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Africa: Aids and Human Security
Africa: Aids and Human Security
Date distributed (ymd): 011007
Document reposted by APIC
Africa Policy Electronic Distribution List: an information
service provided by AFRICA ACTION (incorporating the Africa
Policy Information Center, The Africa Fund, and the American
Committee on Africa). Find more information for action for
Africa at http://www.africapolicy.org
+++++++++++++++++++++Document Profile+++++++++++++++++++++
Region: Continent-Wide
Issue Areas: +economy/development+ +security/peace+ +health+
SUMMARY CONTENTS:
This posting contains excerpts from a statement by UNAIDS
Executive Director Peter Piot last week, stressing the struggle
against AIDS as an issue of human security. Another posting
distributed today has the closing remarks by AIDS activist Eric
Sawyer at a conference on Health, Law, and Human Rights, stressing
the need "for the legal, medical, public health and activist
communities to join together to pursue a principled fight for the
human right to health."
+++++++++++++++++end profile++++++++++++++++++++++++++++++
AIDS and human security
Statement by Peter Piot, UNAIDS Executive Director
United Nations University,
Tokyo, Japan 2 October 2001
[Excerpts; full text at:
http://www.unaids.org/whatsnew/speeches/eng/piot021001tokyo.html]
Ladies and gentlemen,
The September 11 attacks on New York and Washington have been
deeply shocking, across the world. They are shocking because
suddenly, taken-for-granted assumptions about personal safety and
national security were shattered.
The attacks have forced us all to reflect on the nature of
security: what it means personally as well as geo-politically.
For each of us, it brings to mind security in the widest sense,
and raises the question of how to reinforce the fundamental human
bonds that allow us to live together in peace and stability.
There is a world of difference between the root causes of
terrorism and the impact of AIDS on security. But at some deep
level, we should be reminded that in many parts of the world,
AIDS has caused a normal way of life to be called into question.
As a global issue, therefore, we must pay attention to AIDS as a
threat to human security, and redouble our efforts against the
epidemic and its impact.
Since the creation of UNAIDS six years ago, we have been
positioning AIDS not only as a global epidemic of an infectious
disease, but as a development issue, as well as an issue of human
security. The latter concept was formally recognized in the UN
Security Council's first debate on AIDS, in January 2000. This
debate also marked a shift in the concept of 'security' - from
the absence of armed conflict, to a wider definition of human
security, encompassing the fundamental conditions that are needed
for people to live safe, secure, healthy and productive lives.
At the same time as the Security Council's debate, the CIA
produced a report on 'The Global Infectious Disease Threat and
Its Implications for the United States'. It argued that AIDS will
pose a rising global threat and will complicate US and global
security over the next 20 years. The report also claimed "The
relationship between disease and political instability is
indirect but real ... infant mortality--a good indicator of the
overall quality of life--correlates strongly with political
instability"
In January last year, the idea that AIDS is a security issue was
new. Now, the idea is widely accepted.
The impact of AIDS is a major issue for national security and
many armed forces worldwide, for all peacekeeping and
humanitarian operations, and for wider notions of economic
security, food security, policing and social stability. ...
The global AIDS epidemic is one of the central security issues
for the twenty-first century.
AIDS and global insecurity coexist in a vicious cycle. Civil and
international conflict help spread HIV, as populations are
destabilized and armies move across new territories. And AIDS
contributes to national and international insecurity, from the
high levels of HIV infection experienced among military and
peacekeeping personnel, to the instability of societies whose
future has been thrown into doubt.
Because it takes place over a timeframe of years and decades, the
world has failed to realize that AIDS is a massive attack on
global human security. But this is not a security threat we are
powerless to prevent. The epidemic is not inevitable: we know how
to reduce the spread of HIV and alleviate the epidemic's impact.
