On January 10, the United Nations Security Council made history. For the first time, it focused on a health issue as a matter of international security. Some countries criticized the U.S., as that month's chair, for trivializing the organization's role or even as being a showcase for Al Gore's run for the presidency. But a look at the numbers leaves little doubt that AIDS in Africa threatens to move beyond a regional disaster to a global catastrophe.

How Bad is the Problem?

The western world periodically shakes its head at the number and viciousness of wars in Africa-as though those in Vietnam, Cambodia, Iraq, Bosnia, Kosovo and Colombia were somehow more humane. They were not, of course, but that is rapidly becoming an irrelevant comparison in measuring tragedy by loss of life. AIDS is the new standard of human devastation. Last year, the disease killed 10 times more people in Africa than all armed conflict in the continent. And that is just the beginning of human calamity that is almost beyond comprehension. Over the next decade, AIDS will kill more people in Africa than casualties in all the wars of the 20th century.

More than 16 million people worldwide have died of AIDS: 10 million of them died in sub-Saharan Africa. Little wonder that the United Nations calls the AIDS pandemic there "the worst infectious disease catastrophe since bubonic plague." The Black Death wiped out about 20 million Europeans in the 14th century.

Africa may soon fare even worse.

While the sub-Saharan region has only one-tenth of the world's population, it has over 80 percent of the global total of those with AIDS. More than 20 million people are already HIV infected, and nearly 500 more become infected each hour. The U.N. projects Africa's averaged life span to drop by 14 years between 1990 and 2010. In some parts of Africa, coffin making has become a growth industry.

The pandemic is causing massive changes in all of life in most sub-Saharan African countries. A report in December by the U.S. Office of National AIDS Policy indicates that in some areas, up to one-quarter of all children live with an HIV-positive parent. In nine countries, one-fifth to one-third of all children under age 15 have been orphaned by AIDS. Across the continent, there are over 10 million AIDS orphans, and during the next decade, that will rise to 40 million. A whole generation of children is being traumatized by watching their parents die before their eyes. A few of these children are taken in by charitable institutions, others by family members or neighbors. Some simply live on their own as best they can. They are often exploited as a cheap labor source and are at extraordinary risk of physical and sexual abuse. Too many end up on the streets where casual sex becomes a way of life and prostitution a way to survive. All this, of course, will increase still further the rate and extent of HIV-AIDS.

Governments forced to spend more and more trying to control AIDS see death rates rise from other diseases that are left unchecked as funds are shifted. Children drop out of school to help care for dying parents and never return. Decades of painfully slow economic progress is being rolled back by a disease that robs nations not only of the energy of workers, but of skills that might have been passed on to others, and of a generation of children who will never have the chance to learn.

One study indicates that over the next 20 years AIDS will reduce the economies of sub-Saharan Africa by one-fourth. This has moved Harvard economist Jeffret Sachs to note that "a frontal attack on AIDS in Africa may now be the single most important strategy for economic development."

But this is not just an Africa problem. Trends in infection rates indicate that AIDS deaths in Asia will mirror those of Africa unless drastic actions are taken soon. India already has more HIV-infected persons than any other country-an estimated FIVE million, and that is expected to double every 14 months. All of South East Asia seems similarly threatened and China may be as well. Russia has seen its HIV infection rate double in just two years. AIDS is the world's problem.

How Did This Happen?

There is no mystery about how AIDS spreads. Despite the western alarm about a tie to the drug culture through shared needle use, for most of the world's people the disease is transmitted mainly by heterosexual contacts. The good news is that control is possible, even at the individual level. The bad news is that controlling infection involves inducing basic changes in one of life's most sensitive areas, human sexual practice.

There are many reasons why HIV/AIDS has become rampant first in Africa. In many countries, multiple sex partners, particularly for men, is the norm. Even marriage may reduce the numbers only slightly. A survey done in Zambia last year reported that 80 percent of married men in that country are involved in extramarital affairs. Thus, the risks of infection are involved in extramarital affairs. Thus, the risks of infection are brought home to wives and girlfriends who may not themselves be promiscuous. This has led to an HIV infection rate even higher among women than among men in sub-Saharan Africa.

Underlying the sexual promiscuity that has caused AIDS to explode are economic realities that make control difficult. In sub-Saharan Africa, the search for work and income often separates families. Thousands of men leave their villages to labor in mines, many foreign-owned, that have no place for families. Only single-sex dormitories are provided dormitories are provided for workers who live for months at a time far from home. Each mining camp has nearby a ready supply of women "sex workers." The title is one of choice, a reminder that these young women are there for economic reasons of their own. In desperately poor areas, where education and training have often been specifically withheld from women, selling sex provides a way to survive.

Armed conflict is the common way of life in too much of sub-Saharan Africa. In perhaps a dozen major wars and at least twice that number of insurrections, armies and armed bands engage in seemingly endless struggles across the countryside. Men and boys are separated for years from families. The sex trade serves them as it does mine and factory workers, and when willing partners are not available, rape is a constant danger to women.

Protected sex is unknown to many, regarded as too expensive to others, or simply rejected as an unacceptable interference with the cultural rights and expectations of men.

AIDS has exploded in much of Africa, in part because of a conspiracy of silence. Reports indicate that sexual understanding; roles and expectations are almost never discussed between partners and are taboo in public. The has been fueled for almost 20 years by the silence of national leaders who feared the loss of the support of young men if they dared to suggest that sexual practices must be changed.

