Business Day, 27 November 2002, AIDS report: Signs of progress, but the worst effects are yet to come

Threat of famine in southern Africa is closely linked to devastating disease

THE latest figures reported by the United Nations (UN) and the World Health Organisation in this year's AIDS Epidemic Update illustrate how the spread of the deadly disease has become increasingly entangled with other humanitarian crises in Africa, painting a grim picture of the continent.

In southern Africa, more than 14-million people are at risk of starvation in Lesotho, Malawi, Mozambique, Swaziland, Zambia and Zimbabwe.

All six countries are predominantly agrarian societies grappling with serious AIDS epidemics. More than 5-million adults out of a total population of 26-million are infected with HIV in these countries, where AIDS killed an estimated 500000 people last year. Most of those who died were in their productive prime.

Few of those infected have access to medical care, still fewer access to life-prolonging antiretroviral medicines. At the end of last year, less than 4% of people living in low- and middle-income countries who needed these drugs were receiving them.

The report emphasises that the cruelly symbiotic relationship between ill health and economic hardship means that households with sick family members struggle to produce and purchase food, and rapidly deplete their meagre assets.

AIDS-related deaths in a farming household can cause crop output to plummet by as much as 60%, says the report.

A study conducted in Malawi found that about 70% of surveyed households had suffered labour losses due to sickness.

The report points out that just as the hunger crisis is not simply due to unkind weather, but rather a complex web of mishaps and misguided policy decisions, so too is the AIDS pandemic.

Yet although it singles out Malawi, hobbled by a lethal combination of adverse weather conditions, HIV, rampant inflation and ill-advised agricultural policy decisions, the report holds back from pointing fingers in a similar fashion at specific government HIV/AIDS prevention programmes.

Instead, it provides a chilling statistical snapshot of Africa, warning that without "massively expanded prevention, treatment and care efforts, the AIDS death toll on the continent is expected to continue rising, before peaking around the end of the decade".

South of the Sahara, an estimated 3,5-million new infections occurred this year, and AIDS claimed the lives of 2,4 million Africans. Botswana, Lesotho, Swaziland and Zimbabwe have all broken the 30% barrier for national adult HIV prevalence rates, reaching levels higher than the experts believed possible.

The worst is still to come, yet there is a glimmer of hope, says the report.

It cites SA, where HIV prevalence rates for pregnant women under the age of 20 fell to 15,4% in 2001, down from 21% in 1998. Combined with a drop in syphilis rates, the report argues, this suggests that prevention and awareness campaigns are bearing fruit.

That is certainly welcome news to the national health department. Spokeswoman JoAnne Collinge says the department expects that by next March it will have spent close to R1bn over a three-year period on HIV prevention.

Similarly encouraging results are emerging from Ethiopia, Uganda and Zambia.

Another positive sign, says the report, is that almost 40 sub-Saharan countries have developed national strategies to fight HIV/AIDS almost three times more than two years ago and 19 countries have national AIDS councils, a sixfold increase since 2000. Like much of the report, this particular finding raises a host of unanswered questions, as its broad-brushstroke approach offers little insight into which of these structures are effective.

Nonetheless, UNAIDS executive director Peter Piot argues that there is strong evidence from around the world that the AIDS epidemic does yield, in some cases dramatically, to "determined human intervention".

"Over the past two years the international community has come to recognise what is needed, in terms of resources and political leadership, to combat the pandemic. But we cannot say in either category that we are anywhere near where we need to be to have a significant impact on the epidemic."

UNAIDS estimates that to combat HIV/AIDS, low- and middle-income countries will require 10,5bn a year by 2005, rising to 15bn a year by 2007 a level that will need to be maintained for at least a decade thereafter.

For sub-Saharan Africa, up to 80% of the requisite financial resources will have to come from international sources, says the report.

Considering that many of the pledges made to the UN's Global Fund to Fight AIDS, TB and malaria have still not been honoured, and that only five rich countries have fulfilled a 1970 commitment to raise development aid to 0,7% of gross domestic product, the outlook for Africa is far from encouraging.