SUMMARY OF EVENTS
Before the seventeenth century the world’s population increased very slowly. It has been estimated that by 1650 the population had doubled since the year AD 1, to about 500 million. Over the next 200 years the rate of increase was much faster, so that by 1850 the population had more than doubled to 1200 million (1.2 billion). After that, the population growth accelerated so rapidly that people talked about a population ‘explosion’; in 1927 it reached the 2 billion mark. By the year 2000 it had passed 6 billion and at the end of 2011 it reached 7 billion. In 2003 the UN calculated that if the population continued to increase at the same rate, the global total would be somewhere between 10 billion and 14 billion by 2050, depending on how effectively family planning campaigns were carried out. It was also estimated, given the much lower birth rates in the developed world, that almost 90 per cent of the people would be living in the poorer countries. During the 1980s the spread of HIV/AIDS reached pandemic proportions; most countries in the world were affected, but again it was the poor nations of the Third World which suffered worst. This chapter examines the causes of the population ‘explosion’, the regional variations, the consequences of all the changes, the attempts at population control and the impact of AIDS.
28.1 THE INCREASING WORLD POPULATION SINCE 1900
(a) Statistics of population increase
It is easy to see from the steeply climbing population total in Figure 28.1 why people talk about a population ‘explosion’ in the twentieth century. Between 1850 and 1900 the world’s population was increasing, on average, by 0.6 per cent every year. During the next 50 years the rate of increase averaged 0.9 per cent a year; it was after 1960 that the full force of the ‘explosion’ was felt, with the total world population increasing at the rate of 1.9 per cent a year, on average. In 1990 the population was increasing by roughly a million every week, and the total had reached 5300 million. In 1994 there was an increase of 95 million, the biggest ever increase in a single year so far. In 1995 the record was broken again, as the total population grew by 100 million to 5750 million. According to the Population Institute in Washington, 90 per cent of the growth was in poor countries ‘torn by civil strife and social unrest’. During 1996 a further 90 million were added to the population, and by 2000 the global total was well past 6 billion. It topped the 7 billion mark at the end of 2011.
However, there were important regional variations within the general population increase. Broadly speaking, the industrialized nations of Europe and North America had their most rapid increase before the First World War; after that their rate of increase slowed considerably. In the less developed, or Third World nations of Africa, Asia and Latin America, the rate of population increase accelerated after the Second World War, and it was in these areas that population growth caused the most serious problems. The growth rate began to slow down in some Latin American countries after 1950, but in Asia and Africa the rate continued to increase. Figure 28.2, which is based on statistics provided by the United Nations, shows:
Figure 28.1 World population increases from AD 1 to 1995
Figure 28.2 Rate of population growth by regions
(b) Reasons for the population increase
The population increase in Europe and North America in the later part of the nineteenth and the early twentieth centuries had several causes.
After 1900 the growth rate in Europe began to slow down, mainly because more people were using modern contraceptive techniques. Later, the economic depression of the 1930s discouraged people from having as many children.
The rapid population growth after 1945 in Third World countries had three main causes:
Table 28.1 Deaths within one year of birth, per thousand births
28.2 CONSEQUENCES OF THE POPULATION EXPLOSION
(a) The industrializing nations of Europe and North America
The population growth of the nineteenth century helped to stimulate further economic development. There was a plentiful workforce and more people to buy goods, and this encouraged more investment and enterprise. Nor were there any great problems about feeding and educating these growing numbers, because prosperity meant that the necessary resources were available. Later on, there were unexpected effects on the age structure of the population in the developed nations. This was especially true in Europe where, because of the very low birth rates and longer life expectancy, a growing proportion of the population was over 65. By the 1970s, in countries such as Sweden, France and Britain, about 15 per cent of the population were over 65. In the early 1990s, with this proportion still increasing, questions were being asked about whether state welfare systems would be able to afford to pay pensions to all old people if this trend continued into the twenty-first century.
