Aids: Globalisation as Epidemic

Issue section: 

Sarah Ensor examines the reasons for the spread of Aids in Africa.

Centuries from now television audiences will not look back at Aids as we do at the Black Death of the 14th century. We've seen the dramatisations of scabrous, sacking-clad peasants collapsed in smoky huts, utterly helpless before an apocalyptic disease and a middle aged historian in a leather jacket. He cheerfully explains that the death of one third of the population of Europe loosened the bonds of feudalism and created a space for a new economic form, capitalism, to emerge. The plague of HIV/Aids that is ravaging Africa is not a development opportunity. It is more likely to be seen in future as a crime against humanity.

At least 28 million people have died from Aids and 26 million of these deaths have been in Africa. Some 70 percent of all the HIV+ people in the world live in sub-Saharan Africa and it is the continent's leading cause of death. If the current infection rates continue, then by 2010 another 30 million Africans will have died. In 2002 alone 5 million more people were infected, 3 million died and 14 million children were orphaned. By 2010 the number of orphans is expected to rise to 28 million as a child is orphaned every 15 seconds.

If they are lucky these children will be looked after by grandparents or neighbours. If not, they will be alone or have responsibility for younger siblings. They drop out of school to find work. If there isn't any work they will turn to 'survival sex' for money or protection. Crushed by the weight of responsibility and afraid to talk about starving to death, children worry about funeral rites and how as head of the family they will arrange a marriage. In South Africa and Zimbabwe, where 20 to 25 percent of adults are infected, half of today's 15 year olds are expected to die of Aids before they are 40. In Botswana this will be closer to two thirds.

Aids, like every other catastrophe in human history, has its roots deep in the structures of the society that gave birth to it and for these we have to look at the economic policies of the Structural Adjustment Programmes (SAPs) imposed by the world's richest countries on the rest of the world. When applied to the relatively developed countries of the former USSR after 1989 SAPs were immediately disastrous for most of the population. Welfare safety nets were removed, state-owned industries privatised and thousands of workers laid off. Deep cuts were made in healthcare and food price subsidies, and pensions plummeted along with wages. In the late 1980s 14 million people in the Soviet Union lived on less than $4 per day. This would have been bad enough but within five years of its collapse this became 147 million people - more than 50 percent of the population. Life expectancy fell in all 15 of the former Soviet republics. In the Russian Federation male life expectancy dropped to just 56 years by 1998 and in some regions reached as low as 38 years. The Aids epidemic that began here in the early 1990s took hold in this social disintegration and has now infected at least 1.2 million people.

In Africa SAPs (today cynically renamed Poverty Reduction Strategies) were applied to much less developed economies than the Soviet Union so the consequences have been even more extreme. In Nigeria the cutting of fuel subsidies sees desperate people taking appalling health and safety risks to break into pipelines to collect fuel. In Kenya the World Bank insisted that clinics charge $2.15 for the basic examination to detect sexually transmitted infections which increase susceptibility to HIV. Unsurprisingly attendance at clinics has fallen by as much as 60 percent. The trade rules of the SAPs are designed to hold back African industrial development. For example, Mozambique is prevented by the terms of its loans from processing its own crop of cashew nuts. Exported raw, the crop has far less value and creates fewer, less skilled jobs than had it been roasted, salted and packaged in local factories and then exported. Meanwhile in South Africa, with its vast tracts of fertile land and enormous mineral wealth, 100,000 jobs have been lost every year since 1996, except in 2001 when 1 million jobs were lost. Unemployment has reached 40 percent. Here, as everywhere else, women who are left with no work are forced into prostitution. They cannot worry too much about HIV and a horrible death in the future. If they don't work now, they and their children will die anyway from hunger.

