HIV/AIDS and Human Insecurity in Southern Africa

The nexus between the HIV/AIDS pandemic and human security is particularly visible in the SADC region. SADC’s harmonized policy and institutional framework for HIV/AIDS should compel states to keep to their commitments in fighting HIV/AIDS.

Published on 08 December 2011 in ISS Today

Gwinyayi A Dzinesa  Senior Researcher, African Conflict Prevention Programme, ISS Pretoria Office

Southern Africa joined the rest of the globe in celebrating World AIDS day on 1 December. According to a recent report from the Joint United Nations Programme on HIV/AIDS (UNAIDS) while infection rates have fallen in four Southern African countries – Botswana, Malawi, Tanzania and Zimbabwe - HIV/AIDS continues to be one of the most pervasive human security threats facing the region. The pandemic has affected the Southern African Development Community (SADC) region more severely than any other subregion in the world. In 2007 UNAIDS estimated that Southern Africa, home to 4 percent of the global population, accounted for 35 percent of all people living with HIV/AIDS worldwide and 32 percent of the world’s new HIV infections and AIDS-related deaths. About 1.15 million Southern Africans were infected during 2008, which translates into an average of 3 150 new infections each day. While Southern Africa’s HIV/AIDS epidemics appear to have stabilized, in 2009 nine SADC countries (Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe) continued to bear a disproportionate share of the global AIDS burden, with each having a national adult HIV prevalence higher than 10 percent. In 2009, Swaziland had an adult HIV prevalence of 25.9 percent, making it the country with the highest level of infection in the world. South Africa, the region’s economic powerhouse, has the world’s largest number of people living with HIV/AIDS, estimated at 5.6 million in 2010. The pandemic has ceased to be primarily a health concern but is at the core of human security in Southern Africa, which has been grimly described by UNAIDS as the ‘global epicentre of HIV/AIDS’.

Basic human security elements that HIV/AIDS impacts negatively include survival, safety, opportunity, dignity, agency, and autonomy. The high incidence of the HIV/AIDS pandemic has undermined the potential of Southern Africa to achieve the Millennium Development Goals (MDGs) by 2015. Halting the spread of HIV/AIDS is intricately linked with the seven other MDGs that impact human security: eradicating extreme poverty and hunger; achieving universal primary education; promoting gender equality and empowering women; reducing child mortality; improving maternal health; combating other diseases such as tuberculosis; ensuring environmental sustainability; and developing a global partnership for development. As former UN Secretary-General Kofi Annan stated: ‘Halting the spread of HIV is not only an MDG in itself; it is a pre-requisite for reaching most of the others.’ As in the rest of sub-Saharan Africa, HIV/AIDS has wreaked havoc on all sectors of society in the region, affecting health and education; agriculture and food security; the life and dignity of individuals, households, and communities; the traditional safety net; and poverty and inequality. SADC’s key planning instruments, such as the 2003 Regional Indicative Strategic Development Plan (RISDP) and the 2004 Strategic Indicative Plan of the Organ (SIPO) (Organ on Politics, Defence, and Security Cooperation [OPDSC]), acknowledge the threat posed by HIV/AIDS to regional integration and economic development.

Efforts by individual SADC member states to address HIV/AIDS predate the official SADC regional response to the pandemic. During the 1980s, individual SADC countries variously focused on HIV prevention, care and support, as well as mitigating the pandemic’s socioeconomic impact under the rubric of the Global Programme on AIDS, managed by the World Health Organization (WHO). Since the 1990s, SADC countries have recognized that the pandemic affects all sectors of their economies, making it imperative to craft multi-sectoral strategies to address HIV/AIDS. To coordinate their plans, the region’s governments have established national AIDS councils and commissions, which remain major actors in the regional fight to reduce the socio-economic impact of the pandemic. SADC’s drive to develop harmonized HIV/AIDS policy and institutional mechanisms has built upon existing and proven country-level best practices.