That silence is now being broken. Last September, at an international conference, ten Heads of African states declared AIDS a national disaster that demands an emergency response. One after the other, they indicated that it is the biggest single threat to national and regional development. A year and one-half ago, South African President Thabo Mbeki spoke these words:

For too long we have closed our eyes as a nation, hoping the truth was not so real. For many years, we have allowed the human immunodeficiency virus to spread…at times we did not know that we were buying people who had died from AIDS. At other times we knew, but chose to remain silent.

Now we face the danger that half our youth will not reach adulthood. Their education will be wasted. There will be a large number of sick people whom the healthy will not be able to maintain. Our dreams as a people will be shattered.

What Can be Done?

The hardest task must be undertaken almost solely by the African countries themselves at risk. There must be changed sexual behavior. Hopefully that will involve a shift away from a social ethic that is too accepting of multiple sex partners. But history and human nature being what they are, there must also be an all-out promotion of safer sex practices. For that to be effective in Africa, women must have a larger role in determining the rules of sexual behavior and in protecting themselves. Thus Barry Bloom, Dean of the Harvard School of Public Health says, "Empowering women is critical to controlling the (HIV/AIDS) epidemic."

There are other steps that almost certainly will have to involve the richer countries like ours:

Aids cannot yet be cured, but its health effects can be softened and life can be extended with today's potent drug cocktails. Every effort should be made to extend these at the lowest possible cost in less developed countries. That means finding ways to bend what has become the iron law of patent rights and proprietary knowledge. There must be ways of ensuring that life-saving substances are not left solely in the hands of profit maximizers. Even so, medication and cure hold little hope for most people in sub-Saharan Africa who can hardly afford food, let alone a lifetime of treatment.

More and better care for AIDS orphans can be provided. That is not merely a humanitarian gesture. It is key to reducing infection. Support for orphanages, village centers and individual families who take in orphaned children can provide an environment safe from sexual abuse and exploitation. It also could provide an opportunity to educate children and equip them with economic survival skills that may make the future more hopeful.

The search for vaccines against HIV/AIDS must be intensified; that means spending more money. The world spends an estimated $200 billion each year on AIDS research, but only $300 million of that goes to vaccine research. Money alone cannot solve scientific problems, but it can speed the process. If an when there is a vaccine, there also must be funds enough to make it available to all those at risk.

The U.S. Response

The Clinton Administration made good use of its temporary position as Chair of the U.N. Security Council to focus world attention on AIDS in Africa. When Vice President Gore spoke there, he announced that the Administration will seek an additional $100 million for the cause, plus $50 million more for vaccine research. That would bring the total U.S. AIDS commitment to $325 million next year.

One problem, of course, is that Congress must provide the money. Another is that the amount is still a very long way from a fair share of the $1 billion to $3 billion per year the director of the United Nations AIDS program says will be needed just to fight the epidemic in Africa alone. Clearly, the U.S. must do much more and so must other rich countries. Africa simply does not have the resources to do it alone, even if it had the will.

Suggested Actions

Congress has weighed into the AIDS in Africa issue with several bills that would amend the U.S. foreign assistance act.

Last summer Rep. Barbara Lee (D-Calif.) and Rep. Mark Foley (R-Fla.) introduced the "AIDS Marshall Plan Fund for Africa' (H.R. 2765). The bill now has 76 cosponsors, including three Republicans, and is in many ways the most comprehensive of the legislative proposals. The legislation would authorize $200 million for each year 2001-2005, plus a 25 percent match of contributions by other governments and private sources. A weakness of the bill is that the Fund it seeks to establish combines U.S. government appropriations with contributions from private sources and other governments and places them under control of the U.S. Treasury. That does not seem likely or practicable.

Rep. Jim Leach (R-Iowa), who is also a co-sponsor of H.R. 2765, has introduced his own bill (H.R. 3519) that builds on Rep. Lee's intent by calling on the U.S. Treasury to negotiate with the World Bank a more proper international " home" for an AIDS Trust Fund. This bill would authorize 100 million for each of the years 2001-2005. A parallel bill (S. 2033) has been introduced in the Senate by Sens. John Kerry (D-Mass.) and Richard Durbin (D-Ill.)

The most comprehensive Senate bill is s. 2026 introduced by Sens. Barbara Boxer (D-Calif.) and Gordon smith (R-Ore.). The bill makes combating HIV/AIDS a priority of the U.S. foreign assistance program. It authorizes $2 billion over 5 years to include in that effort primary prevention and education; voluntary testing and counseling; medications to prevent mother-to-child transmission; and care for those living with HIV/AIDS.

1. Contact your Senators. Urge support for a major commitment this year to fight AIDS in Africa. Suggest that the Boxer/Smith "Global AIDS Prevention Act of 2000" (S.2026) is the most comprehensive measure currently before the Senate and that it deserves their support.
2. Contact your Representative. Urge support for a major commitment this year to fight AIDS in Africa. Suggest that while the Lee/Foley bill (H.R. 2765) is the more comprehensive and better funded approach, H.R. 3519 by Rep. Leach more properly locates the AIDS Prevention Fund in the World Bank rather than in the U.S. Treasury. Both bills deserve their support.

Addresses

Honorable________
U.S. Senate
Washington, DC 20510

Honorable________
U.S. House of Representatives
Washington, DC 20515

General Assembly

The 1994 Assembly resolution on "Compassionate Ministry in Dealing with the Issue of AIDS" states: "We acknowledge that we are a global community. While the scourge of AIDS is devastating to the United States, it is much greater in magnitude in other parts of the world community. We recognize our responsibility to encourage AIDS education and prevention policies…"