THESE WORDS by Joel Pauls Wohlgemut, appearing in his 2002 prize-winning Canadian Medical Association Journal article, "AIDS, Africa and indifference: A confession," are arguably some of the most courageous to appear in the academic literature in recent times. It is a confession of indifference: indifference to the African AIDS crisis that now claims the lives of about 5,000 Africans daily and accounts for 80 percent of the world's AIDS deaths. Africa is also a continent that houses 95 percent of the world's AIDS orphans, 70 percent of the people newly infected by HIV, and 90 percent of the world's children living with HIV/AIDS. Needless to say, the amount of human suffering behind these figures is almost unimaginable. "Viewed from the perspective of suffering," writes P. Farmer and A. Kleinman in "AIDS as Human Suffering" (published in 1998 in P. J. Brown's Understanding and Applying Medical Anthropology), AIDS must rank with smallpox, plague, and leprosy in its capacity to menace and hurt, to burden and spoil human experience, and to elicit questions about the nature of life and its significance. Suffering extends from those inflicted ... to their families and intimates, to the practitioners and institutions who care for them, and to their neighborhoods and the rest of society
Africa's past advances in human development have been literally reversed by the HIV/AIDS epidemic, with indices such as life expectancy plummeting by twenty years in some countries. The burden of this pandemic no doubt presents an economic nightmare for an economy already in distress--where about 300 million (approximately 50 percent) of the continent's people live in extreme poverty, fewer than half the children complete primary school, and drought cycles have become more frequent, greatly affecting the capacity to produce food. Recently, proportions of the African population having access to health services, safe water, and sanitation have been reported to be 51 percent, 40 percent, and 31 percent, respectively. The debt burden for Africa stood at $315 billion in 2000, and all African countries except the Republic of South Africa were reported to be spending more on servicing this debt than on health care. With some African countries now receiving aid in the form of loans, the economic situation can only get worse.
Accounting for less than 1 percent of world exports, it is clear that Africa will never emerge from the AIDS calamity on its own. Despite aspirations of better healthcare for all Africans, many would now agree that most African countries are just too poor to doctor themselves against AIDS and its consequences. Perhaps what remains their only hope is that other nations, acting out of concern and respect for human dignity or whatever moral code, might come to their aid and provide relief.
Over the past years, however, the AIDS crisis in Africa has worsened to catastrophic levels, with little being done to arrest the progress of the disease there because many in the affluent world, as A. Trowbridge wrote in the November/December 2000 Humanist, "looked upon assistance to Africa as charity that [they] had a right to offer or withhold." As a consequence, with too few domestic resources of its own, what contributions Africa has received have had little meaningful success in staunching the growth of HIV and AIDS on that continent. The 1990s saw the commitments of many donors decline to a trickle and become increasingly sporadic. Aid levels have dropped relative to the growth of HIV--to the extent that the lack of finances has become the primary constraint on progress against AIDS in Africa. And as we saw recently when the G-8 met at Gleneagles in Scotland, it now takes the world's biggest rock concert to focus the attention of the world on the plight of Africa's poor.
In response to the plummeting aid levels, the United Nations introduced the Global Health Fund with the goal of raising $10 billion annually--from governments of the economically affluent countries as well as private donors--for the fight against HIV/AIDS, tuberculosis, and malaria in the developing countries. …