Imperialism and AIDS in Africa

Revolutionary Worker #1065, August 6, 2000

I am 14 years old. I have four brothers and three sisters younger than me. I come from Uganda. I am studying in primary six. I have come here to say something about AIDS and its problems.

AIDS means acquired immune deficiency syndrome. It's a terrible disease. It killed both my mother and father in 1992. It killed all brothers and sisters of my father. It has killed many men and women in Uganda.

Some houses have been closed. But our house was not closed because my father and mother left me with four brothers and two sisters. I look after them. I also look after my grandfather who lives near us, because his wife died and nobody was there to look after him. He is 84 years old. He lost his wife in 1992. Grandfather does not see. He has eye problems. It is me who looks after the family. Other orphans have the same life. They don't have blankets; they don't eat meat; they don't have sugar; they sleep in huts. Some go to eat at the neighbors or they get one meal a day The teacher calls us orphans, but I don't want that name. Even other children don't want that name. They think we are animals.

An AIDS orphan in Uganda

From July 9 to 13 the 13th International Conference on AIDS was held in Durban, South Africa. Over 12,000 scientists, AIDS activists, community heath workers, physicians, people with AIDS, and others attended this conference-the first ever held in Africa, where AIDS has taken its largest toll.

The conference helped focus world attention on the horrific human devastation AIDS has caused throughout Africa. However, much of the media focused on two issues: the controversy around South African President Thabo Mbeki's role at the conference and the announcements from drug companies that they would supply some of the drugs needed by people suffering from AIDS at reduced cost.

President Mbeki was criticized because he appointed to his AIDS panel a number of so-called "AIDS dissidents" - scientists who hold the discredited view that infection by the HIV virus is not the cause of AIDS in individuals. He was also mocked for suggesting that trying to rely on expensive drug treatments to contain the AIDS epidemic would not work in South Africa because of the incredible poverty of the medical system left over from apartheid. The media also distorted Mbeki's views, suggesting that he does not believe that the HIV virus causes AIDS. In fact, Mbeki routinely refers to HIV/AIDS-including in his speech at the conference. But this became the "news"-not the question raised by Mbeki about the relationship between the spread of AIDS in Africa and the impoverished conditions throughout the continent. In his speech to the Durban conference Mbeki denounced "unacceptable disparities in wealth." "For most people in the world today," he said, "every step of life, from infancy to old age, is taken under the twin shadows of poverty and inequality, and under the double burden of suffering and disease." He said that poverty is the conditions in which AIDS thrives.

What the western media did was distort any views that suggested that oppressive social conditions played a huge role in causing the AIDS epidemic.

Since the end of the apartheid system, Mbeki and the ANC worked with imperialist powers to bring about a transition from raw colonial dictatorship to a more nuanced dictatorship of mixed colonial and new black comprador rule. They have led South Africa down a neo-colonial path that has attempted to "develop" South Africa by relying on imperialist investments-a path that can never lead to real liberation and is unable to solve the problems of widespread poverty and inequality. The countries in Africa can only achieve liberation by kicking out imperialism. And it is outrageous for imperialist countries-which are largely responsible for the conditions that have led to the spread of AIDS in Africa-to wag their fingers at Mbeki, as if he was the main obstacle to stopping the epidemic.

And it is scandalous to see giant pharmaceutical companies-who, over the last decade, have recorded record profits of billions of dollars while preventing millions of poor people dying from AIDS access to potentially life saving treatments-fronting like they are the saviors of Africa. Apparently imperialist hypocrisy has no limit.

Evidence shows that the HIV virus is the infectious agent that causes the spread from individual to individual. But the existence of a worldwide epidemic-especially in the African continent-of HIV infection and AIDS is fundamentally caused by social conditions, including poverty, drug addiction, reactionary religious views and practices, male supremacy and associated sexual practices, national oppression, and the deliberate indifference of capitalist medical establishments to a disease concentrated among the poor.