SADC identified HIV/AIDS as one of its four key priority areas alongside military security, food security, and governance. The pandemic was given prominence as a standing item on the agenda of the SADC Summit of Heads of State and Government, which committed itself to the formulation of a conducive regional policy environment and institutional framework to tackle the effects of HIV/AIDS. SADC has also endorsed continental and global instruments and mechanisms to combat the impact of HIV/AIDS, such as the April 2001 Abuja Declaration, through which member states allocate at least 15 percent of their national budgets to the health sector; the 2001 New Partnership for Africa’s Development (NEPAD); the 2006 Brazzaville Commitment On Scaling Up Towards Universal Access to HIV/AIDS Prevention, Treatment, Care, and Support in Africa; the MDGs, adopted at the United Nations Millennium Summit of 2000; and the UN General Assembly’s 2001 Declaration of Commitment on HIV/AIDS.

SADC’s overarching strategic framework comprises two major sections: the first provides an overview of the regional HIV/AIDS situation and analyses of responses; and the second lays out the operational planning, such as goals and objectives and the activities that need to be undertaken. The subregional body recognizes that the war against HIV/AIDS needs a coordinated, sufficiently funded, innovative, interdisciplinary, and multi-sectoral strategy.

SADC has established an HIV and AIDS Unit, comprising a core team of four experts complemented by project staff, within the SADC Secretariat’s Department of Strategic Planning, Gender, and Policy Harmonization, in order to coordinate the subregional body’s response to the pandemic. The HIV and AIDS Unit is tasked with ensuring the successful operationalization of SADC’s HIV/AIDS strategic framework. The common regional HIV/AIDS strategy focuses on six major areas: policy development and harmonization in key areas of prevention, care, treatment, and support; mainstreaming HIV/AIDS strategy within all SADC policies and programmes; capacity building to mainstream HIV/AIDS strategy; development of requisite technical resources; resource mobilization; and monitoring and evaluation of regional and global commitments. Given the multidimensional and multi-sectoral nature of the HIV/AIDS pandemic, SADC’s HIV and AIDS Unit is expected to work closely with the SADC Secretariat’s directorates (those that have a focal point dedicated to HIV/AIDS) and other units.

Funding for prevention, treatment, care, and support activities in SADC has increased considerably in the past decade from sources like the World Bank’s Multi-Country HIV/AIDS Programme for Africa (MAP) and the European Union. From the United States, the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria have been major sources of investment. PEPFAR, an initiative to combat the global HIV/AIDS pandemic, was launched in 2003 by former US president George W. Bush, who committed to provide US$15 billion to fund the plan’s first five-year cycle (2003–2008). After assuming office in 2009, President Barack Obama announced a US$51 billion budget for PEPFAR, but over a period of six years—this was not in line with the US$48 billion that Obama promised would be rolled out by 2013, nor with the additional US$1 billion annual increase he had promised during his election campaign. The Global Aids Alliance estimated that that the consequent shortfall would lead to 1 million people worldwide not receiving antiretroviral treatment and expose 2.9 million pregnant women to transmitting HIV to their children, with Africa, especially Southern Africa, the hardest hit. About 27 million people would also not have access to sexually transmitted infection prevention programmes, while 1.9 million orphans and vulnerable children would not receive care and support services. The Global Fund to Fight AIDS, Tuberculosis, and Malaria was established in 2002 to prevent and treat these three profound health concerns. By 2009 the fund had approved US$15.6 billion for 572 programmes in 140 countries, with 57 percent of the monies channelled to sub-Saharan Africa.

UNAIDS estimated that at the end of 2008, US$13.7 billion had been made available for the global AIDS response, representing a 21 percent increase above the US$11.3 billion in 2007. However, fears that the global financial crisis of 2007–2009 would reduce political interest and financial support for HIV/AIDS programmes in the region at a time when treatment costs were increasing due to longer life expectancy were realized when global AIDS funding flat-lined between 2008 and 2009. The Global Fund is not asking for new proposals since it lacks sufficient funding.

Critics of the notion that the uncertain global economic climate precluded increases in HIV/AIDS funding have pointed out that the trillions of dollars provided to bail out the banking sector show that the issue is one of political priorities rather than resource constrains. Against this backdrop it is important that SADC states meet their commitment under the AU’s Abuja Declaration to allocate at least 15 percent of their national budgets toward health in order to alleviate the dire consequences of reduced HIV/AIDS funding.