(b) The Third World
The rapid population growth caused serious problems: some countries, like India, Pakistan and Bangladesh, became overcrowded and there was insufficient land to go round. This forced people to move into towns and cities, but these were already overcrowded and there were not enough houses or jobs for all the new arrivals. Many people were forced to live on the streets; some cities, especially those in Latin America, were surrounded by shanty-towns and slums which had no proper water supply, sanitation or lighting.
(c) It became increasingly difficult to feed the population
All areas of the world succeeded in increasing their food production during the late 1960s and 1970s, thanks to what became known as the ‘green revolution’. Scientists developed new strains of heavy-cropping rice and wheat on short, fast-growing stems, helped by fertilizers and irrigation schemes. For a time, food supplies seemed to be well ahead of population growth; even a densely populated country like India was able to export food, and China became self-sufficient. In the USA crop yields increased threefold between 1945 and 1995, and the Americans were able to export surplus crops to over a hundred countries. However, in the mid-1980s, with the world’s population growing faster than ever, the ‘green revolution’ was running into problems and scientists became concerned about the future.
There seemed no way in which food production could be doubled from less land. In 1996, on average there were 1.8 acres of cropland to each American and the US diet was made up of 31 per cent animal products. By 2050 there was likely to be only 0.6 of an acre per head. The Stanford scientists came to the conclusion that the solution was for people everywhere to eat less meat; it was suggested that by 2050 the US diet would probably be about 85 per cent vegetarian. Matters were made worse in parts of Africa (Ethiopia, Angola, Mozambique and Somalia) during the 1980s and 1990s by drought and civil wars, which played a part in causing severe food shortages and tens of thousands of deaths from starvation.
(d) Resource shortages in the Third World
Third World governments were forced to spend their valuable cash to feed, house, and educate their growing populations. But this used up resources which they would have preferred to spend on industrializing and modernizing their countries, and so their economic development was delayed. The general shortage of resources meant that the poorest countries also lacked sufficient cash to spend on healthcare. Following a meningitis epidemic in the African state of Niger, Save the Children reported (April 1996) that one-sixth of the world’s population – over 800 million people – had no access to health-care. Health systems in many poorer countries were collapsing, and the situation was becoming worse because richer countries were reducing aid. The report estimated that it cost at least $12 a person a year to provide basic healthcare; but 16 African countries (including Niger, Uganda, Zaire, Tanzania, Mozambique and Liberia) plus Bangladesh, India, Pakistan, Nepal and Vietnam were spending much less than that. In comparison, Britain was spending the equivalent of $1039 (£723). In fact Zaire was spending only 40c per head a year, while Tanzania managed 70c. This meant that simple immunization against easily preventable diseases was not being carried out in these countries. Widespread epidemics could be expected before the end of the century, and a rise in the child mortality rate. When the AIDS epidemic spread, around the turn of the century, it was clear that Africa in particular would be in dire crisis. Another disturbing fact was that almost all these states were spending vastly more per head on defence than on healthcare.
28.3 ATTEMPTS AT POPULATION CONTROL
For many years people had been giving serious thought to the question of controlling the population before the world became too overcrowded and impossible to live in. Soon after the First World War, scientists in a number of countries first began to be concerned at the population growth and felt that it was a problem that should be studied at international level. The first World Population Congress was held in Geneva in 1925, and the following year an International Union for the Scientific Study of Population was set up in Paris. As well as scientists, the organization also included statisticians and social scientists who were concerned about the probable economic and social effects if the world’s population continued to grow. They did valuable work collecting statistics and encouraging governments to improve their data systems, so that accurate information about population trends could be collected.
Illustration 28.1 Posters from India and Africa encouraging people to use birth control and limit families to three children
(a) The United Nations Population Commission
When the United Nations Organization was set up in 1945, a Population Commission was included among its many agencies. When the Third World population began to ‘explode’ during the 1950s, it was the UN which took the lead in encouraging governments to introduce birth-control programmes. India and Pakistan set up family-planning clinics to advise people about the various methods of birth control available, and to provide them with cheap contraceptives. Huge publicity campaigns were launched with government posters recommending a maximum of three children per family (see Illus. 28.1). Many African governments recommended a maximum of three children, while the Chinese government went further and fixed the legal maximum at two children per family. But progress was very slow: ancient practices and attitudes were difficult to change, especially in countries like India and Pakistan. In the Roman Catholic countries of South America, the Church continued to forbid artificial birth control.
