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NEPAD: The Need to Mainstream HIV/AIDS

George C. Lwanda*

Abstract

HIV/AIDS in Africa

In Africa, especially southern Africa, HIV/AIDS has reached alarming proportions. Whereas sub-Saharan Africa accounts for only ten percent of the global population, by 2000, the region was already home to twenty-five million people (70 percent of the world’s persons living with HIV/AIDS). That was in 2000. The 2003 UNAIDS AIDS update estimates that 26.6 million Africans live with HIV/AIDS and that southern Africa alone, despite making up only two percent of the world’s population, accounts for thirty percent of all people living with HIV/AIDS in the world.

Infection rates in the high-risk African countries are even more alarming, ranging from thirteen percent to thirty-six percent. Southern Africa as the hardest hit region on the continent has infection rates ranging from 2.8 percent in Angola to thirty-six percent in Botswana. South Africa, with an infection rate of thirteen percent has the largest number of HIV/AIDS infected people in any country in the world, whilst Botswana has the highest infection rate (thirty-six percent). These statistics are no secret and are readily available on many websites, books, and libraries and should not be ridiculed or ignored as they represent the loudest cry of warning of an impeding social and economic crumble of the African continent.

HIV/AIDS and its Effects on African Development

Controversy surrounds the question of whether HIV/AIDS has any social and economic impact (on development). The most direct and obvious consequence of AIDS is an increase in mortality, but even this itself takes years to start unfolding. This is due to the gradual manner in which the disease takes its victims. Besides calls for behavioral change and the rhetoric of other ‘politically correct’ statements, the socio-economic consequences of the disease on Africa’s development process have largely been ignored and at best been given token reference (by the continents’ leading political figures). Many politicians, policy-makers and ordinary citizenry have chosen, consciously or otherwise, to close their eyes and rebuff any attempt to estimate or accept the socio-economic effects of the disease. Denial by the victims and their guardians, as well as the custodians of the African development policies and their citizenry has served to undermine progress in the fight against the disease on the continent.

This has led to the general stigmatization of the disease, which has been worsened by the fact that open talk on sex is a taboo in most African countries. So bad is the stigmatization that the World Bank estimates that only three percent of HIV positive people in Africa actually go to clinics because of the negative stigma attached to the disease. The problem has been further fuelled by the continued call by most African religious groups who continue to stop their followers from using condoms, maintaining that condom use is ‘deviant’. Unfortunately, religious institutions are very influential amongst Africa’s poor.

One thing is clear: the challenge posed by the plight of the HIV/AIDS epidemic on the continent of Africa and its development efforts threatens to grow should the epidemic continue unobstructed. Denial withstanding, some of the effects of the disease are glaring. These effects cascade menacingly from the health of the individual, to the family, the community, the nation and eventually the continent.

The first and most apparent effect of the disease has been the enormous loss of lives across the continent. Millions of lives have already been lost to the disease. Closely related to this is the cascading effect of the disease on poverty from the individual to the family, community and the nation and feeding on it. “Poverty is the second cousin of HIV infection” (Akukwe 2002, 2). At the family level, the suffering of a family member, usually the breadwinner, translates into the loss of income for the family. Other family members are then tied from income generating activities due to their having to care to the sick. This often forces most of the poor African households to sell their animals and farming implements, as they hopelessly search for a traditional or medical cure for their patient.

The effects cascade further; unfortunately, poverty tends to lead to (the poor) people indulging in risky activities so as to survive. Faced with this unfortunate situation, young girls have turned to prostitution whilst boys have generally turned to crime, drugs and alcohol abuse, further fuelling the epidemic and generating a vicious poverty cycle in which they and many others will become entrapped.

An example of this is the number of prostitutes who, despite being aware of the dangers of HIV/AIDS, continue to engage in unprotected sex claiming that there is no way that they can be thinking long-term when survival is an every day struggle. A Malawian prostitute illustrates the problem:

(The Daily Times, Friday 28 May 2004)

HIV infection results in opportunistic infections that overtake the weakened body immune system, and thereby increase the incidence and intensity of endemic diseases, such as tuberculosis, malaria, meningitis, cholera etc. on the continent. This has resulted in the general ill health of the continent as more people contract the disease and many others become prone to contracting it. Hence, the disease has generally reduced life expectancy of the population of sub-Saharan Africa. The US Bureau of Census estimates that, “by 2003, Botswana, South Africa and Zimbabwe will have seen growth rates of 1.1 percent per year to 2.3 percent per year in the absence of AIDS reduced to negative population growth rates of between –0.1 percent per year and –0.3 percent per year (Monitoring the AIDS Pandemic 2000) (See Table 1). Bottom line: a situation is unfolding in which future African generations will grow up faced with the reality that regardless of what they do, adulthood is beyond their reach! (Unless they migrate to the North.)

