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International Security 27.2 (2002) 159-177

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HIV/AIDS and the Changing Landscape of War in Africa

Stefan Elbe

Since the discovery of AIDS more than two decades ago, 60 million people have been infected with HIV, the virus that causes AIDS, and more than 20 million have died from AIDS-related illnesses. The HIV/AIDS pandemic has become a humanitarian and human security issue of almost unimaginable magnitude, representing one of the most pervasive challenges to human well-being and survival in many parts of the world. 1 It has taken a particularly heavy toll on sub-Saharan Africa, where AIDS is now the primary cause of death. 2 In light of this magnitude, HIV/AIDS is not only having devastating effects on the individuals and families touched by the illness; it is also beginning to have much wider social ramifications. In some African countries, HIV prevalence rates have reached between 20 and 30 percent of the adult population. In these countries HIV/AIDS is giving rise to a vast array of economic, social, and political problems.

An important development overlooked by scholars in this regard is the growing impact of HIV/AIDS on the nature and conduct of armed conflict in Africa. 3 As the director of the Joint United Nations Program on HIV/AIDS [End Page 159] (UNAIDS) recently noted, "Conflict and HIV are entangled as twin evils." 4 Armed conflicts certainly facilitate the spread of HIV/AIDS, but the virus also leaves its distinctive mark on the nature and conduct of war in regions where prevalence rates are already high. Historically, novel social developments have tended to influence the ways in which societies wage war, and HIV/AIDS has proven no different. "Over the past five years," one analyst has noted, "HIV/AIDS has changed the landscape of war more than any other single factor." 5 To date, however, academic attention to this relatively new aspect has not been commensurate with the increasingly significant role that HIV/AIDS has played in recent armed conflicts in Africa. 6 The question for scholars is: What happens when a sexually transmitted, lethal illness such as AIDS is introduced into the social environment in which these conflicts take place?

This article argues that HIV/AIDS is increasingly influencing three components of armed conflicts in Africa: their combatants, how the conflicts are conducted, and their social significance. The argument developed over the next five sections is that although these influences may at times be subtle, together they are elevating the social cost of armed conflict in Africa to new levels.

The first section presents an overview of the AIDS epidemic in Africa. The second section explains how armed forces in Africa, embedded within this [End Page 160] larger social context, have become a high-risk group for the transmission of HIV/AIDS. The third section illustrates how the virus has been used as a weapon of war in some regions of the African continent. As a result, the social ramifications of these conflicts have begun to extend far beyond the battlefield, leading, as the fourth section argues, to a significant increase in the number of eventual AIDS-related war casualties. The article concludes by suggesting that the emerging symbiosis between HIV/AIDS and armed conflict in Africa can be reversed only if the combatants, as a high-risk group and vector of the illness, participate in local and international efforts to reduce its spread. To this end, it also suggests several policy recommendations.

HIV/AIDS in Africa

Armed conflicts in Africa are increasingly occurring in environments of widespread HIV/AIDS prevalence. To appreciate this important change in the broader social context of these conflicts, it is useful to consider the magnitude of the AIDS pandemic in Africa over the past two decades. Logistical, political, and human rights constraints complicate the task of collecting accurate data. Nevertheless, UNAIDS and the World Health Organization estimate that, in several sub- Saharan countries, between a fifth and a third of the adult populations are living with HIV/AIDS. In sub-Saharan Africa approximately 28.5...


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