November 30, 2004

AIDS and Africa, again

I have written on AIDS and Africa, before, and discussed the horrifying impact of this syndrome on that continent. But, there were a couple of articles this weekend in the NY Times that brought it all back again. A team of reporters spent 5 weeks in Lavumisa, Swaziland, a small town in South Africa. They interviewed scores of residents. The reporters also recorded their observations. The story is hard to put down. But, primarily, it is a newspaper article. This means it has heart rending human suffering details with hard facts about the impact on the society. I am interested in the facts, here, although I read the human suffering details in the article and found them quite moving. No, my interest is primarily in the huge dislocative effects on society writ large. The disease is destroying society and in Africa and turning the clock back on decades of social and economic progress. As the article asks:

Epidemics typically single out the aged and young - the weak, not those at society's core. So what happens to a society when its fulcrum - its mothers and fathers, teachers, nurses, farm workers, bookkeepers, cooks, clerks - die in their prime?

No one will be able to forecast with any great degree of certainty how this will play out, but we can extract some nuggets from the article just the same, which I do in the extended entry:

Across the region, AIDS has reduced life expectancy to levels not seen since the 1800's. In six sub-Saharan nations, the United Nations estimates, the average child born today will not live to 40.

Here in Swaziland, a kingdom about the size of New Jersey with one million people tucked into South Africa's northeast corner, two in five adults are infected with H.I.V., the virus that causes AIDS. Life expectancy now averages 34.4 years, the fourth lowest on earth. Fifteen years ago, it stood at 55. By 2010, experts predict, it will be 30.

Today, Lavumisa's schools are collapsing. Crime is climbing. Medical clinics are jammed. Family assets are sold to fend off hunger. The sick are dying, sometimes alone, because they are too many, and the caretakers are too few. Much of this is occurring because adults whose labors once fed children and paid school fees and sustained families are dead.

At Lavumisa Primary School, a beige L-shaped building of concrete classrooms clumped around a red dirt yard, enrollment has fallen nearly 9 percent in five years, to 494 students, as children drop out to support families. One in three students has lost at least one parent.

Mr. Shiba can state that at the beginning of this year, Ndabazezwe High had 40 students who had lost at least one parent. Nine months later, there were 73, 20 of whom had lost both father and mother, nearly all of whom are desperately poor. A decade ago, Mr. Shiba said, the school had perhaps five orphans, none of them needy.

Both the primary and the high school are staggering under the burden of feeding and educating a growing army of orphans who, by and large, cannot pay the school fees. The state has pledged to pay to educate orphans, but so far it has picked up but half the Lavumisa primary-school fees. Mr. Shiba said the high school was getting a mere $15 of the $100 a year it costs to educate each orphan.

Ndabazezwe High School is now deeply in debt by Swazi standards. It owes $275 for electricity; $200 for water; $260 for books and hundreds more for office equipment. The security guards have not been paid in two months. Borrowed money bought the woodworking and home-economics materials needed for final exams. Even school lunches are hit-or-miss.

Mr. Shiba and Stephen Nxumalo, the headmaster at Lavumisa Primary, reluctantly intend to carry out a resolution adopted in May by the nation's main teachers' organization. Starting in January, students who do not pay their fees - currently about 100 in the primary school, 258 in the high school - will be barred from classes.

When a family loses a parent to AIDS, public health experts here say, the household production of maize quickly falls by half; the number of livestock owned by nearly a third. It is the equivalent of draining the bank account.

Lavumisa and other towns like it are windows into the crisis that has beset Swaziland. AIDS kills an estimated 50 people here and H.I.V. infects 55 more each day, erasing hard-won economic gains of the last 20 years, according to the United Nations and the World Health Organization.

"It is the most efficient impoverishing agent you can find; it just sucks out the resources," said Dr. Derek von Wissell, who directs Swaziland's National Emergency Response Council on H.I.V./AIDS, the agency charged with stemming the epidemic.

Until the late 1990's, when AIDS began to hit with force, Swaziland seemed a society on its way up, making strides in health care, education and income. No more.

Economic growth and agricultural production have slowed. School enrollment is down. Poverty, malnutrition and infant mortality are up. By 2010, the United Nations forecasts, children who have lost one parent or both will account for up to 15 percent of Swaziland's one million people.

The adult H.I.V. infection rate, 38.8 percent, now tops Botswana's as the world's highest. The death rate has doubled in just seven years.

"Swaziland is frankly beyond the threshold of what we thought could happen," said Duncan Earle of the Global Fund to Fight AIDS, Tuberculosis and Malaria, who oversees $48 million in AIDS-related grants to the kingdom. "Ten years ago, we thought the peak infection rate would be 20 to 25 percent. This stretches the imagination."

