The impact of HIV/AIDS on stability and security
Severe instability and state collapse is a multi-faceted phenomenon involving a number of interrelated processes. These can include damaged social institutions (such as the family, and the education and health systems), a volatile economy, poverty, high crime, the erosion of the government’s popular legitimacy, and control of the armed forces ( Allen 1999 ; Elbe 2003 ; Barnett and Whiteside 2002 : 4-98). High rates of HIV/AIDS may contribute to all of these processes, as recognized as early as 1990 when the CIA added AIDS incidence/prevalence to the list of variables to be considered when analysing state stability ( Elbe 2003 : 45).
Increased attention is now being paid to the strategic implications of HIV/AIDS, including its potential role as a causal factor in forced migration. Due to the fairly recent nature of the debate, complexity of the issue, and lack of information and reliable data, it is not possible to give a definitive picture of the strategic implications posed by HIV/AIDS. Opinions on the issue fluctuate between those who believe that the security risk posed by HIV/AIDS is dangerously underestimated and that HIV/AIDS could weaken states to the point of collapse ( Singer 2002 : 146; Schneider and Moodie, 2002 ), and those who believe that HIV/AIDS is a contributory factor to instability, but not the main cause ( Elbe 2003 : 9-10). Some of the key issues will now be addressed.
Impact upon socio-economic and political stability
At the micro-economic level, HIV places great strain on agricultural output, food security, household earnings, and ability to cope due to adult morbidity and mortality from HIV/AIDS. It is estimated that infection of HIV by a family member results in a decline in household income by as much as 40 to 60 per cent ( Lundberg et al. 2001 ). Women are particularly badly affected, as men tend to have more access to assets than women. HIV/AIDS also leads to a loss of knowledge and skills due to increased adult mortality, with particular impact on agricultural output and land use. This is accompanied by an increase in household expenditure (for medical care, drugs, transport, and funeral expenses) which thereby reduces the amount of income the household has available for other essential items. Access to credit is also increasingly restricted ( Lundberg et al. 2001 ; De Waal 2003a : 1234-7; Barnett and Whiteside 2002 : 222-41; Harvey 2003 ).
The social impact of HIV/AIDS is profound. For example, in sub-Saharan Africa in 1999, 860,000 primary school children lost their teachers to AIDS, and Africa is expected to lose 10 per cent of its teachers to AIDS by 2005 ( Harvey 2003 : 16). The Zambian Ministry of Education reports that 2.2 per cent of teaches died of AIDS in 1996 . This was more than the number produced by all teacher training colleges. The death rate in Zambia is expected to triple by 2005 ( Barnett and Whiteside 2002 : 311).
The ability of governments to provide effective health services is severely affected as HIV/AIDS increases the strain on what are already extremely limited resources. HIV/AIDS also impacts upon economic growth and tax revenue and therefore the ability fund health care. Health staff are dying of AIDS whilst there is a shortage in replacement staff as the national labour pool reduces from sickness and death from the disease. In Malawi it is estimated that between 25 and 50 per cent of all health care workers may be dead from AIDS by 2005 ( Foreman et al. 2000 ). In the mid-1990s it was estimated that 66 per cent of Rwanda’s health budget and over a quarter of Zimbabwe’s went on treatment for people with HIV/AIDS ( Commons Select Committee on International Development, 29 March 2001 ). According to the US National Institute for Security (December 2000) the worst affected countries will devote more than half of their health budgets to tackling the disease.
Not only are countries having to cope with the direct costs of preventing and treating HIV/AIDS, they are also having to do so whilst macro-economic growth declines as HIV/AIDS mortality and morbidity hit the most economically productive demographic age groups. The disease reduces access to education, decimates the labour force, increases absenteeism, increases training costs, and reduces productivity. It also reduces savings, erodes the tax base, and reduces the size and wealth of markets. It may also increase uncertainty, and undermines confidence in the economy, and so could discourage private and foreign investment.
A number of macro-economic studies and predictive modelling exercises have been conducted to assess the impact of the disease upon national economies. A World Bank study (2000a) suggests that an adult prevalence rate of 10 per cent may reduce the growth of national income by up to a third. A macro-economic predictive modelling study of South Africa by Arndt and Lewis (2000) projected that by 2010 the economy would be 17 per cent smaller than it would have been without AIDS and the per capita income 8 per cent smaller. A World Health Organization report conservatively estimates that the economic value of the lives lost due to AIDS in sub-Saharan Africa is equivalent to 11 per cent of the region’s combined gross national product in 1999 ( WHO 2001 : 31-2). While these losses could be absorbed for a year or two, they pose larger problems when they occur cumulatively over a sustained period of time. A senior World Bank official cited HIV/AIDS as the single greatest threat to economic development in sub-Saharan Africa (quoted in Harvey 2003 : l2). According to Alex De Waal (2003b: 1-23), Director of Justice Africa, HIV/AIDS has effectively thrown the process of political and economic development into reverse in a number of countries.
