Can the millions of dollars the U.S. and other developed countries spend to support sub-Saharan African nations jump-start their economies without more attention paid to the biggest threat facing them: the rampant spread of HIV/AIDS?
Figures released by the United Nations AIDS program suggest that the failure of developed nations to dedicate adequate resources to the global AIDS epidemic may leave dozens of African governments without the means to cope. The World Bank, in cooperation with U.N. AIDS and other international partners, is ratcheting up efforts to tackle HIV/AIDS, but our work alone will not be enough. No longer just a health problem, AIDS is now a development challenge for the entire world.
The U.N. AIDS report provides a devastating account of the scope of the AIDS epidemic in Africa. Life expectancy in southern Africa, which rose to 59 in the early 1990s, is expected to drop to just 45 between 2005 and 2010, the lowest level in half a century. For the first time, new evidence shows that more African women have HIV than men. By the end of 2000, an estimated 13 million Africans will have lost one or both parents to AIDS.
Even as African hospitals and health care systems buckle under the weight of AIDS, the economic effects extend well beyond the health sector. AIDS cuts down young people whose work potential makes them essential to national development. According to U.N. AIDS, a study of commercial farms in Kenya found that illness and death are the leading cause of leaving work, with only 2% of employee drop-out now caused by old age. Economic mainstays such as sugar farming are down 50% in productivity.
Perhaps the most ominous sign, though, is the decline in rank suffered by many African countries in the Human Development Index, an international standard based on levels of health, wealth and education. Almost all the downward changes Africa has experienced on the index are because of AIDS-related drops in life expectancy. Ordinarily measurable only over a generation, changes in African life expectancy are now an annual event. Lifespan in a dozen African nations has decreased by a staggering 25%.
To translate a human crisis into an economic and development catastrophe, one could think of it this way: A 25% drop in farm output would be considered an agricultural collapse. A similar reduction in literacy would be an educational disaster. A 25% loss in life represents no less dire a disaster and must be met with crisis intervention measures immediately.
African presidents have begun to assert this critical leadership, speaking out with unprecedented commitment against HIV, but their efforts are unlikely to be sustained without greater international support. Those concerned about whether Western countries can afford to spend more on AIDS may be surprised to learn how little is spent now. All told, spending by industrialized nations on AIDS programs other than their own now totals less than $500 million a year, a tiny sum for one of the great health crises of this and the next century. The U.S. increased spending by $100 million last year, a tremendously important contribution, but no real stretch for the world's leading economy in a time of prosperity. Annual U.S. spending on global AIDS is still less than that spent by Atlanta to repair roads before and after the Olympics.
As a percentage of gross domestic product, the U.S. contributes less to global AIDS than do Norway, the Netherlands, Denmark, Sweden, Australia, Canada, the United Kingdom or Belgium. Many of the highly profitable U.S. pharmaceutical giants have done little to market products in the African countries hardest hit by HIV/AIDS and in some cases are resisting efforts to make specific drugs available.
Global development efforts seek to improve economic stability, reduce unemployment and eliminate premature illness and death. All of these goals will be undermined unless governments of industrialized nations stop pinching pennies on AIDS.The true price for failing to meet the global AIDS challenge is even greater than economic collapse: It is the loss of humanity.