Unless the global response to AIDS steps onto a 'war-footing' we
will continue to lose ground against the epidemic. Asia is the
crucial new battleground - actions taken today in Asia will
determine the global shape of the epidemic in a decade's time.
UNDP - one of the 8 cosponsoring organizations of UNAIDS - did
ground-breaking work on the notion of human security in the first
half of the 1990s. They proposed eight components of human
security: economic, food, health, environmental, personal,
community and political. With the possible exception of
environmental security, all these aspects of security are deeply
affected by the HIV/AIDS epidemic.
Economic security
The impact of AIDS on rates of economic growth in developing
countries is marked. There is a direct relationship between the
extent of HIV prevalence and the severity of negative growth in
GDP.
But measures of per capita GDP in fact underestimate the human
impact of AIDS, as AIDS kills people as well as economic
activity. The cumulative impact of HIV on the total size of
economies is thus even greater. By the beginning of the next
decade, South Africa, which represents 40 per cent of the
region's economic output, is facing a real gross domestic product
17 per cent lower than it would have been without AIDS. ...
The immediate impact of AIDS is felt most acutely in households
where one or more members are HIV infected. In South Africa,
households will on average have 13 per cent less to spend per
person by 2010 than they would if there were no HIV epidemic. In
Cote d'Ivoire the household impact of HIV/AIDS has been shown not
only to reverse the capacity to accumulate savings, but also to
reduce household consumption. AIDS not only affects income, with
lower earning capacity and productivity, it also generates
greater medical, funeral and legal costs, and has long term
impact on the capacity of households to stay together. This is
most manifest in the cumulative number of children orphaned by
AIDS, which now totals nearly 14 million.
Household impact is one of the points at which AIDS and poverty
demonstrate their inter-twined, negative relationship. AIDS
exacerbates and prolongs poverty in every context.
Take Botswana, the country with the highest HIV prevalence in the
world with over one in three adults infected. Although Botswana
has one of the highest per capita incomes in sub-Saharan Africa,
a proportion of its population lives in poverty. In 1996, 38 per
cent of the population was living in poverty, down from 49 per
cent a decade earlier. But in a decade, as a result of AIDS, the
proportion of Botswana's population in poverty will return to 45
per cent.
In poorer households, AIDS takes a greater proportion of
available expenditure, and limits access to everything from
health care to food.
Food security
Emergencies, including food emergencies, are a major point of
vulnerability to AIDS. When populations are on the move and the
basic security of life is threatened, HIV risks rise. Women, in
particular, may often find themselves in circumstances where they
are subject to sexual violence, or forced to trade sex for food.
The challenge therefore is to make sure that emergencies are the
focus for interventions to reduce HIV risks. ...
Health security
More than 20 million people have died worldwide since the
beginning of the epidemic, three quarters of them in sub-Saharan
Africa. Globally, HIV/AIDS is now well established in the list of
the top five leading causes of death. It is only surpassed by
disease groups such as ischiaemic heart disease, cerebrovascular
disease, and lower respiratory infections - whose predominance is
largely because they are typical causes of death for old people.
In sub-Saharan Africa, AIDS is responsible for 1 out of 5 deaths,
twice as many as for the second leading cause of death.
The demographic impact of AIDS is unique for two reasons. First,
unlike most other causes of death, AIDS deaths will continue to
rise in the coming years as a result of infections that have
already occurred. Second, HIV infection is highest in young women
and men in their most productive years, including in the best
educated and skilled sectors of populations, as well women of
child bearing age, together with attendant transmission to
children. In the worst affected countries, in twenty years time
the standard population pyramid will have turned upside down,
with more adults in their 60s and 70s than those in their 40s and
50s.