A long-promised flood of antiretroviral drugs financed by the Global Fund and other donors could help stem the carnage. But like the rest of sub-Saharan Africa, Swaziland is starting slowly. Only about 4,000 of the 26,000 who need drugs get them. Perhaps 8,000 will have them by the end of 2005.

In 16 months, the Global Fund has disbursed $5.1 million in AIDS grants to Swaziland. Yet not until this month did the overwhelmed Health Ministry hire its first two doctors to work on H.I.V. programs. Some $2.8 million earmarked for orphans' education is locked in the Treasury, even as the government this year spent $600,000 on the king's 36th birthday party.

To the United Nations envoy for AIDS in Africa, Stephen Lewis, it is hard to fathom the consequences awaiting a nation with a vanishing middle generation.

"I resist an apocalyptic scenario," Mr. Lewis said. "But I have to admit, in the middle of the night I ask myself: 'How are these societies going to survive?' "

Virtually all the Swazis dying today were infected in the 1990's, when the infection rate was far lower than it is today. Those who are just now infected will not fall gravely ill until about 2012 - a tidal wave of illness and death that is still eight years away.

How Lavumisa and other similar towns will cope with that is anyone's guess. "Nobody has ever walked that road," Dr. von Wissell said. "Nobody."

I think we can all agree that there are certain horrible issues we can draw from the above quotes.

One, if the next generation is not educated, if they cannot go to school, there is limited hope for the future of that country. Where are the next doctors to come from? Or teachers? Or computer programmers? Or engineers? Or even bureaucrats to administer the foreign aid programs?

Two, as the family structure breaks down, and there is no mention, I note, of any organized religion, who is going to teach the tradtional morals and values to the next generation? This has long term society altering consequences, too.

Three, what happens to the economy. People are growing less corn and thus have less to sell. They will then have less money to spend on goods and services. They move to a barter system, perhaps. There are no taxes paid to the government on that system! How can the government run programs to help the people with no tax base?

Four, crime has picked up already. Who is paying the police to combat that? How are they paying them?

Five, how can this country ever attract foreign investment if you need to hire three people for every job because two of them are going to die?

Six, how much worse can it get?

The NY Times also, in the Week in Review section, ran another piece about Africa and AIDS and this one just infuriated me. Here was the offending bit of politcally correct, don't blame the victim, it isn't their fault, it is all down the racism bit:

The troubles are easy to enumerate: perhaps one million South Africans already dead from AIDS, from four to five million people infected with H.I.V., a tiny fraction of those receiving antiretroviral medication, and women now about three times more likely than men to become infected. A report issued last week by the United Nations said women now account for 60 percent of all infections in sub-Saharan Africa.

The sexual behavior - unprotected sex with multiple partners in sordid settings - is less easy to elucidate. This is post-apartheid sex, as dictated by lingering poverty, violence, the vulnerability of young black women with scant prospects, and the prevalence of migrant black male laborers uprooted from wives and homes.

In places like Guguletu, where unemployment is about 60 percent, it is clear enough that the fight against AIDS in Africa is also a fight against the continent's painful legacy of exploitation, racism, corruption and waste. Medicines help, but they resemble armored divisions in the fight against terrorism: they will win some important victories, but they will not take you to the root of the problem.

I have a problem with the bit I bolded above. I think and believe that AIDS is a problem that can be fought with a little piece of latex, among other things. Use a condom. Control your risk. Failure to do so is a personal choice at the end of the day. It cannot be a legacy of racism or exploitation or corruption. Unless it was rape, you make the choice about what goes into your body and whether you are protected. To write otherwise, absolves the actor of all personal responsibility for their choices. I hate that. It seems more racist to me than anything else because it removes the human element. I believe that people can make choices and that they must. Otherwise, as we have talked about before, Africa will be a dead zone. No one can seriously want that.

Posted by Random Penseur at November 30, 2004 08:40 AM

This is almost too hard to fathom. If you have a virtual certainty of dying from screwing around, isn't that enough incentive to stop screwing around? I can't understand the mindset of people who continue on such a course of self destruction.

Posted by: Jim at November 30, 2004 04:25 PM

No matter how often you post on Africa, I still find it worth keep at it.

Posted by: Jester at November 30, 2004 09:52 PM

Thanks for this article extract. I understand your angryness about the bold part you highlighted in the end, although, I don't share it. I think you make the hidden assumption that societies' norms and values, hence, culture, down there is similar to the one we enjoy (freedom of choice, free self-expression and so on).

It's the culture down there that favors the spread of AIDS. It's a sexual disease and people are reluctant to talk about it. Look at the "nipplegate" scandal one year ago and you see that even in very "advanced" economies and societies, some topics are taboo.

Posted by: Johann at March 14, 2005 11:57 PM
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