THE IMPACT OF HIV/AIDS ON HUMAN SECURITY IN SOUTH AND
by
Pieter Fourie & Martin Schönteich[1]
Traditionally, the
concept of ‘security’ has been interpreted in militaristic terms as the
military defence of the state, involving ‘structured violence manifest in state
warfare’ (MacLean, 1998:2; see also
Bedelsky, 1999:1). Since the end of the
Cold War this narrow definition of security has become less relevant
(Hadingham, 2000:113).
The term ‘human
security’ was first officially used in the 1994 Human Development Report of the
United Nations (UN) Development Programme. According to the report, the
intention of human security is ‘… to capture the post-Cold War peace dividend
and redirect those resources towards the development agenda’ (Axworthy,
1999:2). Hubert (1999) expands this
conceptualisation, stating that
….in essence, human security means safety for people from both violent and non-violent threats. It is a condition of state of being characterised by freedom from pervasive threats to people’s rights, their safety or even their lives… It is an alternative way of seeing the world, taking people as its point of reference, rather than focusing exclusively on the security or territory of governments. Like other security concepts – national security, economic security, food security – it is about protection. Human security entails taking preventative measures to reduce vulnerability and minimise risk, and taking remedial action where prevention fails.
HIV/AIDS does not fit
into the traditional definition of security. However, as Hadingham (2000:120)
argues, in terms of the post-Cold War human security regime, HIV/AIDS poses a
‘pervasive and non-violent threat to the existence of individuals, as the virus
significantly shortens life expectancy, undermined quality of life and limits
participation in income-generating activities. The political, social and
economic consequences are equally detrimental to the community, in turn
undermining its security.’
In January 2000, the
United Nations’ UN Security Council debated the impact of AIDS on peace and
security in Africa. The debate was the first in the Council’s history that
discussed an health issue as a threat to peace and security. UN secretary-general Kofi Annan told the
Council: ‘The impact of AIDS in Africa was no less destructive than that of
warfare itself. By overwhelming the continent’s health and social services, by
creating millions of orphans, and by decimating health workers and teachers,
AIDS is causing social and economic crises which in turn threaten political
stability… In already unstable societies, this cocktail of disasters is a sure
recipe for more conflict. And conflict, in turn, provides fertile ground for
further infections’ (UN press release, 2000).
At the same Security
Council meeting the president of the World Bank, James Wolfensohn, said that
AIDS was not just a health or development issue, but one affecting the peace
and security of people in Africa. While life expectancy in Africa had increased
by 24 years in the last four decades of the twentieth century, the continent’s
development gains were threatened by the AIDS epidemic and life expectancy
gains were being wiped out. ‘In AIDS, the world faced a war more debilitating
than war itself… Without economic and social hope, there could not be peace,
and AIDS undermined both. Not only did AIDS threaten stability, but a breakdown
in peace fuelled the pandemic,’ Wolfensohn said (UN press release, 2000).
Unfortunately, these statements cannot be dismissed as hyperbole: HIV/AIDS is now the leading killer in
Sub-Saharan Africa (SSA); its mortality
rates surpassing people killed in warfare – in 1998 alone, for example, 200,000
people died from armed conflicts in Africa, compared with 2.2 million from AIDS
(The Star, 12 January 2000).
Although Africa is
late in reacting to the HIV/AIDS pandemic as a security threat, the United
States’s Central Intelligence Agency (US CIA) has been tracking the disease’s
impact on the human security of SSA for more than ten years: in 1990 CIA Interagency Intelligence
Memorandum 91-10005 instructed the agency’s analysts to track the dissolution
of states all over the world by adding the effect of HIV/AIDS as one of the
variables that determine which states would self-destruct (Gellman,
2000:A01). For these agencies the link
between HIV/AIDS and security goes beyond the reality of AIDS as a physical
killer: the CIA warns that ‘the
relationship between disease and political instability is indirect but real’
(NIC, 2000). The UN has picked up on
this point, stressing the impact of HIV/AIDS on states’ developmental progress:
[AIDS] is present in
a number of countries already facing conflict, food scarcity and poverty, and
poses real threats to social and political stability where it is most
concentrated – in Africa. The Security
Council redefined security as an issue going well beyond the presence or
absence of armed conflict, one which affects health and social services, family
composition and social structure, economies and food security.
There is now broad acknowledgement that AIDS has become a global development crisis, potentially affecting national security in some countries. Armed conflict and associated population movements provide fertile ground for the spread of AIDS, while the epidemic itself can be seen as a risk factor in the breakdown of social cohesion and in social and political instability, in addition to a threat to security forces (UN, 2001:9).
Malan (2001:53)
accuses African governments of extreme negligence in their response to the
human security aspects of HIV/AIDS – it was only at the Organisation of African
Unity (OAU) summit as recent as May 1999 that an African government minister for the first time called the disease a
major threat to economic and social development. Holzhausen (2001:17) echoes this sentiment,
enjoining African governments to go beyond an admission of the dire impact of
AIDS on African communities. He
underlines the importance of the South African White Paper on Defence in a Democracy’s
insistence that ‘[a] common [i.e. regional, cross-national] approach to
security in Southern Africa is necessary’.
At long last, the
African continent’s leaders seem to have – ostensibly at least – woken up to
the human security challenge of HIV/AIDS.
A UN Economic Commission for Africa (UNECA) discussion document
referring to ‘key areas for joint African-international action’ states that
‘[HIV/AIDS] is Africa’s number one survival issue. Without an effective effort to overcome
HIV/AIDS, all of Africa’s progress in terms of development and governance will
be reversed’ (UNECA, 2001:11).
QUANTIFYING THE FUSS:
HIV/AIDS IN AFRICA
The global HIV/AIDS
epidemic is far more extensive than initially anticipated. The number of people living with HIV/AIDS at
the end of the last century was more than 50 percent higher than had been
predicted in 1991 by the World Health Organisation (WHO) (WHO, 2000). As the
Worldwatch Institute points out, the HIV epidemic raging across Sub-Saharan
Africa is a tragedy of epic proportions;
one that is altering the region’s demographic future. It is reducing life expectancy, raising
mortality, lowering fertility, creating an excess of men over women, and
leaving millions of orphans in its wake (Brown, 2000:1).
Due to the long
period between infection with HIV and eventual death due to AIDS-related
diseases, many Africans remain sceptical about the demographic impact of the
disease; AIDS remains distant and
unreal, perpetuating denial and stigmatisation.
In an effort to make the disease more ‘real’ – to give it greater visual
impact – we include the following two figures:
According
to UNAIDS (SAIRR, 2001:226), at the end of 1999 the HIV-infection rates in
various African countries for people between the ages of 15 and 49 years were
as follows:
Country HIV-infection rate
Botswana 35.8%
Burundi 11.32%
Central African Republic 13.84%
Djibouti 11.75%
Ethiopia 10.63%
Ivory
Coast 10.76%
Kenya 13.95%
Lesotho 23.57%
Malawi 15.96%
Mozambique 13.22%
Namibia 19.54%
Rwanda 11.21%
South Africa 19.94%
Swaziland 25.25%
Zambia 19.95%
Zimbabwe 25.06%
The figure below gives
projections of life expectancy and population growth in South Africa and six
other African countries for 2010:
_______________Life expectancy_______________ _____Population growth_____
Country Without AIDS With AIDS Years lost Without AIDS With AIDS
Namibia 70.1 38.9 31.2 2.8% 1.2%
Botswana 66.3 37.8 28.5 1.9% 0.2%
Swaziland 63.2 37.1 26.1 3.1% 1.7%
Zambia 60.1 37.8 22.3 3.1% 2.0%
Kenya 69.2 43.7 25.5 1.8% 0.6%
Malawi 56.8 34.8 22.0 2.2% 0.7%
South Africa 68.2 48.0 20.2 1.4% 0.4%
Keep in mind that the
majority of the people cited in the first figure are not yet sick with the
effects of HIV/AIDS. They will only
start dying within the next five to ten years.
The 15- to 49-year old age group is where the leaders of society
is: the governing elite, the moneyed
youth, the economically active, the mothers, teachers, agricultural labourers,
miners, and so on. What will the effect
of their initial morbidity and eventual premature mortality be on the social
cohesion, economies and military security of their countries as a whole?
Let’s make HIV/AIDS
even more real. A recent UN publication
(UN, 2001:1, 5-6) quantified the reality of HIV/AIDS in Africa as follows:
·
An estimated
36.1 million people are living with HIV.
In 2000, about 5.3 million people around the world became infected,
600,000 of them children.
·
Since the
epidemic began, AIDS has killed a total of 21.8 million people – almost three
times the population of Switzerland. In
2000 alone, AIDS claimed three million lives.
