PHA-Exchange> Speech to Parliamentarians --AIDS in Africa

[aviva]

THE HIV/AIDS CATESROPHE IN EASTERN AND SOUTHERN AFRICA

Urban Jonsson
Regional Director, UNICEF, ESARO


1.	Armed conflicts and the HIV/AIDS pandemic dominate the lives of 
people in sub-Saharan Africa. (SSA)  Both are complex emergencies that 
kill people.  Last year, armed conflicts killed some 3-400,000 people, 
while AIDS killed 3.4 million – almost ten times more.  While armed 
conflicts seem to have an almost limitless budget and world-wide media 
attention, external assistance to fight the HIV/AIDS pandemic in sub-
Saharan Africa in 2000 was only US$215 million, equivalent to the value 
of two jumbo jets and is still not the daily headlines news in the 
world.  Future historians will have serious difficulties to explain the 
lack of worldwide action when a whole continent was threatened.

2.	Updated estimates on the HIV/AIDS crisis have recently been 
issued by the UNAIDS Secretariat. They reflect a shocking picture.  At 
the end of last year 40 million people were living with HIV/AIDS out of 
which 26 million lived in SSA.   In 2001, 3 million people died of 
AIDS, of which 2.3 million lived in SSA, and 5 million were newly 
infected, with 3.4 million in SSA.  With only 10 percent of the world’s 
population, SSA has 70 – 80 percent of the HIV/AIDS problem. And the 
problem is getting worse.

3.	At present more than 25 percent of the adult population are 
infected in Botswana, Swaziland, Zimbabwe and parts of South Africa.  
And even more scaring is the rapid growth of the epidemic.  In 1990 in 
South Africa less than 1% of pregnant women were HIV – positive; ten 
years later the prevalence had increased to almost 25%.  What do these 
figures mean?  During World War II Soviet Union was the country that 
lost most people – 12 percent of the population – only one third of the 
percentage HIV-positive in some African countries.  We have no 
experience of what will happen to a country where one third of the 
population is dying.

4.	For many years a ‘conspiracy of silence’ dominated most African 
leaders.  This ‘conspiracy’ has been broken at the senior national and 
international levels.  However, there is a 'Second Wall of Silence’, 
not so well defined as the first wall, but even more damaging.  
This ‘Second Wall of Silence’ includes the wall between government 
officials and communities; between husband and wife; between parents 
and children; between teachers and students and between boyfriend and 
girlfriend.  These walls reflect the social context in which 
individuals construct and re-construct their roles.  These walls hinder 
necessary development and information.  These walls must be removed in 
any successful fight against HIV/AIDS.

5.	Even if the first wall of the Conspiracy of Silence at the 
national and international level has been broken, it has been replaced 
by a ‘language of convenience’, a meta-language that is comfortable and 
acceptable in high-level meetings.  We talk about gender disparities, 
when we know it is about men exploiting women, sometimes using 
violence;  we talk about non-consensual sex when we mean rape or we 
talk about high-risk sexual behaviour when we mean male pleasure, lust 
and power.  Such language breeds hypocrisy and builds a wall between 
our language and the reality.

6.	This denial is combined with great hypocrisy.  It is not very 
useful to tell young people not to have sex, while at the same time 
many leaders in society demand and have sex with young women and 
girls.  Or that some elders and even parents tell young girls to have 
sex in exchange for money for food.  Or the fact that sex-workers in 
Durban had a boom during the HIV/AIDS conference in 2000.

7.	It is very important to recognize that HIV/AIDS is a disease 
very different from other diseases.  First, HIV is invisible, neither 
felt by the individual, nor seen by others.  And less than 5% have 
tested themselves.  Second, it takes several years for HIV to develop 
into AIDS, which is both felt and seen.  Third, contrary to most other 
diseases, AIDS kills people in the 20 – 35 years age group, leaving 
children and elderly alone. And finally shame and stigma surround 
HIV/AIDS; the Second Wall of Silence is hindering that people talk 
about HIV/AIDS; instead, fatalism, hypocrisy and even cynicism grow.

8.	Perhaps one of the most tragic results of AIDS is the explosion 
of children orphaned by AIDS.  In 1999 there were 13.2 million children 
globally orphaned by AIDS, with 12.1 million living in SSA.  The 
traditional African extended family can not cope any longer.  Many 
cities are filled with street children.  Children without shelter, 
food, clothing and education.  What will happen with these children 
when they grow up?  This in indeed an enormous emergency, and it is a 
shame that the richer countries do not respond to this emergency on a 
scale commensurate with the size of the problem

9.	The HIV/AIDS crisis in sub-Saharan Africa must be seen in the 
context of poverty.  At this time when health and education services 
should expand, many countries need to spend 20 – 30% of their national 
budget on debt service, more than what they can afford to spend on 
health and education together.  Rapid and comprehensive debt relief is 
therefore increasingly seen as necessary for governments to cope with 
the rapidly deteriorating condition resulting from the HIV/AIDS 
pandemic.