HIV/AIDS can also increase civil crime. The ability of police forces to conduct their work is reduced. In Zambia, AIDS is estimated to have caused 75 per cent of deaths in the police force between 1998 and 2000, whilst crime has reportedly risen as some people living with HIV/AIDS are apparently less concerned with the potential repercussions of criminal activity given their limited life expectancy ( Elbe 2003 : 49). As mentioned in the previous section, the high numbers of orphans as a result of AIDS has also increased risk of crime, and of orphans being abducted by criminal gangs or insurgent groups and becoming child soldiers ( UNICEF/ USAID/UNAIDS 2002 ; Barnett and Whiteside 2002 : 210). It is estimated that up to half of all combatants in Sierra Leone were in the age range of 8 to 14 years ( Peters and Richards 2003 ).
The impact upon the disease at the governance level is less understood and requires more study, but it is assumed to erode the capacity to govern. Weak political leadership over HIV/AIDS would inevitably exacerbate the situation. Tensions could also emerge if one group felt itself disproportionately affected by HIV/AIDS and/or marginalized from care and treatment. For example, in Uganda in the mid-1990s the Defence Minister is alleged to have suggested that one of the most likely potential triggers for a coup was the perception among the military that the government was not doing enough to combat HIV/AIDS ( Elbe 2003 : 50). Ruling groups have in the past been willing to manipulate health and nutritional supplies to damage the support base of political opponents. According to one specialist, ‘the uneven distribution of essential HIV treatment based on social, ethnic, or political criteria could well put unmanageable pressures on social and political structures, threatening the stability of regimes throughout Southern Africa’ ( Cheek 2001 ). The prominence of HIV/AIDS as a campaign electoral campaign issue is also increasingly likely, as apparent in the general election in Malawi in May 2004 ( http://www.guardian.co.uk/international/story/0,,1220449,00.html).
This social and economic upheaval is generally taking place in political economies that were already fragile and weakened by a variety of other factors such as poverty, acute inequality, and weak governance. A report to the Select Committee on International Development at the British House of Commons (29 March 2001) noted that ‘evidence suggests that in societies facing economic crisis and a lack of clear political leadership the presence of HIV/AIDS with its associated stigma may cause instability’. It goes on to note that ‘there is thus a prima facie argument … that HIV/AIDS increases poverty, that there will be greater social insecurity and possibly conflict as a result of the HIV/AIDS epidemic’.
- HIV Insite/University of California (Political economy of HIV/AIDS) - http://hivinsite.ucsf.edu/InSite?page=kbr-08-01-10
- Oxfam/Save the Children, ‘HIV/AIDS and Food Security in Southern Africa’, December 2001 - http://www.oxfam.org/eng/pdfs/pp021127_aids_safrica.pdf
- UNAIDS (economics and development) - http://www.unaids.org/en/in+focus/topic+areas/economics+and+development.asp
- UNAIDS (impact on agriculture and rural households) - http://www.unaids.org/en/in+focus/topic+areas/impact+on+agriculture+and+rural+households.asp
- UNAIDS (non-school education) - http://www.unaids.org/EN/in+focus/topic+areas/education+-+outside+school-settings.asp
- UNAIDS (school education) - http://www.unaids.org/EN/in+focus/topic+areas/schools.asp
- UNESCO (impact on education) - http://portal.unesco.org/en/ev.php-URL_ID=2295&URL_DO=DO_TOPIC&URL_SECTION=201.html
- WHO (Report of the Commission on Macroeconomics and Health) - http://www3.who.int/whosis/menu.cfm?path=whosis,cmh&language=english
- World Bank (HIV/AIDS) - http://www1.worldbank.org/hiv_aids/
Impact upon national and international security
From the limited data available, it appears that HIV/AIDS is having a serious impact upon armed forces around the world, with prevalence rates far exceeding those found in civilian populations both in their country of origin and in the surrounding civilian population in the area of deployment ( Altman 2003 ; Heinecken 2001 ). UNAIDS studies indicate that military forces have infection rates between two and five times higher than the civilian population ( UNAIDS 1998a : 2). According to the National Intelligence Council (2000), several armed forces in sub-Saharan Africa have HIV prevalence rates of around 10 to 20 per cent, with some as high as 60 per cent. Rates in the Cambodian military range from 6 to 17 per cent, and in Haiti 1995 prevalence rates in the military were reported to be around 10 per cent. In 1996, 34 per cent of all deaths among active-duty military personnel in the Congo were estimated to be AIDS related. In Zambia and Namibia, AIDS-related illnesses now constitute the leading cause of death among the military and police forces. In Thailand, the military has designated HIV/AIDS a threat to national security ( Elbe 2003 : 23). Reasons for higher prevalence rates include mobility, frequent casual sexual relations (particularly with sex workers), peer pressure, and alcohol and drug use ( Elbe 2003 : 17). The issue of demobilization of combatants, their reintegration into civilian life, and the impact this may have on the spread of HIV/AIDS is also an area of concern ( Carballo et al., October 2000 ).