Current prevalence data do not convey the full picture facing
individuals in high HIV prevalence populations. Because
prevalence is a measure of current infection levels amongst
living individuals, it does not capture infections amongst those
who have already died or who have not yet become infected but
will be in the future. On the basis of current incidence and
mortality patterns, it is possible to estimate the lifetime risks
of contracting HIV and dying from AIDS faced by young people
embarking on the sexually active phase of their lives. In a
country such as South Africa, or Zambia, where prevalence in the
year 2000 has reached about 20 per cent, a 15-year old teenager
faces a lifetime risk of HIV infection and of death from AIDS of
over 50 per cent, unless the current rate of new infections drops
dramatically.
Personal security
The impact of the AIDS epidemic on personal security is both
direct and indirect.
Directly, people who are living with HIV or affected by HIV have
often been the targets of physical violence, as well as suffering
the psychological violence of stigma and discrimination.
We only have to recall the care of Gugu Dalmini to understand the
extremes of violence that HIV can provoke. Gugu Dalmini was
murdered in December 1988, only two weeks after she stood in
front of a World AIDS Day meeting in a South African township,
disclosing that she was living with HIV. Her murder must never be
forgotten as testimony to the suffering of people living with
HIV, and her legacy must be that we all redouble efforts against
to fight HIV-related stigma.
As well as its direct effects, the AIDS epidemic has an indirect
impact on personal security by its contribution to social
instability. In particular, because HIV is transmitted mainly
sexually, it is most prevalent among young adults. Therefore when
AIDS starts causing illness it is often people with young
families who find themselves dealing with the additional burden
of AIDS.
The impact of a generation of young people who have not had the
support they need from their parents, and many of whom are
themselves HIV infected, is having serious effects on social
cohesion. These are the same age groups that have historically
been most vulnerable to involvement with crime.
The results are already being felt. The issue of crime, street
violence and instability as a result of the AIDS epidemic has
already emerged as a serious concern in a number of countries,
particularly in sub-Saharan Africa.
One group of young people most affected by the HIV/AIDS epidemic
is the children left behind when their parents die. Already, 13
million children have been orphaned by AIDS, losing either their
mother or both parents before the age of 15. AIDS has had a
dramatic affect on the global number of orphans, and in
particular in Africa which accounts for 90% of the total number
of AIDS orphans. In developing countries, before AIDS around 2
per cent of children were orphaned, but now in many countries, 10
per cent or more of children are orphans.
The war in Sierra Leone left 12,000 children without families.
AIDS in Sierra Leone has already orphaned five times that number.
How will families and communities cope? How many orphaned boys,
and particularly girls, will not go to school because there is no
one to pay their school fees, or no one to dress them and get
them out of the house in the morning, or because they have to
help grow the food to feed the remaining family? What does it
mean for society to have a significant proportion of desocialized
youth? How many will end up desperate and easy prey for militias
and warlords? These are all hugely important issues, yet we have
barely begun even to raise them, much less address their
solutions.
Community security
AIDS affects the very fabric of society. Community structures
break down. Coping capacity reduces. Policing capacity reduces.
Communal conflict increases. Public administration, governance
and social services become unsustainable.
In many of the worst affected countries, civil services are
having to recruit two or three people to fill one job, to cover
inevitable absences for sickness, death and funerals - and where
there is not the money or the people available, essential public
service task are left undone. Police services are heavily
affected in Namibia the police earlier this year stated that AIDS
has become a heavy burden for the police, and in Kenya it
accounts for 75 per cent of all deaths in the force over the past
two years.
In education, AIDS has a negative impact both on the supply of
teachers and on the capacity of children to continue in school.
Across sub-Saharan Africa an estimated 860,000 children lost
their teachers to AIDS in 1999, and in some countries many more
teachers die than retire, and the teaching force is being
depleted almost as rapidly as new teachers can be trained.
Political security
National security is directly threatened by social and economic
instability, lack of predictability, and weakened governance as a
result of AIDS. ...
Adding to these broad effects on political instability, AIDS has
a direct effect on military capacity as an issue of national
security.