(b) How successful were the campaigns?
The best that can be said is that in parts of Asia the population growth rate was beginning to fall slightly during the 1980s; but in many African and Latin American countries it was still rising. Table 28.2 shows what could be achieved with the spread of birth control.
Table 28.3 shows the 1986 populations and growth rates of various regions, compared with the 1950–9 growth rates. The most rapid growth rate in 1986 was in Africa, where some countries had rates of over 3 per cent per year. The table also reveals how serious the problem of overcrowding was in some areas where there were on average over a hundred people to every square kilometre. This was not so serious in the developed nations of Europe, which had the prosperity and resources to support their populations; but in the poorer nations of Asia, it meant grinding poverty. Bangladesh was probably the world’s most crowded country with an average of 700 people to every square kilometre. The population growth rates of Bangladesh and Britain provide a startling comparison: at the present growth rates, Bangladesh will double its population of 125 million in less than 30 years, but Britain’s population of 58.6 million will take 385 years to double in size. The Population Institute predicted (December 1995) that, with effective birth control, the global population could stabilize by 2015 at about 8 billion. However, without effective promotion of family planning, the total could well have reached 14 billion by 2050. With the population of Europe and North America growing so slowly, it meant that an ever-increasing proportion of the world’s population would be poor.
Table 28.2 Use of contraceptives and the birth rate
% of married women using contraceptives, 1986
Fall in the % birth-rate, 1978–86
4.5 > 3.2
3.2 > 2.1
Colombia (S. America)
4.3 > 2.6
3.5 > 1.6
Table 28.3 Population growth rates and density
On the other hand, some historians feel that the fears about the population explosion have been exaggerated. Paul Johnson, for example, believes that there is no need to panic; once Asia, Latin America and Africa become more successfully industrialized, living standards will rise, and this economic betterment, along with more effective use of contraception, will slow down the birth rate. According to Johnson, the example of China is most encouraging: ‘The most important news during the 1980s, perhaps, was that the population of China appeared virtually to have stabilised.’
However, the case of China raises another issue: how far should a government go in its efforts to control population? In 1978 a group of scientists calculated that unless Chinese women were limited to one child each, China would face disaster – the country’s resources would simply not be sufficient to feed the population. Conversely, if the one woman one-child limit could be achieved, then the Chinese would become prosperous and assume their rightful place among the world’s leading nations. In 1980 the government duly announced the one-child policy. Historian Matthew Connelly describes what happened next:
This was the most coercive phase in the whole history of China’s one-child policy. … All women with one child were to be inserted with a stainless steel, tamper-resistant IUD [intra-uterine device], all parents with two or more children were to be sterilized, and all unauthorized pregnancies terminated. There was not even a pro forma injunction to avoid coercion. … In 1983 more than 16 million women and more than 4 million men were sterilized in China, nearly 18 million women were inserted with IUDs, and over 14 million underwent abortions.
There was widespread criticism of this policy in China itself. The All-China Women’s Federation demanded an end to ‘infanticide and the abuse of women’. There was outrage among Roman Catholics and pro-life supporters around the world, especially in the USA. Eventually the Chinese government softened the policy, but claimed that it had been successful, and was therefore justified. Now that China’s population has stabilized and the birth rate is even falling, this means that there are fewer people to share the available resources; therefore standards of living should rise and poverty should be reduced. However, some observers point out that although this in itself is a great achievement, it does not solve the problems facing the ecosystem. Matthew Connelly explains why, using as an example some Asian countries which adopted population control policies:
If Asians have only 2.1 children, but also air conditioning and automobiles, they will have a greater impact on the global ecosystem than a billion more subsistence farmers … [because] they tend to consume more of everything per capita, whether fuel, or water, or wide open spaces.
