Global voices on HIV/AIDS

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7344.1034 (Published 27 April 2002) Cite this as: BMJ 2002;324:1034

Unfairness of social and economic structures affect AIDS in Africa

  1. Dorothy Logie, primary care adviser in public health, Borders NHS
  1. Cheviot View, Bowden, Melrose TD6 0ST
  2. 1018 North Charles Street, Baltimore, Maryland, MD 21201, USA elainebaruwa@yahoo.com
  3. Oshakati State Hospital, Private Bag 5501, Oshakati, Namibia
  4. Department of Medical Physics
  5. Department of Emergency Medicine Royal Perth Hospital, Perth, Western Australia 6847, Australia
  6. University of Western Australia, Perth, Western Australia 6009, Australia
  7. Department of Research, Universidad Metropolitana Barranquilla, Colombia AA 50-576
  8. Department of Medical Physics, Royal Perth Hospital, Perth, Western Australia 6847
  9. Family Medicine and Primary Health Care, Medical University of Southern Africa, 0204 South Africa
  10. Department of Molecular and Cellular Pharmacology, University of Miami School of Medicine, FL 33124, USA
  11. Department of Obstetrics and Gynaecology, General Public Hospital, Korneuburg A-2100, Austria
  12. Global Fund to Fight AIDS, Tuberculosis, and Malaria, International Conference Centre Geneva, 9-11 Rue de Varembe, CH-1202 Geneva 20, Switzerland

    EDITOR—The fact that health is fragile and determined less by health services than by the relative fairness of social and economic structures was missing from the debate on global AIDS.1 Sub-Saharan Africa contains 10% of the world's population and bears 70% of the global burden of HIV/AIDS. It also exists on 1% of the global economy and, with the recent economic slump, this figure is falling. In January Zambia heard that the mining group AngloAmerican is pulling out of copper production (which accounts for 75% of the country's export earnings). The mines are likely to close in the next 10 months, putting 9500 miners and 1600 other workers out of work. These men will migrate in search of new work—one of the many social factors contributing to the epidemic.

    HIV has gained the biggest foothold in poor countries with rising unemployment and declining health and educational services. Over the past 20 years the World Bank and the International Monetary Fund have conducted a massive social experiment in poor African countries. It is called structural adjustment and has encouraged privatisation of industry, such as Zambia's copper mines, increased unemployment, cut food subsidies, and introduced charges for health and education. The ideology of structural adjustment has recently been repackaged and renamed poverty reduction strategy and programmes with the intention of giving countries ownership of reducing poverty. But the basic macroeconomic programme is not for discussion.

    Africa urgently needs a realistic evaluation of the continuing effects of debt and neo-liberal economic prescriptions on the health of its people. It also needs increased aid. The Global Fund for AIDS, Tuberculosis, and Malaria must be supported by new money: the United Kingdom's pledge of £75m ($108m; Embedded Image123m) is to be taken from money already earmarked for aid. The money must be used to boost …

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