In short, the disease is spread via a virus, but the epidemic is caused by the system-by class society, its reactionary social relations, and the poverty of the people. The conditions under which the AIDS epidemic has spread in the African continent are tied, by a thousand threads, to imperialism, neo-colonialism, and apartheid.

This article will examine some of the specific imperialist policies that have created the conditions for the AIDS epidemic in Africa.

An African Nightmare

Around the world, an estimated 34.3 million people are now HIV-positive, up from 27.6 million last year. Every day more than 16,000 people are infected.

Africa, in particular sub-Saharan Africa, has suffered the most from the AIDS virus. Seventy percent of new infections are in sub-Saharan Africa-even though this area has only 10% of the world's population. Of children under 15 with the AIDS virus, nine out of 10 are in sub-Saharan Africa. Since the start of the epidemic, an estimated 34 million people living in the region have been infected. 11.5 million of these have already died, one quarter of them children. In 1998 alone, two million African men, women and children died from AIDS-related illness.

It was announced at the Durban conference that in the next 10 years, life expectancy in Botswana is expected to fall to only 29 years, 30 years in Swaziland, and 33 years in Namibia and Zimbabwe. Without AIDS, life expectancy would be about 70 years in those countries. In these four countries more than a quarter of adults carry the virus. In some districts, the rates are even higher: In one study, a staggering 59% of women attending prenatal clinics in rural Beitbridge, Zimbabwe, tested HIV-positive.

13.2 million children have already been orphaned by AIDS worldwide-and 12.1 million of them are in sub-Saharan Africa.

Only 17 years have passed since AIDS was first found in Africa, and the virus has already killed more than 11 million sub-Saharan Africans and infected more than 22 million others. The virus is striking hardest against the most productive section of Africa's population: adults aged 15 to 49. And experts warn the epidemic is only in its early stages.

Imperialism and Africa

It is no accident that Africa has been hardest hit by AIDS/HIV. Centuries of colonialism and imperialism have devastated the continent. The theft of the land, labor, minerals and other wealth of the African continent played a crucial role in the economic development of Europe and the United States. During the slave trade millions of men, women and children were kidnapped and taken to the U.S. where their forced labor formed the backbone of the early U.S. economy.

At the Berlin Conference in 1884-1885 all of Africa was divided among the European powers. Not a single African was present. Despite fierce resistance, by the early 1900s only two countries, Ethiopia and Liberia, were not outright colonies. Land was seized for plantations and mines, and Africans were forced to work for very low wages and in deplorable conditions. Over 10 million people were killed in the Congo during the reign of King Leopold of Belgium-many of those who survived had their hands chopped off as punishment for failing to meet quotas for rubber production.

Despite imperialist claims that they were developing Africa, health for the African people declined under European rule. The population of many countries in sub-Saharan Africa decreased from the 1890s through the end of World War II.

By the mid-1970s most African countries had achieved formal independence, but economic domination by Western powers continued. When nationalist leaders opposed imperialist economic interests they were eliminated. In the Congo, for example, the CIA under Kennedy had the nationalist leader Patrice Lumumba assassinated in the early 1960s. During this period many of the so-called "newly independent"-neo-colonial-countries developed large debts to the imperialist powers. The borrowed money was not used to help the people of these countries. Instead the loans were used to build the infrastructure necessary for the imperialists to extract the country's resources, build and maintain armies to keep down the masses and enforce neo-colonial rule, and line the pockets of the imperialist's lackeys.

Now, at the start of the 21st century, half of all Africans live in absolute poverty-fighting simply to get enough food to survive another day. More than half the population of Africa lacks access to safe water and 70% are without proper sanitation.

Structural Adjustment Programs and AIDS

In the last few decades so-called structural adjustment programs or SAPs have been imposed on countries in Africa by international financial institutions like the World Bank and the International Monetary Fund (IMF). Under these programs, as a condition of new loans or of refinancing existing loans, countries must drastically reduce government spending and make other changes so that more money can go to pay off their debt.

