Postcard From Pretoria
One of my former students, Katy Glenn, is working in South Africa and sent me the following post on the ongoing AIDS pandemic:
There is much talk here about HIV/AIDS, especially after the release of a major study on the epidemic like the update just published by UNAIDS. The discussion generally focuses on whether AIDS prevention campaigns are working, how to make anti-retroviral drugs accessible to more people, and why Thabo Mbeki's government continues to take such a perplexing, and often infuriating, approach to combating the disease's spread throughout South Africa's population. There is less attention paid, however, to what HIV/AIDS means in terms of the continent's security.
Africa's AIDS crisis has dealt a severe blow to its militaries. UNAIDS estimates that the HIV prevalence rate in African militaries is two to five times the rate among the comparable civilian population in times of peace, and far higher during an ongoing conflict. This is a chilling statistic under any circumstances, but especially when the stunningly high rates of HIV/AIDS prevalence in Africa are taken into account. In sub-Saharan Africa, the HIV prevalence rate among adults aged 15-49 is 7.2%. In Southern Africa specifically, the numbers are higher still: 21% in Zimbabwe and a devastating 29.5% in South Africa. Studies have shown that the armed forces in Angola, Cameroon, Nigeria, South Africa, and Uganda have much higher rates of infection than the general population. AIDS is the leading cause of death among members of Africa's armed forces--outstripping both combat and malaria.
Consider the case of South Africa, which receives 8% of the total foreign aid given to fight HIV/AIDS, and has partnered with the United States to study ways to manage AIDS within the military. Even here, the HIV prevalence rate among the South African National Defense Force (SANDF) is estimated by the minister of defense to be around 23%, and seven out of every ten deaths in the military are AIDS-related. Despite its relative wealth and the substantial amount of aid it receives to fight HIV, South Africa cannot afford to put all HIV-positive soldiers on anti-retroviral drugs. The health of the South African military has repercussions for all of Africa, given South Africa's involvement in peacekeeping operations across the continent.
The problem is not just one of the numbers AIDS kills within the military, but whom it kills. When high-ranking officers are claimed by the disease, years of experience and investment are lost, and the military is faced with a dearth of qualified soldiers to take leadership positions.
Weakened, depleted African military forces translate into trouble on three fronts: First, an increased likelihood of attempted coups d'état against governments perceived to be too weak to defend themselves; second, more protracted civil wars between rebel forces and state troops (a corollary to this problem is an increase in recruitment of child soldiers); third, an inability to, as the popular phrase puts it, find "African solutions to African problems," which most often means sending African troops to handle continental conflicts. The US and the EU have enthusiastically embraced the idea of supporting African peacekeeping forces and thus keeping their own soldiers out of Africa, but if HIV prevalence rates among the continent's armed forces do not decrease, we will before long reach a point where there just aren't enough African soldiers.















Dean Slaughter
While what is happening in South Africa and throughout Africa can make one weep isn't clear that American's, even Black Americans, don't care? We may want to keep AIDs or ebola in Africa but other than that is there a continent that concerns America less? With the end of the Cold War places like Angola, Somalia, Ethopia have all dropped off the radar screen.
Even the nothern tier of the continent which has oil doesn't excite Americans. Rather that appeals to either statistics or empathy doesn't Africa have to be brought into the world community now? Trade links and the like aggressively established so that we give Africa an occaissional thought before much of the continent is decimated?
November 30, 2005 6:27 AM | Reply | Permalink
Thank you very much for passing this along.
There really are a limited number of things the US can do to help in this situation. As Daniel Greenbaum points out, we pretty much have chosen to do nothing at all. One of the things we could do is teach condom usage and distribute condoms to Africa. But we have chosen not to do that because it offends the sensibilities of some Americans.
Like many of the things we have chosen to ignore or do nothing about, Americans will not see consequences for ourselves for years to come. But if Africa devolves into complete chaos I would imagine it would be a wonderful place for terrorist recruitment and training. Instead of one country ruled by the Taliban, imagine a continent of nations like that.
November 30, 2005 6:59 AM | Reply | Permalink
Maybe the war in Iraq is turning me into an isolationist, maybe I always was an isolationist. But when I look at the results of our interventions in the affairs of distant contries, with which we have little or nothing in common, I am not encouraged by the results. While I can see why our leadership in areas like AIDS prevention is useful, I do not regard the fact that too many Africans and their respective leaders seem unable to respond to the causes of these own problems as being our cross to bear. Furthermore, if we spend less time meddling in other countries affairs we will probably find that various types of radical political groups will find fewer reasons to see us as "Target #1", in their jihads.
November 30, 2005 11:49 AM | Reply | Permalink
The discussion generally focuses on whether AIDS prevention campaigns are working, how to make anti-retroviral drugs accessible to more people, and why Thabo Mbeki's government continues to take such a perplexing, and often infuriating, approach to combating the disease's spread throughout South Africa's population.
