"Urban transport systems based on a combination of rail lines, bus lines, bicycle pathways, and pedestrian walkways offer the best of all possible worlds in providing mobility, low-cost transportation, and a healthy urban environment." –Lester R. Brown, Plan B 4.0: Mobilizing to Save Civilization.
There is no precedent for the number of lives affected by the HIV epidemic. To find anything similar to such a potentially devastating loss of life, we have to go back to the smallpox decimation of Native American communities in the sixteenth century or to the bubonic plague that took roughly a fourth of Europe’s population during the fourteenth century. HIV should be seen for what it is—an epidemic of epic proportions that, if not checked soon, could take more lives during this century than were claimed by all the wars of the last century.
Since the human immunodeficiency virus was identified in 1981, this infection has spread worldwide. By 1990, an estimated 10 million people were infected with the virus. By the end of 2004, the number who had been infected climbed to 78 million. Of this total, 38 million have died; 39 million are living with the virus. Twenty-five million HIV-positive people today live in sub-Saharan Africa, but only 500,000 or so are being treated with anti-retroviral drugs. Seven million live in South and Southeast Asia, with over 5 million of them in India alone.
Infection rates are climbing. In the absence of effective treatment, the parts of sub-Saharan Africa with the highest infection rates face a staggering loss of life. Adding the heavy mortality from the epidemic to the normal mortality of older adults means that countries like Botswana and Zimbabwe will lose half of their adult populations within a decade.
The HIV epidemic is not an isolated phenomenon. It is affecting every facet of life and every sector of the economy. Food production per person, already lagging in most countries in sub-Saharan Africa, is now falling fast as the number of field workers shrinks. As food production falls, hunger intensifies among the dependent groups of children and the elderly. The downward spiral in family welfare typically begins when the first adult falls victim to the illness—a development that is doubly disruptive because for each person who is sick and unable to work, another adult must care for that person.
The massive loss of young adults to AIDS is already beginning to cut into economic activity. Rising worker health insurance costs in industry are shrinking or even eliminating company profit margins, forcing some firms into the red. In addition, companies are facing increased sick leave, decreased productivity, and the burden of recruiting and training replacements when employees die.
Education is also affected. The ranks of teachers are being decimated by the virus. In 2001, for instance, Zambia lost 815 primary school teachers to AIDS, the equivalent of 45 percent of new teachers trained that year. With students, when one or both parents die, more children are forced to stay home simply because there is not enough money to buy books and to pay school fees. Universities are also feeling the effects. At the University of Durbin in South Africa, for example, 25 percent of the student body is HIV-positive.
The effects on health care are equally devastating. In many hospitals in eastern and southern Africa, a majority of the beds are now occupied by AIDS victims, leaving less space for those with other illnesses. Already overworked doctors and nurses are often stretched to the breaking point. With health care systems now unable to provide even basic care, the toll of traditional disease is also rising. Life expectancy is dropping not only because of AIDS, but also because of the deterioration in health care.
The epidemic is leaving millions of orphans in its wake. Sub-Saharan Africa is expected to have 18.4 million “AIDS orphans” by 2010—children who have lost at least one parent to the disease. There is no precedent for millions of street children in Africa. The extended family, once capable of absorbing orphaned children, is now itself being decimated by the loss of adults, leaving children, often small ones, to take care of themselves. For some girls, the only option is what has come to be known as “survival sex.” Michael Grunwald of the Washington Post writes from Swaziland, “In the countryside, teenage Swazi girls are selling sex—and spreading HIV—for $5 an encounter, exactly what it costs to hire oxen for a day of plowing.”
The HIV epidemic in Africa is now a development problem, a matter of whether a society can continue to function as needed to support its people. It is a food security problem. It is a national security problem. It is an educational system problem. And it is a foreign investment problem. Stephen Lewis, the U.N. Special Envoy for HIV/AIDS in Africa, says that the epidemic can be curbed and the infection trends can be reversed, but it will take help from the international community. The failure to fully fund the Global Fund to Fight AIDS, Tuberculosis and Malaria, he says, is “mass murder” by complacency.
Writing in the New York Times, Alex de Waal, an adviser to the U.N. Economic Commission for Africa and to UNICEF, sums up the effects of the epidemic well: “Just as HIV destroys the body’s immune system, the epidemic of HIV and AIDS has disabled the body politic. As a result of HIV, the worst hit African countries have undergone a social breakdown that is now reaching a new level: African societies’ capacity to resist famine is fast eroding. Hunger and disease have begun reinforcing each other. As daunting as the prospect is, we will have to fight them together, or we will succeed against neither.”
For more information, see Curbing the HIV Epidemic
Excerpted from Chapter 6, “Early Signs of Decline,” in Lester R. Brown, Plan B 2.0: Rescuing a Planet Under Stress and a Civilization in Trouble (New York: W.W. Norton & Company, 2006), available at www.earth-policy.org/books/pb2.