·
Sub-Saharan
Africa is by far the world affected region in the world. An estimated 25.3 million Africans were
living with HIV at the end of 2000. By
that time, a further 17 million had already died of AIDS – over three times the
number of AIDS deaths in the rest of the world.
·
On the African
continent, two million more women than men carry HIV. Some 12.1 million children have lost their
mother or both parents to the epidemic.
By the end of 2000, an estimated 1.1 million children under 15 were
living with HIV, largely due to mother-to-child transmission.
·
In several
Southern African countries, at least one in five adults is HIV-positive. Adult prevalence rates rise as high as 20
percent in Namibia and Zambia, 24 percent in Lesotho, 25 percent in Swaziland
and Zimbabwe, and almost 36 percent in Botswana.
·
Countries such
as Botswana and South Africa have redoubled their efforts to contain the
epidemic, but it will take years for this to bear fruit. In 2000, the HIV prevalence rate among
pregnant women in South Africa rose to its highest level ever: 24.5 percent, bringing to 4.7 million the
estimated total number of South Africans living with the virus.
Explicitly linking
the disease to security, the UN report continues to say the following:
·
The epidemic
destabilises societies in profound ways.
As parents and workers succumb to AIDS-related illnesses, the structures
and divisions of labour in households, families, workplaces and communities are
disrupted, with women bearing an especially heavy burden. From there, the effects cascade across
society, reducing income levels, weakening economies and undermining the social
fabric.
·
The economic
and developmental impact can be especially dramatic. It is estimated that gross domestic product
(GDP) growth shrinks by as much as 1-2 percent annually in countries with an
HIV prevalence rate of more than 20 percent.
Over several years, the loss of economic output accumulates
alarmingly. Calculations show that
heavily affected countries could lose more than 20 percent of GDP by 2020.
·
The epidemic
increases the strain on state institutions and resources, while undermining
social systems that enable people to cope with adversity. In badly affected countries, education and
health systems are compromised, economic output shrinks and state institutions
such as the judiciary and police are undermined. In some societies, increased social and
political instability can result.
·
AIDS thrives
in settings already marked by high degrees of socio-economic insecurity, social
exclusion and political instability.
Individuals subjected to those conditions – migrant workers, displaced
people, refugees and ostracised minorities worldwide – face much higher risk of
infection.
·
Similarly, it
is often the absence of economic security that propels people into sex work for
a living, and many end up in prison where they face a higher risk of infection.
·
In the past
decade, HIV/AIDS has emerged as a major threat in emergency settings. Humanitarian operations can place both relief
workers and local populations at greater risk of infection, with children and
young people being especially vulnerable.
The increased likelihood of sexual violence and prostitution among
refugee populations broadens and accelerates the spread of HIV.
An estimated 22 million
orphans in Sub-Saharan Africa by 2010 are expected to comprise a ‘lost orphaned
generation’ with little hope of educational or employment opportunities. Such societies will be at risk of increased
crime and political instability as these young people become radicalised or are
exploited by various political groups for their own ends – the child soldier
phenomenon may be one example (NIC, 2000). The increase in crime and political
instability, moreover, will be accompanied by a probable increased availability
in illicit small arms and increased operations of organised criminal
organisations in Sub-Saharan Africa.
What drives this
disease at such a horrific pace in Africa?
Are Africans particularly vulnerable to HIV? The answer to the last question is ‘yes’ –
given the socio-economic factors referred to above. Africans are not more sexually promiscuous
than people in the West or in the greater global North, but the poverty,
geographical displacement and regional conflicts have become the societal determinants
that are fanning HIV infection on the continent.
The Jaipur Paradigm
has been devised to serve as an econometric model to illustrate the interaction
between HIV and society. Analysts praise
the paradigm for its simplicity – its central premise is that in relation to
HIV, societies are distinct in two parameters distributed on a continuum: susceptibility and vulnerability. Susceptibility is defined as ‘those aspects
of a society which make it more or less likely that an epidemic will develop’,
and vulnerability refers to ‘those aspects of a society which make it more or
less likely that an epidemic will have a serious impact on social and economic
organisations’ (Decosas, 1999:111). According to the Jaipur Paradigm, two
factors modulate the level of susceptibility and vulnerability of a
society: the level and distribution of
wealth and income, and the degree of social cohesion. The latter concept is, of course, difficult
to quantify, but easy to identify intuitively.[2] Visually, the Paradigm operates on two axes,
as follows:

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This is all good and well on a theoretical level, but what were the vectors of HIV/AIDS in Africa on the ground? Which specific variables contributed to and continue to compound the rapid spread of HIV on the continent? Analysts (Decosas, 1999:167; Shell, 2000:12-15) point to the following key factors in explaining the epidemic proportions of the disease in SSA:
1.
Labour migration
Studies have shown
that mobile workers such as long-distance truck drivers have a higher
probability of being HIV-infected than their communities of origin. Migrant labourers are separated from their
families for a long periods of time, are prone to visit prostitutes or have
multiple sexual partners, become HIV-positive, and then return to their primary
sexual partners to spread the virus in those home communities. Decosas (1999:167) demonstrates that the
profile of HIV infection in West and Southern Africa is directly related to the
regional pattern of labour migration:
Widening the focus to the entire continent reveals a crescent-shaped distribution of high HIV prevalence extending from Namibia in the south-west along the east coast to Kenya, then via Southern Sudan into the Central African Republic. As in the West African region, the southern horn of this crescent coincides with a zone of intense labour migration to a single destination, South Africa. The northern horn is less clearly related to a single migration focus. Population movements above the region of the Great Lakes are more likely due to displacement caused by war.
Ironically then,
HIV/AIDS has become the Frankenstein of Africans’ dream for a better life: the search for greater economic security
(jobs, money, housing) is one of the direct causes of the spread of the
disease.
War is an instrument
for the spread of HIV/AIDS. ‘History has revealed time and time again that the
Three Horsemen of the Apocalypse – Famine, Pestilence and War – often gallop
together’ (Chalk, 2000:103). With over a
dozen violent conflicts, tens of thousands of troops and guerrilla fighters in
the field, and some eight million refugees and internally displaced persons,
conflict has become a major factor in the spread of HIV in Africa.
Military conflict
brings economic and social dislocation, warns the Joint UN Programme on AIDS
(UNAIDS), including the forced movement of refugees and internally displaced
persons, and resulting in a loss of livelihoods, separation of families,
collapse of health services, and dramatically increased instances of rape and
prostitution. All this creates conditions for the rapid spread of HIV and other
infectious diseases (Fleshman, 2001:16).
The impact of HIV on
civilian populations lies in the high rates of sexual interaction between
military and civilian populations whether through commercial sex, or in rape as
a weapon of war; and in the extreme vulnerability of displaced and refugee
populations to HIV infection.
Rape and other forms
of sexual violence – such as forced prostitution – are frequently used in war
for a number of reasons. ‘Rape is an outlet for the sexual aggression of
combatants and it is related to the idea that women are war booty; it is used
to spread terror and loss of morale; and it is used to undermine women’s
ability to sustain their communities during times of conflict’ (Matthews,
2000:18).
Refugee populations –
many of which are single women and unaccompanied children – are particularly
vulnerable to being pressured into having sex or being raped. In the early
stages of conflict situations, when a large number of refugees are on the move,
their need for food and other basic necessities can be acute. Exchanging sex
for money or food can therefore be commonplace. Women, for example, are six
times more likely to contract HIV in a refugee camp than the general outside
population (Gardiner, 2001:2). ‘Among refugee and displaced people it is common
for the number of commercial sex workers to increase because women feel they
have no other way to keep their families alive,’ according to Dr Christen
Halle, the head of the UN department of peacekeeping operations. Over time
established refugee camps also attract prostitutes from surrounding communities
to cater for the many male refugees without partners.
Young adolescents,
with little to do in refugee camps, will often start to experiment with sex
earlier than young people in other more stable situations. Moreover, amid the
chaos and deprivations of the conflict that is the cause of the mass movement
of people, materials for HIV prevention such as condoms are in limited supply.
Refugees are also likely to have inadequate access to basic health care
services, including care for sexually transmitted diseases, thereby further
increasing their risk of acquiring HIV through unprotected sex (UNAIDS,
1997:4-5.
According to a 1999
World Bank report countries with big armies have higher HIV infection rates. In
developing countries, military forces are often based near urban centres and
consist predominantly of young, unmarried men. For the average developing
country, reducing the size of the military from 30 percent to 12 percent of the
urban population will reduce seroprevalence among urban adults by about 4
percent (Confronting AIDS, 1999:32).
