Africa And NEPAD: What About HIV/AIDS?

By Chinua Akukwe

The Perspective
Atlanta, Georgia

Posted April 23, 2002

The African conceived and led New Partnership for Africa's Development (NEPAD) is an ambitious attempt by African leaders to jumpstart development in the continent. However, NEPAD as currently articulated, lacks a serious focus on the HIV/AIDS epidemic in Africa. As a vehicle for Africa's renaissance, based on indigenous initiatives and focused external support, NEPAD must be seen as a vehicle for tackling major impediments to the economic growth and political stability in Africa. The HIV/AIDS epidemic is unarguably the greatest threat to Africa's development at this point in time. I discuss why HIV/AIDS should be on the shortlist of any NEPAD strategic priorities.

NEPAD is touted as a "holistic, comprehensive integrated strategic framework for the socioeconomic development of Africa." NEPAD provides a "vision for Africa, a statement of the problems facing the continent and a program of action to resolve these problems…" The goals of NEPAD include (a) promoting accelerated growth and sustainable development (b) eradicating widespread and severe poverty, and (c) halting the marginalization of Africa in the globalization process. Sectoral priorities of NEPAD include bridging the infrastructure gap in the continent; human resource development initiative (poverty reduction, higher education attainment levels, reversing brain drain, and health); agriculture; the environment; cultural issues, and science and technology.

As African leaders prepare to engage their G-8 counterparts during the June 2002 meeting in Canada, the current focus of NEPAD is on five areas of development:

1. Capacity building on peace and security.

2. Economic and corporate governance.

3. Infrastructure development.

4. Financial standards and the establishment of a Central Bank.

5. Agriculture and market access.

These focus areas of development in NEPAD are appropriate and deserve commendation. However, it is difficult to contemplate a serious attempt at jumpstarting development in Africa without urgent attention to HIV/AIDS, a condition that can negate not only the vision of NEPAD but also its goals, priorities, and current areas of focus. I briefly review the effect of HIV/AIDS on NEPAD's goals, priorities and current areas of focus.

HIV/AIDS is a formidable foe of accelerated growth and sustainable development in Africa. According to the World Bank and UNAIDS, HIV/AIDS in the hardest hit countries of Africa is directly responsible for an annual loss of 0.5-1.2 GDP. This is in a continent that must achieve a growth rate of 7 percent to meet the United Nations Millennium Development Goals (MDG) of halving poverty levels by 2015. By 2020, heavily infected countries may lose up to 20 percent of their GDP to AIDS. HIV/AIDS is also fingered as a major factor in the current life expectancy in Africa of 47 years instead of 62 years, without AIDS.

HIV/AIDS is also a deadly opponent of any serious poverty alleviation effort in Africa, where at least four of every ten individual live on less than $US1 a day. By picking off the most productive segments of the society, AIDS creates a cascade of poverty enhancing effects at family, community and national levels. The World Health Organization's Macroeconomic Commission in its recent report estimates that regions that suffer truncated lives from early deaths and chronic disability stand to lose billions of US dollars a year. According to the UNAIDS, in Botswana where one of every third adult is living with HIV/AIDS, one quarter of households can expect to lose a breadwinner within 10 years, and per capita household income for the poorest quarter of households will fall by 13 percent. As breadwinners fall sick and die, household income dries up, food becomes increasingly scarce and/or rationed, children are pulled out of school, and poor families spend limited savings and household holdings on fruitless AIDS palliative treatment. Communities are deprived of their best-trained leaders, and nations suffer from the untimely deaths of its best bureaucrats, technocrats, doctors, nurses, teachers and other professionals. Public expenditure on healthcare will go up at a time of declining tax revenue from limited numbers of productive workforce.

Africa's marginalization in the globalization process is exemplified, according to the World Bank, by its almost zero share of global manufactured goods, less than 2 percent of global trade, and its reliance on volatile commodity prices as sources of foreign exchange. As a continent that export mostly non-processed goods, Africa in addition to the impediments of massive agricultural subsidies imposed by the West, must deal with its small domestic markets that are dependent on the HIV/AIDS ravaged tiny middle class. Business organizations in many parts of the AIDS hard-hit Southern Africa have to hire two or more persons for the same job, and are incurring heavy costs in absenteeism, insurance premiums and death benefits. At least 28 percent of miners in South Africa are believed to live with HIV/AIDS. According to both the World Bank and UNAIDS, private investments are not likely to flow consistently to countries that are losing their best workers to AIDS because of stagnating demands and high labor costs. Farmers are also at the receiving end of HIV/AIDS: the International Labor Organization, an arm of the UN, estimates that at least 7 million farm workers in Africa have died of AIDS, and millions more are still at risk. In addition, critical investments in soil enhancement and irrigation are drying up because of the epidemic, according to the UNAIDS.