In the midst of these reduced life expectancies lurks the unfortunate consequence of an increase in orphans. UNAIDS estimates that whereas only two percent of all children in the developing world were AIDS orphans, by 1997 this figure had gone as high as eleven percent in some African countries (UNAIDS 2000f, 28). This has slowly led to the crumbling of one of Africa’s most treasured traditions: the extended family.

By plucking out the most productive segment of the African society and hence disrupting the continuum of knowledge transfer from experienced workers to younger inexperienced workers, the epidemic not only poses a great challenge to human resource development on the continent but is also a deadly antithesis of any serious developmental effort in Africa. Even more distressful is the fact that million of seemingly healthy young Africans who form the future human resource and expertise pool of the continent may be unknowingly living with HIV, which will only manifest itself clinically in the years to come.

At the national and continental level, costs of running firms are steadily rising due to increased labor turnover caused by absenteeism and death as a result of HIV/AIDS. In the process, nations have also lost leaders, bureaucrats, technocrats, doctors and other professionals as well as the breakdown of the knowledge continuum due to the scourge. Actually, the World Bank and UNAIDS estimate that African countries most afflicted by AIDS will lose annually between 0.5 to 1.2 percent of Gross Development Product (GDP) due to the epidemic.

The epidemic has also placed an extra pressure on the already overburdened African women who play a very important role in continent’s most life sustaining activity – agriculture or the production of food for the family. With the advent of the HIV/AIDS, women’s time is being diverted to caring for sick family members. This has consequently been detrimental to the continent’s food security status.

Lastly, the undue burden that the epidemic has placed on the already crumbling African healthcare system, crippled by poor policies and the harsh realities of neo-liberal economic policies, has increased hunger and poverty levels. Healthcare has consequently been increasingly regarded less as a basic right and more increasingly as a profit-making product. The consequence of this regrettable scenario has been the skewed availability of healthcare in favour of the rich. This could set the conditions ripe for future civil unrest as the poor fight for their share of decent health standards. The high rates of infection in most of the national defense forces of African nations also portends danger signals for civilian governments if the infected soldiers die in large numbers without receiving life saving drugs.

The Interplay between NEPAD and HIV/AIDS in the Development Nexus

“Improving the health and longevity of the poor is an end in itself, a fundamental goal of economic development. But it is also a means to achieving the other development goals relating to poverty reduction.” (WHO 2002)

That AIDS has the potential to grind economic development, or whatever remains of it in Africa, to a halt is no joking matter. However, going through the NEPAD document one is surprised that HIV/AIDS is mentioned only three times in the entire document; all this despite the fact that it is the continent’s biggest killer. NEPAD with its token reference to the HIV/AIDS pandemic may have, therefore, marginalized itself from one of the most crucial factors in delivering the African continent from economic decay to prosperity. A fact bluntly stated by Stephen Lewis, the HIV/AIDS advisor to Kofi Annan in June 2002. In a speech in the run-up to the G8 Summit in Canada, Lewis reiterated:

It seems to me that there’s a critical flaw at the heart of the NEPAD document. For all its talk of trade, and investment, and governance, and corruption, and matters relating to financial architecture, there is only pro forma sense of the social sectors, only modest references to the human side of the ledger. And in a fashion quite startling, NEPAD hardly mentions HIV/AIDS at all. But how can you talk about the future of sub-Saharan Africa without AIDS at the heart of the analysis? The failure to do so leads to a curious and disabling contradiction.

This is not to say that the authors of NEPAD wholly repudiate the existence and danger of the epidemic, indeed perfunctory homage is accorded to the danger of the scourge in the NEPAD document. Paragraph 125 of the NEPAD document accedes that “One of the major impediments facing African development efforts is the widespread incidence of communicable diseases, in particular HIV/AIDS, tuberculosis and malaria. Unless these epidemics are brought under control, real gains in human development will remain an impossible hope” (NEPAD 2001: 1, 25).

