Jeffrey Katz, Manager of the Bank’s Partnerships and External Affairs for the Africa Region, began the session with an introduction of the book and speakers. David Lindauer, Professor of Economics, Wellesley College, and co-editor of the book, AIDS and South Africa: The Social Expression of a Pandemic, gave the opening presentation. The book resulted from a conference he and co-editor Kyle Kauffman organized at Wellesley College to increase awareness of the pandemic in South Africa. He noted that AIDS in the U.S. is considered a public health problem since the infection rate is less than one percent. When it reaches 20 percent, such as it is in South Africa, it becomes a macroeconomic issue as well. The conference brought together many different professional disciplines to examine the pandemic from a variety of perspectives. The conference was received well enough for the organizers to launch into a book project, where event speakers authored chapters for the project. Lindauer quickly discussed some of the individual contributions and chapter subjects. In his overview, he characterized the African National Congress’s response to the pandemic as its greatest failure.
Kauffman said South Africa was complacent about AIDS during the 1990s, when at the start of the decade, the infection rate was one percent. Large migrant labor, the subservient role of women, lack of government engagement were listed as contributing factors in the growth of infection rates. He said other nations should look closely to understand the lessons of South Africa well. Kauffman noted that much art created during the 1970s and 1980s focused on apartheid, but little art has been produced on HIV/AIDS. He then discussed an art exhibition he co-organized that opened in South Africa and will be seen in Europe and North America, and then showed some of the artwork. The use of art, Kauffman said, expands the community of dialogue beyond the traditional scope of policy makers and economists.
Jeffrey Lewis, Manager of the Bank’s Development Prospects Group, discussed his chapter, Assessing The Demographic and Economic Impact of HIV/AIDS. Lewis said South Africa had many traditional development challenges, but the scale of the pandemic convinced him to focus his work on HIV/AIDS since its impact would be felt in all aspects of the country’s economy. It is the most important health issue on the continent and has impacted all aspects of African society. Routine blood screening does not generally take place, so to determine the extent of the pandemic is difficult. Determination of infection rates comes when women come in for prenatal care. The epidemic, according to 2002 data Lewis reviewed, is still expanding. One in four pregnant women is infected, he said. Projections suggest that the epidemic will reach its height in the next couple years. Importantly, about one third of the work force during their most productive years is infected. He discussed demographics of several African countries including some of the specifics of Botswana. He looked at the macro effects of the impact on households, businesses and the government. For business, costs, absenteeism, productivity, experience are all important impacts. For households, loss of a worker, orphan rates, social outcomes of raising children without a parent. The government also impacted by many direct and indirect effects of the pandemic. The military and teaching professions are cited for having lost many workers. Lewis then discussed some AIDS scenarios that he generated using a number of factors. He compared some of the preventative actions by Thailand and compared it to South Africa.
Keith Hansen, Manager of the Bank’s ACTafrica program, expressed disappointment on demonstrating the linkages between macroeconomics and AIDS to motivate action. He noted that when he worked on environmental issues in the Bank a decade ago, the issue held little traction until Intel made it an issue of economics. The book drives home the point that AIDS is an issue of social dynamics and processes and norms. It revealed how the political dynamics and social structure in South Africa allowed the disease to spread. Empowerment, and not necessarily information, is at the root of the issue. The end of apartheid was a trigger for the spread of AIDS, he said. The policy lessons for South Africa are generic and can profoundly help other large developing countries such as India, China or Russia. The world is not well equipped to address social epidemics, which allowed AIDS to spread. Hansen suggested many international organizations and institutions, including the Bank, were blind to the crises that was unfolding, and said the book should provide useful lesson for future prevention.
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