
sectors. A study in South Africa found that at current levels of benefits
per employee, the total cost of benefits would rise from 7% of salaries
in 1995 to 19% by 2005 due to AIDS. Companies like British Petroleum and
Barclays Bank have stated that they are now hiring two employees for every
one skilled job, assuming that one will die of AIDS.
The Indeni Petroleum Refinery in Zambia reportedly spent more on
AIDS-related costs than it declared in profits.
of AIDS Per Employee in
Various Industries in Selected Sub-Saharan African Countries
Group International, USAID
Policy Project, 1999.
AIDS is a security and stability issue. According to the Economist,
"the estimated HIV prevalence in the seven armies embroiled in the
Congo range from 50% to 80%." Recent reports project that the South
African military and police are also already heavily infected by HIV.
Moreover, as these troops participate in an increasing number of regional
interventions and peacekeeping operations, the pace of the epidemic is
likely to accelerate. Extremely high levels of HIV infection among senior
officers could lead to rapid turnover in those positions. In countries
where the military plays a central or strong role in government, such
rapid turnover could weaken the central government's authority. For those
countries in political transition, instability in the military and security
forces could slow or even reverse the transition process.
This dynamic merits attention, not only in Africa where the pandemic
is already entrenched, but also in India and the Newly Independent States
where the pandemic is intensifying its grip.
is a crime issue. The South African Institute for Security Studies
has linked the growing number of children orphaned by AIDS to future increases
in crime and civil unrest. The assumption is that as the number of disaffected,
troubled, and undereducated young people increases, many sub-Saharan African
countries may face serious threats to their social stability. Without
appropriate intervention, many of the two million children projected to
be orphaned by AIDS in South Africa alone will raise themselves on the
streets, often turning to crime, drugs, commercial sex, and gangs to survive.
This seriously affects stability and promotes the spread of HIV among
these highly vulnerable young people.
Lusaka, Zambia alone, 100,000 children are estimated to be living
on the streets. Most have been orphaned by AIDS. By the year 2000,
one million children in Zambia, or one out of every
three children, will be orphaned by AIDS. Hundreds and hundreds
of these children spend their
nights on Cairo Road, sleeping in gutters and in trees, hoping to
remain out of the “line of fire”. Some are new to the streets,
others have called it home for years. The longer they stay, the
harder they get. In an effort to survive, too many are forced into
crime, sex, and drug operations. While none would actually “choose”
this life, once they “belong to the streets” it is difficult to
turn back. Though good data are lacking, it is likely that HIV
infection is spreading like wildfire among these children. Given
their grim reality, it is amazing that as the dawn breaks, so many
of them gather at the gate of the Fountain of Hope to attend school.
While this school is simply a collection of wooden benches around
outdoor blackboards, the desire to learn among these hungry, homeless
children gives us hope.
As goes Africa, so will go India, South-East Asia, and the Newly Independent
States, and by 2005, more than 100 million people worldwide will be
According to current
projections, by 2005, AIDS deaths in Asia will mirror those in Africa.
As the world's most populous continent, Asia will soon come to dominate
the HIV picture accounting for one out of every four infections worldwide
by the end of the year. Already,
trends suggest that Asia may surpass Africa with the highest number of
India is increasingly
at the center of the global epidemic, with more HIV infected people than
any other country in the world – an estimated 5 million.
While the current death rate remains low in comparison to sub-Saharan
Africa, infection rates are increasing rapidly and are expected to double
every 14 months. Surveillance of the disease is particularly
difficult in India as cultural norms, gender inequities, and stigma continue
to drive the epidemic underground. As
a result, AIDS cases in India are thought to be under-diagnosed, and therefore,
poorly treated. By 2000, AIDS
will cost India $11 billion or 5% of GNP.
According to Surgeon
General Satcher, “It was only a few years ago that epidemiologists offered
projections of disease prevalence for sub-Saharan Africa that were met
with disbelief. If the present warnings go unheeded, South Asia, Southeast Asia,
and, perhaps, China will follow the disastrous course of sub-Saharan Africa.”
The Newly Independent
States have also registered astronomical growth in HIV infection rates
over the past few years. In the last four years alone, Eastern Europe
and Central Asia have seen six-fold increases in HIV infections.
In the Russian Federation,
HIV infections have increased 27-fold between 1994-1997.
And in the Ukraine, HIV infections have increased 70-fold. Injection drug use now accounts for 80% of new infections in the
Russian Federation and the increasing number of new users signals a growing
dual epidemic of AIDS and drugs.
& Children Living With HIV/AIDS
& Children Newly Infected
Europe & Central Asia