Newsday - May 30, 2001
Laurie Garrett, Staff Writer

Brundtland, the former prime minister of Norway, was named director general of the World Health Organization a year and a half ago. Since then, she has cornered ministers of finance, World Bank officials and other economic leaders to convey her message: AIDS and economic development are intimately linked.

In an exclusive interview with Newsday, Brundtland said government leaders' recognition "that AIDS is key to development is a real level up from what was business as usual a year ago.ö

Brundtland, a blunt and canny politician, taps her pen sharply against a pad, the concussions underscoring her points. "We are all in this together,ö she says. "We have to be increasing our attention to the levels of the challenge. Remember: It's a political issue.ö

As the impact of AIDS intensifies and extends, hope for economic development and improvement in the lives of the world's poor can be expected to evaporate.

Echoing Brundtland is United Nations Secretary General Kofi Annan. Earlier this month, he told the World Health Assembly in Geneva: "The biggest enemy of health in the developing world is poverty, and the struggle for health is part and parcel of the struggle for development ... and yet the devastation wrought by HIV/AIDS is now so acute that it has, itself, become one of the main obstacles to development.ö

Behind the scenes, economist Robert Hecht and his boss, Dr. Peter Piot, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), have been pushing the world's financial leaders for two years to commit resources to battle HIV in order to forestall inevitable economic tolls a decade later.

Hecht, an American formerly attached to the World Bank, makes a pitch using a simple graph that plots HIV prevalence on one axis and gross domestic product per capita, or GDP, on the other. Since GDP is the classic measure of economic strength, the graph "is a show-stopper,ö Hecht says, striking a nerve among financial leaders.

It demonstrates a direct relationship between HIV prevalence rates and declining GDP in hypothetical countries. If a country has an HIV prevalence of, for example, 20 percent HIV in its adult population, its GDP will fall every year by about 1.2 percent.

In real terms, that means in a nation like Tanzania, with an HIV prevalence of about 20 percent, citizens -- regardless of whether or not they are HIV-positive -- will see the value of their wealth decline, year after year, by about 1.2 percent. After a decade, even with a stable HIV rate, the nation's economy would take a substantial hit.

The World Bank recently forecast 30 percent to 40 percent drops in GDP by 2020 for several African nations. That would follow five decades of loans and investments aimed at improving desperate conditions in poor nations.

"I don't think we've yet fully understood the magnitude of the impact of the interactions that are coming down the road,ö Hecht said recently in his Geneva office. "On labor, on the civil service, on teaching corps, on medical corps -- as they get depleted [by AIDS], how is that going to have negative impacts on the future of these countries? I believe it's going to be pretty frightening stuff, as we go forward.ö

The pitch from UNAIDS calls for every nation to spend more now to slow down the virus.

"If you spend now you'll spend less than if you wait,ö Hecht tells ministers of finance.

This year some of the world's leaders have responded. Thirteen African nations have pledged $43 million from an estimated $700 million in their newly granted debt relief funds. Four other African nations -- including Zimbabwe and South Africa -- will spend a combined $85 million on AIDS programs. And oil-rich Gabon just announced creation of a $1-billion fund for AIDS prevention and treatment.

The poor nations are now spending their own money -- not just funds donated by the rich world, the UN and charities. Kofi Annan last month asked African leaders gathered at the annual Organization for African Unity summit to commit 15 percent of their budgets to health, including AIDS; the leaders agreed to do so as a matter of principle, rather than firm commitment. Still, it reflects, Hecht sayss, that the big message -- linking economic development to the pandemic -- is making Africa's leaders fearful about the futures of their fragile economies and political systems.

Some African observers think AIDS has already proven destabilizing to both national economies and politics. Dr. David Katzenstein, an AIDS specialist at Stanford University in California who has worked in Harare, Zimbabwe, for 16 years, goes so far as to connect the epidemic with political struggles. "Why was there holocaust in Rwanda?ö he asks. "Why is Central Africa falling apart? Why is [Zimbabwean President Robert] Mugabe still in power?

"In part it's because these countries are in a mass psychosis due to AIDS. Why would we expect people to behave any more rationally than our European ancestors did during the Plague? In terms of Africa regaining a role in the world economy, it's got to work this problem out first.ö

David Gordon, an analyst for the CIA and the National Intelligence Council, says that the pandemic "will exacerbate all of the conditions that have made Africa extraordinarily vulnerable to violent conflict,ö and predicts that all of sub-Saharan Africa will experience a 20 percent decline in GDP over the next 20 years.

The relationship between the disease, economics and violence is both direct, "and it is indirect. Disease is not going to lead directly to violence,ö conflict analyst Thomas Homer-Dixon of the University of Toronto explains. "Disease will have a tremendous capacity to weaken the state.ö

Earlier this month, the United Nations Food and Agriculture Organization issued a report on the impact AIDS has leveled upon African agriculture. Since 1985, the FAO says, 7 million agricultural workers have died of AIDS on the continent, and 16 million more deaths are expected by 2021. Poor farm families live so marginally to begin with that even a single death in the household plunges a family into malnutrition, according to the report. And since agricultural production in most African countries is women's work, the illness and death of a mother means that "agricultural skills may be lost since children are unable to observe their parents working.ö

Economic development experts have engaged in finger-pointing, with many blaming the World Bank for placing Africa, in particular, in a vulnerable position during the early years of the pandemic. Harvard economist Jeffrey Sachs, for example, argues African leaders were encouraged during the 1970s to borrow heavily in order to build roads and modernize.

"Then, in 1981 to 1982, interest rates globally soared, countries went bankrupt. And this coincided with the explosion of AIDS,ö Sachs said in a speech earlier this month at the Aaron Diamond AIDS Research Center in Manhattan. African countries couldn't repay the debt, and Sachs said the message from the World Bank and other leaders was, "You're in trouble because you made mistakes. Don't expect us to bail you out.ö

By 1999, AIDS was sweeping across the continent -- and, according to Sachs' calculations, all outside financial help to assist the AIDS fight totaled just $70 million. What Africa needs, he says, is something in the neighborhood of $10 billion a year in order to wage a war against the virus.

During the 1980s, as Africa's collective debt soared, the World Bank ordered social spending cutbacks in poor countries, and during that decade health spending fell on average by half.

Throughout Africa, medical services such as those for treatment of sexually transmitted diseases were no longer free. Kenya, for example, charged a fee of $2.15 per visit to a sexually transmitted disease clinic, and a 60 percent decline in patient visits followed -- even as AIDS was spreading, according to analyst Joseph Collins of the University of California in Santa Cruz.

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