Stress Factor 4 - HIV/AIDS

In sub-Saharan Africa, where the HIV/AIDS pandemic has hit hardest, countries are experiencing debilitating rates of illness and death among technicians and professionals in the private sector, in public services and in the military. These losses threaten to erode the functional capacity of some of the world’s weakest states and could significantly hamper their abilities to develop economically, and to respond to chronic domestic discontent and sudden crises.

Over the next two decades a wave of AIDS-related deaths among working-age adults in the seven worst AIDS-affected countries is likely to produce population age structures never before seen in history, with the numbers of old and very young predominating over those of the working-age population. These age structures seem likely to foster the potential for political instability.

AIDS orphans — now 14 million globally, 11 million of them in sub-Saharan Africa alone — are swelling the ranks of street children in the cities of developing countries. These children are more than a human tragedy. They are a likely source of future urban discontent, criminal activity, and recruits for insurgencies or police states. Government support for placing homeless orphans in families and in schools could help reduce future risks.

Policy Prescription

Military forces in about 20 African and Asian countries appear to have extraordinarily high HIV prevalence rates, posing threats to their operational readiness, to peacekeeping commitments, and to communities with which they come in contact. A few HIV/AIDS education and prevention programs in the armed forces of developing countries — Uganda, Senegal, Morocco, Tanzania and Thailand — have produced notable results. Such efforts should be multiplied by increasing funding to international military-to-military, civilian-to-military and military-to-civilian HIV/AIDS programs.

Only significantly expanded prevention efforts, or a massive mobilization of treatment programs, or an unforeseen vaccine breakthrough, or some combination of all three of these is likely to stave off major demographic changes and disruptive losses of human capital in countries seriously affected by AIDS. Public health specialists recommend a massive international effort giving equal weight to HIV prevention and AIDS treatment programs in each of these states. It is essential that these involve promotion and supply of condoms to all who could benefit from their use, including military personnel.

Proportion of reproductive-age population (aged 15-49) living with HIV.