LONDON Hunger, as it has before, is threatening southern Africa with devastation and death. More than 16 million people in half a dozen countries may go without enough food in the coming months, according to estimates by humanitarian agencies.
The causes include insufficient rains, corrupt governments and deep-rooted poverty that leaves people vulnerable to the slightest change in circumstance.
But this time, there is another factor contributing to the possibility of famine the extraordinary prevalence of AIDS.
When people are sick, they cannot work the fields or feed their families. They cannot bring food to markets or contribute to the economy. Hunger takes an even more terrifying hold than it otherwise might.
As AIDS and HIV, the virus that causes it, become ever more common, the effects of the disease in Africa, already the most severely affected continent, are spreading into virtually every aspect of society. Education is diminished, poverty is increased, health care systems are ravaged and economic development is stymied.
Even the average length of human life has decreased significantly. In Botswana, where nearly 39 percent of the population is infected with HIV, life expectancy 10 years ago was more than 60. Now is it is projected that a Botswanan baby born in 2010 will die, on average, before he or she turns 27.
The U.S. Census Bureau projects that in many African countries life expectancy in the 21st century will soon fall to levels not seen since the 19th century.
That projection prompted President Bush to ask Congress for $10 billion in new spending and $5 billion in already-allocated assistance over five years to provide AIDS drugs to 2 million Africans. The program, which Mr. Bush announced Jan. 28 in his State of the Union address, also would help prevent 7 million new infections, and care for those infected with the virus and children orphaned by the disease.
“This nation can lead the world in sparing innocent people from a plague of nature,” Mr. Bush said in his address last week. International health care officials lauded the proposal as historic and essential.
Sub-Saharan Africa’s AIDS epidemic began in the late 1970s. It has reached frightening proportions. About 29.4 million people in the region are estimated to be living with HIV or AIDS, according to UNAIDS, the United Nations’ AIDS-fighting association. An estimated 3 million people became infected in 2002, or 91,780 a day. Some 2 million people died.
In four countries Botswana, Lesotho, Swaziland and Zimbabwe more than 30 percent of the people carry the virus. Two of those countries, Zimbabwe and Lesotho, are also among those hardest hit by hunger.
But those numbers do not tell the whole story.
“The number of people with AIDS is staggering, and the number of people infected each day is even more so,” said Lynn Heinisch, an Africa-based spokeswoman for CARE USA, a relief and development agency. “But what is difficult to convey is the impact this has on families and communities. It’s much more than just a health issue. The epidemic is affecting everyone, including the most productive members of society.”
It is common to refer to the nations of sub-Saharan Africa as “developing countries.” But the terminology has become a cruel misnomer: Many countries in the region are not developing at all, they are moving backward. Incomes are dropping, and economies are shrinking.
One of the primary reasons is AIDS, which mainly strikes people in their most productive years. And the implications are alarming.
Winnie Mpanju-Shumbusho, director of HIV/AIDS strategy at the World Health Organization, estimated more than a year ago that by the year 2020, Africa’s most affected countries could see their economies shrink by 20 percent. Nothing in the intervening 14 months has made that prediction seem overly pessimistic.
“A lot of people think of HIV/AIDS as a health problem, and it’s really a development issue,” said Stevan Jackson, a spokesman for the World Bank. “The way it affects people, especially in Africa, is first and foremost in economic development. It can decrease economic development by a large degree due to absenteeism, as people get sick.”
According to a report by the Coca-Cola Africa Foundation, AIDS forces companies to spend more and earn less. More money is spent on health care costs, burial fees, and training and recruitment. Revenue is decreased because of staff turnover, time spent on training and absenteeism because of illness and attendance at funerals.
The health care systems of African countries are increasingly damaged, not only because there are more patients, but also because there are fewer doctors.
Educational systems are deteriorating, as well.
“Teachers are dying faster than they can be trained in many areas,” Mr. Jackson said.
Beyond that, many children orphaned by AIDS and there will be an estimated 25 million of them by 2010 must forgo school so they can take care of younger siblings.
The Africans of tomorrow, it appears, will be less educated, poorer and shorter-lived than the Africans of today.
There are some bright spots, notably Uganda and Senegal, both of which have waged loud and multifaceted campaigns against the disease.
Uganda, where the infection rate peaked in the early 1990s at what was then an astonishing 14 percent, has cut its infection rate to 8 percent. In Senegal, which never allowed the disease to really take hold, the infection rate is estimated to be 1.4 percent.
But overall the picture is grim. There is no indication that the epidemic has crested. Previous theories that populations would reach a “saturation point” of about 30 percent have proven false.
In Africa, the epidemic is disproportionately affecting women. Fifty-eight percent of infected Africans are female.
Outside Capetown, South Africa, AIDS is ravaging the impoverished squatters’ town known as Driftsands.
Nosisa Dyasi, 37, a mother of four, lives in a one-room shack with no electricity or running water. She suffers from full-blown AIDS, but has no anti-retroviral treatment available to her, only topical medicines to ease the symptoms. The closest public clinic, at the Khayelitsha township several miles away, is overwhelmed with patients.
Mrs. Dyasi is dying, a fact that causes her son, Khanyiso, 16, to weep quietly as his mother talks about her condition. Aid workers in the neighborhood have no answer when asked who will care for Mrs. Dyasi’s children the youngest is 9 after she’s gone.
The steep rise in the number of parentless children is “a crisis turning into a catastrophe,” said South African Anglican Archbishop Njongonkulu Ndungane, successor to Desmond Tutu. He said in an interview that his country is “haunted by the stares of the orphans” and the government “has a blind spot” about the AIDS crisis.
The epidemic in South Africa is expected to kill 7 million people by 2010.
“Study after study has shown that there is no effective development strategy in which women do not play a central role,” U.N. Secretary-General Kofi Annan wrote recently in the New York Times. “When they are fully involved, families are healthier. They are better fed. Income, savings and reinvestment go up. And what is true of families is true of communities and eventually of whole countries.”
But because African women are succumbing to the tragedies of famine and AIDS, which Mr. Annan said are “directly linked,” the skills, coping abilities and caring they provide are being lost.
“Because of AIDS,” Mr. Annan wrote, “farming skills are being lost, agricultural development efforts are declining, rural livelihoods are disintegrating and household earnings are shrinking all while the cost of caring for the ill is rising exponentially.”
The glue that has held African families together and provided promise for the future is coming apart.
“The fabric of societies is unraveling at a terrifying rate,” said Miss Heinisch, the CARE spokeswoman. “Much, much more needs to be done to support those who are trying to hold it together.”
Charles W. Holmes, foreign editor of Cox Newspapers, contributed to this report from South Africa.