AIDSAlert 21 January 2000 MORE DEVASTATING THAN WAR BY VIRGINIA VAN DER VLIET Virginia van der Vliet has written widely on the South African AIDS epidemic and is the author of The Politics of AIDS (published by Bowerdean in London in 1996), which examines the global AIDS pandemic. Her expert services are available to PulseTrack members on a consultancy basis. At the initiative of the US, which holds the revolving presidency of the United Nations Security Council for January, this month has been declared the "month of Africa". The focus will be on Africa's wars, its economy and, for the first time, a health issue - AIDS. The unusual (and somewhat controversial), decision to examine AIDS in a forum usually devoted to the discussion of armed conflicts, and their political and socioeconomic context, was justified by US vice president Al Gore, who presided over the first part of the session: "We must understand that the old conception of global security - with its focus almost solely on armies, ideologies and geopolitics - has to be enlarged. We need to show that we not only can contain aggression, prevent war and mediate conflicts, but that we can work together to anticipate and respond to a new century with its new global imperatives." Gore also announced that the Clinton administration was proposing to increase the amount of money allocated to fight AIDS especially in Africa and India, by $100 million - to a total of $325 million. The 15-member Security Council's decision to address the AIDS issue underlines the growing realization that the epidemic is rapidly becoming sub-Saharan Africa's number one security issue. In his address, UN Secretary - General Kofi Annan warned: "By overwhelming the continents health and social services, by creating millions of orphans, and by decimating health workers and teachers, AIDS is causing social and economic crises which in turn threaten political stability. In already unstable societies, this cocktail of disasters is a sure recipe for more conflict. And conflict in turn, provides fertile ground for further infections". The AIDS statistics dwarf the figures of Africans lost in war - 13.7 million already dead, 23.3 million infected with no hope of treatment or cure in sight, 9 million AIDS orphans. As UNAIDS executive director, Dr Peter Piot, noted: "In its demographic, social and economic impact, the epidemic has become more devastating than war, in a continent where war and conflict appear to be endemic." AIDS adds to the fragility and complexity of the continent's geopolitical systems. Eleven of the world's 27 conflict zones in Africa; 15 sub-Saharan countries face food emergencies; sharpened now by drought in East Africa; the orphan generation may become a generation of disaffected youth. War itself drives the epidemic - rape as a weapon of war is probably as old as human conflicts, as is the reliance of soldiers on commercial sex. AIDS has lent this a new dimension. Piot notes that soldiers involved in the Great Lakes region's conflicts reportedly raped women "of the enemy side", with the stated intention of infecting them with HIV. In studies of women in conflict zones, one study showed 17% of raped women, previously negative became sero-positive; in another refugee women were found to be six times more likely to become infected in camps than those living outside. Peacekeeping forces also pose problems. Should UN peacekeepers be tested for HIV? US ambassador to the UN, Richard Holbrooke, who pushed to have African issues on the agenda during his month-long Security Council presidency, comments that for a poor country to enroll its soldiers in such UN exercise can earn them hard currency. Where the soldiers come from areas with high HIV rates, Holbrooke fears it might create the greatest irony of all; in the cause of peace-keeping to spread a disease which is killing ten times as many people as war". He believes the UN should test for HIV, but is encountering enormous resistance, especially from Africans, who are particularly concerned about the issues of privacy and stigmatization which it raises. Holbrooke is adamant that testing HIV-positive should not be grounds for dismissal. On a continent where a job in the military is one of the few which provide a secure income, and each soldier supports perhaps 15 dependants, discharging a soldier could not only plummet the family into destitution before they have had time to prepare for the breadwinner's death, it could also have social repercussions where large numbers of military are infected. Another danger is the problem of peacekeepers from elsewhere going into heavily infected areas and becoming infected, perhaps with new strains of HIV, which they then bring to their home country. Massive education campaigns, akin to those used against sexually transmitted diseases during World War II are necessary. It was, however, on the consequences of AIDS epidemic on the social and economic fabric of Africa that the major emphasis fell. Mark Malloch Brown, Administrator of the United Nations Development Programme, advised the Council: "View this as a three-front war; the classrooms and clinics of Africa, the families of Africa, and third, international action - the critical support needed to back Africa's frontline". He talked of the "extraordinary depletion of the region's human capital", saying that estimates suggested "the numbers of active teachers and doctors in the most affected countries could be reduced by up to a third in the coming years. Yet schools and clinics are not only at the heart of any defensive strategy for dealing with the consequences of the epidemic, they (also) spearhead the offensive for cultural and behavioural change. As Malloch Brown notes, behavioural change required uncompromising, often painfully embarrassing, honesty particularly on the topic of sex. Those countries like Uganda, which have grasped the nettle, are beginning to see results. A number of speakers at the conference emphasized that the key to meeting the AIDS challenge lay in more resources. Malloch Brown noted that in the US, with 40,000 new cases annually, spends approximately $10 billion annually for prevention, care, treatment and research. Africa, with 4 million new cases each year, spends approximately $165 million annually - which does put Gore's announcement of an additional $100 million proposed for the US's Worldwide fund into perspective. Namibian health minister, Dr Libertine Amathila told the Council that estimates for an appropriate African AIDS budget would be about $2.5 billion a year, rather than the available $165 million. "Even in Namibia, where we allocate 15% of the GDP to health services, we have not made an impact on the treatment of HIV / AIDS". Most of the calls were for bigger budgets, more international cooperation, better treatment options, cheaper drugs, and urgent attention to the development of a vaccine for African HIV strains. Dr Timothy Stamps, health minister for Zimbabwe took a more aggressive stance. He contrasted, the billions spent on the Y2K bug with the "piddling" amount spent on AIDS. He accused the "Western entertainment industry" of promoting promiscuity, and the industrialized countries of appearing "oblivious" to AIDS in Africa for the past 15 years. "The question we ask is: "Is this merely lack of understanding, or a new form of racial discrimination, another ethnic cleansing process?" Cynics may believe "Africa month" is a useful showcase for presidential hopeful, Al Gore, courting the African American vote. Others may believe it was a useful forum for alerting the Council to the issues, and for proposing a long wishlist of AIDS initiatives. Unfortunately, however urgent or potentially effective these initiatives could be, they do not require Security Council endorsement. For South Africa, the construction of AIDS as a security issue, should be thought-provoking. Apart from the security issues our own runaway epidemic raises, the possibility of South Africa becoming a magnet for AIDS refugees from other hard hit areas needs debate. Ends......
