The AIDS Political Crisis

In my continuing quest to completely eliminate any free time, I stumbled across AIDS and Power: Why There is No Political Crisis - Yet by Alex de Waal on the Social Science Research Council's website.

I haven't bought the book yet, but the Table of Contents and the first chapter, A Manageable Catastrophe, are available online.De Waal's premise is interesting: while we're doing a decent (but not good) job of managing AIDS - getting antiretrovirals to where they are needed, at affordable prices, we haven't focused on eliminating AIDS - changing behavioral patterns to limit incidences of HIV infections. This has two important ramifications:

1. Teenagers in developing countries have a shockingly high likelihood of developing AIDS
2. 'Today's generation faces a greater inequity in global life chances than its predecessors, and this is increasingly due to adult mortality and not child deaths.'

However,

demographic modelling suggests that even at very high prevalence levels - up to 40% or so - can be sustained indefinitely without a fall in the absolute numbers of a population. At that prevalence, the great majority of adults will end their lives early to AIDS. Today's crash in life expectancy will not be quickly reversed... (de Waal 6)

It is this final point - that current population levels will be maintained, but the demographic makeup will shift downward, to a population primarily of children, teenagers, and young adults, that leads de Waal to consider this a 'perpetuated calamity'. As this New York Times article discusses, very young populations contribute to strife and instability:

In poor countries with rapidly growing populations, intense competition for education, jobs and land among the young contributes to discontent and makes it easier for rebel groups to recruit, said Elizabeth Leahy, the primary author of a new report for Population Action, a nonprofit group in Washington.

Hence, the concern, at least from the West.

But it is not a simple matter of government officials ignoring the news. African rulers are canny, with a 'sound appreciation of how power functions.' They know that 'they won't be removed from office or even face political threats on account of AIDS.' (de Waal 2) If the opposite were true, believe that Mbeki and others would not have bothered with the AIDS denial that has so shocked and outraged Westerners. They might privately admit it, but they wouldn't base policy on it.

Sadly, AIDS does not head the population's list of priorities. Concerns such as unemployment, poverty, crime, education and general health improvements regularly outrank AIDS. (7) De Waal ends the chapter:

We should not mistake managing the political and social threats emanating from the AIDS epidemic for an effective response to the immense human tragedy of HIV/AIDS itself... [W]e still lack the kind of evidence we need if we are to be able to design effective policies and programmes to overcome HIV/AIDS. We are not seriously demanding that our leaders prevent HIV infections, and we should not be surprised that they are failing to do so. (10)

I'm intrigued.