Mombasa, Kenya-More than a personal tragedy for those it touches, the spread of HIV/AIDS threatens to unravel social and economic development in countries across the globe.

In the Rakai district of Uganda, transport, agriculture and marketing systems have been severely disrupted. Over a third of the adults in urban centers and 12 per cent of adults in rural areas are estimated to be HIV positive. Thousands have died, leaving behind young orphans, ghost towns and untended fields.

In Rwanda, a large number of civil servants, teachers, politicians and other technically skilled people are infected with HIV. The death toll among them and others in their most productive years of life has soared in the past five years.

In Zambia, where copper is the main source of foreign exchange and employment, it is likely that 65 per cent of the industry's workforce will be infected with HIV by the end of this century.

"AIDS is not only a health problem," said William H. Draper, III, Administrator of the United Nations Development Program (UNDP), in a recent address to African ministers of planning. "It is perhaps the most serious threat to development in Africa. Without a concerted effort to combat HIV, all of the gains made over the past half century could be wiped out in one generation."

Sub-Saharan Africa's worsening crisis could be a presentiment of things to come in other regions of the world. Every day, 5,000 more people become infected with HIV. By the year 2000, experts predict that the number of people infected may reach 30 million. A good portion of those affected are likely to be in the Philippines, Thailand, Indonesia and India, where tens of millions of people are at risk. Recent research from the World Health Organization (WHO) warns that HIV is increasing in Asia "at a pace reminiscent of that in sub-Saharan Africa in the early 1980s," but that it "may have an even greater potential for spread, given the adult population of nearly 500 million as compared with 225 million in sub-Saharan Africa."

In Latin America and the Caribbean, WHO estimates that HIV infection among adults has reached one million. And the infection has begun to make its way across North Africa and the Arab States.

Though governments everywhere are alarmed at the threat of the disease, only high-level political commitment will enable them to halt its spread and cope with the epidemic's devastating consequences. In the months ahead, governments will confront the implications of HIV/AIDS for development through a series of UNDP workshops being offered to senior government officials and United Nations staff in the 114 countries where UNDP has offices. One of the aims is to communicate the dire effects of the epidemic, not only on the population at large, but on agriculture, industry, labor supply, credit systems, national savings and other crucial aspects of the economy. Losses in income and productivity are likely to dwarf the direct health care costs of the epidemic.

As might be expected, innovative ways of coping with these challenges are emerging from the countries most severely affected. One key has been to devise prevention and support programs that are multisectoral in nature, through the coordination of various national ministries. In Uganda, this has been successfully carried out, with the president's office assuming responsibility for the national AIDS prevention drive. "The experience of African governments that have dealt most effectively with the problem shows that HIV cannot be tackled solely by national health ministries," says Elizabeth Reid, UNDP's policy adviser on HIV and development, who chaired a preparatory workshop in Mombasa, Kenya last year. "The only adequate response is for governments to involve a wide range of ministries and to create a supportive environment."

Another lesson learned is that local communities and nongovernmental organizations (NGOs) must be made equal partners in HIV prevention and in caring for those who are ill. In the past decade, many African communities, relying solely on themselves, have found ways to check the spread of HIV and to care for the sick, the dying and for survivors. Organizations such as the Society for Women and AIDS in Africa (SWAA), a continent-wide network, are counseling women on how to protect themselves against HIV infection.

Posters in Kenya alert the public to the dangers of HIV/AIDS. The AIDS Support Organization, or TASO, in Uganda, has successfully battled discrimination against people with HIV/AIDS and lobbied for government support for prevention programs. Studies in Kenya, Malawi and other African countries show that people are acting on their knowledge of HIV and AIDS by asking for mutual fidelity from their partners and by using condoms without fail. Support from religious and social leaders has accelerated behavioral change.

In many ways, the process of combating the epidemic and coping with its fallout has only just begun. But 10 years into the fight against AIDS, there is hope that a partnership among national and local governments, international organizations and communities can help ease the human toll of AIDS, as well as lessen its social and economic impact. 

By: Siddharth Dube, from: Choices (The Human Development Magazine), April 1992. From the United Nations Development Program.