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Editorial
02/2003
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A disaster of global scale
American doctors became aware of the new disease in 1979. In 1983, a first stock-taking revealed a (then) frightening figure: 1,556 cases had been registered by that time. Now, 20 years later, the total is 40 million, and the true dimensions of the threat are only now becoming visible. By 2010 there could be 100 million or more cases, and for many countries in the South and East of the globe the danger of the collapse of their economic and political systems is looming. AIDS is becoming a central subject of development cooperation, and will be a central issue of world politics – but most politicians have not yet grasped that.
A study by the US secret service National Intelligence Council (NIC) with the alarming title "The Next Wave of HIV/AIDS" covers some of the most populous and politically influential countries in the world, including Russia, China and India, in which infection rates until now were relatively low (or not published). For these countries, in which the epidemic is only just beginning to spread, the NIC forecasts a total of 50-75 million HIV-infected by the end of this decade – even more than in Southern and Central Africa, where 30-35 million new infections are predicted by the same time. The study was de-classified faster than usual because the US government fears disastrous consequences for the political and economic stability of these countries if large parts of precisely the generation that is well educated and takes political and economic decisions dies off.
The head of the UN Development Programme (UNDP), Mark Malloch Brown, forecast at the end of 2001 that "the number of the infected will reach hundreds of millions in the near future”, and that "entire national economies will collapse since the loss of adults fit for work will result in societies consisting only of the very young and the very old". Peter Piot, Executive Director of UNAIDS, noted recently: "It is now clear that the AIDS epidemic is still in its early stages. And let's be equally clear: our fight back is at an even earlier stage."
Some countries have proved that the fight against HIV/AIDS does not have to be in vain. In Brazil, a national programme against AIDS and sexually transmitted diseases was created as early as the end of the 1980s. The programme's principles include that the whole population is entitled to free HIV tests and access to prevention and therapy measures. The state provides patients with anti-retroviral medications. In most Brazilian schools the curriculum includes lessons on HIV/AIDS. The result: the annual number of new infections is dropping sharply, and is now below the figures forecast by UNAIDS for Brazil.
But many of the countries in which AIDS is a great problem are simply to poor to be able to finance the required countermeasures, or taking such measures is impossible due to civil wars. An example is Burundi, where in seven years of internal fighting the number of infected adults has risen to 7 per cent. The country would have to spend US$ 43 million per year on combating AIDS – which in view of its foreign debt totalling US$ 195 million is absolutely impossible. In other countries, measures against the spread of HIV/AIDS fail because their governments still refuse to discuss the disease in public. The problem of the stubborn President of South Africa is well-known. In China, the obsession that the socialist system must continually show successes does not permit the publishing of realistic figures on the spread of the disease. The official total of the HIV-infected is 30,736; UNAIDS estimates it to be 850,000. The UN organisation complains that the Chinese government has "not even taken basic precautions against a spreading of the AIDS epidemic". China's first conference on the subject took place in 2001. It was not before 2002 that the Chinese media were allowed to report more on AIDS, and that public education campaigns have begun. But in view of the wretched condition of the state public health system there can be no thought of comprehensive medical care of the patients.
Of course, in societies in which sexual questions cannot be discussed as openly as even we have been able to do only for some decades, it is difficult to change this attitude within a few years. The education process cannot reach the mass of the population if it has not yet reached the opinion-forming elites and the political leadership. Therefore development cooperation that aims to help here must work at both levels at the same time. To exemplify the problems that arise in this field it may be interesting to look at the differences over the terminology employed. May one speak of "HIV-infected", or is it obligatory to use euphemistic phrases such as "people living with HIV"? There was a debate on this point with some of the authors of this issue. I think that it does not get us any further if we hang a veil over the truth. Formulations which pretend to be "politically correct" are only a symptom of the user’s own lack of enlightenment.
Finally, it must be said yet again that the fight against HIV/AIDS costs money. Kofi Annan puts the annual sum required at US$ 7-10 billion. Money received by the Global Fund which he founded totalled somewhat more than US$ 2 billion in its first two years. That makes clear that the spread of the pandemic will continue with only few obstacles in its way.
Von Reinold E. Thiel
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