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The economics of HIV in Africa
EDITORIAL
THE LANCET Volume 360, Number 9326
The economics of HIV in Africa “. . . the consequences of [AIDS] stand to undermine all efforts to promote development in Africa.”
This statement was part of the Africa plan issued last week by the G8 leaders from their summit in Kananaskis, Canada, in response to the New Partnership for Africa Development (NEPAD), an initiative of African leaders. The G8 leaders allocated US$6 billion to Africa, not all of it new, and a paltry sum compared with the US$40–50 billion annually that the World Bank estimates is needed (see p 61). Unfortunately Africa, and hence AIDS, seems to have dropped down the G8 leaders’ list of priorities. The summit chairman, Jean Chrétien, put fighting terrorism first on his list of achievements of the summit. This reordering of priorities does not make sense. The scale of the HIV/AIDS pandemic, and its economic implications, are given in the UNAIDS document, Report on the global HIV/AIDS epidemic, prepared for the 2002 AIDS conference taking place in Barcelona, Spain, next week. In 2001, 3 million people died of AIDS, a figure that dwarfs the numbers killed by terrorist attacks. 40 million people worldwide (3 million children) were infected with HIV, with 29 million of those living in Africa. Life expectancy is 47 years in sub-Saharan Africa, compared with 62 years if no HIV were present. The effects on children have the most important implications for future economic recovery. In Africa, few will not be affected by HIV at some time in their life. In addition to the chances of being infected—in Lesotho a 15-year-old has a 74% chance of being infected by age 50—14 million children worldwide have lost one or both parents as a result of the disease. In Zimbabwe, 94 000 children—one in 20— have lost both parents as result of HIV/AIDS. By early adolescence one in five can expect to lose at least one parent. These children are more likely to become part of a poorer household and less likely to fulfill their potential in schooling. The psychological effects are as yet unquantified. The direct and indirect effects on children of HIV will have economic implications for their society. There are no simple solutions to the global HIV/AIDS epidemic and its economic conseTHE LANCET • Vol 360 • July 6, 2002 • www.thelancet.com
quences, but unless action is taken soon there will be no workforce to develop Africa. To begin with, the developed nations in general, and the G8 group in particular, must be prepared to raise Africa to the top of their list of priorities. Africa must be financed as never before, with HIV/AIDS control as a central part of the plan. As the UNAIDS report says in its preface: “effective responses are possible, but only when politically backed and full scale”. In parallel, a shift in thinking about the disease is necessary. With all the money in the world, the HIV/AIDS pandemic will continue to grow unless everyone is encouraged to know their HIV status and be prepared to get treatment. HIV should be considered an infectious disease like any other, with testing and treatment being the norm, rather than the exception. Kevin de Cock and colleagues argue for such a strategy in Africa on p 67 of this week’s issue. They suggest that public health approaches to the African AIDS pandemic are more appropriate than the human rights approaches that have prevailed as the model in the developed world, with insistence on anonymous testing and extensive counseling. Such a refutation of the exceptionalist approach to AIDS would require commitment from political leaders at the highest level, and should not be confined to Africa. Political leaders should be encouraged to be honest about the effects of HIV on their own families; in countries where the adult infection rate reaches 20% there can be no shame in being infected. Kenneth Kaunda of Zambia has already spoken of how HIV killed both his son and daughter-in-law, leaving his grandchildren orphans. Universal knowledge of HIV status would have a direct effect on transmission. For example most cases of motherto-child transmission of HIV—approximately 800 000 in 2001—occur from women who do not know they are infected. Until a pragmatic public health approach to HIV/AIDS is taken, it will be impossible to tackle the pandemic head on, and all attempts to promote development in Africa will be wasted. The Lancet 1
For personal use. Only reproduce with permission from The Lancet Publishing Group.
THE LANCET Volume 360, Number 9326
The economics of HIV in Africa “. . . the consequences of [AIDS] stand to undermine all efforts to promote development in Africa.”
This statement was part of the Africa plan issued last week by the G8 leaders from their summit in Kananaskis, Canada, in response to the New Partnership for Africa Development (NEPAD), an initiative of African leaders. The G8 leaders allocated US$6 billion to Africa, not all of it new, and a paltry sum compared with the US$40–50 billion annually that the World Bank estimates is needed (see p 61). Unfortunately Africa, and hence AIDS, seems to have dropped down the G8 leaders’ list of priorities. The summit chairman, Jean Chrétien, put fighting terrorism first on his list of achievements of the summit. This reordering of priorities does not make sense. The scale of the HIV/AIDS pandemic, and its economic implications, are given in the UNAIDS document, Report on the global HIV/AIDS epidemic, prepared for the 2002 AIDS conference taking place in Barcelona, Spain, next week. In 2001, 3 million people died of AIDS, a figure that dwarfs the numbers killed by terrorist attacks. 40 million people worldwide (3 million children) were infected with HIV, with 29 million of those living in Africa. Life expectancy is 47 years in sub-Saharan Africa, compared with 62 years if no HIV were present. The effects on children have the most important implications for future economic recovery. In Africa, few will not be affected by HIV at some time in their life. In addition to the chances of being infected—in Lesotho a 15-year-old has a 74% chance of being infected by age 50—14 million children worldwide have lost one or both parents as a result of the disease. In Zimbabwe, 94 000 children—one in 20— have lost both parents as result of HIV/AIDS. By early adolescence one in five can expect to lose at least one parent. These children are more likely to become part of a poorer household and less likely to fulfill their potential in schooling. The psychological effects are as yet unquantified. The direct and indirect effects on children of HIV will have economic implications for their society. There are no simple solutions to the global HIV/AIDS epidemic and its economic conseTHE LANCET • Vol 360 • July 6, 2002 • www.thelancet.com
quences, but unless action is taken soon there will be no workforce to develop Africa. To begin with, the developed nations in general, and the G8 group in particular, must be prepared to raise Africa to the top of their list of priorities. Africa must be financed as never before, with HIV/AIDS control as a central part of the plan. As the UNAIDS report says in its preface: “effective responses are possible, but only when politically backed and full scale”. In parallel, a shift in thinking about the disease is necessary. With all the money in the world, the HIV/AIDS pandemic will continue to grow unless everyone is encouraged to know their HIV status and be prepared to get treatment. HIV should be considered an infectious disease like any other, with testing and treatment being the norm, rather than the exception. Kevin de Cock and colleagues argue for such a strategy in Africa on p 67 of this week’s issue. They suggest that public health approaches to the African AIDS pandemic are more appropriate than the human rights approaches that have prevailed as the model in the developed world, with insistence on anonymous testing and extensive counseling. Such a refutation of the exceptionalist approach to AIDS would require commitment from political leaders at the highest level, and should not be confined to Africa. Political leaders should be encouraged to be honest about the effects of HIV on their own families; in countries where the adult infection rate reaches 20% there can be no shame in being infected. Kenneth Kaunda of Zambia has already spoken of how HIV killed both his son and daughter-in-law, leaving his grandchildren orphans. Universal knowledge of HIV status would have a direct effect on transmission. For example most cases of motherto-child transmission of HIV—approximately 800 000 in 2001—occur from women who do not know they are infected. Until a pragmatic public health approach to HIV/AIDS is taken, it will be impossible to tackle the pandemic head on, and all attempts to promote development in Africa will be wasted. The Lancet 1
For personal use. Only reproduce with permission from The Lancet Publishing Group.