From Africa Recovery, Vol.13 #2/3 (September 1999), page 30 (part of special feature on ECA conference "Financing for Development")

AIDS: the development emergency

Governments must face facts and act immediately, says Peter Piot of UNAIDS

Along with armed conflict, AIDS has become the "greatest obstacle to development" in much of sub-Saharan Africa, says Dr. Peter Piot, Executive Director of the Joint UN Programme on HIV/AIDS (UNAIDS). Glad for the invitation to address African ministers of finance, planning and economic development at the ECA conference in May, Dr. Piot laid out the facts of this "development emergency." He also outlined what could be done about it: "[Africans] must set the agenda for [their] own development. And that agenda must prominently include AIDS."

He challenged African ministers to get personally involved by speaking out strongly and publicly on how HIV/AIDS threatens their country's future. Ministers should mobilize political support and human and financial resources at domestic and international levels, he added. National success in the fight against HIV/AIDS "depends on people like you," said Dr. Piot, insisting that "your voice on HIV/AIDS will send a powerful message to others."

Ministers must mobilize more resources for AIDS prevention, Dr. Piot continued. A recent study found that in 1997, African countries spent just $150 mn on AIDS prevention, of which only 10 per cent came from governments. In contrast, UNAIDS says at least $1 bn is needed to curb the epidemic. Governments, therefore, must increase average per capita spending on AIDS prevention and shift funds for education, health, infrastructure and rural development into AIDS prevention for the simple reason that the epidemic "is undermining the very goals of these other investments."

Africa's economic performance has improved in recent years, he acknowledged. But further gains will be undermined because, while AIDS is already an epidemic in some countries, the disease is "set to explode in others in the next few years." In order to halve poverty by 2015, Africa needs 7 per cent annual growth of gross domestic product (GDP). But instead, said Dr. Piot, citing a conservative World Bank estimate, countries with high HIV prevalence will lose 1 per cent of per capita GDP growth each year. And over the next decade, the cumulative loss for Kenya could be 15 per cent of per capita GDP, while human welfare indicators would worsen dramatically across Southern Africa due to AIDS.

HIV/AIDS will have a terrible impact on households and at all levels of the national economy and society, said Dr. Piot. Incomes, education, agricultural and industrial productivity would all become victims of the epidemic. And efforts to attract high-quality investment would be in vain.

But Africa as a whole could learn from Senegal and Uganda, where strong political support, broad institutional participation and effective programmes had curbed new HIV infections and improved care for the sick. Dr. Piot emphasized the importance of leadership -- from the head of state to district level -- and partnerships with non-governmental organizations, communities and the private sector. Cultural norms also had to change, to allow frank, public discussion of how to prevent HIV/AIDS transmission.

A key part of the effort would be the "International Partnership against HIV/AIDS in Africa." This, said Dr. Piot, was born of a 1998 resolution of the Organization of African Unity, the second Tokyo International Conference on African Development (TICAD-2), and recent bilateral discussions. It aims to ensure implementation in most African countries of large-scale AIDS programmes within the next five years that sharply reduce new infections, provide care for people with HIV/AIDS, and give tangible support to affected households and communities. The basis, Dr. Piot continued, is stronger collaboration between the seven members of UNAIDS -- UNICEF, UNDP, World Bank, World Health Organization, UNESCO, UN Fund for Population (UNFPA) and UN Drug Control Programme -- and African countries themselves. And the method is to mobilize high-level political support, organize and implement strong, national programmes against HIV/AIDS, raise much more funding for these action plans, and establish national and regional technical teams for programme design and implementation. "We are not powerless," Dr. Piot insisted.

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BOX 1:

HIV/AIDS at a glance:

• At least 9 million Africans have already died of AIDS. In 1998 alone, 1.5 million adults -- equal to Botswana's total population -- died of AIDS, along with 500,000 children -- equal to Equatorial Guinea's total population.
  
• In 1998, 3.5 million adults -- equal to Eritrea's population -- contracted HIV and HIV-positive mothers infected another 500,000 children at birth.
  
• Over 22 million Africans -- roughly Uganda's population -- currently live with HIV/AIDS.
  
• Half of hospital in-patients in Zimbabwe today have AIDS-related illnesses.
  
• By 2005, AIDS treatment costs could take over 60 per cent of Zimbabwe's Ministry of Health budget; the figure for Kenya's health ministry budget is over 50 per cent by 2005.
  
• One teacher is dying from HIV/AIDS every day in Côte d'Ivoire, which is not the most heavily affected country.
  
• An average family's income will fall by half when a family member dies of AIDS.
  
• In one-third of rural households affected by HIV, agricultural output falls by half. One study in Zimbabwe showed maize output down by 61 per cent, vegetables by 49 per cent and cotton by 41 per cent.
  
• Military personnel are two-to-five times more likely to contract HIV than civilians.
  
• Company profits have fallen 7-20 per cent in some African countries as a direct result of HIV/AIDS.
  
• Employee benefits, as a percentage of salary, could rise from 7 to 19 per cent in South Africa because of AIDS.

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