“There's a wealth of real possibilities for change to a more sustainable and more human course.” – Bill McKibben, billmckibben.com on Plan B.
Chapter 10. Stabilizing Population by Reducing Fertility: Africa Breaking Down
A generation ago, virtually the entire world appeared to be progressing economically and socially. A better future was in prospect for all. Now that has changed as the HIV epidemic ravages Africa. It is not only causing millions of deaths, it is undermining the continent's economic future. If issues rooted in population growth, such as land hunger and water shortages, are not addressed, they could be equally disastrous. By analyzing what happened in Africa, perhaps we can avoid a social catastrophe of similar dimensions elsewhere.
History offers few examples of leadership failure comparable to that of Africa's in response to the HIV crisis. The HIV epidemic that is raging across Africa is now taking some 6,030 lives each day, the equivalent of 15 fully loaded jumbo jets crashing daily—with no survivors. This number, climbing higher each year, is expected to double during this decade.13
Public attention has initially focused on the dramatic rise in adult mortality and the precipitous drop in life expectancy. But we need now to look at the longer-term economic consequences—falling food production, deteriorating health care, and disintegrating educational systems. Effectively dealing with this epidemic and the heavy loss of adults will make the rebuilding of Europe after World War II seem like child's play by comparison.
While industrial countries have held the HIV infection rate among adults to less than 1 percent, in 16 African countries the figure is over 10 percent. In South Africa, it is 20 percent. In Zimbabwe and Swaziland, 25 percent. And in Botswana, which has the highest infection rate, 36 percent of adults are HIV-positive. These countries are expected to lose one fifth to one third of their adults by the end of this decade.14
Attention is focusing on the high cost of treating those already ill, but the virus is continuing to spread. As deaths multiply, life expectancy—the sentinel indicator of economic development—is falling. Without AIDS, countries with high infection rates, like Botswana, South Africa, and Zimbabwe, would have a life expectancy of some 65 years or more. With the virus continuing to spread, life expectancy could drop to 35 years—a medieval life span.15
Whereas infectious diseases typically take their heaviest toll among the eldest and the very young who have weaker immune systems, AIDS claims mostly young adults, depriving countries of their most productive workers. In the epidemic's early stages, the virus typically spreads most rapidly among the better educated, more socially mobile segment of society. It claims the agronomists, engineers, and teachers needed for economic development.
The HIV epidemic is affecting every segment of society, every sector of the economy, and every facet of life. For example, close to half of Zimbabwe's health care budget is used to treat AIDS patients. In some hospitals in Burundi and South Africa, AIDS patients occupy 60 percent of the beds. Health care workers labor until the point of exhaustion. This epidemic could easily produce 40 million orphans by 2010, a number that will overwhelm the resources of extended families.16
Education is also suffering. In Zambia, the number of teachers dying with AIDS each year approaches the number of new teachers being trained. In the Central African Republic, the reduction of the teaching force by AIDS closed 107 primary schools, leaving only 66 open. At the college level, the damage is equally devastating. At the University of Durban-Westville in South Africa, 25 percent of the student body is HIV-positive.17
In addition to the continuing handicaps of a lack of infrastructure and trained personnel, Africa must now contend with the adverse economic effects of the epidemic. AIDS dramatically increases the dependency ratio—the number of young and elderly who depend on productive adults. This in turn makes it much more difficult for a society to save. Reduced savings means reduced investment and slower economic growth or even decline.
At the corporate level, firms in countries with high infection rates are seeing their employee health care insurance costs double, triple, or even quadruple. Companies that were until recently comfortably in the black now find themselves in the red. Under these circumstances, investment inflows from abroad are dwindling and could dry up entirely.18
Even as disease consumes Africa, food security is deteriorating. Land hunger, water scarcity, and nutrient depletion are reducing the grain produced per person. In East, Central, and Southern Africa, the undernourished share of the population has increased over the last two decades.19
Making matters worse, food security is declining as the epidemic progresses. At the family level, food supplies drop precipitously when the first adult develops full-blown AIDS. This deprives the family not only of a worker in the fields, but also of the work time of the adult caring for the AIDS sufferer. A survey in Tanzania found that a woman whose husband had AIDS spent 60 percent less time tending the crops. Declines in food production from the epidemic have been reported in Burkina Faso, Côte d'Ivoire, and Zimbabwe. In pastoral economies, such as Namibia, the loss of the male head of household is often followed by the loss of cattle, the family's livelihood.20
Sub-Saharan Africa, a region of 600 million people, is moving into uncharted territory. There are historical precedents for epidemics on this scale, but not for such a concentrated loss of adults. The good news is that some countries are halting the spread of the virus. The key is strong leadership from the top. In Uganda, where the epidemic first took root, the active personal leadership of President Yoweri Museveni over the last dozen years has reduced the share of adults infected with the virus from a peak of 14 percent down to 8 percent. In effect, the number of new infections has dropped well below the number of deaths from AIDS. Senegal also responded early to the threat from the virus. As a result, it prevented AIDS from gaining momentum and held the infection rate to 2 percent of its adults, a number only slightly higher than in industrial countries.21
Saving Africa depends on a Marshall Plan-scale effort on two fronts: one to curb the spread of HIV and the other to restore economic progress. Winning the former depends directly on Africa's national political leaders. Unless they personally lead, the effort will almost certainly fail. Once a leader outlines the behavioral changes needed to contain the virus—such as delaying first intercourse, reducing the number of sexual partners, and using condoms—then others can contribute. This includes the medical establishment within the country, religious leaders, nongovernmental groups, and international health and family planning agencies.
To compensate for the "missing generation," countries will need assistance across the board in education. This is an area where the U.S. Peace Corps and its equivalents in other countries can play a central role, particularly in supplying the teachers needed to keep schools open. Social workers are needed to work with orphans. A program of financial assistance is necessary for the extended families trying to absorb the projected millions of orphans.
Given the high cost of doing business in an AIDS-ridden society, special incentives in the form of tax relief are needed to attract corporate investors, incentives that could be underwritten by international development agencies. And debt relief is essential to the rebuilding of sub-Saharan Africa.
The bottom line is that there is no precedent in international development for the challenge the world now faces in Africa. The question is not whether we can respond to this challenge. We can. We have the resources to do so. If we fail to respond to Africa's pain, we may not only witness the economic decline of an entire continent, but in the process we will forfeit the right to call ourselves a civilized society.
13. UNAIDS, op. cit. note 5.
16. Ibid.; "AIDS, Diseases to Leave 44 Million Orphans by 2010," Reuters, 13 July 2000.
17. UNAIDS, op. cit. note 5, p. 29; university study from Prega Govender, "Shock AIDS Test Result at Varsity," (Johannesburg) Sunday Times, 25 April 1999; "South Africa: University Finds 25 Percent of Students Infected," Kaiser Daily HIV/AIDS Report, 27 April 1999.
18. UNAIDS, op. cit. note 5.
19. Grain production from USDA, op. cit. note 11; information on malnutrition from U.N. Food and Agriculture Organization (FAO), The State of Food Insecurity in the World 2000 (Rome: 2000), pp. 27-28.
20. UNAIDS, op. cit. note 5, pp. 32-33.
Copyright © 2001 Earth Policy Institute