The armed forces
constitute a significant population block in many African countries. They are
highly mobile and often called upon to serve at borders or to deploy outside of
national boundaries. Military personnel are a population group at special risk
of exposure to sexually transmitted diseases (STDs), including HIV. In peace
time, STD infection rates among armed forces are generally 2 to 5 times higher
than in civilian populations. A 1995 estimate of HIV in Zimbabwe, for example,
places the infection rate for the armed forces at 3 to 4 times higher than the
level in the civilian population. In times of conflict, the risk of HIV
infection for military personnel can be more than 50 times higher compared to
civilians (UNAIDS, 1998:3).
There are a number of
factors unique to the military environment which raise the risk of HIV
infection among military personnel. Military service – especially during
wartime – often includes lengthy periods spent away from home. As a result
military personnel are tempted to look for ways to relieve loneliness, boredom,
stress and the build-up of sexual tension. According to UNAIDS, ‘probably the
single most important factor leading to high rates of HIV in the military is
the practice of posting personnel far from their accustomed community or their
families for long periods of time. Aside from the emotional stress this places
on individuals, the practice encourages use of commercial sex’ (UNAIDS,
1998:1).
Most male military
personnel are in the age group at greatest risk of HIV-infection – the sexually
active 18-24 year age group. Relatively low levels of maturity combined with
high levels of testosterone among this age group boosts aggression and the
willingness to take risks. These traits are further enhanced by a military
culture which encourage aggression and risk-taking as important characteristics
of effective combat soldiers. However, off the battlefield this can lead to
risky sexual behaviour such as purchased sex and sex without a condom.
Soldiers, especially those stationed in conflict areas often have more
disposable income than the local population. This gives them the financial
means to purchase sex on an on-going basis, something which is facilitated by
the fact that military bases frequently attract large numbers of sex workers.
Aggressiveness may
lead soldiers to engage in coercive sex and pursue sex with multiple partners.
During times of conflict this is abetted by high levels of alcohol and drug
consumption by soldiers far removed – both physically and psychologically –
from the norms and values of the civilian life they left behind.
In some African
countries where the epidemic has been present since the early 1980s, armed
forces report HIV-infection rates of 50 to 60 percent. Estimates suggest that
HIV infection rates in the armed forces of Southern African countries could be
at least twice as high as the national average (Heinecken, 2001:109). In 1998
it was estimated that the Zimbabwean armed forces had an HIV-prevalence rate of
80 percent, followed by Malawi (75 percent), Uganda (66 percent) and Angola (50
percent) (Bisseker, 1998:34). A more recent study estimates that AIDS will kill
between 25 percent and 50 percent of Malawi’s military personnel by 2005
(Foreman & Scalway, 2001).
High levels of HIV
prevalence among military personnel detrimentally impact upon the effectiveness
of armed forces and consequently their country’s national security. The primary
impact of HIV on the military lies in the impact on human capital –
compromising armed forces’ readiness, thereby limiting capabilities to impose
social order and protect countries from external intervention. According to the
Kenyan National AIDS Control Council, HIV/AIDS poses threats to the national
security sector through lack of continuity in rank and leadership, increased
recruitment and training costs, reduced military and emergency preparedness and
threats to internal stability and external security (East African Standard, 18
August 2001).
As in the general
population, most soldiers in Southern Africa will be debilitated by the effects
of the virus in their mid- to late 20s. This age group generally provides the
largest number of operationally deployable soldiers, and a large number of
officers who perform skilled and supervisory functions. ‘The potential shortage
of qualified and experienced members in these ranks inevitably leads to a
hollowing out of the [military] organisation at the level of middle management.
Besides the loss of continuity of command, this encourages the rapid promotion
of younger inexperienced members, which in turn affects morale, discipline and
cohesion as the overall competency of the armed forces is eroded’ (Heinecken,
2001:11). Charles Heyman of Jane’s World’s Armies points out: ‘Lots and lots of
people in their late twenties are contracting AIDS. And that has a tremendous
knock-on effect inside the organisation, because you’re loosing leaders,
non-commissioned officers and technicians, the people you can least afford to
loose’ (ICG Report, 2001:20).
Armed forces form the
basis of a country’s defence and constitute the underpinning of stability both
within states and between them. If they become debilitated by disease, national
security is compromised. In some African armed forces, the rate of HIV
infection has meant that they have been unable to deploy even half of their
troops at short notice (Heinecken, 2000:14). Foreign and domestic threats to a
country’s national security are aggravated by the security vacuum left by
weakened military forces. The International Crisis Group (a private
multinational organisation devoted to understanding and preventing conflict)
warns that ‘even the perception that a neighbour’s military is suffering from
an AIDS epidemic, suggesting a tactical advantage, may trigger wars’ (ICG
Report, 2001:21). In weak states with divided societies – a common feature of
many countries in SSA – opposition groups could be tempted to exploit the
weaknesses of armed forces debilitated by disease, by instigating civil unrest
or toppling the ruling elite.
Armies are regarded
as vectors of disease. After the First World War the Spanish Influenza epidemic
of 1918/19 was spread largely by homeward bound troops from the battlefields of
Europe. ‘The map of the allied First World War demobilisation also became the
map of the global influenza pandemic’ (Shell, 2000:9). Worldwide the epidemic
killed some 25 to 40 million people; more than the casualties of the First
World War. In South Africa, where the influenza epidemic killed almost a
quarter of a million people, the epidemic spread with the occupants of troop
trains returning from Europe via Cape Town harbour.
In the case of HIV,
soldiers having defeated an external enemy or completed their tour of duty in
another part of their country often unwittingly introduce a lethal enemy into
their communities and homes. For reasons given above, soldiers stationed far
away from their homes face a significant risk of being infected with HIV,
especially if they are posted to areas where the prevalence of the epidemic is
high. Soldiers coming from communities with low prevalence levels are thus
likely to abet the spread of HIV in their communities after they return from
their tour of duty. As one researcher puts it, the HIV virus uses returning
combatants as ‘Trojan Horses’ to enter a low-prevalence area and then spread
itself among the civilian populations surrounding military bases (Shell, 2000).
In a
sexually-transmitted HIV epidemic (as is the case in Africa), the speed at
which HIV spreads from people with a large number of sexual partners to those
with very few partners depends on the extent of mixing between people with
different levels of sexual activity. If people, such as young male soldiers,
who have had large numbers of partners, then have sex with those who have had
fewer partners – such as their wives or girlfriends (known as disassortative
mixing) – the epidemic will achieve high levels of infection in the entire
population (Confronting AIDS, 1999:68). In this case soldiers serve as ‘bridge
populations’ in the spread of HIV – they link people in groups that otherwise
might not mix, such as partnerships between people with high-risk behaviour and
those with very low-risk behaviour. Research has shown that mixing between
different groups of different sexual behaviours ‘can have a profound effect on
the potential course of the HIV/AIDS epidemic’ (Confronting AIDS, 1999:72).
This is the case where a soldiers who has unprotected intercourse with sex
workers and has either a wife or steady girlfriend and thereby may transmit HIV
to a monogamous woman who would not otherwise be at risk.
As with military
personnel generally, peacekeepers face a higher than average risk of exposure
to STDs, including HIV. For example, Nigerian military personnel who worked as
peacekeepers in the late 1990s had a HIV-prevalence rate of 7 percent after one
year of peacekeeping duties. This increased to 10 percent after two years, and
15 percent after three years (Alban & Guinness, 2000). Another study of
Dutch sailors and marines on peacekeeping duty in Cambodia established that 45
percent reported having had sexual contact with sex workers or other members of
the local population during a five-month tour (UNAIDS, 1998:1).
In many African
post-conflict societies multinational peacekeeping forces are burdened by
having to secure stability, provide humanitarian aid and diffuse conflict while
at the same time exposing their soldiers to the risk of infection – especially
where peacekeeping forces are deployed for lengthy periods in regions with high
civilian infection rates.
Approximately
one-third of the 38,000 soldiers and civilian police officers under UN command
are serving in Africa, often in countries with some of the highest
HIV-prevalence levels in the world (Raghavan, 2001). As a result, some nations
may be unwilling to send peacekeeping forces to high-risk areas, raising
important questions regarding foreign relations and regional security
(Heinecken, 2001:113). Former US ambassador to the UN, Richard Holbrooke, is on
record as stating that ‘the US will never again vote for a [UN] peacekeeping
resolution that does not require action by the UN’s Department of Peacekeeping
Operations to prevent AIDS from spreading to peacekeepers’ (Holbrooke, 2000).
High HIV-prevalence levels can consequently jeopardise future humanitarian and
peacekeeping operations, especially in African countries.
Peacekeepers may also
be responsible for the spread of HIV. In Sierra Leone and Liberia, for example,
peacekeepers from other countries in the region have been among the main agents
for spreading HIV (Atlanta-Journal Constitution, 11 April 2001). This could
undermine peacekeeping efforts as soldiers from countries with high
HIV-prevalence make up 11 percent of the UN force totals (ICG Report,
2001:22-23).
