The famine that is now gripping Southern Africa, and the emerging hunger in Ethiopia, are seen increasingly as results of AIDS as well as a direct threat to people living with HIV, according to UNAIDS.
Launching UNAIDS' annual report on the global epidemic, Dr Peter Piot identified this as the clearest example so far of how AIDS is undermining security on a global scale. If the response to AIDS does not rise to meet this challenge, then this may represent the future for all too many countries, not only in Africa but possibly in parts of Asia too. However, all is not lost and there are signs of hope in a number of countries where the proportion of young people with HIV has been declining.
The UNAIDS report details how food shortages are fuelling the spread of HIV in southern Africa and that, in turn, illness and death caused by HIV is causing a massive decline in agricultural productivity. The report indicates that 7 million agricultural workers in 25 African countries have died of AIDS since 1985. In 2001 alone, AIDS killed nearly 500,000 people in six predominantly agricultural countries both creating and adding to the threat of food shortages and famine in southern Africa and the Horn of Africa.
Dr Alan Whiteside, the South Africa-based economist and expert on AIDS and development issues, who also spoke at the UNAIDS launch, went further in linking the political instability of Zimbabwe, in particular, and the AIDS epidemic in that country.
Across Southern Africa, only Botswana and Swaziland have experienced a real growth in average income (GDP per capita) in the last ten years. Where life expectancy plummets – as it has done in Botswana and Swaziland as well as the other countries in the region – this inevitably affects the way countries are governed and the expectations people have of their governments.
Intricate links between HIV and famine need to be understood
The connection between AIDS and famine operates at several levels, according to Whiteside.
While the immediate problem for farmers has been drought, the impact of AIDS is felt if and when there is an opportunity, which may be brief, to take advantage of rain to plant crops. If a household member is ill at such critical times, then the crops are not planted and the crisis is extended.
Beyond this, there is a loss of key workers, especially agricultural extension workers. These are expert advisers, at high risk of HIV because they are mobile in the course of their work and have a higher-than-average income.
As the epidemic deepens in rural areas – and in several Southern African countries, including Zimbabwe, it now exceeds 30% of the adult population – so there is the loss of experience and knowledge among farmers about how to work the land.
All three factors mean that recovery from drought will be more difficult than it ever was before.
The linkage between AIDS, famine and instability works in both directions. When people are struggling to meet basic needs and trying to cope with illness, their time and motivation to engage with politics is limited. They see less value in working for long term improvements, if they don’t expect to live to see them.
Equally, as people struggle to survive in a period of conflict, their ability and commitment to avoid HIV are also reduced. There are clear parallels, Dr Whiteside thought, between the violent political conflict which took place in KwaZulu Natal in the early 1990s and present-day problems in Zimbabwe. This was a major reason why KwaZulu Natal has been worse affected by HIV than other parts of South Africa.
Did a successful response to AIDS depend on a level of democracy? This was hard to say, but AIDS could not be de-stigmatised without the active and visible involvement of people with HIV in responding to the epidemic. It could not be imposed by decree, said Dr Whiteside.