Implicit within this is the effect that HIV/AIDS is having upon peace-keeping operations ( Tripodi and Patel 2002 ). Many armed forces with high HIV prevalence rates also regularly contribute to international peace-keeping operations aimed at mitigating and containing the outbreak of armed conflicts. In addition, peacekeeping forces are at increased risk of becoming infected by being deployed in areas of high prevalence. This is particularly so in Africa where three-quarters of the police officers and soldiers under UN command are stationed ( International Crisis Group 2004 ). According to senior officers in the French army’s health services, tours of duty overseas multiply the risk of HIV infection for French military personnel by a factor of five. Among Nigeria’s military forces returning from peace-keeping duties in Sierra Leone and Liberia, HIV infection rates were 11 per cent compared with the national adult rate of 5 per cent. ( UNAIDS 1998a : 5). The effect is that peace-keepers act as vectors of HIV, spreading the virus among population in areas of deployment and back in their country of residence. As a result, HIV/AIDS has additional regional and international strategic ramifications by hindering international attempts to respond to conflict by threatening peace-keeping operations as countries become less able or willing to contribute personnel ( Elbe 2003 : 39). However, some military forces are responding to the threat in a progressive manner, such as prevention programmes being run by the Ugandan military ( ICG 2004 ). The UN General Assembly has also recognized the problem and in September 2003 launched a global initiative on ‘Engaging Uniformed Services in the Fight against HIV/AIDS’ in partnership with UNAIDS, UN’s Department of Peace-keeping Operations (DPKO), and national governments ( http://www.unaids.org/en/in+focus/topic+areas/uniformed+services.asp).
Elbe (2003: 23) notes that ‘the crucial question, therefore, is not whether HIV/AIDS is having an impact on the armed forces, but rather how, in the worst-affected countries, this impact will manifest itself, and with what overall strategic significance. These include impacting upon human and financial resources due to continual replacement and training of lost personnel, an inability to find sufficient numbers of new recruits, and damaged morale and cohesion, and civil-military relations.’
Peter Singer (2002: 146) believes that HIV/AIDS will weaken armed forces ‘to the point of failure or collapse’. The most common hypothesis is that such a reduced military capacity could increase a state’s vulnerability to external attack, or its vulnerability to internal rebel groups, because of the perception by the aggressors that the armed forces were no longer an effective threat. However, Stefan Elbe (2003: 36) notes that high prevalence rates amongst armed forces could conceivably have benign strategic benefits with a reduction in operation efficiency hampering expansionist military plans in bellicose countries.
- CIA (HIV/AIDS) - http://www.cia.gov/search?NS-search-page=results
- Foreman, M., ‘Combat AIDS - HIV and the World’s Armed Forces’, Panos Institute, 2002 - http://www.panos.org.uk/PDF/reports/COMBAT per cent20AIDS per cent20PDF.pdf
- International Crisis Group, ‘HIV/AIDS as a Security Issue’, Brussels/Washington, June 2001 - http://www.icg.org/home/index.cfm?id=1831&l=1
- International Crisis Group, ‘HIV/AIDS as a Security Issue: Lessons learnt from Uganda’, Kampala, April 2004 - http://www.icg.org/home/index.cfm?id=2606&l=1
- UNAIDS, ‘Engaging Uniformed Services in the Fight Against HIV/AIDS’ - http://www.unaids.org/EN/in+focus/hiv_aids_security+and+humanitarian+response/hiv_aids+and+uniformed+services/engaging+uniformed+services+in+the+fight+against+hiv_aids.asp
- UNAIDS (uniformed services) - http://www.unaids.org/en/in+focus/topic+areas/uniformed+services.asp