While HIV/AIDS is
thus likely to hinder international attempts to respond to conflict, the
epidemic is also likely to complicate attempts at post-conflict reconstruction
in countries with high HIV-prevalence rates. Efforts at demilitarisation and
reintegrating combatants may be threatened by dying families and villages where
combatants would normally return to; and by the breakdown of government, police
and civil society to the point that they may be useless in filling the gap the
military leaves behind (ICG Report, 2001:23).
4.
Bad blood
The South African
blood transfusion services started testing the donor blood as late as
1985. The military, like the university-
and church-going populations, were considered excellent donor populations. The military at their own request stopped
donating blood for ‘security reasons’.
Be that as it may, notes Shell (2000:13), one could not wish for a
better blueprint for initiating a pandemic than the map of personnel living on
South African military bases.
5.
Regional transport infrastructure
Shell (2000:13)
furthermore points out that HIV is not only a camp follower of military
campaigns but also travels in style on civilian aircraft, railroads, highways,
roads and also spreads humbly by bicycle and on foot. Ironically, Southern Africa’s well-developed
transport infrastructure – well-utilised after the demise of Apartheid and the
abolition of ‘influx control’; and given
the stress on economic regionalism and economic integration – has become
excellent corridors for accelerating infection.
6.
A free-riding disease
Tuberculosis and
sexually-transmitted diseases are endemic to Southern Africa. According to Shell (2000:14), up to half of
the population of SSA has had TB.
HIV-positive people provide an open window for the opportunistic
invasion of TB. With increasing use of
antibiotics – and South Africa has one of the highest usages in the world, one
may expect increasingly resistant variants of TB appearing in the general
population.
*
If one couples
factors 1-6 with the dire implications of the socio-economic indigence
described in the Jaipur Paradigm, it becomes clear that HIV/AIDS in Southern
Africa is the result of different levels of human insecurity; the latter creating a downward spiral or
vicious circle of ensuing military and social insecurities that compound the
whole problem. To paraphrase: HIV/AIDS in Africa is not merely a health
problem anchored in the sexual behaviour of individuals. Rather, it is the cause and result of human
insecurity – the confluence of socio-political variables on a systemic,
regional level that should be viewed through a more circumspect developmental
lens.
In the following
section we regard the impact of HIV/AIDS on the security of people’s public and
private spaces – the former referring to the sphere of socio-economic
interaction (macro-economic, governance, as well as the functions intra-state
justice), and the latter denoting the household levels of social interaction.
HIV/AIDS AND SECURITY IN PUBLIC & PRIVATE SPACES
HIV/AIDS already has
a huge and detrimental impact on the economy of South and Southern Africa. Both the production and the consumption
levels of economies are affected, and this has dire implications for foreign investors’
willingness to make any long-term investments in SSA. In fact, it is becoming increasingly apparent
that different sectors within the broader Southern African economy will have to
completely restructure to ensure self-preservation.
Economists have
identified several major areas of macro-economic vulnerability. These include effects on the labour supply
and productivity, remuneration cost increases, demand changes among households,
higher government expenditure, as well as instances of severe risk exposure in
key sectors of the economy.
In probably the most
encompassing study of the impact of HIV/AIDS on the macro-economy of South
Africa, Quattek (2000:33-4) found that ‘[t]he infection rate among the
economically active population peaks at about 25.5 percent by 2006, well above
the 16.7 percent peak for the total population’. Not only will HIV/AIDS affect the day-to-day
quality of life of HIV-positive individuals and their families; the disease will remove these people from
their places of work while they are ill, leading to increased absenteeism also
on the side of spouses. Where spouses
had already died, children will have to be taken from schools in order to look
after sick adults/parents. Household
spending power will decrease, labour productivity will suffer, the corporate
memory or skills base within companies will literally die out, and the economy
as a while, the state and the private sector will have to pick up the tab for
training new workers, paying health bills and so on, which will drain the fiscus
from any capacity to expend moneys on other essential services.
Some South African
states already simply do not have the monetary and physical capacity to deal
with the sheer amount of people sick with AIDS-related illnesses: Mabuza and Masuku (2000) report that ‘AIDS
patients in Swaziland are flocking to neighbouring South African clinics after
being turned away from hospitals in their hometowns. At least 22 percent of residents in the small
kingdom are HIV-positive and hospitals have begun sending AIDS patients home in
an attempt to reserve meagre resources for uninfected people’.
An ING Barings study (Quattek, 2000:49 & 50) quantifies the
sectoral impact of HIV/AIDS in South Africa as follows:
HIV+ per 100 workers AIDS deaths per 100 normal deaths
Sector (2005) (2015)
Agriculture,
forestry and fishing
23.2 503.9
Mining
29.3 759.2
Consumer
manufacturing
23.0 867.2
Forestry
products 20.2 636.6
Chemicals
21.6 632.5
Metals
19.9 658.4
Machinery
21.2 563.6
Construction
23.9 694.6
Retail
21.3 876.4
Catering
and accommodation
23.0 601.9
Transport
and storage
23.5 652.6
Communication
16.5 528.4
Finance
and administration
12.4 479.6
Business
services
15.6 788.8
Health
20.0 471.9
General
government
24.5 229.1
Again, it is useful
to separate the these figures for their illustrated effect on morbidity (by
2005) and mortality (by 2015). For
example, by 2005 just under a third of all workers in South African mines will
be HIV-positive – these workers will be absent from work regularly, leading to
decreased productivity on mines. Mining
companies will have to provide pecuniary resources to cope with the health
status on mines, individual households will have decreased income, less spending
power, and extended family members will have to stop work in order to look
after the sick. By 2015 this seminal
sector of the South African economy will look like a war-zone: almost eight mine workers will be dead or
dying due to AIDS-related disease compared with one ‘normal’ death. And this is but a single sector of the
economy.
The effect will be
felt throughout the economy. Quattek
(2000:52) projects that ‘the average annual trend rate of GDP growth over the
next 15 years is likely to be 0.3-0.5 percentage points below the rate in a
no-AIDS scenario’. The savings
constraint on both the macro-economic and household levels will be severe, and
only the most brave or ignorant foreign companies will want to invest in South
Africa. As DaimlerCrysler South Africa’s
chief executive stated in June 2001, ‘AIDS is definitely one f the factors
inhibiting foreign investments – on top of all the structural issues. When I try to persuade foreign suppliers to
invest here, they ask about four things – trade unions, cost of capital, crime
and AIDS’ (Innocenti, 2001).
Of course South
Africa is not the only country in SSA that are experiencing such odds in its
economy: According to Forsythe and
Roberts (1994) the average company (in heavy industry, transportation, wood
processing and in the sugar industry) in Kenya was expected to incur
HIV/AIDS-related costs at an average annual loss of US$150,000 in 1992, and by
2005 the annual cost would average US$403,000 per business. Health-care costs, HIV-absenteeism and
training alone will account for over 60 percent of all AIDS-related company
costs in that country.
Southern Africa also
has a large informal economy – conceptualised as ‘those businesses that were
unregistered and did not have a value added tax (VAT) number’ (SAIRR,
2001:355), the enterprises (excluding a significant amount of domestic workers)
within this sector provided an income for an estimated 2,705,000 South Africans
in 1999. In 1996, the informal sector
accounted for 15 percent of the total amount of economically active South
Africans (SAIRR, 2001:405). Wilkins
(1999:223) cautions that informal enterprise operators and workers tend to
belong to groups (women and young people) who are at a high risk of infection
with HIV. Due to the structure and
social determinants inherent to its operation, the informal sector is hard hit
by HIV/AIDS: ‘when the operator of an
informal enterprise, and probably one or two other family members develop
AIDS-related illnesses, can no longer work and eventually die, the enterprise
will die with them’ (Wilkins, 1999:223).
Also, due to their insular existence, it is exceedingly difficult to
reach the informal sector with orthodox anti-HIV/AIDS interventions and
programmes. Again, the poorest and most
isolated sectors of society are at the greatest risk to be infected and
affected by the disease.
In August 1999, the
Zimbabwean Commercial Farmers’ Union put figures reflecting the decline of the
country’s agricultural food output at the following: maize by 60 percent, cotton by 47 percent and
vegetables by 49 percent (Sayagues, 1999).
Why? Because of the loss of
workers and workdays due to HIV/AIDS. In
northern Uganda millet and sorghum are left overgrown because labour goes into
caring for the sick and in the east of that country pastoralists are dying
before they can transmit skills in herd care.
In Namibia – a country dependent on water-purification plants for a
consistent supply of fresh water – NamWater (the country’s largest water
purification company) says that HIV/AIDS is crippling its operations and the
company is experiencing loss of productive hours increasing absenteeism (IRIN,
2001). In Malawi it was reported that
the death of the primary male in a farm household will lead to a loss of income
for that household of over 50 percent (Norse, 1991). The UN’s Food and Agricultural Organisation’s
(FAO) Committee on World Food Security notes that in the 27 most
HIV/AIDS-affected countries in Africa, seven million agricultural workers have
already died from AIDS since 1985.
