Globaleyes

In Poor Health: The Impact of Globalization and Trade on HIV/AIDS in Africa

Wasai Jacob Nanjakululu

This is the third in a series of articles on economic globalization with an international perspective sponsored by the Peace Ministries Program of MCC Canada.

 

It may seem odd to link globalization with HIV/AIDS in Africa. After all, one is about open markets and trade policies and the other is simply a health issue, right? Wrong. The ability for African countries to respond to HIV/AIDS themselves is dependent on their ability to better control the terms of trade, elicit more favourable patent policies on medications, and climb out of poverty — all issues linked to globalization.

While globalization has garnered some benefits for the urban elites in Africa — information, communication and technology — these positive outcomes have not reached the urban poor and rural folk who form over 80 percent of African populations. Over 60 percent of Africans live below the poverty line.

Meanwhile, every day in Africa:

• HIV/AIDS kills 6,500 people
• 9,500 people are infected with the HIV virus
• 1,400 newborn babies are infected during childbirth or by their mothers' milk

These statistics are grim enough on their own, but even harder to swallow when it becomes clear what role globalization plays in hindering lasting solutions.

The early globalization in Africa: Structural adjustment programs

When HIV/AIDS hit Africa in the 1980s, it found health systems already weakened by the structural adjustment programs (SAPs) foisted on countries by the World Bank and the International Monetary Fund (IMF). Many nascent local industries collapsed when markets were liberalized and they were forced to compete with cheap imported products from Europe, Asia and America.

Not only did this loss of jobs mean people could no longer afford basic social services, such as education, health, sanitation, and water, but SAPs also adversely affected the ability of African governments to raise revenues and provide services to their people.

Africa's declining share of world trade

While SAPs plunged Africa further into poverty, trade rules continue to harm Africa — and its ability to solve the HIV/AIDS crisis. In 1980 Africa had a six percent share of world trade. By 2002 this had dropped to just two percent despite the fact that Africa has 12 percent of the world's population. If Africa could regain just an additional one percent share of global trade, it would earn $70 billion more in exports each year — several times more than what the region currently receives in foreign aid.

For example, Ghana can export raw cocoa duty-free to Europe, but a 25 percent tariff is applied if that cocoa is processed before export. Yet, it is this processing that helps a country earn more money, develop its manufacturing base and expand its economy. While fair trade could be Africa's ticket out of the vicious cycles of poverty, unfair trade rules like this trap Africa at the gates.

The World Trade Organization (WTO) is the place where these rules are written. But of the 38 African nations who belong to the WTO, 15 nations have no representative at all at the headquarters in Geneva. In contrast, most rich nations have dozens of staff to protect their trading interests.

What does this mean for the AIDS war in Africa?

Most, if not all, HIV/AIDS interventions in Africa are heavily dependent on foreign aid from the rich countries. If Africa could have its rightful share of world trade, it could easily raise its own resources to pay for HIV/AIDS interventions. Currently, most HIV/AIDS interventions are not sustainable as the funding comes with conditions.

For instance, Mozambique is a beneficiary of PEPFAR (the US President's Emergency Plan for AIDS Relief), and like other beneficiary countries of this fund, it can only buy drugs approved by the US Food and Drug Administration, which rules out the vastly cheaper generic treatments.

In South Africa, efforts to provide low cost AIDS medications resulted in a high profile legal battle between activists and the pharmaceutical industry in 2001. The activists were trying to get affordable medicines, while pharmaceutical companies were trying to protect the intellectual property rights on their drugs. Fortunately, the activists won the case.

From one hurdle to the next

While generic antiretroviral drugs (ARVs) are now free and available in most sub-Saharan countries, another hurdle is being erected. Europe is about to conclude Economic Partnership Agreements (EPAs) with African, Caribbean and Pacific countries that will essentially set up free trade areas between these regions and Europe.

For Africa, this means governments will lose much needed tariff revenues, necessary to fund social services, including AIDS medications. This is problematic because a balanced diet and good nutrition need to go hand-in-hand with taking ARVs.

The first casualties of EPAs will be farmers and their agricultural products, which do not enjoy the subsidies that those from Europe do. Those living with HIV/AIDS, who are predominantly poor, will also suffer. Subsidized imports may make food cheaper in the short term, but in the long term lost jobs, undermined local production, and higher food prices are likely to result.

Those working in manufacturing industries risk losing their jobs too, as those industries close due to competition from more established industries in Europe. In a word, EPAs will bring massive loss of revenue at the individual, household and national levels throughout Africa, a situation that does not help the effort to combat AIDS in Africa.

Which way for Africa?

African governments and other global development actors serious about helping Africa should advocate for fair trade to help the continent pay its own bills. HIV/AIDS should be treated as a development issue rather than just a health issue. It is therefore imperative that other sectors of development (particularly global trade) be reviewed and challenged globally, so that Africa can solve its own problems, including putting in place a sustainable HIV/AIDS program.

 

Wasai Jacob Nanjakululu is a social scientist who works for the Agency for Cooperation in Research and Development (ACORD), which is based in Nairobi, Kenya. He has over ten years experience working in the area of HIV/AIDS strategic planning, programming, monitoring and evaluation in Africa. MCC has seconded an officer to work at ACORD.

 

The perspectives included in Globaleyes do not necessarily reflect MCC opinion.