In the 1980s and '90s, SAPs were imposed on 42 governments in sub-Saharan Africa. By the end of the 1980s most non-oil-producing countries in Africa used 30 to 70% of their export revenues to pay the interest on their debts. During the 1980s more capital went out of Africa than went in. Under these programs, between 1960 and 1990, average per capita income in Africa fell almost 25%-from $850 to $645.

At a time when up to 70% of adults in some hospitals are suffering from AIDS-related illnesses, many African countries have had to cut their health expenditures in order to satisfy IMF conditions. These circumstances make it almost impossible to treat those with the virus effectively, to undertake effective campaigns to reduce high-risk behavior, or to provide essential resources in the fight against HIV transmission such as condoms or sterile needles.

For example, in Tanzania-where over half a million children are orphans as a result of AIDS-the government spends only around $3.20 per person per year on health. Tanzania spends more than three times more on debt repayment each year than it does on health care. During the past five years, total spending on health care and education has fallen around 40% in real terms-largely as a result of IMF pressures. Such health cuts have had a devastating impact, resulting in poorly maintained health centers and hospitals; few drugs; lack of sterile equipment; no paper to keep records; hospitals being unable to provide food and so on.

Cuts in health spending have had the greatest impact in rural areas. SAPs in Zimbabwe forced cuts in government grants for rural health clinics. As a result, staff at the Musami Hospital were only able to visit half the villages that they could visit before the cuts. The number of people served at these clinics declined by 25%.

In African countries under SAPs, health workers have little or no job security, and some have not been paid for months. Many have to take second jobs simply to feed their families. As a result, many jobs go unfilled and there is a "brain-drain" to other countries where health professionals receive better pay. In Ghana the number of doctors decreased from 1,782 in 1985 to 956 in 1991. In Cote d'Ivoire, attendance at the country's teaching hospital fell 50% following the country's currency devaluation in 1994-while the prices of medicine rose 30 to 70%.

A nurse in Senegal describes the conditions at the regional health center where he works. The center lacks the most basic medicines and supplies-including disinfectants, masks, gloves and disposable syringes. He, one other nurse, and a part-time physician serve over 150,000 people. He sees over 70 patients a day-many of whom die from diseases that would be treatable if medicine and equipment were available. "My work is one frustration after another," he said. "Under these conditions, I simply cannot provide my patients the kind of health care that they urgently need."

Between 1980 and 1993 the number of people per nurse in Senegal rose more than six times, from 1,931 in 1980 to 13,174 in 1993. Many other African countries reported similar or even greater reductions in the numbers of nurses during the same period.

Currency devaluations, aimed at making exports cheaper, are a central policy of IMF-designed SAPs. Such devaluations have resulted in a massive increase in the cost of imported goods, such as pharmaceutical supplies, pricing them even more out of reach of most Africans.

International financial institutions have mandated that countries institute "cost-recovery" for health care, which takes the form of user fees. The introduction of user fees has placed basic health care beyond the means of many poor and sick people in Africa. Patients must now pay for consultations with doctors and for medicines, and in many cases are also required to provide their own syringes, needles and drip sets when attending health clinics.

User fees result in delays in patients seeking medical attention and undermine access to care. The number of patients in Zimbabwe receiving treatment at Marewa Musami Hospital and Harare Central Hospital fell 25% in January 1992 after a rise in hospital fees. When the cost of an outpatient visit was raised from Z$1.50 to Z$17 in 1994, outpatient attendance and non-urgent admissions again fell substantially.

Reduced access to medical care has played a major role in the spread of HIV in Africa. For example, easily treatable STDs and genital ulcers increase the chance of getting AIDS. One study in Tanzania demonstrated that treatment for STDs, costing as little as $2.11 per person, can cut the number of people getting HIV by 42%. When the World Bank advised Kenya to introduce a user fee of $2.15 to attend STD clinics, attendance fell by 35 to 60%. In Zimbabwe, the introduction of charges for condoms in October 1992 under the country's SAP led to a dramatic fall in distribution.