Sixteen million more deaths are likely by 2020. The FAO (2001) provides the following table
reflecting labour force decreases in the ten most heavily-affected countries:
Country 2000 2020
Namibia 3.0
26.0
Botswana 6.6
23.2
Zimbabwe 9.6
22.7
Mozambique 2.3
20.0
South
Africa 3.9
19.9
Kenya 3.9
16.8
Malawi 5.8
13.8
Uganda 12.8 13.7
Tanzania 5.8
12.7
Central
African Republic 6.3
12.6
Ivory
Coast 5.6
11.4
Cameroon 2.9
10.7
At the agricultural household level, the HIV/AIDS cycle of destruction goes like this (Sayagues, 1999):
A man is taken ill. While nursing him, the wife can’t weed the maize and cotton fields, mulch and pare the banana trees, dry the coffee or harvest the rice. This means less food crops and less income from cash crops. Trips to town for medical treatment, hospital fees and medicines consume savings. Traditional healers are paid in livestock. The man dies. Farm tools, sometimes cattle, are sold to pay burial expenses. Mourning practices forbid farming for several days. Precious time for farm chores is lost. In the next season, unable to hire casual labour, the family plants a smaller area. Without pesticides, weeds and bugs multiply. Children leave school to weed and harvest. Again yields are lower. With little home-grown food and without cash to buy fish or meat, family nutrition and health suffer. If the mother becomes ill with AIDS, the cycle of asset and labour loss is repeated. Families withdraw into subsistence farming. Overall production of cash crops drops.
Bearing in mind that the
farm household is the primary production unit in large sectors of Southern
African economies, the impact of HIV/AIDS on these units has to be seen within
the context that these household units represent a complex system dependent on
human capital and remittances. The
impact of HIV/AIDS on the human security aspects of this system are
manifold: the area of land under
cultivation becomes smaller (land is often allocated by community authorities
to families on the basis of their size), agricultural output declines, the crop
variety decreases as cash crops are abandoned owing to the inability to
maintain enough labour for both cash and subsistence crops, and livestock
production declines due to medical costs (the latter often requires the sale of
livestock) – Shell (2000:17) reminds us that the cost of treating a single
terminal case of AIDS with an AZT cocktail per month is equivalent to placing
19 schoolchildren in primary school for a month. Also, agricultural skills are lost – as Du
Guerny (1999:15) points out, the oral tradition of passing on skills of the
trade will die with parents – ‘owing to the gender division of labour and
knowledge, the surviving parent is not always able to transfer the skills of
the deceased one’.
When parents die,
older children are left to fend for younger ones (whilst caring for sick and
dying adults). In addition to the
factors noted in the previous paragraph, the FAO (2001) also warns that
agricultural post-production, food storage and processing are impaired. Thus, the security of food and other raw
materials between harvests are at risk, including the availability of seed for
subsequent cropping. The FAO report
concludes by underlining the systemic impact of HIV/AIDS on agriculture and
food security: ‘HIV/AIDS does not merely
affect certain agriculture and rural development sub-sectoral components,
leaving others unaffected. If one
component of the system is affected, it is likely that others will also be
affected, either directly or indirectly’.
The irony is – as noted earlier – that decreased food production and
subsequent hunger might logically lead to the movement of large quantities of
indigent populations – not only within their own countries, but across porous
Southern Africa borders. This will
exacerbate the movement of people caused by military conflicts elsewhere, again
leading to increased vulnerability to HIV-infection on the continent as a
whole.
Du Geurny (1999:16)
mentions a few factors that need to be introduced at the agricultural
production level to alleviate the disruptive effects of HIV/AIDS on food
security:
·
A minimum wage
or floor price for a product can guarantee a minimum income to a poor household
which, in turn, would lead to migration taking place under better circumstances
and conditions. (For those agricultural
households that have already that critical (subsistence) levels of agricultural
production such a measure would, however, be too late. Also, given foreign agricultural producers’
insistence on sector liberalisation in terms of World Trade Organisation (WTO)
prescriptions, one wonders whether African states would be able to afford such
seemingly protectionist measures).
·
The storage of
crops so that sales could be better timed in relation to market changes.
·
Training and
the provision of survival skills are essential for orphans in order to protect
them from exploitation and abuse.
·
Property
rights related to real estate could be adjusted to protect families who would –
in terms of customary law – lose their land when the male head of that family
dies. Norse (1991) echoes this
sentiment:
Governments can act to ensure security of tenure for widows who, under some traditional land tenure systems, would lose land rights upon the death of their husbands. They can strengthen farm support services to ensure that technical advice, credit and labour-substituting production inputs are available. Agricultural research programmes can be redesigned to match more closely the needs of farm families with reduced adult numbers.
Adjustments need to
be made that would improve the day-to-day quality of life of those who remain
to till the soil – women and children.
‘They need stronger hoes and lighter ploughs; farming techniques that require less labour,
like zero tillage; and instead of
expensive pesticides, natural pest control’ (Sayagues, 1999). Furthermore, some coping strategies like
income diversification, share-cropping and labour-saving technology such as
mixing crops can be beneficial.
Communities are evolving ingenious responses, such as sharing farm
chores, house repairs and child care, and changing cultural practices like
expensive funerals.
Ostensibly, these
options might seem viable as countermeasures for HIV/AIDS or the effects of HIV/AIDS, but the FAO (2001)
points to deeply-entrenched societal beliefs and practices that would render
them null and void, or impossible to implement.
How, for instance, can one even begin to address issues related to
HIV/AIDS in societies where sexual behaviour are not openly discussed? How can one empower women who survive their
husbands in communities with highly rigid hierarchical gender structures? Despite an increasing focus on human security
issues, the stigmatisation and marginalisation of individuals with HIV/AIDS or
families affected by the disease continue to hamper HIV/AIDS
interventions. As recently as December
1998 Gugu Dlamini was stoned to death by her community outside Durban, South
Africa when she declared her HIV-status.
Clearly, the more private levels of human interaction – at the
household, community and gender levels – need as much addressing as the human
interactions in the public domain. The
ideal, surely, would be to move from ‘coping mechanisms’ to a quality of life
that is sustainable – a move to a more encompassing sense of human security.
The possible impact
that HIV/AIDS will have on issues related to so-called ‘good governance’ and
sustainable democracy in SSA have not really been examined in any great
depth. The few pieces of analysis on
this topic echo the CIA’s mentioned focus on AIDS’ impact on the dissolution of
states. Of course quite a bit has been
written on the disease’s implications for governments’ ability to expend
resources on essential services with AIDS draining the fiscus, but Willan
(2000:14) is one of the few analysts who have attempted to address the
potential of HIV/AIDS to undermine democratic governance itself. She highlights a few areas that together
might lead to the breakdown in democracy – HIV/AIDS can, in her view, cripple a
country’s attempts to establish and maintain democracy and equity because:
·
The next
generation of political and economic leaders is being wiped out.
·
Women are
bearing the brunt of the disease – they are the primary caregivers and are
subsequently removed from the public sphere, from political participation.
·
As mentioned
below, a magnitude of orphans pose a long-term threat to stability and
development.
·
Family
structures and social society are breaking down due to their inability to cope.
·
The increase
in the budgetary demand on governments are projected to increase to the nth
degree – cutting down on delivery in other sectors of society.
·
A crucial tax
base is being lost.
·
This might
lead to decreased respect for government, leading to social unrest in light of
non-delivery and ensuing frustration.
·
Citizen
support and participation in democratic governance will wane, as more people
develop terminal diseases and are removed from the public sphere. This will also affect civil society’s
capacity to take part in public debates, translating into a loss in society’s
ability to build a sense of national cohesion.
·
The
inclination and ability to pay debts such as rates and health bills often
dwindles when there is an increase in personal and family illness.
Although the causal
link between these factors and a collapse in governance capacity and democratic
social values are speculative at best, these analysts are of the opinion that
the future of democracy in South and Southern Africa – infantile and already
tenuous – will be adversely affected by HIV/AIDS. Willan (2000:14) argues that, unless HIV/AIDS
is regarded by governments and civil society as more than ‘mere’ health and
economic issues, ‘democracy itself is threatened’.
Goyer (2001:13) agrees, noting with dismay that the ‘relationship between HIV/AIDS and politics is only just beginning to be examined. In addition to the factors mentioned by Willan, he points out that the demographic impact of the disease is almost sure to change future voting patterns and political activity – we simply do not know what to expect. Of particular concern is the link between conflict and the epidemic. As noted above, AIDS and military conflict go hand-in-hand in Southern Africa – the one feeding the other. And if – according to Goyer (2001:13) – the link between cross-national military violence and HIV/AIDS is already so easy to prove and quantify, why should the disease not have a detrimental impact on security and issues related to governance within states? After all, the disease can well be personified as an abusive husband; as an invading military force: it penetrates societies and kills off the economically viable sectors of society.
