By Dr. Chinua Akukwe

 The international conference on HIV/AIDS  in Durban, South Africa that ended recently dominated the mainstream print and electronic media in Western capitals. Various media organizations provided graphic information on the devastating consequences of this hydra-headed monster of a disease in  Africa. As the more than 12,000 conference participants debated the scope of President Mbeki of South Africas speech or argued over the origin of the HIV virus in the palatial settings of Durban, it is important to make the following observations on what may have occurred during the week-long Conference.

During the week-long Conference:

1) Between  7,500 and 10,000 South Africans will have contracted the dreaded HIV infection;
2) More than 10,000 Nigerians will have become infected;
3) At least 70,000 Africans will have become infected; and,
4) At least 42,000 families in Africa have buried someone, most often a man or woman at the prime, productive stages of their lives.

The HIV/AIDS crisis in Africa is the most devastating disaster to befall the continent. Within the last two decades, the AIDS virus is responsible for ten times more deaths in Africa than all wars combined. Sale of coffins is booming in many African countries such as Zimbabwe and Zambia from the high death toll of AIDS. According to UNAIDS (the UN agency responsible for HIV/AIDS), about 25 million persons live with HIV/AIDS in Africa, and 13 million have already died of the disease. In the next ten years, most of the HIV positive Africans will die painful deaths without access to life saving treatment. Africa accounts for 95% of the 13 million orphans worldwide. More than 95% of all new infections in children 15 years or below occur in Africa. At least 95% of all mother-to-child transmission occurs in Africa. By the year 2010, at least 40 million African children will have no father or mother to assist them as they go through their most critical formative years in life. For the first time in many traditional African societies, the extended family system is no longer adequate as many orphans have to fend for themselves.

The rates of HIV infection in the so-called high risk African countries range from 13% to 36% among the adult population. For example, Botswana has an infection rate of 36%, Zimbabwe, 25%, and South Africa 13 percent.  Although Nigerias current rate of infection is about 5.4% (one in 20 adults), the large population base of 110 million people will likely ignite a major catastrophe in a few years time. According to some estimates, by 2020, more than 75 million Nigerians may carry the virus if the present trend continues.


The Direct and Collateral Effects of HIV/AIDS in Africa

The HIV infection is like a stealth bomber that moves at supersonic speed, with major direct and collateral effects. There are two important direct effects of the infection: The infective status which is infinite, and, the deteriorating health status during the AIDS stages of the disease. Once an individual becomes HIV positive, that person is theoretically, and for all practical purposes, capable of transmitting the infection to another individual. At least 90% of all infected individuals worldwide are unaware of their high risk status because of their robust physical appearance. These individuals may continue to propagate the disease, unwittingly. Thus, it is not surprising that in many parts of Africa, robust or healthy looking individuals are not seen as at risk of transmitting the virus. The second direct damage is the deteriorating health status that invariably incapacitates the individual during the AIDS phase of the disease, with multiple opportunistic infections. This is the stage that many relatives begin a whispering campaign on the cause of the individuals illness.

The collateral effect of HIV/AIDS is as devastating as the direct effects. I will summarize the collateral effects as follows:

1) Poverty is the second cousin of HIV infection. Poor countries, poor neighborhoods or communities are more likely to have high rates of infection, and less likely to have the resources to combat the disease. Once HIV/AIDS establishes a foothold in a poor setting, that community is on a slow but progressive economic, social, and cultural decline;

2) Sex is a taboo subject in most African societies, and the predominant heterosexual transmission of HIV in Africa makes it a difficult subject matter. According to World Bank estimates, only 3% of HIV positive individuals go into clinics because of the stigma associated with AIDS;

3) HIV/AIDS is closely related to sexually transmitted diseases and Tuberculosis, two common conditions in Africa;

4) HIV/AIDS has devastating effect on the life expectancy of any nation. For example, by 2010, Namibias life expectancy rate would have been 70.1 years compared to the projected 38.9 years because of AIDS. Many countries in Southern African will lose at least twenty or more years of life expectancy in the next decade because of AIDS.

5) HIV/AIDS destroys the economic engine room of African societies such as teachers, professors, doctors, nurses, engineers, lawyers, community leaders, and so on. The children of these bread winners are likely to drop out of school, with the older children assuming increasing parental roles for their younger siblings;

6) Gender inequity in Africa continues to be a major problem for HIV prevention programs. For example, a woman who is faithful to her husband cannot, in many African societies, refuse sexual advances from her high risk husband, without fear of physical harm, economic retaliation or social ostracism. Rape of teenage girls or seduction of these girls by high risk  sugar daddies continues unabated;

7) HIV/AIDS creates an undue burden on the health care system of African countries. Health authorities in Africa are now spending their paltry budget on AIDS related clinical care. For example, large provincial hospitals in South Africa report 50% or more occupancy rates of their hospital beds by AIDS patients.  In addition, many African governments in the next several months must reach a decision on how to reconcile the use of a promising drug, nevirapine that significantly reduces maternal transmission of HIV infection with the transmission of the infection through continued breast feeding. Preliminary results suggest that HIV positive nursing mothers can re-transmit the virus to their babies during breast feeding after receiving nevirapine at birth. This dilemma is very real as the manufacturers of nevirapine are promising to donate large quantities of the drug to needy African nations.