Poor health, caused by an unbalanced or insufficient diet, reduces resistance to diseases, including AIDS. And people who are malnourished and become infected with the virus, die quicker. The requirement that governments slash their expenditure under SAPs has forced many African countries to remove price subsidies, resulting in spiraling food prices.

In Zimbabwe, following the removal of price controls in March 1993, the price of bread went from Z$1.63 to Z$2.20 overnight. Sales in many bakeries immediately fell 50%. One third of children in Africa are significantly malnourished. UNICEF reports that SAPs have contributed to the widespread deterioration in the nutritional status of children, pregnant women and women with children.

Imperialists Ignore AIDS in Africa

The U.S. and other imperialist powers act as though they have just become aware of the HIV/AIDS epidemic in Africa. In fact, these powers have known of the developing crisis for many years and ignored the crisis at a time when assistance could have greatly reduced its impact.

A recent article in the Washington Post quoted the author of a 1991 CIA report on the AIDS epidemic in Africa. The report predicted the trajectory that the epidemic would take in the 1990s. The author said that one military colleague at the National Intelligence Council told him, "Oh, it will be good, because Africa is overpopulated anyway." Other military experts who read and commented on the 1991 CIA report focused only on the potential damage to allied military forces. The Washington Post reported that one military figure concluded that even if large numbers of officers began dying of the disease, "That boosts morale, because there's more room for advancement."

Other imperialist institutions showed similar lack of concern for the growing AIDS epidemic in Africa. After comparing the potential for death from the AIDS epidemic in Africa with the bubonic plague that struck Europe in the 14th century, a June 1992 report by the World Bank's population and human resources department wrote that AIDS might benefit Africa economically: "If the only effect of the AIDS epidemic were to reduce the population growth rate, it would increase the growth rate of per capita income in any plausible economic model."

In the U.S., the Center for Disease Control (CDC) and U.S. Agency for International Development (USAID) held out for years against paying for AIDS tests overseas. In the U.S. these types of tests were effective in greatly reducing the spread of AIDS. "The argument was that testing was too expensive, and it led to things that were more expensive," Gregory Pappas, a physician and Health and Human Services official, told the Washington Post. "The philosophy in development circles was, don't create demand. The implications of a lot of people knowing that they have HIV, instead of just dying of it, is [that] it creates demands on the development assistance agencies."

Duff Gillespie, who oversaw AIDS assistance as director of USAID's programs on population, health and nutrition, argued that overpopulation not AIDS was the most important problem for Africa. Michael Merson, former chief of the World Health Organization's AIDS program told the Washington Post, "Duff was very much worried about not letting the population budget be used for AIDS."

Drug Profiteers and Access to Medicine

On the first day of the Durban Conference over 2,000 protesters marched to demand that pharmaceutical companies make drugs available cheaply to poor countries. Many of the demonstrators carried placards with pictures of pharmaceutical executives, calling them drug profiteers. During the conference demonstrators occupied the exhibit booths of pharmaceutical manufacturers like Pfizer and Merck.

New drug therapies have made it possible for many people living with HIV or suffering from AIDS in the U.S. to pursue relatively healthy lives. But the new triple drug therapies that are saving lives in the U.S. cost more than $12,000 a year per patient. And they are virtually unheard of in poor countries where the AIDS epidemic is hitting the hardest. For example, at current prices, Zambia couldn't afford multidrug AIDS therapy for its population even if it spent its entire national income on AIDS/HIV drugs!

In the face of the growing AIDS epidemic, the U.S. government and pharmaceutical manufacturers have tried to prevent countries in Africa from importing these drugs from other countries-where they sell for a fraction of the price-or manufacturing cheap generic versions. The U.S. government threatened trade sanctions against South Africa when it was considering such methods in order to make the life-saving drugs available. As president of the U.S.-South Africa Bi-national Commission, Vice President Gore led the U.S. trade threats against South Africa.