This was borne out in a joint report by a group of scientists from 105 institutions published shortly before the Earth Summit Conference of July 2012. This confirmed that one of the main causes of the rapid rise in consumption was ‘the growing middle class in developed countries and the very lavish lifestyles of the very rich across the planet’. American biologist Paul Ehrlich put it this way: ‘The current redistribution of wealth from poor to rich must be halted, and overconsumption by the rich must be controlled with programs such as those that transformed consumption patterns in the United States when it entered World War II.’ Former World Bank economist Aklog Birara suggested that
the world can no longer afford to follow the same economic and social model of insatiable demand and concentration of consumption and wealth in a few hands. I cannot imagine that the rest of the world would tolerate continuation of 20 per cent of humanity consuming 80 per cent of the world’s goods and services, while one-fifth of the poorest consume only 1.3 per cent. Is this not what triggered the Arab Spring and is likely to trigger Springs in the rest of the poorest and most repressed countries?
This last point was taken up by Paul Liotta and James Miskel, who highlight another worrying aspect of the still growing population; the growth of huge cities with populations of over 10 million. They calculate that by 2025 there will be at least 27 of these mega-cities around the globe. In Africa, Asia, the Middle East and South America these massive concentrations of people inevitably include a large proportion of poverty-stricken have-nots. In the authors’ words: ‘Crowded masses within these unaccommodating spaces will have literally nowhere else to go; if left to their own devices by inept or uncaring governments, collective rage, despair and hunger will inevitably erupt.’ They argue that mega-cities are attracting terrorists and various types of criminal gangs; unless governments meet this challenge by taking effective counter-measures, some of them will present a serious security threat to the rest of the world.
As the world population reached 7 billion at the end of 2011, the majority view was still that efforts to reduce population growth in areas like Africa must not be relaxed. Greater efforts should be made to provide contraceptives to everybody in the developing world who wants them; and greater use of the internet should be made to spread information about the various methods of birth control.
28.4 THE POPULATION INCREASE AND ISLAMISM
(a) Samuel Huntington and the ‘clash of civilizations’
Another aspect of population growth that many Western observers found threatening was that many of the states where the population was increasing most rapidly were Muslim. It was believed that by 2020 the total Muslim population would far outweigh the non-Muslims in the West, bearing in mind also that many Muslims actually lived in the West. It was in a 1992 lecture that the American political commentator, Samuel Huntington, first proposed the ‘clash of civilizations’ theory. He later elaborated the theory in his book The Clash of Civilizations and the Remaking of World Order (1996). He argued that with end of the Cold War, the clash of ideologies was also over, and that in the future, the great conflicts would be between different cultures and civilizations. The USA would be ‘the primary bastion, agent, champion and defender of Western civilization’ against whatever challenges presented themselves. He also pointed out that the rise of the West had depended more on military force than cultural persuasion. ‘The West won the world not by the superiority of its ideas or values or religion (to which few members of other civilizations were converted) but rather by its superiority in applying organized violence. Westerners often forget this fact; non-Westerners never do.’
At the time Huntington was writing, it was becoming increasingly clear that Islamism was the main challenge to Western liberal values – stable democracy, regard for human rights, and capitalist free-market economies. The Iranian revolution of 1979, which overthrew the pro-American government of the Shah Reza Pahlevi (see Section 11.1(b)) and set up an Islamic republic, was regarded by many in the West as a dangerous manifestation of the threat from Islamic fundamentalism. Even more so when Iranian students kidnapped over 50 Americans and held them hostage for 444 days, in an attempt to force the US to hand over the former Shah who was living in exile in the USA. Then in October 1981 President Sadat of Egypt was assassinated by members of a militant Islamic group, the Egyptian Islamic Jihad, because they thought he was too pro-American and he had made peace with the Israelis (see Section 11.7). Islamism came to be regarded by many in the West as synonymous with terrorism, as a whole series of attacks took place on American targets (see Section 12.2(c)): US embassies in Beirut and Kuwait (1983 – carried out by Islamic Jihad), the US embassies in Nairobi (Kenya) and Dar-es-Salaam (Tanzania – both in 1988), the destruction of the airliner over Scotland with the loss of 270 lives (1988), a bomb explosion in the World Trade Center in New York (1993), the damaging of the destroyer Cole in harbour in Yemen (2000) and the following year the climax of 9/11 with the destruction of the World Trade Center in New York (see Section 12.3). Many Americans condemned Islam as a whole, calling Muslims ‘a colossal threat’ and ‘a failed faith and civilization’, and claiming that Muslims everywhere ‘lack the liberal gene’. As President Bush launched his ‘war against terrorism’ with the attack on Afghanistan, announcing that countries were ‘either with us or against us’, it looked as though Huntington’s predictions were about to become reality.