Raw materials

The sub-Saharan countries now make up 32 out of 40 of the least developed countries with a total income not much more than Belgium. Debt has increased from $84.1 billion in 1982 to $235.4 billion in 1997. These are the conditions that have bred the epidemic of HIV/Aids. The result, in working and living conditions across Africa, is reminiscent of the industrial revolution. Now Africa, besides being used as a vast source of raw materials for multinational corporations, is being hollowed out of its most productive people. In Botswana life expectancy 25 years ago was 71, now it's 39 years, and it's only one of several African countries where expected life has dropped below 40 years.

However, even without a cure or vaccine, HIV is not some invincible superbug. Unlike a cold virus, which can survive for days on surfaces sneezed on, HIV dies within a few hours outside the body and can be killed by bleach, alcohol and soapy water. Anti-Retroviral (ARV) drugs or Highly Active Antiretroviral Therapy (HAART) reduce illness and death from Aids by 70 percent. They are even more successful at preventing mother to child transmission during birth or breastfeeding. If you are HIV+ in Britain with access to the NHS, you can expect to live for decades with the disease much in the way that people live with other life-threatening conditions like diabetes. Former culture minister Chris Smith has been HIV+ for 22 years now.

But brand name ARVs are very expensive. A year's supply will typically cost $10,000 to 15,000 per person. Zambia could spend its entire national income on drugs and still not be able to treat every Zambian infected with HIV. The same amount of generic drugs produced in India costs just $300. The multinational pharmaceutical companies or 'Big Pharma' argue that the research and development (R&D) of such drugs cost $300 million to $500 million and the money has to be recouped through high prices. This is an argument for nationalisation of the companies but it's also an enormous lie. The US government and other non-profit organisations actually paid about half the cost of the research and development of these drugs, and Merck & Co for instance, one of the largest pharmaceutical companies, only spends 6 percent of its revenue on R&D while allocating 17 percent to profit. The cost of the drugs to fight the opportunistic diseases associated with Aids such as TB and thrush are nothing like as high but there is still room to profiteer. The branded thrush treatment costs $5. In Thailand the generic version costs less than 28 cents.

Activists have been fighting back with demonstrations and civil disobedience, and in South Africa the Treatment Action Campaign (TAC) has smuggled generic drugs from India. In 2001 demonstrators forced the corporations to back down when they were suing the South African government to prevent generic drugs imports. They were also shamed into donating the treatment for thrush.

With great personal courage Zackie Achmat, the chair of TAC who is HIV+, refused to take ARVs as long as they were not generally available to the rest of the population. At the time South Africa's President Thabo Mbeki was denying that HIV leads to Aids, and therefore the utility of ARVs. When forced to accept the overwhelming evidence that HIV untreated does lead to Aids, he said that South Africa could not afford the treatment. One of his spokespeople actually remarked that drugs to prevent mother to child transmission were undesirable because of the healthy orphans it left the state to deal with. At the same time the South African government showed where their real interests lay when they spent $3 billion on an arms deal to safeguard their regional interests. In 2003 the South African government finally announced plans to distribute ARVs but people in the townships who are HIV+ still face eviction because they cannot pay their rent.

Not every government in Africa has been resistant to tackling the disease. Botswana has begun supplying free ARVs and in Senegal there is a high level of acceptance of condoms and their usage to prevent infection and they are widely used. Uganda also had a huge public information campaign with distribution of condoms and infection rates fell. The scale of the epidemic isn't just due to ignorance but also to a combination of the virus, poverty and lack of affordable public services.

Before the G8 met at Gleneagles, Brown and Blair made what they hoped would be soothing noises about Africa, debt and poverty. Although the G8 leaders announced the cancellation of billions of dollars of debt and aid for Africa, within days we found out that this was only partial debt relief. We also saw the photographs of people starving in Niger only a mile or two from markets full of food that they could not afford to buy. The government of Niger resisted handing out free food because privatisation and the free market are the World Bank's plan for Niger's 'development'.

The Aids epidemic is rooted in the system that Blair and Brown defend. So we must step up the pressure, in part to deliver real and genuine aid for Africa, but also to directly help the millions who are suffering from this disease.