Fortune Profiles the ‘Death’ of Africa
"The HIV/AIDS epidemic moving through Africa is unlike any plague the world has ever seen," Fortune reports in an eight-part feature detailing the decline of sub-Saharan Africa. Although more people will eventually die from AIDS-related illnesses than the 20 million who perished from the "medieval Black Death," the people of Africa are "in denial about the disease," as many governments are unwilling to address it, people do not inform their families about their positive status and the infected do not seek treatment. The more than 25 million Africans who are HIV-positive comprise all levels of African society, including miners, politicians and the military. Clem Sunter, an executive director of a South African mining company, said, "Africa will never be the same. We don't know yet what the social and economic consequences will be, but AIDS will define the shape and structure of society in Africa." The statistics, Fortune says, are "stupefying:" Three-quarters of the world's AIDS population lives in Africa; in Botswana, more than three out of every 10 men and women ages 15 to 50 are HIV-positive; and a 15-year-old Botswanan boy will have an 85% chance of dying from AIDS if the epidemic continues at its current progression. The epidemic in South Africa flourished after the fall of apartheid, as its "borders became more porous, trade with neighbors resumed and HIV exploded." Since then, the infection rate has increased from 1% to 20%. This has "jeopard[ized]" the economic growth that came after apartheid, and other African countries "are seeing AIDS devour modest gains in life expectancy and economic growth." A Matter of Conscience, Not Money The economic effect beyond the AIDS epidemic is negligent, as according to Fortune, "[I]t sounds callous to say so, [but] the world would hardly notice if Africa's entire economy disappeared overnight" (O'Reilly, Fortune, 11/13). To illustrate this point, South Africa has the continent's largest economy, yet its gross national product is smaller than the gross state product of Louisiana (O'Reilly, Fortune, 11/13). While the African crisis may not resonate in our pocketbooks, "it should be making a very large dent ... in our collective conscience," Fortune says, adding, "AIDS is genocide by Mother Nature, and it is killing a continent." There exists a cyclic nature to the disease and its economic devastation, in which family members of afflicted individuals must sell "their most valuable assets to pay for treatment," thereby creating conditions of poverty which contribute to the spread of the virus. Ignorance and social customs also contribute to the devastation of the continent. Many families of HIV-positive individuals go to "traditional healers" who charge large sums of money and offer "prayers and burn incense, or suggest that a victim cure his AIDS by having sex with a virgin." A wife who loses her husband to AIDS but manages to avoid getting HIV still has to turn over all her property to her brother-in-laws; tribal customs dictate that she also must be "cleansed," which "means having sex with the husband's brothers to wash away his spirit." And as parents die from AIDS, Africa's orphan population is becoming "immense," as the United Nations estimates that there are 13 million orphans throughout the continent. Believing the Myths Several sexual practices have helped to increase the transmission of HIV/AIDS in Africa. African men often favor " dry sex," leading women to use herbs and other means to dry their vaginas before intercourse. Dry sex can result in vaginal tears and abrasions that increase the rate of HIV transmission. Despite the fact that 95% of Africans are aware that unprotected sex leads to AIDS, an overwhelming majority do not use condoms. In a Zambian survey, only 6% of participants reported using a condom in their last encounter with a spouse or live-in partner. "[T]heir behaviors don't change. ... They know it kills, but they do it anyway," Nils Gade, head of the Society for Family Health, said. Most men in eastern and southern Africa are uncircumcised, which "seems" to make them "more vulnerable to HIV." In addition, some men, believing popular myths that says that sex with a virgin will cure them of HIV, take young girls as partners and transmit the virus. Others believe that young girls are less likely to have the virus than older women. A survey of 1,600 children in Lusaka found that 25% of 10-year-old girls in poor sections of town had had sex, while 60% of 16-year-old girls had been sexually active. Breakdown by Profession While general sexual practices contribute to