However, Raymond Baker (see Further Reading) argues that such blanket condemnations of Islam ignore some of the most influential Islamic thinkers of the last half-century, who have put forward a vision of Islam that champions ‘rationality, science, education, tolerance, social justice, democracy and political participation. In Turkey, for example, democracy has worked successfully and Islamists have done well in elections. Compared with other parties, “they are perceived by the population to be greatly supportive of local communities”.’ In Palestine, the militant Hamas Party won the election fairly in 2006; but the USA, claiming to be committed to democracy, were most reluctant to accept the voters’ verdict (see Section 11.11(g)). Certainly many respected Muslim writers had already rejected the ‘clash of civilizations’ theory. Abdullahi Ahmed An-Na’im, a professor of law in Atlanta, USA, and formerly of the University of Khartoum (Sudan), argued that ‘all the governments of predominantly Islamic countries have clearly and consistently acted in consideration of their own economic, political or security interests. What is happening everywhere is simply the politics of power, as usual, not the manifestation of a clash of civilizations.’ During the 1990s the UN and NATO actually supported Muslims in Kosovo and Bosnia (see Section 10.7), as well as in Somalia and Chechnya. In the aftermath of the 9/11 attacks on the USA, some Muslim states sided with the Americans and offered their support. Pakistan provided vital help, and its president, Pervez Musharraf, condemned Pakistani extremists for bringing Islam into disrepute. Thus Pakistan received considerable financial aid from the USA in return for its co-operation, as did Kazakhstan, Tajikistan and Uzbekistan. Another Muslim, Ziauddin Sardar, wrote (Observer, 16 September 2001) that ‘Islam cannot explain the actions of the suicide hijackers, just as Christianity cannot explain the gas chambers, or Catholicism the bombing at Omagh. They are acts beyond belief by people who long ago abandoned the path of Islam.’ He insisted that terrorist actions were completely alien to the faith and reasoning of Islam; it was a war against a small group of Muslim terrorists [al-Qaeda] and the rogue states that were harbouring them.
Other writers have made the point that Islamism, like Christianity, is far from being a united entity. There are at least three major divisions of Islam and many subdivisions and groups. Paul Berman (in Terror and Liberalism, 2004 edition), an American political and cultural critic, argues that distinct cultural boundaries do not exist – there is no ‘Islamic civilization’, nor a ‘Western civilization’, and that the evidence for a civilization clash is therefore not convincing. Edward Said pointed out that the Islamic world numbers over a billion people, includes dozens of countries, societies, traditions, languages and, of course, an infinite number of different experiences. It is therefore simply false to treat them all as a monolithic entity called Islamists, who are inherently violent, who are anti-modern and anti-liberal, who do not believe in democracy and who want to turn the clock back to the seventh century, when Islam began. Noam Chomsky has dismissed the whole theory as being merely a new justification for the USA ‘for any atrocities that they wanted to carry out’. The USA needed a new threat on which to lay the blame for their interventionist policies, now that the Soviet Union was no longer a viable threat. And indeed one example of this: the invasion of Iraq was blamed on al-Qaeda and Saddam Hussein’s non-existent weapons of mass destruction, when in fact the real reason for the attack was to enable the USA to protect their oil supplies.
