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Laying waste a continent

By Peter Piot

Saturday, Nov 30, 2002, Page 9

ILLUSTATION: MOUNTAIN PEOPLE

It is no coincidence that the six southern African nations that now face the prospect of mass famine -- Lesotho, Malawi, Mozambique, Swaziland, Zambia, and Zimbabwe -- also have substantial and still growing HIV epidemics, with between one sixth and one third of their populations infected. In southern Africa, famine and AIDS are, in fact, directly related. Addressing the links between hunger, disease, lack of education and war is vital to long-term solutions to humanitarian emergencies. The world's most serious health problems, including HIV/AIDS, are deeply connected to the violence and poverty that shackle hundreds of millions of people around the world.

In observance of this week's commemoration of World AIDS Day, UNAIDS (the joint UN program on HIV/AIDS) has released new data showing that 3.1 million people died of AIDS this year. Five million were infected with HIV over the course of the year and 42 million men, women and children are now living with the virus.

Chronology AIDS will have killed 3.1 million people in 2002, five million more were newly infected with the deadly virus and for the first time since the start of the epidemic, half of the 42 million people living with HIV/AIDS are women. The following are some key events in the development of the epidemic: 1981 Outbreaks of two rare illnesses are reported among young homosexual men in the US. The disorders, a respiratory infection called pneumocystis carinii pneumonia and a cancer, Kaposi's sarcoma, usually infect older men. 1981-1983 Scientists and researchers start to recognize the emergence of a new disease that destroys the body's immune system, preventing sufferers from fighting simple infections. The illness is also found to affect intravenous drug users and blood transfusion recipients. 1984 The Human Immunodeficiency Virus, HIV, is identified as the cause of the disease. Scientific papers suggesting that AIDS is spread through blood are published in The Lancet and the New England Journal of Medicine. 1985 Scientists develop diagnostic test for the virus. First World AIDS Conference in Atlanta, Georgia. 1987 Zidovudine (AZT), the first treatment for HIV, is launched. 1988 Dec. 1st is designated World AIDS Day. 1991 Videx (ddl), like AZT a member of a class of drugs called reverse transcriptase inhibitors (RTIs), is launched. 1994-1995 Zerit (d4T) and Epivir (3TC), other RTIs, are launched, increasing the choice of treatments. 1996 Triple drug cocktails including protease inhibitors that block the replication of HIV in the body are revealed at the 11th World AIDS Conference in Vancouver, Canada. 1998 Scientists image the crystalline structure of the gp120 protein the HIV virus uses to break into the human immune system cells it attacks. 1999 A chimpanzee named Marilyn helps confirm that the AIDS virus first passed into people from chimps; genetic tests show HIV is closely related to a simian immunodeficiency virus or SIV that infects chimps but does not make them sick. 2000 Five top drug companies agree to slash the price of HIV and AIDS treatments for developing countries, in a breakthrough U.N. deal. 2002 The Global Fund to Fight AIDS, Tuberculosis and Malaria is set up to fund the fight against the three top infectious diseases. In a report showing the epidemic is still in its early stages, the U.N says that AIDS will kill 70 million people over the next 20 years, mostly in Africa, unless rich nations step up their efforts to curb the disease. Source: Reuters

But what do these numbers mean? What happens when 42 million people in the prime of their lives become ill, the great majority of them unable to access any kind of treatment?

AIDS is combining with other factors -- including droughts, floods and in some cases shortsighted national and international policies -- to cause a steady fall in agricultural production in Africa. An AIDS-related death in a farm household causes crop output to plummet - often by up to 60 percent. Household incomes also shrink, leaving people with less money to buy food. Multiply that by millions and famine is not far behind. According to the UN Food and Agricultural Organization, 7 million agricultural workers in 25 severely affected African countries have died from AIDS since 1985. A 2002 study in central Malawi has shown that about 70 percent of surveyed households had suffered labour losses due to sickness.

`Scaling up global spending on 12 proven prevention strategies to US$4.8 billion per year by 2005 would save 29 million people from HIV infection by the decade's end.'

Women in agricultural societies, who perform the bulk of duties related to household food production and care, have been particularly hard hit. When caring for a sick husband, the amount of time a wife has available for tasks such as planting, harvesting and marketing drops up to 60 percent. When the male head of household dies, she may find herself denied access to necessities such as credit, distribution networks or land rights. When she becomes ill or dies, the household often collapses completely -- leaving orphans to fend for themselves without schooling or the skills to carry on food production. More than 11 million African children have now lost one or both parents to AIDS.

UN agencies are mobilizing to address the famine in southern Africa, and have launched a joint appeal for more than US$600 million in assistance, including more than US$500 million in food aid. This critically needed assistance may alleviate the symptoms. But as UN Special Envoy James Morris notes, the "dramatic impact of HIV/AIDS on the humanitarian situation in southern Africa is not fully appreciated." The scale and severity of the impact of AIDS makes swift recovery unlikely. And because the food crisis intensifies and prolongs the epidemic -- as insecurity heightens risk, and poor nutrition hastens illness -- HIV/AIDS responses must also be significantly stepped up.

This epidemic is not only about Africa, or famine. On every continent, AIDS is travelling along social fault lines and exploiting weakness, hurting both lives and economies. HIV infections increased by 25 percent in Eastern Europe and Central Asia this year. Infections in Asia jumped by 10 percent. Together in India and China, well over 5 million people are now living with HIV, and nearly 2 million are infected in the Caribbean and Latin America. In Indonesia, where there was virtually no injecting drug use 10 years ago, about a quarter of the country's estimated 200,000 needle drug users are now infected with HIV.

One of the best things we can do now to safeguard economic and human development in the future is to invest heavily in alleviating the impact of the epidemic, extending access to care and scaling up proven HIV prevention efforts. We know that when prevention programs are mounted seriously, they work. Along with sustained drops in HIV rates in Uganda, prevention efforts are beginning to bear fruit among young people in Ethiopia, South Africa and Zambia. Prevalence is leveling off in Cambodia and the Dominican Republic. Countries as different as Senegal and Poland have demonstrated that the combination of leadership and community involvement can keep the epidemic at bay.

Scaling up global spending on 12 proven prevention strategies to US$4.8 billion per year by 2005 would save 29 million people from HIV infection by the decade's end. When the immediate needs for HIV-related care and treatment are added, the required annual spending directly on AIDS in low and middle income countries is US$10.5 billion. This year, spending will be less than US$3 billion. And the more we delay making a proper investment in the AIDS fight, the more the eventual costs will escalate.

Perhaps for the first time, southern Africa's famine brings the world face-to-face with the true scale of the consequences of AIDS. With 5 million new HIV infections globally this year alone, if we do not dramatically increase action against AIDS, we will be sowing the seeds of future humanitarian disasters -- and not only in southern Africa.

Peter Piot is the executive director of UNAIDS.
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