In June 1999 a group of AIDS activists brought attention to the outrageous actions of the U.S. by demonstrating at several stops on Gore's campaign tour and disrupting his announcement that he was running for president. The demonstrators, organized by ACT-UP and AIDS Drugs for Africa got within a few feet of Gore holding banners and chanting "Gore's Greed Kills." The activists dubbed the Gore 2000 campaign "Apartheid 2000."

The U.S. appears to have let up from its most overt threats in the face of worldwide exposure. But how many people died needlessly while the U.S. rattled its trade sword threatening poor countries that tried to provide medicine for sick and dying people? And U.S. and European pharmaceutical companies continue to block widespread access to these essential medicines by asserting that only the patent holders be allowed to manufacture them.

In the months leading up to the Durban conference and at the conference itself there were announcements from various drug manufacturers that they would make some of their drugs available to poor people in some countries at low or no cost. However a closer look reveals that many of these offers are designed to prevent countries from manufacturing their own generic versions of the drugs and are full of strings that hold back widespread availability of these urgently needed medicines.

For example, Pfizer announced recently that it would make fluconazole (trade name Diflucan), a drug used to treat cryptococcal meningitis, available for free in South Africa. Cryptococcal meningitis is a fungal infection of the brain. It is one of the opportunistic infections that strike people with AIDS. Without fluconazole people with AIDS who contract this disease usually die within two months.

Pfizer sells the drug in South Africa for $4.15 for a daily dose. A generic version is manufactured in Thailand for 29 cents. Worldwide sales of Diflucan were more than $1 billion in 1999.

Activists in groups like Doctors Without Borders (MSF) have exposed many of the conditions that Pfizer has imposed on this offer. "The cumbersome conditions that Pfizer is imposing on its much-publicized offer to provide fluconazole for free to people with AIDS is disappointing," said Eric Goemaere, MD, of Doctors Without Borders, in South Africa. "Most outrageous is Pfizer's attempt to structure this donation like a clinical trial, adding onerous reporting and training requirements. South African physicians are experienced professionals and it is patronizing to require special training for routine treatments."

In addition Pfizer will not provide the drug free to people in countries other than South Africa who cannot afford it. It will only provide the drug for cryptococcal meningitis and not for other fatal infections that the drug is used to treat. And the company has refused to lower the price to those who are not covered by its offer.

"South Africa is facing one of the world's most acute AIDS epidemics with more than 10% of the population infected with HIV. More than 100,000 people died here of AIDS last year," said Dr. Goemaere. "It is unacceptable that Pfizer still refuses to sell this product at an affordable price in poor countries, or to let others have the legal right to do so."

On May 11, the "big five" drug companies announced that they had reached an agreement with the United Nations AIDS organization (UNAIDS) to provide reduced prices for AIDS drugs in the third world. However, MSF claims that by shopping around in world generic markets, developing countries could reduce the yearly cost of triple-drug therapy from the American benchmark of $15,000 to as little as $200 a year-much lower than the levels promised by the "big five" which would see the cheapest rate dropping to about $2,000.

Daniel Berman, from MSF's Access to Essential Medicines Campaign, said, "The few developing countries that have achieved significant access for people with AIDS have done so by aggressively pursuing generic strategies. The numbers are staggering: 80,000 people were treated in Brazil through use of affordable generic drugs that brought triple-drug therapy down to a cost of approximately $1000/year. But in Uganda, where the government was working with brand-name drugs in a UNAIDS initiative, less than 1,000 people were treated."


The epidemic of AIDS in Africa is one of the greatest disasters that humanity has faced in recorded history. Tens of millions will die and a whole continent will be shaken for decades. The extent and magnitude of this crisis was not inevitable. It was created by a system that values profits more than the lives of millions.

As RCP Chairman Bob Avakian said:

"If one is conscious of the fact that the world is dominated by imperialism and if one has any inkling of the consequences of this for the great majority of the world's people, then one should feel compelled to help shatter the whole imperialist system and its entire framework, and to remake social relations on an international scale."

For more on the rise to power of the ANC and a critique of their political and economic program see the article "South Africa: Changing of the Guard" in A World To Win #20.

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