To this end, NEPAD has indeed tried to tackle the HIV/AIDS issue, alas flaccidly, using corporates. However, as profit-driven institutions, corporates have their way around some of these problems. Faced with stagnating demand as economies grind to a halt and high labor costs due to the death of employees at the hands of the epidemic, large corporations may and will consider moving production to wherever production costs are cheaper. This has the potential to lead to a drain in private investments to the continent–an antithesis to the stated aims of NEPAD. Even when these firms decide not to relocate, the fact remains that they will only move in to take on HIV/AIDS when it starts hitting profits. The point is that by that time the corporates themselves have little choice; NEPAD or no NEPAD their profits stand doomed if they are to just sit back and watch the situation unfold. In these cases the intervention is not usually long-term. It is, hence, obligatory and apt for NEPAD to assume the role of the pied piper in the fight against AIDS.

Way Forward

“HIV/AIDS must become an integral part of NEPAD. It is not possible to talk about Africa’s renaissance or economic growth without paying serious attention to the number one development priority of the continent” (Akukwe 2002, 2)

NEPAD is without doubt a noble initiative by the political leaders of Africa to the ordinary citizenry of the continent. It is an initiative that, if successful, will not only vindicate African political leaders from the undesirable label of ‘mis-managers’ that the rest of the world has given to them but also most importantly lift millions of hopeless Africans from economic damnation to opulence. However, the thrust of this paper is that in its present state NEPAD will not be able to unleash the vast economic potential of the continent.

To start with, as a blueprint to the economic emancipation of Africa, NEPAD has to adopt an all encompassing line of attack in terms of ownership and avoid as much as possible any marginalisation of any of the continents stakeholders. However, current behavior by the authors of NEPAD tends to cast NEPAD in an ‘elitist’ light. For all its intents and purposes NEPAD remains a politicians club. To this end one of the most common criticisms of the program is its failure to incorporate the other ‘non-political’ sectors of African society e.g. civil society, professionals, academics etc.

It is this top-down approach that has led to the marginalisation of the HIV/AIDS epidemic in NEPAD’s priority areas. The views of NEPAD’s chief architect and advocate, South African president Thabo Mbeki on the HIV/AIDS issue is known to most. Many commentators observe President Thabo Mbeki’s views on the epidemic as retrogressive to the development of the continent. Sadly, he is considered the de facto leader of the NEPAD initiative because he has played a major role in the NEPAD process. It is in this process that his views are seen as having superceded the desperate and immediate needs of millions of Africans ravaged by the disease.

Hence, it is vital that NEPAD abandon its personal identification with President Mbeki and bring on board all the other ‘smaller’ stakeholders of the continent. The need not to marginalize any stakeholder in the continental development process cannot be overemphasized.

Secondly, within the continent, the unsympathetic effects of neo-liberalism are plain. The steady demise of Africa’s health care system is partly due to neo-liberal policies adopted during Structural Adjustment Programs (SAPs). The continent has seen the gifted, the corrupt, or the well-inherited thrive whilst the rest have been left to fend for themselves. Expenditure in social services is almost non-existent and agricultural production as well as economic well-being of the people has plummeted. In the end social programs to mitigate these harsh effects have had to be drawn up and implemented, albeit in a fire-fighting style. The end losers have been Africa’s general populace. It might, therefore, be worthwhile for NEPAD to revisit its immense neo-liberal leaning.

Thirdly, and more importantly, besides “calling for a new relationship of partnership between Africa and the international community”, it is imperative that NEPAD strives, through its member governments, to establish a new state – civil society partnership. If the authors of NEPAD have been bold enough to accept the need for a new partnership with the North, then they should be in a position to accept that the ‘African world’ in which we have been living has been dominated by methodical anti-democratic thinking and policies that have greatly alienated civil society and forced it to helplessly endure a seemingly endless range of oppression and denial of economic well-being and basic human rights primarily stemming from the deliberate actions of the state. As a step forward, African states need to take deliberate steps to establish a new refined state-civil society partnership.

Fourthly, NEPAD should, and with urgency, adopt a proactive, more radical, pied piper role in the formulation and indeed implementation of policies aims at tackling the epidemic on the continent. NEPAD has continually shied from adopting a proactive role in implementation. Its health strategy for example states that:

NEPAD, through the actions of Heads of State and Government and managed by its secretariat, facilitates, enables, focuses, leverages and co-ordinates efforts to achieve its strategies, but is not itself an implementation agency. Core responsibility for implementation rests with individual countries… (NEPAD Health Strategy Executive Summary 2003).