Military forces suffer higher than average levels of HIV
infection. The US Armed Forces Medical Intelligence Centre in
1999 estimated the level of HIV infections among armed forces in
sub-Saharan Africa ranging from 10% in Eritrea, 10 to 20% in
Nigeria, to 40 to 60% in Angola and the Democratic Republic of
Congo.
Conflict exacerbates the spread of HIV, and in turn, in a vicious
cycle, the weakened defences of nations contribute to
international instability.
It has even been suggested by some security analysts that the
international capacity for peacekeeping is being weakened because
some African countries that have traditionally supported
peacekeeping forces have found that AIDS has put so much pressure
on their capacity they may no longer be able to fulfil this role.
What to do?
Let me emphasize, that the issue is not just to draw attention to
the problem, but to do something about it. One of the main
lessons from the last decade of response to AIDS is that we are
not powerless to do something to turn back the epidemic. From
successful responses in countries as diverse as Thailand,
Cambodia, Brazil, Senegal and Uganda we have learnt what works,
and what doesn't.
What can be done?
Let me nominate seven features that are essential to an effective
global effort to turn tide on HIV.
First, there is a need to build multisectoral responses. Just as
we have seen that the impact of the HIV epidemic crossed every
part of economic and social affaris, so too the response must
involve every part of society in a full-scale mobilization
against AIDS.
Second, leadership: the leadership to make AIDS a national
priority, for Prime Ministers and Presidents to step in and say
that AIDS is not just a health issue - it is an issue fundamental
to development, to progress and to human security, the leadership
to tackle stigma and the leadership to marshal the necessary
financial resources for the fight against AIDS - the 7 to 10
billion dollars annually that is needed for an effective response
in developing countries.
Third, the need to find ways of strengthening social inclusion.
HIV feeds on marginalization and so responses that build social
inclusion are necessary - from protections against
discrimination, to developing prevention and care initiatives
that fully involve their target groups in programme planning and
delivery.
Fourth, building stronger coping mechanisms at community level.
It is at community level that the battle against AIDS will
ultimately be won - and communities need to feel they are both
empowered and enabled to cope with and combat the epidemic. Among
other things, that means ensuring that there are efficient
mechanisms for decentralization, so that national responses can
be truly effective trhough every part of a nation.
Fifth, we need to provide international assistance and
solidarity. Through the lens of AIDS as a human security issue we
can see ever more clearly our global interconnectedness. AIDS is
truly a global problem that calls out for global responses -
including resources, for example the new Global AIDS and Health
Fund that will be operational by the end of this year, and
already has one and a half billion dollars pledged to it.
Sixth, we need to address the long-term need to replace depleted
human resources. This agenda is barely beginning, but is vital to
the long-term response to AIDS. Only when we succeed in restoring
and renewing the human capacities that have been battered by the
epidemic can we be confident the most affected countries will be
able to secure their futures.
And last, building a partnership in the response. The response to
AIDS is beyond any one nation or any one agency - it needs
partnership between regions, involving public and private
sectors, governments, civil society and business. UNAIDS itself
is a unique partnership in the United Nations system, bringing
together the joint efforts of eight cosponsoring organizations,
focussed on the one set of objectives.
Conclusion
AIDS has called into question the fundamental continuity of
humanity - the passing from one generation to the next of basic
values, of a legacy of happiness and prosperity, of memories and
hopes.
Being able to make preparations for future generations is
necessary to any notion of human security. Without the security
that allows people to plan for the legacy they will leave to
their children and to their community, the very basis of hope in
the future is called into question. Security means nothing if
there is no future.
But we have the means at our disposal to build this future, to
turn back the epidemic.
We must keep hope alive.
Thank you.
This material is being reposted for wider distribution by
Africa Action (incorporating the Africa Policy Information
Center, The Africa Fund, and the American Committee on Africa).
Africa Action's information services provide accessible
information and analysis in order to promote U.S. and
international policies toward Africa that advance economic,
political and social justice and the full spectrum of human
rights.
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