(b) Islamism and its beliefs and principles
Founded by the Prophet Mohammed (570–632) in Mecca, Islam (meaning ‘submission’, because Muslims submit themselves to the will of God) soon spread throughout Arabia. At its furthest extent it reached across North Africa and into Southern Spain, Malaya, Indonesia, Turkey and eastern Europe, following the capture of Constantinople (Istanbul) in 1453. Mohammed claimed to have received messages from the angel Gabriel, which were written down by his followers, and formed the Muslim holy book, the Koran. This contains the Five Pillars of Islam, the five basic obligatory acts: saying the creed, daily prayers, giving alms for the poor, fasting during Ramadan and making the pilgrimage to Mecca at least once. In addition, Muslims must follow Islamic law, which deals with virtually every aspect of life and society.
As with Christianity, there are several different denominations:
Most Islamists agree that Islam must be involved in politics. They believe that in some way governments must incorporate Muslim principles, concepts and traditions into their policies. One of their central goals is to introduce sharia (Islamic) law in countries that they control. Some believe in achieving this peacefully, but others are prepared to use violence. The West’s conception of Islamism is probably skewed by the fact that the media tends to focus on violent groups such as al-Qaeda, whereas some of the most popular, dynamic and influential Islamists, such as the Muslim Brotherhood in Egypt, the Islamic Action Front in Jordan and the Justice and Benevolence movement in Morocco, get less attention. In Morocco the media has focused on an extremist Salafi group which in May 2003 carried out horrific bombings that killed 45 people. Compared with that, Justice and Benevolence is moderate and benign.
(c) The situation in 2012
In September 2012, anti-American and anti-Western protests swept through the Muslim world following the showing on YouTube of an American film, The Innocence of Muslims. This was extremely insulting to the prophet Mohammed. The protests began in Libya where Islamists attacked the US consulate and killed four Americans, including the US ambassador. It emerged that the attacks had been carried out by an Islamist militia known as Ansar al-Sharia (supporters of Sharia law). As the anti-West protests, many of them violent, spread around the globe, it seemed that the world was on the brink of the long-predicted great civilizations clash.
Then events took an unexpected turn. In Libya counter-protests began to appear, demanding that the militias, which were operating outside government control, should be disbanded. The Jihadist formations Ansar al-Sharia and Abu Salem, together with several other militias, agreed to disband and hand over their weapons, claiming that they had decided their role was over. This left a number of active militias that would take time to deal with, but it was a move in the right direction. It demonstrated clearly what many writers had been arguing for the last 20 years: that the majority of Muslims are moderate and peace-loving, and those in the Third World are facing the usual problem – the struggle to feed their families. They probably have neither the time nor the inclination to take part in a struggle between rival civilizations. The terrorists represent just one strand of militant Islamic fundamentalism, which is intolerant and anti-modern. In fact, all religions have their fanatics, whose extreme beliefs often contradict the very religions they claim to embrace. Francis Fukuyama, writing in 2002, argued that the idea of the theocratic Islamic state is appealing in theory, but that the reality is less appealing:
Those who have actually had to live under such regimes, for example, in Iran or Afghanistan, have experienced stifling dictatorships whose leaders are more clueless than most on how to overcome the problems of poverty and stagnation. … Even as the September 11th events unfolded, there were continuing demonstrations in Tehran and many other Iranian cities on the part of tens of thousands of young people fed up with the Islamic regime and wanting a more liberal political order.
This does not mean, of course, that Muslims do not have genuine grievances. The root cause that lay behind much of the terrorism was Third World poverty, human rights abuses and the ever-widening gap between rich and poor. On the one hand there was the Western capitalist system, thriving on profit-led globalization (though less so after the 2008 financial crisis) and its ruthless exploitation of the rest of the world. On the other hand there was the Third World, which saw itself as marginalized and deprived, and where all manner of problems were rife – famine, drought, AIDS, crippling debts and corrupt governments which abused human rights and failed to share the wealth of their countries among ordinary citizens. Some of these governments, such as President Mubarak’s regime in Egypt, were supported by the West, because they were good at suppressing potential terrorists. The problem with the so-called ‘war on terrorism’ was that it had concentrated on military and police action, with not much evidence of successful aid and nation-building. In Muslim and Arab eyes, the whole situation is epitomized in the Arab–Israeli conflict. On the one hand there is Israel, wealthy, heavily armed, guilty of violating UN resolutions and supported by the USA. On the other hand there are the Palestinians, marginalized, deprived of their land, poverty-stricken and without much hope of improvement. Until these problems are addressed seriously, it is unlikely that the Muslim world and the West can ever be on close terms.
