Unlike Europe's Black Death, Africa can be saved from AIDS

By Gwynne Dyer

LONDON (JP): If a report had been published last weekend forecasting a war that would kill 10 percent to 15 percent of the people of all the countries of central and eastern Europe in the next five years (as World War II did), you would be hearing a lot about it.

Even less extravagant predictions of disaster -- say, of an influenza epidemic that would kill 1 percent or 2 percent of the world's population over the next year (like the influenza epidemic of 1918-1919) -- would certainly be the number one news topic around the world this week.

How odd, then, that a United Nations forecast predicting that a new plague will kill 2 percent of the population of a number of countries each year for the indefinite future got so little attention. Maybe it's because the countries are all in Africa.

The forecast, published on Oct. 30, was part of the UN's annual world population survey. And the plague, of course, is not all that new: it is AIDS, which has been with us for more than a decade now. But the very long incubation period means that the full scope of the damage takes a long time to emerge. Only now is the scale of the tragedy in Africa becoming clear.

AIDS probably originated in sub-Saharan Africa, and it has certainly been epidemic there for longest. Now, says the UN report, it has reached pandemic status in a number of black Africa's 34 countries, with up to 25 percent of the population HIV positive. In African conditions, the vast majority of these people will die over the next 10 years -- though not before passing the virus on to many others.

Ninety-one percent of the world's AIDS deaths so far have occurred in African countries, states the UN report, and 86 percent of people currently infected with HIV also live there. It is desperate news for a continent already weighed down by troubles, and every indication is that it's just going to get worse.

"In looking at global epidemics," commented Lester Brown, president of the Washington-based World Watch Institute, "one has to go back to the 16th century and the introduction of smallpox to the Aztec population of what is now Mexico to find anything on that scale, and before that to the bubonic plague in Europe in the 14th century."

In human terms, what this means is that vast numbers of Africans are dying young. Five years ago, thanks to decades of public health programs, a baby born in Zimbabwe could expect an average lifespan of 61 years -- and Zimbabwean public health experts were looking forward to achieving the 70 years typical of Western Europe in the foreseeable future.

Thanks to AIDS, however, a newborn Zimbabwean today can only expect to live an average of 39 years. Within the next decade, that will drop to 31 years. To put it starkly, a Zimbabwean born in 2008 can expect a life only half as long as a Zimbabwean born in 1993.

The situation may, in fact, be even worse than the UN report suggests, partly because many African countries are still concealing the true statistics on infection rates, and partly because UN statisticians have to work with old data. They give the rate of HIV infection in Zimbabwe, for example, as 25 percent.

That was the rate observed among pregnant women in Harare eight years ago (which caused great alarm at the time). But by last year, the national rate of HIV infection had risen to 40 percent -- and this year a survey of antenatal clinics in southern Masvingo province (a non-urban area where you would expect lower infection rates) found that 67 percent of women there were HIV positive.

Let us spell out what that statistic means. It means that more than two-thirds of the women of child-bearing age in that part of Zimbabwe, at least, are almost certainly going to die of AIDS in the next 10 years -- and so will most of their children.

Because the deaths are spread out in time, the immediate impact of this plague is less visible than in the great pandemics of the past. But cumulatively, AIDS may actually hit Africa harder than the Black Death struck Europe 650 years ago (when around a third of the population died).

The UN report still talks conservatively about "lower population growth rates" (cutting Zimbabwe's, for example, from 3.3 percent annually in the 1980s to less than 1 percent by 2000).

Another recent report. Focus on HIV/AIDS in the Developing World, by Peter Wray and colleagues, forecasts an African population in 2010 that will be 71 million smaller than it would have been without AIDS. But the reality, as in 14th century Europe, may be an absolute fall in population, and perhaps a very steep one.

Unlike the Europe of the Black Death, however, Africa could be saved. In developed countries, new drugs have slashed the death rate and transformed the lives of those infected with HIV. But no African country can afford to pay for anti-retroviral drugs for its population, and few sufferers have enough means of their own.

"I have one patient who is taking the drugs," said Dr. Isaac Dombo, who runs a clinic in Zimbabwe's capital, Harare. "He has a very good job and three members of his family are helping him to pay for the drugs. Others who are desperate scrape up the money to buy them and show dramatic improvement for a few months. Then they run out of money and deteriorate. It is very frustrating."

This is a calamity with almost no external repercussions. Africa barely figures in the global economy, and AIDS problems elsewhere (some Asian countries may face very high infection rates in five years' time) are not in any way linked to Africa's fate.

But it would not be a bad time for those whose ancestors grew rich on turning black Africans into slaves and looting their resources -- western Europeans, Americans, Brazilians, the eastern Arabs -- to think about a grand gesture of atonement. A grand financial gesture of atonement, like putting up the money to fight the worst plague that has struck any human population in modern times.