Unfairness of social and economic structures affect AIDS in Africa

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; 123m) is to be taken from money already earmarked for aid. The money must be used to boost …