27.5 THE HIV/AIDS EPIDEMIC
(a) The beginnings
In the early 1980s AIDS (Acquired Immune Deficiency Syndrome) was thought to be a disease that mainly affected homosexual men; some people called it the ‘gay plague’. Another group which contracted the disease were people who used unsterilized syringes to inject themselves with drugs. At first it was in the wealthy countries of the West, particularly the USA, that most cases were reported, but after governments had launched campaigns about sexual health and the use of condoms to prevent the transmission of HIV (Human Immunodeficiency Virus), the outbreaks seemed to have been brought under control. The widespread use of anti-retroviral (ARV) drugs therapy slowed down the development of the virus and enabled people to live much longer.
It was something of a shock when, during the 1990s, the world became aware that the disease had spread to the poorest countries in the world, and that in Africa it had reached epidemic proportions. Scientists now know that it takes an average of eight to ten years for HIV infection to develop into full-blown AIDS, which was why the virus was able to spread so widely before it was recognized. The epidemic also spread to India, China and the countries of the former USSR. Tony Barnett and Alan Whiteside, in their recent book AIDS in the 21st Century (2002), showed how each epidemic was different: in China the main causes were contaminated needles and the practice of selling blood at state-run blood collection points in the early 1990s. The World Health Organization (WHO) estimated that two-thirds of injections given in China were unsafe and that much of the collected blood plasma was infected. When the symptoms of AIDS began to appear, local officials tried to suppress the news. It was only in 2003 that the government admitted publicly that over a million of its citizens were HIV-positive; the infection was increasing by 30 per cent a year and 10 million could be affected by 2010. In Russia and Ukraine the highest rates were among injecting drug-users, especially those in prison. Experts calculate that once HIV enters the general population and infects around 5 per cent of adults, a general epidemic is likely to follow, as it has in southern Africa.
(b) AIDS in southern Africa
The first cases to be reported in Africa were in a fishing village in south-west Uganda, in the mid-1980s. The HIV virus spread rapidly, transmitted mainly by unprotected heterosexual sex. Governments were slow to realize the significance of what was happening and aid agencies made no provision for dealing with the disease in their assistance programmes. It was in 2001 that a report by the International Crisis Group (ICG) sounded alarm bells. It said that the impact of HIV on Africa was as though it was involved in a major war. The report concentrated on Botswana, but it warned that the impact of AIDS on Africa as a whole was likely to be devastating within just a few years, if nothing was done about it. The report was not exaggerating: in 2001, 3 million people died from the disease in Africa, and 5 million became infected. By 2003 it was estimated that 29.4 million people were living with HIV or AIDS in Africa, and this was about 70 per cent of the global total. A further 3 million people died from the virus in Africa during 2003.
By that year HIV prevalence levels had risen to horrifying proportions. In Botswana and Swaziland, almost 40 per cent of adults were living with the virus or with full-blown AIDS, and the percentage was almost as high in Zimbabwe. In South Africa the prevalence level was 25 per cent. Life expectancy in southern Africa, which had reached the sixties by 1990, had fallen again to the lower forties; in Zimbabwe it was down to 33. One of the tragic side effects of the pandemic was the huge numbers of children left without parents. In Uganda there were over a million orphans; the WHO estimated that by 2010 there were likely to be 20 million AIDS orphans in Africa. There were economic effects too: a substantial proportion of the labour force was being lost, with all its skills and experience. This was being felt especially in farming and food production, while the deaths of so many young women was an irreplaceable loss to the domestic economy and to child-rearing. At the same time there was an increased demand for people to nurse the sick and care for orphaned children.
Why was the epidemic so much worse in southern Africa?