Why are Americans supposed to care when Mbeki is in denial about the disease. This is a very strange situation where NGOs and medical aid from all over the world has shown Africans that the disease is preventable by the use of condoms and for a variety of cultural reasons they refuse to use them, even when they are free.
What are we supposed to do as a country and a culture when millions of people in other countries persist in self-destructive behavior? Just think what Africa will look like if we do have a new flu pandemic. Millions of people with compromised immune systems will die and no one will be able to do much about it.
It is discouraging to read these commenters lapse into the default "US isn't doing enough" mode when much of the money spent on this now in Africa is useless if people there continue to deny reality.
November 30, 2005 12:00 PM | Reply | Permalink
kiltedliberal makes a good point that by ignoring the problem, we sign our own death warrants. Or at least, our own disease warrants. We live on one planet. Whatever the problems in Africa, ignoring them is not an option.
That said, it's frustrating to send help down what looks like a rathole. Cultural attitudes, especially toward rape of women and children, are the worst. But also bad are the problems of female poverty and status so low that only a minority even ask for condoms to be used. The concept that men might want to use condoms for their own sakes, if nobody else's, doesn't seem to be on the map. And then there are customs, which might be modifiable by education campaigns, that help spread the disease. One example is drying the vagina before sex because this is supposed to make it more pleasurable (for the man). Hard to imagine that it does much for pleasure, but it certainly helps spread AIDS.
Viciousness, poverty, and customs spread the virus in a flood, and we're there with our teaspoons, trying to bail. It's better than not being there at all, but it feels so hopeless. Does anyone know of ways some of these cultural and female powerlessness issues have been addressed? Has anything been found to work?
November 30, 2005 12:36 PM | Reply | Permalink
thanks much for this roundup; appreciated.
November 30, 2005 3:23 PM | Reply | Permalink
Great post, Dean Slaughter. And the rest of the discussion has been equally interesting. The question of Africa - whether it counts or not, how to engage with the continent, among other issues - must be central to any new thinking about a progressive foreign policy. How wonderful then to discuss the topic in this forum.
In just these first 5 comments (Greenbaum, Campesino, Kilted Liberal, Razzor, Quixote), one comes across a wealth of insights and opinions. To nearly all, the situation is devastatingly frustrating, to the point of hopelessness. Yet, nonetheless, several consider the possible outcomes if the situation continues to deteriorate at the present rate: risks to global and American health, a continent of failed states and terrorist breeding grounds, and as the post itself concludes, a vast increase in the risk of internal conflicts and humanitarian disasters with the potential to draw in American and other outside forces. Deep-rooted cultural norms are seen as a dominant cause of the problems, thus bewildering all attempts to solde the problem through aid. And taking up the new liberal non-interventionist position, one commenter argues that a) if the problem is in large part fueled by an inability or unwillingness to act on the part of nationals and their leaders, then such problems are not our responsibility, and b) that interventions in distant lands can actually increase the rage directed against us, rather than increasing goodwill. All in all, a rather terrible situation.
I would argue that the tragedy of the situation does not allow for hopelessness, but rather requires our urgent attention and some very creative thinking. It is one world, as was mentioned, and this fact is all the more relevant for the U.S. Our security and other national interests are tied up with the wellbeing of all the world in a way that is not true of any country, both because of the range and extention of our nationals and their interests and due to our role as a global leader (which is ours by virtue of our wealth, capabilities, values, and history--whether we want it or not). And as good liberals, some of us are already coming up with some solutions: more and deeper trade links, get rid of the evil abortion-rider on our aid dollars, use our aid to help alter cultural norms as much as on other spending programs. Excellent ideas all.
I would suggest that as with many other critical areas of the world, American engagement with Africa, and particularly vital questions such as its poverty and struggle with AIDs is critical, not only for the future of the continent but for American security as well. If we fail to engage, fail to support reformers and the stability of states, then we only strengthen the forces of fragmentation. Moreover, we cannot improve our knowledge of the problems Africans face, or apply our techonology and research capacities to their solution, if we are not there. If the situation looks hopeless now, it wil be determinedly so if we decide now to pull back and let events run their course. The converse, that increased engagement, efforts, and aid dollars wil necessarily lead to a betterment of the situation, is not guaranteed. But sometimes you have to be bold and take risks, and really this one is a no brainer.
I like reading President Bush’s speeches, because as surely as his policies bend to the most conservative ends of social, economic, and foreign policy spectrums, his political rhetoric consistently is rooted in the best of center-left thought. As a case in point, I would argue that Bush is absolutely correct in stating that the greatest security threats facing our country in the near, middle, and long term, are related to weak and failed states. There are two distinct reasons why this is the case. First, because these states harbour and nourish global public bads, whether they be big open spaces free from state oversight (and thus facilitative of terrorist training), corrupt officials who are useless in the war against drugs, radical ideologies (which oftentimes arise out poverty, inequality, and social exclusion), diseases, or any of which threaten to spill out into the international sphere causing problems for other states—particularly one as extended as we are. Second, such states are prone to enter into conflict with their neighbors. Particularly in an age of resource scarcity, we should worry that these conflicts have the potential to grow, and to pull larger powers inexorably into the mess. By this view, then, Africa becomes ground zero for the prevention today of a number of of America’s security risks of tomorrow. In other words, part of the new perspective that progressives MUST bring to security planning for the future is the centrality of Africa. That’s right, the centrality of Africa.