Therein lies the disclaimer. Astonishingly, however, NEPAD itself is to date vigorously engaged in the coordination of action programs in sectors such as agriculture and telecommunication.

Lastly, this paper suggests the following as a means of adopting a radical approach to including the HIV/AIDS agenda in the NEPAD process: the inclusion of the assessment of the status of HIV/AIDS eradication in individual countries that have accented to the African Peer Review Mechanism (APRM). Incorporating HIV/AIDS eradication in the APRM will ensure that HIV/AIDS is mainstreamed in a rapid way into the core areas of NEAPD. More importantly, since the APRM is a tool in which African states can learn the most viable solutions to a myriad and multifaceted range of developmental problems confronting the continent, then this will not only ensure interaction amongst African leaders in tackling the epidemic but also that progress on the eradication of the disease on the continent will be periodically monitored and assessed.

Conclusion

“AIDS depends for its success on the failures of development” (Holden 2003, 34)

Africa is presently at a crossroads. Realizing this, the political leaders of the continent have drawn up NEPAD, a visionary initiative offering to the miserable African masses their economic emancipation from damnation. However, the HIV/AIDS epidemic remains the Achilles heel of this visionary initiative as the continent continues to lose many of its gifted daughters and sons, eroding the knowledge transfer continuum, reducing life expectancy and generally pulverizing the continent to economic extinction. We are currently at the epicenter of the deadliest epidemic known to mankind. However, time has nonetheless managed to bestow us relative sympathy. Hence, all is not lost and a chance still remains for the continent to shift the status quo.

General Readings

Abraham, G. 2003. Africa, the tragedy; Africa, the challenge: NEPAD and the new humanitarian agenda. IRRC Vol. 85 No. 852. (December)

Akukwe, C. and Foote, M. 2001. HIV/AIDS in Africa: Time to stop the killing fields. Foreign policy in Focus vol. 6 No. 15 May 2001 (http://www.fpif.org/).

____. 2002. Africa and NEPAD: Are all bases covered? The perspective Atlanta, Georgia. www.theperspective.org/nepad.html 17 April 2002.

____. 2002. Africa and NEPAD: What about HIV/AIDS. The perspective Atlanta Georgia.http://www.theperspective.org/africa_nepad.html 23 April.

____. C. 2003. HIV/AIDS in Africa: Politics, policies, programmes and logistics, (http://m1.mny.co.za/mnsbx.nsf).

Baah, A. 2003. History of African development initiatives. Africa Labour Research Network Workshop, Johannesburg 22 – 23 May 2003.

Barnett, T. and Whiteside, A. 2002. AIDS in the twenty – first century: Disease and globalization. Palgrave: Macmillan .

Ciliers, J. 2002. NEPAD’s peer review mechanism. Institute for Security Studies Paper 64, November 2002.

____. 2003. Peace and security through good governance: A guide to the NEPAD African peer review mechanism. Institute for Security Studies Paper 70, April 2003.

The Daily Times. 2004. Friday 28 May.

Holden, S. 2003. AIDS on the agenda: Adapting development and humanitarian programmes to meet the challenge of HIV/AIDS, Action Aid, Oxfam, and Save the Children UK.

Kanbur, R. 2004. The Africanpeer review mechanism process: Assessment of concept and design. www.people.cornell.edu/pages/sk145, January 2004.

Lewis, S. 2002. NEPAD and HIV/AIDS. Address in the run up to the G8 summit in Canada, June.

Lipalile, M. 2003. Democratic renaissance in Southern Africa: An analysis of socio-cultural, political and economic factors. CODESRIA Southern African Sub-Regional Conference, October 18 – 19 2003.

NEPAD Health Strategy Executive Summary. 2002.

Nkuhlu, W. 2002. NEPAD: A new chapter in African led development. Centre of African studies, University of Edinburgh Annual International Conference May 22 – 23 2002.

Nordiska Afrikainstitutet Uppsala. 2002. The new partnership for Africa’s development- African perspectives. Nordiska African Institute: University Printers, Uppsala 2002.

* Freelance Researcher, Lilongwe, Malawi  , E-mail: glwanda2004@operamail.com, Cell: + 265 9 552 220.

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