Let us look more closely at the purported link between HIV/AIDS and political stability.
HIV/AIDS impacts with
population pressures and trends (particularly migration and urbanisation) to
create more volatile social and political situations. This combination can
produce heightened competition for limited resources and foster more intense
rivalries among groups in countries marked by ethnic, religious, or other
diversity (CSIS, 2000:14). HIV/AIDS
detrimentally affects the capacity of governments, especially on the delivery
of basic social services. Disease can decimate the ranks of skilled
administrators, diminish the reach or responsiveness of governmental
institutions, or reduce their resilience. This will detrimentally affect the
operational effectiveness of such institutions as the armed forces, police,
prosecution service and judiciary. Beyond a reduction in human resources, the
epidemic will result in a reduction in public revenues and budgets will be
diverted towards coping with the epidemic’s impact.
If a government is
perceived to be incapable of adequately addressing health problems created by
the spread of HIV/AIDS, it can produce a heightened sense of marginalisation
amongst affected populations and a stronger sense of deprivation and resentment
towards the government. The psychological impact can be particularly adverse
when combined with chronic poverty. These attitudes can contribute to the
eruption of violence, not just spontaneously, but in some cases as the result
of exploitation by ethnic, religious, or national elites to serve their narrow
interests (CSIS, 2000:15-16).
A US National
Intelligence Council report concludes that there is a definite link between
infectious disease epidemics (in particular HIV/AIDS) and security (NIC,
2000). For example, the report found
that:
·
The impact of
HIV/AIDS is likely to aggravate and even provoke social fragmentation and
political polarisation in the hardest hit countries in the developing world.
·
The
relationship between disease and political instability is indirect but real.
Infant mortality (likely to more than double in a number of Southern African
states because of HIV/AIDS by 2010) correlates strongly with political
instability, particularly in countries that have achieved a measure of
democratisation.
·
The severe
social and economic impact of HIV/AIDS,
and the infiltration of the epidemic into the ruling political and military
elites and middle classes of developing countries are likely to intensify the
struggle for political power to control scarce state resources. This will
hamper the development of a civil society and other underpinnings of democracy,
and will increase pressure on democratic transitions in SSA.
HIV/AIDS and gender
At the 13th
International HIV/AIDS Conference held in South Africa in July 2000 a rather
odd sight met men in the toilet facilities:
a bumper sticker was stuck above several of the urinals – it said, ‘Men
and boys, you hold the future in your hands’.
Crude, but it served as a reminder of what the socio-sexual determinants
of HIV-infection in SSA are. Security
can be a bad thing if it refers to intellectual safety or ignorance, and what
was so pertinent about the sticker was that it forced one to think outside
one’s stereotypical gender box and consider the gender dynamics of the disease.
Consider some the
ways in which HIV/AIDS is a genderised variable (note that ‘gender’ refers to
the socially defined identities and roles assigned to men and women, whereas
‘sex’ refers to the biological differences between men and women (Tallis,
2000:58):
As mentioned above,
rape is used as a weapon or tool of aggression by men against women. There are countless examples of rape as a
tool of pre-considered violence. What
makes it so applicable within the context of this paper is the effect that rape
has on the social security of communities in war-torn areas within which it is
used. Rape and the use of it as a vector
for the pro-active spread of HIV/AIDS has become a symptom of societal
sickness.
Shell (2000:19) mentions the birth of a diabolical new profile of rapists in
South Africa: ‘Township residents … term
such people “Jack Rollers” which another national authority defined in a
glossary as “Township youth who purposefully infect young women with HIV by
raping them. This is a relatively new
phenomenon in South Africa and the youth who do this are said to be unemployed
and frustrated young men who have found out that they are HIV positive and say
that they want to die with others”’.
Another dangerous myth that perpetuates rape is the belief that sexual intercourse
with a female virgin will cure AIDS (Shell & Zeitlin, 2000:8). The result, of course, is that HIV is spread
violently to this sector of the female community.
The practical effect
is that the epidemic is likely to cause crime in more direct ways. The belief
that sex with a virgin can cure HIV/AIDS appears to be widely spread in
Southern Africa (Leclerc-Madlala, 1996:35), with 25 percent of young South
Africans not knowing that this is a myth (LoveLife, 2000). Moreover, rapists
may also be targeting young girls in the belief that being less sexually
active, they are also less likely to have HIV or AIDS (Leclerc-Madlala,
1996:35-36).
A study conducted
among urban South African township youth in 1996 found that for the youth the
knowledge that they were infected with HIV or merely believed that they might
be infected ‘was accepted not only as a death sentence but also as a passport
to sexual licence’ (Leclerc-Madlala, 1996:32). That is, some youths argue that
they would actively spread HIV among as many people as possible if they
themselves were infected with HIV – a philosophy of ‘infect one, infect all’.
Young women expressed a general fear that men would respond to an HIV-positive
diagnosis by raping women (Leclerc-Madlala, 1996:33-34).
A study of Tanzanian women found an association between physical violence and HIV-infection. HIV-positive women were more likely to have had a physically violent partner in their lifetime. HIV-positive women under 30 were ten times more likely to report violence than non-infected women of the same age group (Maman et al, 2001): ‘The strong, consistently positive relationship between a prior history of violence and HIV-infection lends support to the theory that violence may play a role in women’s risk for HIV-infection’ (Vetten & Bhana, 2001:12).
In Africa, homophobia
is probably more entrenched than in the West.
Homosexual behaviour is considered ‘un-African’, and homosexuals are
stigmatised and socially isolated. HIV/AIDS
is also considered a ‘white man’s disease’, and homosexuality is ‘scape-goated’
as the decadent force that had brought the disease to the African continent in
the first place. Despite examples such
as an former Zimbabwean president who was tried and convicted because of
homosexual practice in that country, the myths and silences around sexuality
continue.
The reality of HIV/AIDS in Africa is, however, such that – as Bujra (2000:7)
points out – this chiefly heterosexual disease and the gender dynamics that
perpetuate it can learn a lot from how HIV-positive, homosexual men care for
each other. This shatters the image of
women as the only care-givers in society and challenges orthodox and accepted
notions of what ‘masculinity’ and ‘mothering’ are. A human rights culture and values is probably
the only factor that can counter the perpetuation of myths, lies and silences
around issues of sexuality.
Women are
physiologically at greater risk than men are of contracting HIV through
heterosexual modes of transmission.
O’Sullivan (2000:26) notes that
[i]n Africa the
number of women infected with HIV outnumbers infected men. Twelve point two million African women are
living with HIV/AIDS as compared to 10.1 million men … young African women between the ages of 15
and 19 are four to six times more likely to be HIV-positive than young en of
the same ages. Women are more easily
infected with HIV when they have sex with a positive man than when a man has
sex with a positive woman. …Women’s economic, social, sexual and cultural subordination
and inequality make frighteningly material impacts on each positive women’s
life.
Not only do familial
relations facilitate the spread of the disease amongst the female
population; stereotypical gender roles
place women at greater risk of contracting it from their partners.
4.
Gender roles & culture
For instance, in SSA
women are culturally disempowered to negotiate sexual intercourse with their
male partners – if the latter insists on so-called ‘dry sex’ (which greatly
compounds women’s susceptibility to HIV), women have very little say in the
matter. Also, women are socially
subordinate – they simply do not have any say in whether protection can or
should be used during intercourse (O’Sullivan, 2000:29), access to female
condoms is limited (Monekosso, 1997:6), and medical research institutions do
not put any great priority on the development of ‘stealth’ protective measures
aimed at the female market such as sperm- and microbicides (Gottemoeller,
2000).
Another contributing
factor is the fact that young girls are often married off to much older
men. This compounds these women’s
silence: they are materially and
socially dependent on men and simply do not have the social and economic
resources to claim control over their own vulnerability to the disease. As Ndiaye (2000:61) points out:
Early marriages place African women in a vulnerable
position, as they are passively exposed to risks incurred by having many sexual
partners through the behaviour of their husbands. For a man in many African cultures, it is a
sign of virility to have multiple sexual partners. Thus, women are often infected by their
polygamous husbands or by their partners who adopt risky sexual practices – sex
with a number of women, or prostitutes, or with other men.
As mentioned before,
in many instances African customary law entrenches women’s economic
insecurity. In Zambia, for instance,
widows of AIDS casualties are often victim to instances of ‘property-grabbing’
– the law allowing or not acting against in-laws who claim the land of the
diseased family member (Kinghorn, 1994).