HIV was able to spread more quickly in conditions of poverty, where there was very little access to information and education about the virus and how to prevent it spreading. Widespread hunger reduced resistance to the disease and accelerated the progress from HIV to AIDS. Nor were any of the expensive anti-retroviral drugs available for Africans. The large number of civil wars in Africa produced thousands of refugees, who were often cut off from their normal healthcare services. In emergency situations like these, there was a greater danger of the HIV virus being spread through contaminated blood. Most African governments took a long time to acknowledge what was happening, partly because of the stigma attached to the disease: the belief that it was caused by homosexual sex and the general reluctance to discuss sexual habits. South Africa itself was one of the slowest to take action, mainly because President Mbeki refused to accept the link between HIV and AIDS.
(c) What is being done to combat AIDS?
The experts know what needs to be done to bring the AIDS epidemic under control: people must be persuaded to have safe sex and use condoms; and somehow governments must be able to provide cheap ARV treatment. Brazil is one country where the campaign has slowed down the spread of the disease. In Africa, governments have concentrated on the so-called ‘ABC’ message: ‘Abstain from sex. Be faithful to one partner, and if you cannot, use a Condom.’ Uganda provides the great African success story; the government admitted to the WHO in 1986 that they had some AIDS cases, and President Museveni personally took charge of the campaign, travelling round from village to village to talk about the problem and what should be done. Uganda was the first country in Africa to launch the ABC campaign and provide cheap condoms for its people. People were encouraged to come forward voluntarily for testing. The programme was financed jointly by the government, by aid agencies and by religious organizations and churches. Uganda’s meagre resources were strained to the limits, but the campaign worked, even though very few people had access to ARV drugs: Uganda’s HIV prevalence rate had peaked at 20 per cent in 1991, but by the end of 2003 it had fallen to about 5 per cent. The epidemic had passed its acute stage, but the problem of orphaned children was just reaching its height.
Elsewhere in Africa and China, governments were slow off the mark and the epidemic took a firmer hold, reaching crisis proportions in 2003. Some African countries were beginning to follow Uganda’s example. In Malawi, President Muluzi set up an AIDS commission and appointed a special minister to deal with the problem. But huge sums of money are needed to finance the necessary three-pronged attack on HIV/AIDS across Southern Africa:
There are several international agencies trying to deal with the disease, the most important being the UN’s Global Fund to Fight AIDS, TB and Malaria; the World Health Organization (WHO); and UNAIDS. In December 2003, UN secretary-general Kofi Annan complained that he was ‘angry, distressed and helpless’; 1 December was World AIDS Day, but the outlook was bleak. Reports from all over the Third World showed that the war against the disease was being lost; the virus was still spreading and 40 million people were living with HIV. The UN Fund said it would need £7 billion by 2005 and the WHO wanted £4 billion. Many wealthy countries have given generously; the USA, for example, has promised $15 billion over the next five years, but insists that the money be spent in the way it specifies. The Bush administration favoured programmes which promoted abstinence against those that advocated the use of condoms. The Roman Catholic Church also continues to oppose the use of condoms, even though scientists have shown that it is the best means of prevention available. No wonder Kofi Annan was angry; ‘I am not winning the war’, he said, ‘because I don’t think the leaders of the world are engaged enough.’
By 2012 well over 30 million people had died from AIDS since the first cases were identified in 1981. An estimated 1.8 million of them died in 2010 alone, two-thirds of them in southern Africa, where nearly 15 million children were left orphaned. In the same year around 2.7 million people became infected with HIV. According to the WHO, the attempts to control the epidemic have been intensified; from 2002–8 spending on the campaign in low- and middle-income countries increased sixfold. Since 2008 spending has not increased, but at least the level has been maintained. In May 2012 the WHO published a plan of priority action for the next two years: focusing on HIV prevention, encouraging people who might be at risk to get themselves tested regularly, providing even wider access to cheap ARV drugs and improving and modernizing healthcare systems, especially in southern Africa. There were some encouraging signs: more people than ever before were receiving ARV treatment, the annual number of AIDS deaths had declined and the global percentage of people infected with HIV seemed to have stabilized. However, the UN agencies warn that recent achievements should not lead to complacency; on no account should efforts be relaxed. In fact in eastern Europe infection rates were still rising; and in the USA in June 2012 more than one million people were living with HIV, but probably 20 per cent of them didn’t know they were infected.
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