10.	The response against HIV/AIDS has long been dominated by seeing 
HIV/AIDS as an individual problem.  This has led to health-services 
interventions and communication efforts to change 
individuals,  ‘behaviour’.   Most of these efforts have failed.   It is 
high time that we recognize HIV/AIDS as primarily a social problem.  
Individuals have serious difficulties to change their practices in the 
context of poverty, gender exploitation and peer-group pressure. People 
who are poor are  dominated by circumstance and chance. The social 
context determines individual behaviour and not the other way round.  

11.	This is most clear when it comes to gender relationships.   As 
societies legitimize the subordination of women by men, women can not 
construct their roles as confident partners in the negotiation of when, 
where and how to have sex.  There is absolutely no doubt that the 
continuing silent dominance of men over women is a fundamental social 
cause of the rapid spread of HIV/AIDS in sub-Saharan Africa.  The right 
to voluntary and  confidential testing is strongly promoted by Western 
donors.   But whose rights are we protecting?  The husbands rights to 
decide not to be tested, or his wife’s right to know her husband’s HIV-
status?

12.	Youth, particularly girls and young women, are the most 
seriously infected age-group. This adds to the common perception that 
youth is a problem.  This orthodox thinking must be replaced by a 
recognition that youth themselves are most likely to find solutions to 
their problems.  Employment, peer-group education and the promotion of 
condom use are key strategies.  Today many young people see no future, 
so why bother about a disease that will take years to develop?

13.	Unabated, the HIV/AIDS pandemic will move from a social crisis 
to an economic, a political and a security crisis.  I don’t think that 
anybody here can envisage the result of a situation where one-third or 
more of the most productive population has died or is dying in a 
country.  What is required now is nothing less than a ‘Liberation War 
against HIV/AIDS’. If a country gets into war, the government 
transforms its budget to a ‘war budget’;  all resources are re-oriented 
towards the war effort.  This must be done in the War against 
HIV/AIDS.  There is no second chance for Africa in fighting this 
pandemic.  We are loosing battles every day – unless a mobilization of 
all resources is made, we will loose the whole war. Internationally, it 
requires a mobilization of resources far beyond the capacity of multi-
lateral and bi-lateral organizations.  Given the serious debt-crisis in 
SSA today, new loans can not be the principal solution to the resource 
crisis in ESAR.  Africa needs debt cancellation; not new debt.

14.	Many donors have promoted the idea that NGOs and CBOs should 
take the front line in the war against HIV/AIDS.  This is really 
bizarre.  In which other war would governments trust NGOs to ensure 
national security?  No NGO has ratified any human rights convention.   
It must be the state  that is accountable for the results in the war 
against HIV/AIDs.  Finally, we have to stop wishing for ‘political 
will’.  Instead we should judge the political  leaders for their 
choices. The impunity of not choosing to take action can no longer be 
accepted.

15.	Why is it that ‘African problems require African solutions?’  
The New Initiative for African Development, NEPAD, promoted by many 
African leaders and praised by so many Western Governments, hardly 
mentions HIV/AIDS as a threat to Africa's survival.  While problems in 
Kosovo, Timor or Afghanistan immediately were recognized as 
international problems, with great attention and support from the 
international community, problems in Africa are defined as problems for 
Africans only.  Africa is written off economically, mariginalized 
politically, and now left alone with the greatest social catastrophe in 
modern time.

16.	Some countries in Europe fuelled and benefited from the slave 
trade.  Some European countries colonized Africa in the most brutal and 
exploitative way.  The Nordic countries have always been  friends of 
Africa.  All Nordic countries supported actively of the de-colonization 
and the struggle against Apartheid.  All this was based on solidarity 
and a firm commitment to the UN-principles of Peace, Justice and Human 
Rights.  Now Africa is threatened by HIV/AIDS.  Many more people are 
dying of AIDS than during colonization and Apartheid.  The suffering is 
enormous.  People and governments in sub-Saharan Africa hope for 
continued solidarity from the Nordic countries in the most difficult 
war – the war against HIV/AIDS.  You, parliamentarians are chosen for 
your ideas and capabilities.  It is now up to you to choose to act.  
And act today, because by tomorrow it will be too late.