The African Pandemic Hits Washington

During the next administration, the epic AIDS tragedy now swiftly unfolding will reshape Africa and inexorably dominate U.S. foreign policy toward the continent. Not since the bubonic plague has the world faced an infectious disease pandemic of such sweeping proportions as the present HIV/AIDS global pandemic--at whose epicenter Africa firmly stands. In 16 African countries where HIV/AIDS now rages--all but one in southern and eastern Africa--between one-third and two-thirds of young men and women will eventually die of AIDS. Enlarge the aperture and the view on Africa does not improve: 24 of the world's 25 most AIDS-affected countries are African.

We finally began to recognize, at the end of the 1990s, that HIV/AIDS is not simply another in a string of crises on a crisis-prone continent. It is a colossus that in a large segment of Africa raced far out in front both of most African leaders who were in denial as well as donors and international organizations who were complacent or disinterested. In this period, countless opportunities to act early were lost. The central question now is how (or if it is possible) to regain lost ground--to establish a foothold within Africa that effectively reverses infection rates and provides a modicum of care for the millions who suffer from AIDS and related infectious diseases. For the balance of this decade, as the search for an answer to this question proceeds, HIV/AIDS will increasingly challenge the integrity of the continent and induce changes in U.S. foreign policy. How precisely these changes will unfold is not yet known.

Today it is not certain that immediate action by the international community and African counterparts can stanch the advance of HIV/AIDS in the hottest zone or even in several other African countries where the epidemic appears poised to take off, such as Nigeria, Ethiopia, Ghana, Namibia, and Angola. Whether the outcome is a relative success, abject failure, or some mixed pattern, experiences will not only heavily define Africa's future and impact important U.S. interests in mitigating Africa's proliferating crises, promoting its integration into the global economy, and ensuring reliable access to increasingly important sources of energy; they will also set powerful global precedents.

In effect, Africa provides the prelude to future HIV/AIDS-related developments in India, China, the Caribbean, and countries of the former Soviet Union, where the pandemic may surge in its next phase. How we engage on the soft global issues stemming from HIV/AIDS in Africa will inevitably shape our future response in other parts of the world. For these reasons, U.S. national interests in combating HIV/AIDS in Africa--on moral, humanitarian, economic, and transnational security grounds--will increasingly be understood in global terms. HIV/AIDS will alter how we perceive Africa; how we manage Africa's multiple, proliferating crises; and how we situate Africa globally among U.S. national interests. What these changes will be, and whether they contribute to greater hope or despair, will depend on how effectively the international community and African leaders cope with the massive uncertainties at play. This includes the continent's vulnerability to sudden shocks that set back progress and redefine global perceptions of what is possible in Africa.

The Scope and Nature of the Pandemic in Africa

HIV/AIDS threatens to reverse development gains achieved in the past several decades and could create new, even transnational, security threats. Of the more than 18 million dead thus far from AIDS worldwide, almost 16 million are buried in Africa. This pattern will grow in the foreseeable future. In the next decade alone, AIDS is projected to leave up to one quarter of many African citizens dead, orphan 15 million more children, reduce already marginalized economies by 20 percent, and severely strain fragile or already failing state structures.

As mortality rates skyrocket, life expectancy in many African countries will drop from more than 60 years to less...