How to live with it, not die of it
Much more is needed from rich and poor alike if AIDS is not to reverse years of development
TIME is supposed to be the great healer. Not for AIDS. For AIDS, time is simply the great killer, as far as most people are concerned anyway. It need not be so. In the rich world, the availability of anti-retroviral drugs means that most people infected by the human immunodeficiency virus (HIV) can lead more-or-less normal lives, for years if not decades. But poor countries cannot afford these drugs. In due course, those of their citizens who are infected simply develop AIDS, and die. In Africa, the continent with the greatest number of sufferers—over 70% of the total—an unimaginable human tragedy is now unfolding. It is a tragedy, moreover, that affects many more than the 28m or so Africans living with the virus. AIDS blights almost every activity of government, every facet of the economy, every aspect of everyone's life. Unchecked, it will wipe out the progress of decades of development.
A few examples from Botswana illustrate the devastation. Twenty years ago, the life expectancy of a Botswanan was well over 60 years; now it is heading below 40. Projections—guesses may be a better word—suggest that by 2010 Botswana will have 32% less economic output than it would have done without AIDS. Through greater spending on the disease and reduced revenues because of it, government expenditure will be cut by a fifth. Within families, each main breadwinner is expected to have to carry four extra dependants. Most poignantly, Botswana will probably have 214,000 orphans by 2010. Some will have been infected at birth. Many may be lucky enough to be looked after by grandparents or other relations. But who will pay the school fees? Who, indeed, will teach in the schools, when 38.5% of adults are HIV-positive?
Botswana is untypical in that its prevalence rate is the highest in the world. But it is also untypical in that it is richer than most African countries. In other words, the outlook is just as grave in at least a dozen other countries, and could become so in many more. Yet not all is hopeless. Uganda has shown how a concerted campaign against AIDS can bring dramatic results. It cut its adult infection rate from 30% in 1992 to about 11% in 2000. And as our report shows, even the countries of southern Africa, which have been hit particularly hard by AIDS, are fighting back, though with few resources and, in South Africa's case, in the face of a dismaying government policy that has only recently been abandoned.
A vast amount remains to be done, especially in Africa, where most politicians are still far too reluctant to confront the realities of the pandemic. The stigma of infection must be tackled. Every minister in every African government could make a start by taking an HIV test and announcing that he had done so. A huge campaign is needed to reduce sexual violence against women, one of the most horrible—but common—ways in which the infection is spread. An equally big campaign is needed to supply condoms and, above all, information about AIDS: the young, who are the most vulnerable, are the most in need of education. And now too governments, companies and organisations of all kinds must turn their attention to the demands of living with, not dying of, AIDS.
Hope for all, even the poorest
This may be where the rich world can help most. The world's 40m HIV sufferers need drugs, not just because they are human beings who deserve treatment for reasons of humanity, but because their early deaths bring huge costs to society, and are avoidable. Anti-retrovirals are becoming both cheaper and easier to administer. Though they bring problems of resistance, it is no longer possible to argue plausibly that they cannot be given to even the poorest Africans. But even at $1 a day, such drugs for, say, the 5m or more South Africans with HIV are expensive; at present only 17,000 get them.
Last year it was agreed at a UN summit to set up a global fund to fight AIDS, tuberculosis and malaria, which Kofi Annan, the UN's secretary-general, hoped would spend $7 billion-10 billion a year. Though far from perfect—complaints of red tape abound—the fund needs much greater support: only $378m has been disbursed. Some of its money could, for instance, go towards buying drugs for use in poor countries. Such countries can now legally make generic drugs themselves, but they are usually forbidden to import them, and not just for bad reasons: it is absurd to expect drug companies to forgo profits from the products they have developed. If they see no commercial benefits in research, they will not invest in it. Yet both a vaccine and better drugs are desperately needed.
Plenty of obstacles lie in the way of fighting AIDS. Resistance to drugs is certainly one of them. But resistance to the proposition that AIDS still needs a colossal commitment by rich and poor alike should not be countenanced. Too many people are dying needlessly, taking too much with them.