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Afrique,mon Afrique,mot des maux.
S Keita
What AIDS Means in a Famine
November 19, 2002
By ALEX DE WAAL
ADDIS ABABA, Ethiopia
Just as H.I.V. destroys the body's immune system, the
epidemic of H.I.V. and AIDS has disabled the body politic.
As a result of H.I.V., the worst-hit African countries have
undergone a social breakdown that is now reaching a new
level: African societies' capacity to resist famine is fast
eroding. Hunger and disease have begun reinforcing each
other. As daunting as the prospect is, we will have to
fight them together, or we will succeed against neither.
About 29 million Africans are infected with H.I.V. The
epidemic is spread by heterosexual transmission almost
entirely. Only 30,000 of these people are receiving
antiretroviral treatment. Between three million and four
million people are dying each year from AIDS-related
diseases. Twenty percent of adults in South Africa live
with H.I.V.; the figure is higher still in Botswana, where
life expectancy has plunged below 40 years.
How do such realities relate to famine? Traditional
agrarian societies in Africa were well adapted to the
threat of drought. Food shortage was like a familiar virus,
unpleasant and painful but one to which most people had
resistance. For example, the victims of famine were almost
exclusively young children and the elderly. Young adults
rarely died - and women survived better than men. Society's
core was preserved, and it could recover. Rural Africans
were experts at surviving famine. Women knew exactly what
wild grains, roots and berries could be eaten as famine
foods when there was no maize. Families scattered their
members over a wide area and called on distant relations
for help when times got hard.
These coping skills meant that rural Africa was forgiving
of the shortcomings of international relief programs.
Typically, calls by the United Nations for food donations
fall short of their goal by half or more. Yet the
inhabitants of, say, Mozambique or Sudan have still pulled
through.
This is changing. We are facing a new variant of famine: in
societies hurt by AIDS, famine is more deadly and less
susceptible to existing treatments. The reason is that AIDS
attacks exactly those capacities that enable people to
resist famine.
AIDS kills young adults, especially women - the people
whose labor is most needed. When the rains come, people
must work 16 hours a day planting and weeding the crop. If
that critical period is missed, the family will go hungry.
In a community depleted by AIDS, each working adult must
produce more to feed the same number of dependents - not
just children but sick adults, too.
The burden of care for those sick with AIDS can cripple a
family. Many employers - private and public - have
withdrawn benefits. Town dwellers who fall sick go home to
the village to pass their final months, to die and be
buried. Children orphaned by AIDS are sent to the village
to be cared for. There is a prevailing myth that the
African extended family will cope with this double burden
of care. We are learning the hard way that it cannot.
The drop in adult life expectancy also has implications
that we are only just beginning to appreciate. The normal
generational cycle means that assets like land and cattle
are accumulated and handed down by the older generation.
Grandparents can assist with child care; older women can
pass on a lifetime's experience of gathering and preparing
wild grains and fruits to their daughters. Today all this
is interrupted. Young people are inheriting debts and are
not learning essential skills. How can a young woman,
looking after six children, have the experience and skill
of her mother or grandmother in cultivating her field,
collecting wild fruits and planning for survival through a
tough year? And can she even make any plans on the premise
that things will return to normal some day?
Finally, the first response of any adult faced with a
harvest failure is to tighten her belt. Relief workers in
Africa have become so used to this physiological resilience
that they ignore adults' nutritional needs and just focus
on children. But adult hunger is no longer a passing
difficulty. A person living with H.I.V. needs better
nutrition - more calories and especially more protein - to
stay healthy. Malnutrition accelerates the progression to
AIDS.
As their livelihoods collapse, their family networks fold
and their coping strategies vanish, millions of young women
are turning to what is called "survival sex" to feed their
children. The consequences for H.I.V. transmission do not
need to be spelled out.
In short, H.I.V. is imperiling the ability of African
societies to reproduce themselves. Even when the rains come
we will not see a return to normalcy but merely a breathing
space. And we will be forced to appreciate just how
different this crisis is.
Some senior United Nations leaders, notably Kofi Annan, the
secretary general, have recognized the scale and gravity of
the AIDS cataclysm and its link to famine. But the policy
tools we have are blunt, fashioned for a different kind of
crisis. We can't just ship in food. Food assistance and
scaled-up antiretroviral treatment must go hand in hand. We
need imaginative and large-scale responses to the burden of
care: how to support the millions of people who are looking
after dependent children (many of them orphans) and people
with AIDS? We need to re-examine farming systems to put
more money into farmers' hands and more protein on their
tables. Above all, we need to restore a sense of the future
to a generation facing an appalling crisis, to help unlock
their energies in search of solutions.
Alex de Waal is director of Justice Africa and an adviser
to the United Nations Economic Commission for Africa and
Unicef.
http://www.nytimes.com/2002/11/19/opinion/19DEWA.html?ex=1038776596&ei=1&en=3a66d6f4e1df367a
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