AIDS in Africa: Dying of Debt

The immune disorder AIDS rep resents one of the greatest threats to health and social stability in the history of humanity. Today an estimated
36.1 million people around the world are living with HIV-AIDS. The vast majority of those infected, 25.3 million people, live in one of the globe's
most impoverished regions -- Sub-Saharan Africa.
The countries of Sub-Saharan Africa are experiencing a pandemic rivaled only by the plague that devastated Europe in the 14th century. The
statistics are staggering. In South Africa one in five people has HIV-AIDS, and in Zimbabwe one in four. One in seven Kenyans have the virus. In
Botswana, the country with the highest rate of infection in the world, more than one-third of all adults are HIV positive. Seventeen million people
in Sub-Saharan Africa have died since the pandemic began; 2.4 million people died in 2000 alone. If current trends continue, the number of AIDS
orphans in Africa may exceed 40 million by 2010.
Policy makers in the West have offered a variety explanations for the disaster. They say that African leaders have failed to respond quickly or
effectively enough to the pandemic. They suggest that "African promiscuity" is to blame. To be sure, many African governments could have done
more, and today can be doing more, to stop the disease's spread. But Western leaders' explanations -- which rely on a racist notion of African
"otherness" -- are simply a way for wealthy governments to avoid responsibility for what is certainly the greatest health and humanitarian
emergency of our time. The fact is that Africans are dying in horrendous numbers because they are poor -- and that poverty has been greatly
exacerbated by the policies of the IMF and the World Bank, two institutions controlled by the world's wealthy nations.
Sub-Saharan nations' continuing debt burden is one of the central causes of the AIDS crisis and also a major obstacle to treating the disease. The
region's poverty makes its citizens more susceptible to contracting AIDS. Treatment efforts are frustrated by debtor countries' inability to pay for
health care services because they are spending so much money on interest payments. By refusing to cancel the debts of AIDS-ravaged countries
and by continuing to force poor nations to adopt cutbacks in government services, including health services, the IMF and the World Bank are
contributing to the deaths of millions of people. People are literally dying of debt.
The Sub-Saharan debt crisis and IMF-mandated structural adjustment policies have helped to spread AIDS throughout the region. In the 1980s
and 1990s, scores of indebted African nations agreed to structural adjustment policies such as eliminating subsidies on basic foodstuffs,
removing assistance to farmers, and re-orienting their agricultural economies to export production. These "reforms" had two effects: they
jeopardized people's food security and they created a new class of migrant workers. The elimination of food subsidies in Zimbabwe, for example,
led to a tripling of food prices in the early 1990s, which forced people to cut back on what they ate. The reorganization of agricultural land led to
a displacement of farmers, who then moved to the cities to work or became temporary laborers. The combination of an increase in malnutrition
and an increase in migration and urbanization created a situation under which Africans were both more vulnerable to the disease and more likely
to spread it. "Structural adjustment raises particular problems for governments because most of the factors which fuel the AIDS epidemic are
also those factors that seem to come into place in structural adjustment programs," Dr. Peter Piot, Director of the United Nations' AIDS program,
has said.
Sex isn't the sole determinant of whether a person will contract the HIV virus; sexual behavior alone cannot explain HIV prevalence as high as 25
percent of the adult population. After all, how much sex are we talking about that would produce, in the absence of other factors, prevalence of
HIV in Botswana that is more than 50 times that of the US, 80 times that of France, and 1,000 times that of Cuba? The science here is
unequivocal: An individual's overall health also affects their chances of contracting the virus, and already ill and/or malnourished people are more
likely of becoming HIV-positive. From 1970 to 1997, Sub-Saharan Africa was the only region in the world to experience a decrease in food
production, a decrease in calorie supply, and a decrease in protein supply per capita. In three structurally adjusted countries -- Zimbabwe,
Kenya, and Malawi -- protein supply fell by more than 15 percent. Protein-energy malnutrition weakens every part of the immune system,
making people more vulnerable to viruses such as HIV and more conventional sexually transmitted diseases such as gonorrhea, which further
speed the transmission of HIV.
Even as structural adjustment policies have increased malnutrition and community instability in Sub-Saharan Africa, they have made it harder for
African governments to respond to the growing AIDS crisis. Governments with overwhelming foreign debt payment obligations must cut back on
what they might otherwise allocate to health care and HIV-AIDS prevention. Export earnings that go to service foreign debts are not available to
pay for imports of pharmaceuticals and other health equipment.
At least 23 African countries spend more money on debt repayment than they spend on healthcare. Four countries suffering from massive HIV
infection rates show the deadly forces at work.

Eight percent of Tanzanians are HIV positive. In 1998 the country spent 1.3 percent of its Gross Domestic Product (GDP) on health
care. It spent 3.1 percent of its GDP on debt payments.

Fourteen percent of adults in Kenya have HIV. In 1998 Kenya spent more than three times as much servicing its debt than it did
providing public health care services. Although the World Bank and the IMF consider Kenya a "highly indebted poor country" (or
HIPC), the institutions consider that no debt relief is required. In Kenya there are 22,000 people for every one doctor.

One out of every four Zimbabweans have HIV. In 1998 Zimbabwe spent 10.3 percent of its GDP on debt payments. It spent 3.2
percent of its GDP on health care. Unicef has reported that between 1990 and 1993, the quality of health care services in Zimbabwe
dropped by 30 percent. The World Bank and the IMF do not classify Zimbabwe as a country eligible for debt relief.

In Malawi, 16 percent of adults are infected with HIV. Between 1995 and 1998, Malawi spent twice as much on its debt payments as
it did on its health care. In Malawi, there is only one doctor for every 50,000 people.

The IMF's and World Bank's imposition of "user fees" -- that is, fees for public services -- has made it even more difficult for governments to treat
the AIDS pandemic by lowering attendance at health clinics. For example, the introduction of fees for patients at Nairobi's Special Treatment
Clinic for Sexually Transmitted Diseases (STDs) resulted in a decrease in attendance of 40 percent for men and 65 percent for women over a
nine-month period. In Dar es Salaam, Tanzania the three public district hospitals saw attendance drop by 53.4 percent between the second and
third quarters of 1994, when user fees were introduced.

Whether someone lives or dies of AIDS depends largely on where he or she lives. The 25 million HIV-positive people in Sub-Saharan Africa are
living with a death sentence not because the drugs to treat them do not exist, but because government officials in the world's wealthy countries
don't have the political will to put human life above corporate profit.
The international response to the AIDS crisis must focus on two key areas -- treatment and prevention. For these challenges to be met, several
steps be taken. Wealthy countries need to make a greater financial contribution to fighting the disease, pharmaceutical corporations must work
to provide drugs at prices poor people can afford (currently one-tenth of one percent of Africans have the money to buy life-prolonging AIDS
drugs), and international intellectual property rights rules must be loosened. Perhaps most important, countries' debts must be cancelled
unconditionally. Until that happens, African societies will be unable to respond to the disease that threatens to destroy them.