What can we do to solve the AIDs crisis? I’m not sure, honestly. But that’s why we so desparately need to spend more of our time and resources in asking the questions and seeking the answers. So the response to the new liberal non-interventionists, is two-fold. First, the region is different. There are no (or hardly no) anti-American jihadis in Southern Africa—yet. That could all change if hopelessness and violence futher overwhelms the continent’s peoples, but for now, there just isn’t the large stock of people who hate us in Southern Africa like there is in the Middle East. And second, we don’t really have another option besides more engagement. The status quo has disastrous ramifications for Americans’ future. Instead, we need to do what liberals do best: honestly face the horror of the situation, but recognize the possibility of progress and get to work.
As human beings, we are all concerned about the plight of Africans—their poverty, disease, and poor governance. As Americans, we must recognize that in the new security context, it all counts, particularly places with such devastating combinations of circumstances. Africa must be made central to our foreign policy—not for humanitarian reasons alone, although a compelling case can certainly be made, but for the sake of our national security.November 30, 2005 4:17 PM | Reply | Permalink
As the author of the postcard, I'd like to respond to a few of the comments I've read. It is especially appropriate to talk about this today, 1 December, World AIDS Day. First off, many thanks to Anne-Marie for posting the piece.
Making generalizations about Africa as a whole, whether they be about what African governments are willing to do to fight AIDS, what cultural beliefs Africans hold, or what Africans know about AIDS, is dangerous. We should remember that this continent encompasses Darfur and Pretoria, eastern DR Congo and Lagos. There are, obviously, different levels of awareness about AIDS depending upon where in Africa one lives, and different responses needed to fight AIDS in various countries.
The December 2005 UNAIDS update on Sub-Saharan Africa can be found here. You will find that HIV prevalence is decreasing in some countries and staying steady in many others, that there is solid evidence that sexual behavioral change is taking place, and that there is still much work to be done in creating awareness about this disease.
What US citizens can do: Urge the government to spend more to fight AIDS (we may be spending more than anyone else, but it's not nearly enough.) Tell Bush to lift funding restrictions on NGOs that don't share his views on certain reproductive-rights matters. Finally, perhaps the most important thing: Get a discussion going with friends, your congressional representatives, and/or that guy in line behind you at Starbucks, about why it is that we already have anti-retroviral drugs that can transform AIDS from a deadly disease into a chronic condition, but we are not giving them to all those who need them. Why do we so easily accept the excuses drug companies give us?
Finally, why Americans should care about the prospect of failed African states: Remember the 7 July London bombings? One of the men suspected of planning the attack, Haroon Rashid Aswat, was arrested in Zambia on 20 July. Prior to the bombings, he spent several months in South Africa and also passed through Botswana. Furthermore, South Africa's own intelligence minister says al-Qaeda views SA as a safe haven, and he believes al-Qaeda's network extends through southern and eastern Africa.
December 1, 2005 5:56 AM | Reply | Permalink
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The hollowing out of African militaries due to AIDS is a significant problem, and one that, as the author points out, bodes ill for peace-keeping operations as well as African solutions for African problems. What this means for American national security is another question. I think there may be a temptation to overstate what state failure and governance problems in Africa mean for the U.S.
I fear that advocates who use national security language do so because they think the issue won't get enough attention otherwise. The striking thing about HIV/AIDS it seems to me is that moral concerns have been important drivers for this White House to do something significant about the disease. The question becomes, would they have done that much less if concerns about state failure and terrorism (and wanting to project a benign face of America) not been other important considerations? To put it bluntly, did it take 9/11 to get PEPFAR?
Given the mobilization of Christian conservatives on this issue, along with more liberal AIDS activists, I think this White House was prepared to do a lot already.
I have a posted on this at my blog.
December 2, 2005 9:03 AM | Reply | Permalink
Two thoughts come to mind from reading all of the comments here. One is: we are spending hundreds of billions of dollars in Iraq for war, but not even a tenth of a percent of that in Africa for health betterment. That is an obvious clue if there ever was one.
A second thought is that the road to stopping AIDS in Africa may be the educational road. If we can improve African schools, get more Africans to gain high school and college educations, the cultural barriers others mentioned here can be breached. Without that I doubt that they can.
So, I think the best approach to the AIDS problem in Africa is to accept the need to spend more of our money there - by purchasing AIDS treatment drugs and distributing them there, for example. And, to find ways to increase the education levels in African countries, something that would help a great deal in our own country too, of course.
In any case, there isn't going to be a magic bullet fix for this problem, anymore than there is for the Darfur problem. It is going to be a long drawn out process.
December 3, 2005 9:16 PM | Reply | Permalink