HIV/AIDS and Human Security: A Focus on Women and Economic Security in Southern Africa

By
Elizabeth Armstrong-Mensah, PhD. 

                                                      
Introduction
HIV/AIDS was identified by Joan Holmes, former president of the Hunger Project, as the deadliest epidemic in the world since the bubonic plague of the Middle Ages. First surfacing in the early 1980s, the disease has to date infected over 33 million people around the world. (UNAIDS, 2008) Although the incidence of HIV/AIDS is varied throughout sub-Saharan Africa, and although it is incorrect to speak of a single African epidemichttp://en.wikipedia.org/wiki/Epidemic, sub-Saharan Africa is the region most affected by the epidemic. Inhabited by 14.7% of the world's population, the region is estimated to have more than 22.4 million (67%) people living with HIV/AIDS, with Southern Africa bearing a disproportionate burden of the load. In 2007, the region accounted for 35% of all people living with HIV worldwide and 32% of the world’s new HIV infections and AIDS deaths. 

While not the traditional form of threat to human security, the impact and consequences of HIV/AIDS has catapulted it to a level where it is now considered a new security issue. Whereas the latter form of security focuses on the state, the former has human beings at its center. Regardless of this difference, they both threaten human survival.  HIV/AIDS, on its part, does this by affecting the basic structure and functioning of society through the reduction of society’s ability to produce and distribute food, the loss of skilled human resources needed for effective government, political instability and economic decline. The ensuing results are refugee problems, complex humanitarian emergencies, crime, and a cycle of disease. Although the populations of Africa have been described as elastic in the past, it is certain that the virus will extract a huge cost from the people of the region, and particularly southern Africa in the near future if nothing is done to stem the tide.

This paper examines the impact of HIV/AIDS on women and the economic security of the southern African sub-region. The intent is to underscore the detrimental impact of the epidemic in this part of Africa, get the national governments of these countries to pay greater heed to the disease and as a result, intensify and pursue more aggressive prevention strategies to curb the epidemic so as to curtail further human and economic loss.  

The Concept of Human Security and HIV/AIDS 
The term human security refers to the safety of people from both violent and non-violent threats. It is an alternative way of looking at the world, with the security of people at the center of affairs rather than the security of governments per se. Human security has to do with vulnerability and a condition of being characterized by pervasive threats to individual freedom, rights, safety and survival. Akin to other security concepts, human security is about protection (Fourie and Schönteichl, 2001) and involves taking preventative measures to reduce vulnerability and risk.    

AIDS is the acronym for Acquired Immune Deficiency Syndrome. The ‘Acquired’ part of the acronym denotes that AIDS is not hereditary, but a disease that develops through contact with a disease-causing agent, and the "Syndrome", part, to the fact that AIDS is not a single disease, but a medley of diseases. HIV stands for Human Immunodeficiency Virus. The ‘Immunodeficiency’ part of HIV indicates that the malady is characterized by a weakening of the human immune system. HIV cause AIDS. People diagnosed with AIDS become susceptible to life-threatening diseases called opportunistic infections, which usually would not cause illness in healthy people. When someone dies from AIDS what is being implied is that the person died from the onslaught of opportunistic diseases.  HIV is spread through having unprotected sexual intercourse with infected persons, the transfusion of infected blood, the sharing of needles, syringes, and other drug use equipment with infected persons and from mother to child through pregnancy, childbirth or breast feeding. 

Traditionally, the concept of ‘security’ was interpreted in only militaristic terms as the defense of the state, using structured violence in the form of warfare. However, with the demise of the cold war, this narrow definition was expanded to include issues that go well beyond the presence or absence of armed conflict, to issues which affect health and social services, family composition and social structure, economies and food security among other things. Although HIV/AIDS is not included in the traditional definition of security, current global trends prove that it is indeed a security issue. Thus, Hadingham (2000) posited that,  

…HIV/AIDS poses a pervasive and non-violent threat to the existence 
of individuals, as the virus significantly shortens life expectancy, undermines
quality of life and limits participation in income-generating activities. 
The political, social and economic consequences are equally detrimental to
 the community, in turn undermining its security.

Global Recognition of HIV/AIDS as A Human Security Issue
Prior to 2000, HIV/AIDS was viewed as a public health issue to be discussed only in health fora. When the United States first pushed to have HIV/AIDS discussed in the United Nations (UN) Security Council, many nations protested for procedural reasons. They felt the Security Council was not the appropriate venue to discuss health matters. However, in January 2000, the UN Security Council, responsible for the maintenance of international peace and security, made a historical move by debating the impact of HIV/AIDS in Africa within the context of security.  On July 17, 2000, the UN Security Council made yet another historical move by adopting Resolution 1308, which established HIV/AIDS as a potential threat to human peace and security.  A year later, member states of the UN, recognizing the magnitude of the epidemic, in another unprecedented move, unanimously adopted the UN Declaration of Commitment on HIV/AIDS during the UN General Assembly Special Session on HIV/AIDS in June 2001 by declaring that: 

HIV/AIDS constitutes a global emergency and one of the
most formidable challenges to human life and dignity...                                                               and social development.