Also, society’s
dependence on women and girls as care-givers within the household makes it
impossible or very difficult for females to enter the public sphere and realm
of political decision-making. In a
sense, then, these traditional conceptions of mothering means that the
‘private’ is not allowed to become ‘public’, and the result is that women
remain impotent, suppressed, and thus societally and economically
insecure.
The examples above provide
but a cursory glance at some of the facets of how HIV/AIDS is a genderised
disease in Africa. The upside is,
however, that it is forcing individuals – men and women – to reconsider their
gender roles and to address issues that all relate to a single factor: human rights.
If, in fact, ‘feminism is a radical way of saying that women are
people’, then human rights and the evolution of a human rights culture would be
the practical application of that dictum.
For only within a human rights culture – a culture of free speech,
tolerant of alternative ways of viewing gender relations and societies’ rules
around such relations – would there be any possibility of particularly women’s
susceptibility and vulnerability to the disease being addressed.
In order for this to
happen, though, men will have to grow up socially – they have to take
responsibility for their own sexuality, sexual practices and social
interaction. African males should no
longer be allowed to hide behind customary practice and beliefs in order to
perpetuate death. The stakes are simply
too high.
In contrast to most
infectious diseases (which take their heaviest toll among the elderly and the
very young) HIV/AIDS takes its greatest toll among young adults. The wholesale
death of young adults in Africa is producing orphans on a scale unprecedented
in world history. Historically, large-scale orphaning has been a sporadic,
short-term problem caused by war, famine or disease. However, the HIV/AIDS
epidemic has transformed orphaning into a long-term chronic problem that will
extend at least through the first third of the twenty-first century (Hunter
& Williamson, 2000:1). This is because the increase in orphan rates lags
behind HIV-infection levels by about ten years (the time it takes the average
person who contracts the virus to die from full-blown AIDS).
In 2000, 90 percent
of the 11 million orphans left by the global AIDS epidemic were children living
in SSA, even though only a tenth of the world’s population lives in the region.
According to USAID, Southern Africa had 2.9 million maternal of double orphans
(8 percent of all children under the age of 15 years) in 2000, of which 65
percent were orphaned because of AIDS. By 2010 the region is expected to have
5.5 million maternal of double orphans (16 percent of all children under the
age of 15 years), of which 87 percent will be orphaned because of AIDS. Some
countries in the region will be worse affected than others. In Botswana, for
example, every fifth child is expected to be an orphan by 2010 – 96 percent of
these children will be AIDS orphans (Hunter & Williamson, 2000). To place
these percentages into context, it is sobering to point out that before AIDS
only approximately two percent of children in developing countries were
orphaned (UNICEF, 1999:3).
As the AIDS epidemic
progresses, there will be fewer adults of normal parenting age to care for the
children they leave behind. The burden of care will increasingly fall on other
children or upon the growing proportion of elderly people. In Zimbabwe, for
example, 43 percent of orphan households are headed by a grandmother (Myslic et
al, 1997:6). However, the large number of anticipated AIDS orphans has led the
United Nations Children’s Fund (UNICEF) to conclude that Africa’s age-old
social safety net for such children – in the form of deep-rooted kinship
systems and extended-family networks – is unable to cope with the strain of
AIDS and soaring numbers of orphans in the most affected countries: ‘[c]apacity and resources are stretched to
breaking point, and those providing the necessary care in many cases are
already impoverished, often elderly and might themselves have depended
financially and physically on the support of the very son or daughter who has
died’ (UNICEF, 1999:3).
Growing up without a
parent or parents, and badly supervised by relatives and welfare organisations,
Southern Africa’s burgeoning orphan population will be at greater than average
risk to engage in criminal activity. The many orphaned African children who
will grow up under extreme levels of poverty will be sorely tempted – or even
obliged for the sake of their physical survival – to commit a range of property
related crimes. These crimes would include the theft of food and clothing by
shoplifting and residential burglary, or the theft of other items that can be
sold or traded for the necessities of life. Older orphans in their early
teenage years might resort to mugging and robbery to make ends meet.
The forced migration
of children because of high rural unemployment and poverty levels has long been
observed in developing countries. Studies in Ghana and Uganda found that girls
are increasingly being sent away to relatives in urban areas, or else to agents
who placed them as domestic workers (Michael, 2001:25). This trend is likely to
increase as the epidemic escalates and leaves large numbers of orphans in its
wake. A significant number of child migrants flocking to the cities will
increase the already high numbers of street children in Africa (Brown, 2000).
Street children are both the cause and victims of a range of crimes. Petty
thefts, muggings and theft out of motor vehicles are crimes commonly associated
with street children. Many such children are assaulted, abused, raped and drawn
into prostitution rings.
A large influx of orphaned children
into the urban slums surrounding many African cities will exacerbate
socio-economic conditions, thereby creating a vibrant breeding ground for a
variety of social ills such as crime. Moreover, the frequency of certain types
of crime – such as gang related crimes, vehicle thefts, robberies and
burglaries – is higher in cities than in rural areas, with the rate generally
increasing according to city size. Most factors associated with high crime
rates characterise cities to a greater extent than small towns or rural
villages. Population density, for example, is thought to be associated with
crime, in that greater concentrations of people lead to competition for limited
resources, greater stress and increased conflict. Factors such as overcrowding
and increased consumer demands and expectations that characterise urbanisation
are themselves believed to be associated with high crime rates. High levels of
gang activity and the availability of firearms are also mainly evident in urban
areas and are known to be related to criminal activity (Glanz, 1995:17).
Children who lose a
parent to AIDS suffer loss and grief like any other orphan. However, their loss
is exacerbated by prejudice and social exclusion, and can lead to the loss of
education and health care (Breaking the Vicious Cycle, 1997). That is, the
shame, fear and rejection that often surrounds people affected by HIV/AIDS can
create additional stress for and isolation of children – both before and after
the death of their parent or parents. The psychological impact on a child who
witnesses his or her parent dying of AIDS can be more intense than for children
whose parents die from more sudden causes. ‘HIV ultimately makes people ill but
it runs an unpredictable course. There are typically months or years of stress,
suffering or depression before a patient dies. And in developing countries,
where the epidemic is concentrated, effective pain or symptom relief is often
unavailable to alleviate a parent's suffering’ (Children Orphaned by AIDS,
1997).
Moreover, for a child
living with a parent who has AIDS, the disease is especially cruel as HIV is
sexually transmitted. Consequently, once one parent is infected, he or she is
likely to pass it on to the other parent. Children who loose a parent to AIDS
are thus at considerable risk of losing their remaining parent as well.
Consequently, these children have to take on the role of mother, father or
both, do housework, farm and care for their siblings and their ill or dying
parents, ‘bringing on stress that would exhaust even adults’ (UNICEF, 1999:5).
A report prepared for
UNICEF identifies a set of experiences commonly affecting most AIDS orphans:
·
trauma
associated with losing a parent, which is in most cases exacerbated by the
threat of losing the second parent;
·
witnessing the
parent’s physical deterioration, pain and death;
·
having cared
for the parent in their terminal phase and often being blamed for causing pain;
and
·
anxiety about
their source of livelihood and their ability to retain the family home after
the parent’s death (Loening-Voysey & Wilson, 2001).
Reviewing the impact
of AIDS in South Africa, a department of health publication predicts that
children orphaned because of AIDS could be at risk to engage in delinquent
behaviour. ‘As [orphaned] children under stress grow up without adequate
parenting and support, they are at greater risk of developing antisocial
behaviour and of being less productive members of society’ (Kinghorn &
Steinberg, 2001:15).
Ashraf Grimwood of
the National Aids Coalition in South Africa argues that the increasing number
of AIDS orphans, who grow up without parental support and supervision, will
turn to crime: ‘[c]rime will increase
because of the disintegration of the fabric of our society. It will be made
worse by the lack of guidance, care and support for HIV-positive people,
including children. Children orphaned by AIDS will have no role models in the
future and they will resort to crime to survive’ (Mackay, 1999).
Research commissioned
by the Nelson Mandela Children’s Fund found that South African AIDS orphans are
being ostracised by their communities and exploited financially by relatives
who had taken them in, primarily to receive a state grant. Emotionally, the
orphans were found to be suffering as a result of the deprivation of parental
guidance, emotional trauma as a result of loss, and the problem of having to
cope with adult responsibilities prematurely. Orphans were also vulnerable to physical
and sexual abuse by neighbours and relatives (Thompson, 2001). A USAID research
report came to a similar conclusion:
‘[d]enied the basic closeness of family life, children lack love,
attention and affection… they are often harshly treated or abused by step- or
foster parents’ (Hunter & Williamson, 2000:4).
A review of the
backgrounds of a large sample of children who have killed or committed other
grave (usually violent) crimes in the United Kingdom found that 57 percent had
experienced the death, or loss of contact, of someone important such as a
parent.
