Meeting the Challenge: Canada's Foreign Policy on HIV/AIDS - With a Particular Focus on Africa

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Section 2.0 - The Impact of HIV/AIDS

This section briefly outlines the personal, social, economic, security and human rights impacts of HIV/AIDS, with a particular emphasis on Africa.

HIV/AIDS statistics are staggering. In December 2002, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that there were 42 million people living with HIV/AIDS world-wide and that 27.9 million people had died from AIDS. In 2002, according to UNAIDS estimates, there were five million new infections and 3.1 million deaths. New infections continue at an estimated rate of 14,000 a day. (At time of writing, the AIDS Clock maintained by the United Nations Population Fund showed 44,890,820 infections world-wide.¹)

The vast majority (95 percent) of people living with HIV/AIDS are in the developing world. In sub-Saharan Africa, the region most severely affected, life expectancy has been reduced dramatically - for example, in Zimbabwe by 35 years, and in Botswana and Swaziland by 28 years. Women represent 50-58 percent of HIV-positive adults in sub-Saharan Africa, North Africa and the Middle East, and the Caribbean.

The highest adult prevalence rates are in sub-Saharan Africa (8.8 percent) and the Caribbean (2.4 percent). In some countries in sub-Saharan Africa, the prevalence rates have risen higher than anyone could imagine: Botswana (38.8 percent), Lesotho (31 percent), Swaziland (33.4 percent) and Zimbabwe (33.7 percent). In most countries in Asia, the prevalence rates are still relatively low by comparison, but because of the large populations of countries such as China and India, this still translates into large numbers of infections. Eastern Europe and Central Asia face sharply escalating rates of infection.²

The Human Development Report 2003 noted that "China, India and the Russian Federation - all with large populations and at risk of seeing HIV infection rates soar - are of particular concern. About seven million people are infected in these countries, and in sub-Saharan Africa seven million cases exploded to 25 million in a decade. ... [E]ven in a moderate scenario, by 2025 almost 200 million people could be infected in these three countries alone."³

Where prevalence rises above one percent, there is potential for a more generalized epidemic. A five percent rate threatens exponential growth in the general population. Twenty-four African countries have a prevalence rate greater than five percent among adults (aged 19-49).⁴

The dimensions of the cost

In high-prevalence countries, the impact of HIV/AIDS goes beyond the incredible human suffering and loss of life. For example:

• Families and social structure: In some southern African societies, HIV/AIDS threatens total societal collapse because it not only destroys human capital, but also weakens the mechanism through which knowledge and abilities are translated from one generation to the next. Children are left without one or more parents to love, raise and educate them. In countries like South Africa and Botswana, HIV/AIDS makes reaching the Millennium Development Goal of reducing infant mortality rates by two-thirds by 2015 virtually impossible.⁵
   
• Food security: Agricultural production and food supply become tenuous; families and communities break apart; and surviving young people cease to have a viable future. At the end of 2002, an estimated 14.4 million people were at risk of starvation in six southern African countries. The United Nations Food and Agriculture Organization estimated that seven million agricultural workers in 25 severely affected African countries have died from AIDS since 1985. It warned that 16 million more could die in the next 20 years if massive and effective programs are not mounted.⁶
   
• Economic security: HIV/AIDS threatens social and economic progress. As the Human Development Report 2003 states, "by killing and incapacitating adults in the prime of their lives, [HIV/AIDS] can throw development off course."⁷ The impact on the labour force is dramatic. The United Nations Children's Fund (UNICEF) estimated that by 2010 "the South African economy will be 20 percent smaller than it would have been without HIV/AIDS. This is a total loss of about US$17 billion."⁸ A World Bank study noted that an adult HIV prevalence rate of 10 per cent may reduce the growth of national income by up to a third.⁹
   
• Governability and communal security: HIV/AIDS breaks down local and national institutions that govern society and provide public confidence and a measure of predictability in daily life. It strikes hardest at those who are better off and mobile, often the educated - civil servants, teachers, health care professionals and police. It affects the ability of governments to sustain public services and day-to-day security.
   
• National security: In Africa, many military forces have infection rates as much as five times that of the civilian population, in some cases rates as high as 50 or 60 percent. HIV/AIDS has already diminished the operational efficiency of many of Africa's armed forces, thus making nations more vulnerable to both internal and external conflict.
   
• International security: HIV/AIDS contributes to international security challenges and undermines the capacity of regional and international communities to respond to and resolve conflict. An analysis by the South African Institute of Strategic Studies warns that unless the spread of HIV/AIDS among African armies is stopped, it is possible that many countries, including South Africa, will be unable to participate in peacekeeping operations.¹⁰

While these references are to sub-Saharan Africa, examples of similar impacts in non-African countries, such as Russia, Jamaica or Cambodia, could be cited.¹¹

The HIV/AIDS crisis is also very much a human rights crisis. Indeed, all of the impacts described above have human rights dimensions. HIV/AIDS threatens virtually every civil, political, economic, social and cultural right, while undermining the ability of people to defend their rights and the ability of governments to respect, protect and promote rights. HIV/AIDS presents specific human rights challenges in areas such as stigma and discrimination, confidentiality and the right to health information, employment, and maternal and child health.

A tragedy of the magnitude of HIV/AIDS requires a response that is commensurate in size and scope.

Notes

1. United Nations Population Fund (hereafter UNFPA). AIDS Clock. www.unfpa.org/aids-clock/clock.htm. Accessed 26 August, 2003.
2. UNAIDS/World Health Organization. AIDS epidemic update. December 2002. (Geneva, UNAIDS/WHO, 2002).
3. United Nations Development Programme (hereafter UNDP). Human Development Report 2003: Millennium Development Goals: A compact among nations to end human poverty. (New York and Oxford, UNDP/Oxford University Press, 2003): p. 4. The most radical upswings in infection rates in this region are in the Russian Federation, Ukraine and Latvia.
4. Canada. House of Commons, Standing Committee on Foreign Affairs and International Trade (hereafter SCFAIT). Report of the Standing Committee on Foreign Affairs and International Trade: HIV/AIDS and the Humanitarian Catastrophe in Sub-Saharan Africa. June 2003: p. 16. Available at www.parl.gc.ca.
5. UNFPA. "The Impact of HIV/AIDS: A Population and Development Perspective." Population and Development Strategies. Number 9. August. 2003: p. 9-19.
6. International Crisis Group (hereafter ICG). HIV/AIDS as a Security Issue. (Washington/Brussels, International Crisis Group, 29 June 2001): p. 11.
7. UNDP. Human. 2003: p. 41.
8. SCFAIT. Report. 2003: p. 18.
9. Bell, Clive, Shantayanan Devarajan and Hans Gersbach. The Long-Run Economic Costs of AIDS: Theory and an Application to South Africa. June 2003. World Bank research report.
10. Pharaoh, Robyn and Martin Schonteich. Institute for Policy Studies. AIDS, Security and Governance in Southern Africa: Exploring the Impact. ISS Paper 65, January 2003. (Capetown, Institute for Security Studies, 2003): P.5. See also: Elbe, Stefan. "HIV/AIDS and the Changing Landscape of War in Africa." International Security. 27.2. (Fall 2002): p.166.
11. See, for example: UNFPA. "The Impact." 2003: p 52.

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