Academic journal article Harvard International Review

The Politics of a Health Crisis: Why AIDS Is Not Threatening African Governance

Academic journal article Harvard International Review

The Politics of a Health Crisis: Why AIDS Is Not Threatening African Governance

Article excerpt

Africa's HIV/AIDS epidemic has engendered many nasty surprises. In the 15 years after the continent's first AIDS cases were reported on the shores of Lake Victoria in the early 1980s, the virus spread further and faster than any epidemiologist predicted. Early predictions stated that it was impossible for more than 10 percent of the adult population to become infected; this ceiling, however, was soon broken as infection rates reached 20 percent, 30 percent, and even 40 percent in some populations, at which point the lifetime chance of a teenager contracting and dying from the disease became almost a complete certainty. Life expectancy crashed in a manner unprecedented for a peacetime population, with some southern African populations seeing expected longevity plunge from about 60 years to fewer than 40.


Scholars of historical calamities observe that one disaster often portends a second calamity. Economists have projected that the loss of national income due to AIDS could send some economies into a tailspin--described as "Adam Smith in reverse" by Malcolm McPherson of Harvard's Kennedy School of Government. Management specialists expected that loss of skilled workers would result in essential services such as schools and clinics, not to mention army and police forces, grinding to a standstill. Drawing upon studies of how the rural poor survive famines, I coined the term "new variant famine" in 2002 to describe the vicious interaction between drought and AIDS which was unfolding in southern Africa at that time. I argued that households hit by the disease would be unable to cope with the extra demands of a food crisis and would be plunged into indefinite destitution. Political scientists feared for Africa's stability. How could democracy function when, as one Kenyan nurse protested, "All the voters will be dead?"

Some of these fears are indeed materializing. Others still loom. But some have been proven unfounded or at least exaggerated. Foremost among the dire predictions that have not come true is the expectation that the epidemic would cause a governance crisis, leaving conflict, repression, and anarchy in its wake. Africa has these ills aplenty, but AIDS has not been indicated in their etiology.

Marginalization of AIDS in African Opinion

Since 1999, the University of Cape Town has conducted public opinion surveys in a growing number of African countries. These "Afrobarometer" surveys are a rich source of data on what ordinary citizens think. They have revealed a simple but surprising fact about public opinion: namely that AIDS is never at the top of the list of issues of concern for a population. That position is occupied by unemployment, poverty, famine, and crime, depending on the country in question. Although "health" occasionally comes in at number two, AIDS very rarely breaks into the top three, or even top five issues, though in some countries, notably South Africa, it has been climbing the ladder of concern.

AIDS occupies a commensurately marginal place in African political life. No African government has been overthrown because of its AIDS policies. No election has been decided on this issue. In fact, in South Africa, the ruling African National Congress (ANC) was reelected with an increased majority in 2004 despite President Thabo Mbeki's notorious denial that HIV causes AIDS. True, South Africa has seen street protests over access to treatment, but the Treatment Action Campaign (TAC), which organizes them, has no counterparts elsewhere in the continent. Furthermore, its agenda is reform and not revolution. Surprising as it may seem to AIDS activists from elsewhere, many TAC leaders remain loyal ANC members. Their dispute with Mbeki is not the insurrectionary fervor of the ANC toppling apartheid, but rather one wing of the new political establishment struggling to bring its errant colleagues back in line.

Why is it that a disease which will kill one in six adult Africans and more than half of adults in the continent's southernmost six countries is not the subject of overwhelming political passion? …

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