A 1998 interview
study of young men serving jail sentences, or involved in crime, by the Centre
for the Study of Violence and Reconciliation (South Africa) found that most of
the interviewees were ‘abandoned or kicked out of their homes, or… had to live
with a stepfather or mother who rejected them. Many expressed feelings of being
unloved’ (Segal et al, 1999:24).
The absence of a
father figure early in the lives of young males tends to increase later
delinquency.[3]
Moreover, such an absence will directly affect a boy's ability to develop
self-control: ‘[t]he secure attachment or emotional investment process [a
father figure provides] facilitates the child's ability to develop and
demonstrate both empathy and self-control. By extension, an insecure attachment
will lead to lower levels of empathy and self-control, and to an increase in
violent behaviour’ (Katz, 1999).
Another research
group completed an exhaustive review of family factors as correlates and
predictors of juvenile conduct problems and delinquency. They found that, inter
alia, poor parental supervision or monitoring and low parental involvement with
the child (factors present in orphaned children) compounds problems and
delinquency (Loeber & Stouthamer-Loeber, 1986:29-149). Another study by the
American Psychological Association on violence and youth found that ‘lack of
parental supervision is one of the strongest predictors of the development of
conduct problems and delinquency’ (American Psychological, 1993:19).
Since the early 1990s
reports from government commissions, research reports, and syntheses produced
by national crime prevention organisations have identified a number of common
factors associated with delinquency, violence and insecurity (Crime Prevention
Digest, 1999:20-21):
·
poverty and
unemployment deriving from social exclusion, especially for youth;
·
dysfunctional
families with uncaring and inconsistent parental attitudes, violence or
parental conflicts;
·
discrimination
and exclusion deriving from one or other form of oppression;
·
degradation of
urban environments and social bonds;
·
social
valuation of a culture of violence;
·
presence of
facilitators (such as firearms and drugs);
·
social
valuation of a culture of violence.
Most of the above
factors – all of them if a society is also ravaged by war or conflict – are
present in a large proportion of AIDS orphans in Africa. They grow up
impoverished, tend to be socially excluded, are not fully cared for because of
the loss of their parent(s), are often discriminated against, and grow up in an
environment where social bonds are falling apart because of the high
AIDS-related mortality rates among all sectors of society.
If would appear that
the kind of psychological trauma and lack of parental affection and supervision
experienced by AIDS orphans is a good predictor of subsequent delinquency and
violent criminal activity. Insufficient research has been done on the extent of
the risk AIDS orphans face of engaging in anti-social and violent behaviour in
their later lives. However, given that there will be some 5 million AIDS
orphans in Southern Africa by 2010, it is conceivable that the region will
experience a significant increase in violent interpersonal crime such as
murder, rape and assault, violent property crime such as robbery, and violent
crime against property such as malicious injury to property.
In households with
one adult death the economic impact of AIDS is greater in poor households that
in rich households, according to a World Bank research report. This is because
households that experience an adult death draw on their assets to cushion the
shock of the epidemic. It follows that households with lower levels of assets
can be expected to have more difficulty in coping with the death than
households with more assets (Confronting AIDS, 1999:221-23).
Moreover, while the
prevalence of HIV is widely spread among all sectors of the population in
developing countries, more educated people with higher incomes are in a better
position to learn about the epidemic and alter their behaviour to avoid
infection. Consequently, even in developing countries, AIDS is taking on the
pattern of other infectious diseases, in that the poor are more likely to
become infected: ‘[u]ltimately AIDS may
become most prevalent in the poorest urban slums of developing countries’
(Confronting AIDS, 1999:207).
One of the
consequences of the epidemic in high prevalence countries is not only that
societies will end up poorer than they would have been without AIDS, but income
inequalities are likely to widen. Generally, the poor in Africa are more prone
to being infected by HIV, and are least likely to cope with the financial
implications of the disease. As a result the gap between the poor and non-poor
is likely to get bigger in many African countries in the next 10 to 20 years.
This widening gap
between the very poor and the rest in society is likely to contribute to rising
levels of crime in a number of African countries. It is the level of inequality,
or the relative deprivation of a group or community in a society which is an
important risk factor for crime frequency. According to British criminologist
Jock Young, widening inequalities of income engenders ‘chronic relative
deprivation amongst the poor which gives rise to crime and a precarious anxiety
among the better off which breeds intolerance and punitiveness towards the
law-breaker’ (Young, 1999:8). It is no coincidence that South Africa and Brazil
– two societies with extremely high income disparities – have extraordinary
high levels of property and violent crime.
Because of the
magnitude of the HIV/AIDS epidemic and the social devastation and insecurity it
will cause in Southern Africa, it is difficult to foresee all the implications
it might have on crime. It is, however, possible to predict with some certainty
that criminal justice systems will be detrimentally affected by the epidemic in
the following ways:
·
In many
prisons there is a much higher prevalence of HIV than there is in society
outside (Prisons and AIDS, 1997:3). For example, it is estimated that in South
Africa AIDS will cause the death of some 7,000 prisoners in 2005, which will
increase to 45,000 in 2010 (Prison and Prisoners, 2000:20). This places an
increasing burden on the prison system to care for infected prisoners.
Moreover, prison wardens will be easily intimidated by HIV-positive prisoners
who might threaten to infect them. In South Africa ‘many police officers, as
well as prison officials, report that fighting, biting, scratching and spitting
are normal occurrences in their line of work, many of which result in the
spread of blood’ (Goyer & Gow, 2000:17). With a life expectancy of five or
so years many infected prisoners will have little to loose by failing to
co-operate with prison officials.
·
It is likely
that the administration of justice will suffer under the onslaught of the
epidemic. As more people fall ill and die of AIDS, fewer criminal trials will
be finalised. Within the coming decade, when large sections of Southern
Africa’s population will be physically ill because of their infection, many
trials will be delayed – or will have to be stopped altogether – because the
accused, his witnesses, the state’s witnesses or one of the court officials is
ill, dying or dead because of the disease.
·
The epidemic
will also affect the police services of the region detrimentally as most of
their operational staff are young males who are in the high risk group when it
comes to HIV-infection. These services will function less optimally than they
do today as absenteeism because of illness, and high mortality rates among
police officers increase over the next decade or two.
·
As the number
of AIDS deaths increase over the next decade the political pressure on
governments to devote more resources to health and welfare services will
increase. This, and the negative effect the epidemic will have on the economy
in general, is likely to curtail state expenditure on criminal justice. Under-resourced
and operating with a high number of ill personnel, many operational activities
the criminal justice systems in Southern Africa could stop functioning
altogether.
In Africa, we are
dying. Our economy is under threat. The enemy is attacking the elite in our
society, but also the children, the elderly and the infirm. Using the urge at the core of what makes us
human – the will to reproduce – it has already infiltrated our schools, houses,
mines, governments and churches. The
threat to Southern Africa’s human security is such that those of us who are not
infected, dying and dead are certainly equally affected by the disease.
This state of affairs is partly the result of our historical legacy of
poverty, creating a confluence of time and space that makes this continent the
Armageddon of HIV/AIDS. And we are
losing.
Yet we are in denial. We ponder the causal link between HIV and AIDS whilst the latter is already affecting our food security, our livelihoods, our sense of community. What will be the social effects of the missing generation of young adults unable to rear their children? How will intra-African peacekeeping operations be affected by the epidemic which disproportionately affects military personnel? What impact will the virus have on the functioning of state departments in already poorly performing criminal justice systems in Sub-Saharan Africa? How will 30 to 40 percent of the adult population, which is HIV-positive and dying, react when their government decides to spend limited state resources on policing, education or housing instead of building more hospitals and care centres for those infected by the virus?
African Political
Scientists’ lethargic response to this issue up to now is an indictment of our
academic community – of our ‘intellectual insecurity’
in dealing with this issue. As Marais
(2000:55) notes,
[t]he debate over
[the social determinants and effects of HIV/AIDS] has been lively, but so often
imbued with either racism or academic political correctness that the reality of
the situation is so often misconstrued and invalidated … These kinds of
epistemological complications render all the more difficult efforts to mount an
effective response that answers to the demands of inclusivity, empowerment and
‘ownership’.
May this be a call to intellectual arms.
oOo
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[1] Pieter Fourie (pf@lw.rau.ac.za) lectures Politics at the Rand Afrikaans University in Johannesburg, and Martin Schönteich (martin.s@iss.co.za) is a Senior Researcher with the Institute for Security Studies in Pretoria, South Africa.
[2] Decosas explains social cohesion by way of analogy: Fascist Germany was a highly cohesive society
and the state actively increased cohesion by murdering those who did not
conform to the Aryan ideal. Cohesion may
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[3].See, for example, Bowlby (1947) and Gabel (1992).