Global Policy Forum

By David Loyn

Tens of thousands of people have died in the last two years as drought has hit southern Africa - far more than a harsher drought a decade ago wiped out. These people were victims of food shortages. They were also, directly or indirectly, victims of HIV and Aids. The drought killed so many people, particularly in Zambia, Mozambique, Malawi and Zimbabwe, because the cruel nature of HIV disease means that the most productive people die or are weakened just when society needs them most. This time, the ordinary coping mechanisms, the safety nets which get poor countries through the hard times, were not there.

Death sentence

The UN development body, UNCTAD, predicts that 16 million agricultural workers will die in Africa in the next 20 years. And in societies where teachers and doctors are dying as well as the farmers, HIV/Aids will make another generation poor unless it is checked. In the worst-affected regions of rural southern Africa, a third of pregnant women are HIV positive. This is a health challenge which would be hard to cope with even in the well-financed countries of the global North, but it is a clear death sentence here. And there are disturbing signs that sexual abuse of children is increasing as societies fall apart.

Education under siege

It is 'mass murder by complacency' according to Stephen Lewis, the UN Special envoy on HIV/Aids in Africa.

"My own sense is that education is on the brink," he said, after touring Lesotho, Zimbabwe, Malawi and Zambia in late 2002.

"Teachers were dead, teachers were dying, teachers were ill and away from school, children, especially girls, were being taken out of school to tend to sick and dying parents, children who had lost their parents to Aids weren't in school because they couldn't afford the school fees. It felt, in every instance, as though the education sector was under siege. In Zambia, they lost 1,967 teachers in 2001, over two thousand teachers in 2002; the Teacher's Colleges are graduating fewer than one thousand a year. In parts of Malawi, HIV-positive teachers are estimated at over 30%. How can education be sustained?"

And, as education suffers, its role in the fight against HIV is compromised - the cycle continues. The UN's aim of $10 billion a year for a joint fund to cope with HIV/Aids, TB and Malaria has fallen far short of its target.

Drugs hope

One shaft of light in this gloom is the agreement in the World Trade Organisation for developing countries to import cheap generic versions of anti-HIV drugs from manufacturers in India and Brazil. It will make a difference, although there is still a lot of bureaucracy to go through. But even this was achieved only against opposition led by Andrew Natsios, the head of the American development agency USAID, who believed that the health systems in poor countries could not be relied on to deliver the medicines properly.

The French medical NGO MSF conducted a series of pilot programmes in Africa to prove that take-up of the drugs was as good in the developing world as elsewhere. It is not a magic cure-all. But cheaper versions of antiretroviral drugs will make the reverse of HIV imaginable as part of a combined policy. The Ugandan experience - combining access to prevention and good education - shows what can be done. In Brazil, where the drugs are relatively cheap and available, the spread of HIV/Aids has been halted. Some other countries which are behind on the learning curve, including the two Asian giants China and India, could face significant reverses in their economic progress, if they do not face up to the challenges of HIV/Aids more than they have so far.

Downward spiral

In the optimism of the Millennium summit in 2000, the UN proposed a series of 'Development Goals' to be achieved by 2015. These set targets on areas such as education, healthcare, clean water, and impose responsibilities on the developed world as well as expectations on developing countries. But the spread of HIV/Aids, the most complex health problem ever faced by the world, means that the targets are moving all the time. If the Millennium Development Goals are not to remain a hopeless dream then international development organisations need to rethink their approach fundamentally. If they do not succeed then the cycle which links poverty to Aids will continue to spiral downwards.

The Red Cross "World Disaster Report 2002" asked an uncomfortable question: "Aids is both a root cause of poverty and its consequence. Is it morally tenable any longer for relief agencies to deal with this humanitarian disaster without addressing its causes?"

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