The Scourge of HIVAIDS in Southern Africa
In the mid-1980s, HIV and AIDS were virtually unheard of in southern Africa, but currently, the opposite is true. According to current statistics, AIDS is now the number one killer of people in Southern Africa; claiming more lives than the raging conflicts and wars on the continent (UNAIDS 2000). National HIV prevalence rates vary in sub-Saharan Africa. In West, Central and the horn of Africa, the prevalence rates in 2007 were under 5% of the adult population aged 15 to 49, but exceeded 15% of the same population in seven Southern African countries namely, Botswana, Lesotho, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. (Rebombo, 2006). The HIV epidemic in West, Central and East Africa has remained relatively stable with comparatively lower prevalence rates than in Southern Africa. (WHO, 2004).

In southern Africa, as many as one in four people have HIV/AIDS. It has been estimated that half the infected population acquired the disease before the age of 25. With this trend in infections, the life expectancy of people in southern Africa is at risk. As per Pieter Fourie, the average life expectancy in certain southern African countries will be as low as 35 years in 2010 when it could easily have been 70 years in the absence of HIV/AIDS. Table 1 below illustrates this.    
                                                          
Table 1: Average life Expectancy in Six Southern African Countries by 2010
Country	Without AIDS	With AIDS	Years Lost	
Namibia	70.1	38.9	31.2	
Botswana	66.3	37.8	28.5	
Swaziland	63.2	37.1	26.1	
Zambia	60.1	37.8	22.3	
Malawi	56.8	34.8	22	
South Africa	68.2	48	20.2	
Source: Africa's New Security Threat HIV/AIDS and Human Security in Southern Africa. African Security Review, 10 (4): 29-44 by Pieter Fourie et al.
 
HIV/AIDS is destabilizing all walks of southern African life in the areas of health, education, industry, agriculture, and transport among others. The devastation of this debilitating disease is turning back decades of development and reversing economic growth across the continent. Its impact must be curbed.
HIV/AIDS, Women and Security                                                                                               In 1985, there were as many men as there were women in sub-Saharan Africa infected with HIV, but in 2007 there were around 12 million women living with HIV and AIDS, compared to about 8.3 million men. 
Long before anyone heard of HIV/AIDS, women and girls were discriminated against and oppressed on the basis of their sex and gender-related roles in society. The presence of the epidemic in southern Africa merely aggravated the prevailing situation of inequality and injustice against women. (Innocenti, 2001) Cultural values and norms in southern African societies have created power imbalances in the home. As a result, women are left in subordinate positions to men in many areas including decision-making about sex. Socioeconomic factors such as lack of access to education, personal income and opportunities, increase women’s economic dependence on men, seriously compromising their ability to negotiate protection or leave risky relationships. The issue of forced marriage, as in Swaziland, and the preference for older men for economic gain all expose women and girls to the AIDS epidemic. Sexual harassment at the workplace and the fear of loosing one’s job also contributes to the spread of the epidemic among women. The myth in South Africa and Botswana that a man can cure his HIV/AIDS infection by sleeping with a virgin has increased the rate of child rape in those countries, not to talk about the transmission of the disease to these poor souls.         
Conflict and war, in southern Africa also increases the chances of women and girls contracting HIV/AIDS. (Bollinger, 1999) During such times, as was the case in Angola, soldiers use sexual violence as a weapon of war. Considering women as bounty, they rape and humiliate them. The breakdown in social structure, the lack of legal protection for women and girls, and the need for basic necessities and economic opportunities cause women and children to engage in unsafe sexual practices for food, resources, shelter, protection and money. All the aforementioned factors have disproportionately exposed women and girls to HIV and for the most part significantly undermined their quality of life, limited their involvement in income-generating activities and caused their death. 
HIV/AIDS and Economic Security                                                                                                       As the HIV/AIDS epidemic spreads rapidly in Africa, it leaves an economically devastated continent in its wake. With many people dying or too ill to work, there is a reduction in skilled labor supply and labor productivity in many key sectors of the economy. As a result, national earnings and income are declining, as tax revenues fall. A study conducted by ING Barings shows the sectoral impact of HIV/AIDS on the South African economy below.
Table 2:  Sectoral Impact of HIV/AIDS in South Africa
Sector 			   HIV+ per 100 workers (2005)         AIDS deaths per 100 normal deaths          
                                                                                                                                  (2015)
Agriculture, forestry and fishing 	23.2 					503.9
Mining 					29.3 					759.2
Metals 					19.9 					658.4
Machinery				21.2 					563.6
Construction 				23.9 					694.6
Retail					21.3					876.4
Catering and accommodation 		23.0 					601.9
Business services 			15.6 					788.8
Health					20.0 					471.9
General government			24.5					229.1
Source: Africa's New Security Threat: HIV/AIDS and Human Security in Southern Africa. African Security Review, 10 (4):  29-44 by Pieter Fourie et al.
 