The HIV/AIDS epidemic in Africa put the searchlight on the poor healthcare infrastructure in many countries, including the hardest hit nations. The healthcare system in Africa, in decline for a long time, became inundated with the needs of individuals dying of AIDS. In some countries in Southern Africa, AIDS patients occupy more than 50 percent of all hospital beds. The inadequacies in transportation, energy, telecommunications and information management became glaring in the moral battle to extend lifesaving antiretroviral drugs to Africans living with HIV/AIDS, as opponents repeatedly cited these inadequacies.

Human resource development initiatives in Africa must deal with pervasive effects of HIV/AIDS as experienced workers die, and younger workers remain at risk. As noted by the UNAIDS, the loss of transfer of knowledge between more experienced workers and younger employees, and the higher recruitment cost of replacing sick and dying workers can increase the workers' compensation budget of a typical manufacturing outfit by 10 percent or more in Africa. Far more important, the millions of young men and women that look healthy today and are potential beneficiaries of human resource initiatives may be living unknowingly with HIV that will manifest clinically in less than a decade.

The effect of HIV/AIDS on the environment is still unfolding. However, human beings, the best stewards of the environment in Africa are already at risk of HIV/AIDS. The cultural ramifications of loosing generations of citizens to AIDS will likely be significant. However, one cherished cultural tradition in Africa, the extended family system, is already under strain from the unprecedented waves of AIDS orphans. Science and technology will also take a major hit as the likely elite user die of AIDS and technical workers fall sick.

Peace and security in Africa may come under threat in Africa if the estimated high rates of HIV infection in the powerful African armies hold up. The World Bank, the Economic Commission for Africa and UNAIDS estimate that infective rates in the rank-and-file of national armies in Africa range between 10 and 50 percent. It is highly unlikely that Military commanders will tolerate the specter of high death rates and lack of access to lifesaving drugs. The United States Institute of Peace and the International Crisis Group have provided compelling evidence of how conflicts, massive movements of people, displaced communities, and refugee status facilitate the transmission of HIV through rape, sexual coercion, and trading sex for survival.

Economic and corporate governance, infrastructure development, enthroning transparent financial standards, establishing a Central Bank, improving agriculture output, and increasing access to markets, domestic and abroad, depend on skilled and productive workforce in the public and private sectors. HIV/AIDS remains a formidable threat to the current and future workforce in Africa.

HIV/AIDS is a major impediment to the lofty goals and objectives of NEPAD. I believe that African leaders should immediately adopt HIV/AIDS remedial efforts as one of the focus areas of NEPAD, and set in motion a machinery to translate the Abuja 2001 declaration on HIV/AIDS into a working document for the forthcoming meeting with G-8 nations. The HIV/AIDS working document should address critical issues such as access to antiretroviral drugs, culturally appropriate information, education and communication (IEC) campaigns, and mobilization of Africans everywhere to fight the epidemic. The working document should define the relationship between NEPAD and other players in international AIDS remedial efforts, and document the parameters of aid for development programs regarding HIV/AIDS (UNAIDS estimates that at least 80 percent of resources needed to fight AIDS in Africa will come from external sources). Additionally, the working document should set out specific parameters for accelerated debt relief in exchange for verifiable investments in HIV/AIDS remedial efforts, and for holding African governments accountable in national and local campaigns against the epidemic.

Finally, NEPAD should be an opportunity to develop a continental response to the HIV/AIDS epidemic as part of the new African Union (AU). Although the NEPAD document alludes to the work of the Global Fund for AIDS, Malaria and Tuberculosis, UNAIDS, and other active players in the international arena, the HIV/AIDS epidemic has the capacity to neutralize the lofty aims of African leaders enshrined in the envisaged partnership for development. With 28 million Africans living with HIV/AIDS and more than 20 million already dead, the number one development emergency in Africa deserve priority attention in NEPAD, the touted vehicle for the continent's accelerated development.

About the author: Dr. Chinua Akukwe ( is a former Vice Chairman of the National Council for International Health (NCIH), Washington, DC now known as the Global Health Council, and currently serves on the Board of the Constituency for Africa, Washington, DC

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