8) HIV/AIDS may lead to the political instability of many African countries. For example, the high rates of infection among the Military of South Africa, Zimbabwe, and Zambia portend danger signals for civilian governments if the infected soldiers die in large number without receiving life saving drugs. Furthermore, as scare resources of poor African nations become diverted to AIDS palliative treatment, the internal conflicts in many countries over resource sharing and power may grow worse. The tepid, indifferent, and at times, hostile response of many African leaders to the HIV/AIDS conundrum is a recipe for disaster. To behave as if the HIV/AIDS problem does not exist or to waste time in puerile ideological or moral debates, could lead to catastrophic results. Fortunately, some presidents such as Museveni of Uganda and Obasanjo of Nigeria have publicly stated their personal commitment to halting the rampaging effects of the disease and have technical persons reporting directly to them;

9)   No African country can afford the $11,000 to $15,000 annual cost of life saving antiretroviral cocktail therapy that has dramatically changed the HIV/AIDS landscape in Western countries. Even with the availability of these drugs, I am not aware of any African country that has the infrastructure to manage the logistics of delivering the complex drug regimen to HIV/AIDS patients; and,

10) A new generation of Africans will grow up in this century believing that no matter what they do, they may never live to adulthood because of rampaging effects of the virus. The rate of infection among African youth is the highest in the world. In some countries, female teenagers between 15 and 19 years of age have infective rates of 15% or more.

How to Respond to the HIV/AIDS Epidemic in Africa 

The danger of the HIV/AIDS epidemic is real in Africa. Present and future generations of Africans are at grave risk of a multifaceted menace. As elites jostle over semantics, many Africans become infected or die of the disease. As noted by President Nelson Mandela in his closing speech to the Durban Conference, it is important to square the concern of the HIV/AIDS patients with the rhetoric of experts. The time is now ripe for a comprehensive approach to HIV/AIDS prevention strategy in Africa.

The HIV/AIDS strategy in Africa should be predicated on four fundamental principles:

1) The need for the international community to mobilize resources to provide life saving treatment to the 25 million Africans living with the HIV virus. There is no justification for denying millions of Africans, access to life saving drugs. These drugs have made it possible for HIV positive  individuals in Western countries to go back to work, assist their families and contribute to the betterment of their society. Until the West resolves the issue of providing the same treatment opportunities to all HIV/AIDS patients, the rhetoric of HIV/AIDS will remain hollow. To prosecute the Bosnia campaign, the Western Alliance reportedly spent at least $80 billion without any dent on their current economic prosperity;

2) The need for African leaders to develop and implement a credible HIV prevention program that recognizes the following facts: There is no known cure for HIV/AIDS; The best safe sex message is abstinence or monogamous relationship after relevant tests and knowledge of HIV status, and ; The urgent need to lift the conspiracy of silence about sexual matters  in many African societies. Uganda, Tanzania, and Senegal reportedly made significant advances on HIV prevention through a national dialogue on sex and how it can lead to HIV infection;

3). The critical importance of revamping the health care system in Africa. As of today, the current health system in African cannot manage the complex logistics of providing cheap or free drugs to HIV/AIDS individuals if they are made available. Many African countries neglect their health systems and do not provide incentives for their health workers. The strategy of multisectoral sectoral approach to health matters is not firmly rooted in Africa. As shown in a recent World Bank report on health care in Africa, the health infrastructure in most African countries leaves much to be desired. The political will to fund health services in African countries is lacking. National ministries of health lack technical expertise or serve as backwaters for failed politicians and operatives; and,

4) The ultimate responsibility for managing and eventually conquering the HIV/AIDS menace lie with Africans, in the continent and the diaspora. As shown by the debacle of aid and debt relief, no amount of international assistance will change the HIV/AIDS situation in Africa unless sustained progress is achieved in the following areas of governance (a) Adequate political representation where various shades of opinion are represented at the highest decision-making  apparatus of government (b) Transparent macroeconomic policies that promote private enterprise, ensure the implementation of unambiguous rules and regulation, and, assure the protection of the weak and the infirm in the society, and, (c) Engage community-based entities and non governmental organizations in the design and provision of grassroots health programs.

African governments must develop a mechanism for engaging their professionals in the diaspora in the design, implementation, monitoring and evaluation of HIV/AIDS programs. This approach should be multisectoral with sustained interactions with experts in clinical care, public health, pharmacy, economics, agriculture, business, manufacturing, engineering, political science, anthropology, sociology and other professionals that can help design proactive health and non health programs that will address the direct and collateral effects of HIV/AIDS. It is also important to establish direct relationships with U.S. and other Western-based organizations that are promoting the treatment and prevention of HIV/AIDS in Africa. For example, the

 Constituency for Africa in Washington, D.C.  is promoting an AIDS Marshall Plan for Africa, and organizing town meetings on HIV/AIDS in Africa across America.  Finally, African governments should establish direct linkages with sympathetic legislators and appropriators in Western countries. For example, the U.S. Congressional Black Caucus is active on HIV/AIDS issues in Africa and will benefit from sustained consultations and briefings by African governments.


HIV/AIDS is real in Africa. No matter the origin of the HIV virus or the so-called disagreement about the pathogenesis of the disease, millions of Africans have died of this horrible disease, and 25 million individuals are  living under a certain death sentence. The time to act is now to save lives and create a better future for Africa. The much vaunted African renaissance will become a pipedream if African intellectuals and leaders waste time chasing shadows while the proverbial Rome burns. The die is cast.

Dr. Akukwe is the former Vice Chairman of the National Council for International Health (NCIH), Washington, D.C. E-mail: cakukwe@att.net

Published 24/07/00


Date Uploaded 1/23/2008
Copyright Africa Economic Analysis 2005