From table 2, it is clear that in 2005 a third of all workers in South Africa’s mines were HIV-positive.  Consequently, many individual households experienced decreased income, and less spending power. In some cases, members of the extended family stopped work to take care of their sick. As the impact of HIV/AIDS on households grows more severe, market demand for products and services will fall.                                                                                                                              

Given its incapacitating nature, HIV/AIDS imposes huge costs on all sectors of the African economy. The 2003 ILO report revealed that the annual cost associated with HIV/AIDS and reduced productivity ranges from US$17 per employee to US$1700 per employee.   A recent study in South Africa and Botswana found that HIV/AIDS among workers added 0.45-5.9% to a companies' annual salary and wage bills.  Another study of several southern African countries discovered that the combined impact of HIV/AIDS-related absenteeism, productivity declines, health-care expenditures and recruitment and training expenses reduced profits by at least 6-8% in 2005. NamWater, Namibia's largest water purification company also reported that HIV/AIDS was hindering its operation as absenteeism increased and productivity dropped. Studies of a sugar mill in South Africa put the HIV/AIDS cost per worker per year at R9, 500 (about $1700).

 It is anticipated that by 2015 the sectors of the South African economy will look like a war-zone. The effect of the deaths will be felt throughout the economy. Average annual GDP growth rates will drop by 0.3-0.5 percentage points below the no-AIDS scenario rate. Savings constraints on both the macro-economic and household levels will be severe, and only the brave or most ignorant foreign companies will want to invest in southern Africa. (Danso, 2004) World Bank conservative estimates indicate that in southern African countries where infection levels are higher than 5%, economic growth is likely to slow down and even come to a complete halt at 10% (CSIS 2002). This is frightening.

Another devastating impact of HIV/AIDS on human capital is the fact that it discourages foreign investment. A study conducted by a British House of Commons Committee suggested that foreign companies are increasingly reluctant to invest in Africa for fear of the fact that HIV/AIDS will destabilize the workforce and the markets. `According to South Africa’s chief executive of Daimler Chrysler in June 2001, “AIDS is definitely one of the factors inhibiting foreign investments – on top of all the structural issues. When I try to persuade foreign suppliers to invest here, they ask about four things –trade unions, cost of capital, crime and AIDS”. (Crises Group, 2004) 

HIV/AIDS is threatening the foundations of economic growth and development in southern Africa. The poverty and widespread unemployment that characterize declines in national income makes societies more susceptible to extremist tendencies and violent revolutionary movements. Economic hardship creates conditions that encourage the spread of the disease. If people have less money for food and suffer from malnutrition, they are more likely to engage in risky sexual behavior with multiple partners without giving it a second thought. 

Conclusion
Dealing with the HIV/AIDS epidemic is a daunting task. The fear of discrimination and stigmatization has made it difficult for people in southern Africa to talk openly about the disease, let alone patronize available services. If any inroads are to be made in this direction, then awareness creation campaigns and prevention programs need to be developed and well targeted. These campaigns need to focus on abstinence and comprehensive sex education geared at preventing sexually transmitted infections. Legislation and policies to protect the rights of women, children and other vulnerable groups need to be promulgated and enforced both in times of peace and conflict. In times of civil unrest, atrocities against women and vulnerable groups should be considered as crimes and punishable by tribunals. Obsolete and unproductive cultural norms and practices which create gender hierarchies, inequalities and imbalances between women and men should be abolished, so women can negotiate safer sex relations, and have control over their bodies. Gender inequities need to be eliminated so as to afford women and men equal opportunities, and access to and control over resources. Gender sensitive work environments that protect women also need to be created. 

As HIV/AIDS is a preventable disease, the focus of southern African governments should be on prevention, utilizing strategies and methods best suited to their individual countries local conditions and the state of the epidemic. Condom use should be extensively promoted as a means to not only prevent unwanted pregnancies, but to prevent the spread of HIV. The youth of this region need to be encouraged to delay their sexual debut till later in life and the principle of one man one wife should be encouraged and upheld by law.  Political commitment, strong leadership and a stable political environment is equally necessary to combat the epidemic. Although some countries in the south African sub-region have made some strides in the fight against the epidemic in the last couple of years, the absence of massively expanded prevention efforts will cause the AIDS death toll to continue to rise. 

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