the high rate of HIV/AIDS, variances can be noted in the transmission rates between professions. For example, 29% of miners are expected to be HIV-positive by 2005, while 9% of the people working in South Africa's finance and insurance industries are believed to have AIDS. Workers in the electric- power and railroad industries are also "likely to get clobbered" by HIV/AIDS in the future. The impact of the disease on the continent's labor force is evident. Electric crews are already "becoming less efficient," as skilled workers either become ill from the virus or take time off to attend funerals, Fortune reports. One large Lusaka bank offers "all kinds of benefits and treatment" for its HIV-positive workers, but the workers refuse to visit the bank's HIV centers, fearing that co-workers will learn of their illness. Higher-level workers and company executives are not spared from the virus -- at one power company, eight of the 12 top executives are HIV-positive. "The prevalence of HIV among skilled and highly skilled workers in South Africa is predicted to peak at 23% and 13%, respectively, in five years," Fortune reports. Of the 9% of HIV-positive workers in South Africa's finance and insurance industry, 99% are skilled or highly skilled employees. "No society can afford to lose its best and brightest," Fortune states, adding that HIV/AIDS is "decimat[ing]" the "homegrown managerial talent Africa so desperately needs." A higher level of education does not seem to reduce one's risk of contracting HIV/AIDS either; educated men and women, who are mobile and can "travel and party," are at high risk for the virus. Fortune notes that well-educated, well-paid men are at "particularly high risk" for HIV/AIDS, since they have incomes that they can afford to trade for sex. In Zambia, educated women past their teens are three times more likely to contract HIV than uneducated women. Ignoring the Problem Economists are finding it difficult to respond to the African HIV/AIDS epidemic, in part because they receive "wildly inconsistent answers" when surveying African countries about HIV among their labor forces. Many companies "don't want to know" about the effects the virus can or will have on their work force. Gillian Nur Samuels, who led a study for the independent South African insurance company Metropolitan Life, said, "People are burying their heads. Most companies feel it won't impact them. They are trying to ignore it." However, a problem exists: "Even if no other African caught HIV again ... the plague would continue to kill for a decade or more," Fortune reports. Last year, 3.7 million Africans became infected with HIV, 22% more than in 1995. Yet many top government officials have remained "invisible" on the issue. The "worst offender" in ignoring the HIV/AIDS epidemic is South African President Thabo Mbeki, whose "foolishness" and refusal to distribute AZT to pregnant women is partly responsible for the spread of HIV through vertical transmission. Dr. Colin Eisenstein, medical director at Anglo Gold, the nation's largest gold-mining company, is "furious" at Mbeki for his stance on HIV/AIDS. "If there was a foreign army camped out on our border that we knew was going to kill 25 million people, we'd do something about it," he said. However, not all African governments have ignored the problem -- Ugandan President Yoweri Musevini, for example, has "led the charge" to battle HIV/AIDS, and the rate of HIV infection in Uganda has declined from 15% to 8% in the past 20 years. Finding Solutions In contrast to those companies that "don't have a good grasp of the problem," some companies are proactively trying to quell the spread of HIV/AIDS. Ford Motor Company, for example, flew in officials from the CDC to educate local executives at its plant in Pretoria, South Africa. The plant then shut down and assembled all of its workers for a day of seminars, a speech from the local CEO and dramas on AIDS. John Strydom, Ford's medical director in Pretoria, installed condom dispensers and plastered walls with laminated posters announcing Ford's obligations to HIV-positive workers. Despite these efforts by companies, "[n]o large-scale solution to AIDS in Africa is possible until the continent's leaders acknowledge their plague and cheap medicine becomes widely available to fight it," Fortune states. (See Science & Medicine for an update on vaccines in clinical trials.) HIV/AIDS in Africa is "a complicated, maddening dilemma," which will cause suffering for decades "[n]o matter what well-intentioned people do" (O'Reilly, Fortune, 11/13).This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.