Text: UNAIDS Head Speaks on AIDS and Global Security

03 October 2001

Text: UNAIDS Head Speaks on AIDS and Global Security

Calls AIDS a central security issue of 21st century

Governments and international bodies around the world are focusing on terrorism as a threat to global security in the wake of September 11 attacks on the United States, but HIV/AIDS is another threat to human security that must receive concentrated world action, according to Joint United Nations Program on AIDS (UNAIDS) Executive Director Peter Piot.

"The global AIDS epidemic is one of the central security issues for the 21st century," Piot said in an October 2 speech at United Nations University in Tokyo.

Piot said HIV/AIDS must be viewed not only as a global disease epidemic but also as a security issue because of its impact on armed forces, peacekeeping operations, national economies, food supplies, and social stability.

Piot outlined the pervasive impact of the HIV/AIDS epidemic and its negative influence on various social sectors. But he also stressed that governments can take action, and he outlined a seven-point, anti-disease campaign:

--build responses that involve all sectors of society;

--national leaders must be involved;

--strengthen social inclusion in solutions;

--improve stronger community coping mechanisms;

--increase international assistance;

--plan for replacement of depleted human resources;

--build partnership in the responses.

Following is the text of the Piot speech as prepared for delivery:

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JOINT UNITED NATIONS PROGRAMME ON AIDS
UNAIDS

AIDS and human security

Statement by Peter Piot, UNAIDS Executive Director

United Nations University, Tokyo, Japan
2 October 2001

Ladies and gentlemen, The September 11 attacks on New York and Washington have been deeply shocking, across the world. They are shocking because suddenly, taken-for-granted assumptions about personal safety and national security were shattered.

The attacks have forced us all to reflect on the nature of security: what it means personally as well as geo-politically. For each of us, it brings to mind security in the widest sense, and raises the question of how to reinforce the fundamental human bonds that allow us to live together in peace and stability. There is a world of difference between the root causes of terrorism and the impact of AIDS on security. But at some deep level, we should be reminded that in many parts of the world, AIDS has caused a normal way of life to be called into question.

As a global issue, therefore, we must pay attention to AIDS as a threat to human security, and redouble our efforts against the epidemic and its impact.

Since the creation of UNAIDS six years ago, we have been positioning AIDS not only as a global epidemic of an infectious disease, but as a development issue, as well as an issue of human security. The latter concept was formally recognized in the UN Security Council's first debate on AIDS, in January 2000. This debate also marked a shift in the concept of 'security' -- from the absence of armed conflict, to a wider definition of human security, encompassing the fundamental conditions that are needed for people to live safe, secure, healthy and productive lives.

At the same time as the Security Council's debate, the CIA produced a report on 'The Global Infectious Disease Threat and Its Implications for the United States'. It argued that AIDS will pose a rising global threat and will complicate US and global security over the next 20 years. The report also claimed "The relationship between disease and political instability is indirect but real ... infant mortality -- a good indicator of the overall quality of life -- correlates strongly with political instability"

In January last year, the idea that AIDS is a security issue was new. Now, the idea is widely accepted.

The impact of AIDS is a major issue for national security and many armed forces worldwide, for all peacekeeping and humanitarian operations, and for wider notions of economic security, food security, policing and social stability.

Of course, the Japanese Government has been leading the global movement to pay more attention to the notion of human security. They draw the distinction between freedom from fear -- the traditional purview of security, and freedom from want, insisting that both aspects are equally a part of the wider notion of human security.

Today, I want to look in more detail at all the components of the AIDS and security equation, both as it has impact on national security as narrowly defined and in terms of the wider 'human security' concept.

The global AIDS epidemic is one of the central security issues for the twenty-first century.

AIDS and global insecurity coexist in a vicious cycle. Civil and international conflict help spread HIV, as populations are destabilized and armies move across new territories. And AIDS contributes to national and international insecurity, from the high levels of HIV infection experienced among military and peacekeeping personnel, to the instability of societies whose future has been thrown into doubt.

Because it takes place over a timeframe of years and decades, the world has failed to realize that AIDS is a massive attack on global human security. But this is not a security threat we are powerless to prevent. The epidemic is not inevitable: we know how to reduce the spread of HIV and alleviate the epidemic's impact.

Unless the global response to AIDS steps onto a 'war-footing' we will continue to lose ground against the epidemic. Asia is the crucial new battleground -- actions taken today in Asia will determine the global shape of the epidemic in a decade's time.

UNDP -- one of the 8 cosponsoring organizations of UNAIDS -- did ground-breaking work on the notion of human security in the first half of the 1990s. They proposed eight components of human security: economic, food, health, environmental, personal, community and political. With the possible exception of environmental security, all these aspects of security are deeply affected by the HIV/AIDS epidemic.

Economic security

The impact of AIDS on rates of economic growth in developing countries is marked. There is a direct relationship between the extent of HIV prevalence and the severity of negative growth in GDP.

But measures of per capita GDP in fact underestimate the human impact of AIDS, as AIDS kills people as well as economic activity. The cumulative impact of HIV on the total size of economies is thus even greater. By the beginning of the next decade, South Africa, which represents 40 per cent of the region's economic output, is facing a real gross domestic product 17 per cent lower than it would have been without AIDS.

One of the long-term impacts of AIDS on a nation's human resources. In many of the worst affected countries, AIDS has substantially weakened national elites: the business people, managers, politicians and community leaders who were poised to lead their nation's future into the twenty-first century.

In settings where subsistence agriculture predominates, measured economic productivity only scratches the surface of the total impact of HIV on livelihoods. For example, AIDS hits the long term capacity for agricultural production, as livestock is often sold to pay funeral expenses, or orphaned children lack the skills to look after livestock in their care.

The immediate impact of AIDS is felt most acutely in households where one or more members are HIV infected. In South Africa, households will on average have 13 per cent less to spend per person by 2010 than they would if there were no HIV epidemic. In Cote d'Ivoire the household impact of HIV/AIDS has been shown not only to reverse the capacity to accumulate savings, but also to reduce household consumption. AIDS not only affects income, with lower earning capacity and productivity, it also generates greater medical, funeral and legal costs, and has long term impact on the capacity of households to stay together. This is most manifest in the cumulative number of children orphaned by AIDS, which now totals nearly 14 million.

Household impact is one of the points at which AIDS and poverty demonstrate their inter-twined, negative relationship. AIDS exacerbates and prolongs poverty in every context.

Take Botswana, the country with the highest HIV prevalence in the world with over one in three adults infected. Although Botswana has one of the highest per capita incomes in sub-Saharan Africa, a proportion of its population lives in poverty. In 1996, 38 per cent of the population was living in poverty, down from 49 per cent a decade earlier. But in a decade, as a result of AIDS, the proportion of Botswana's population in poverty will return to 45 per cent.

In poorer households, AIDS takes a greater proportion of available expenditure, and limits access to everything from health care to food.

Food security

Emergencies, including food emergencies, are a major point of vulnerability to AIDS. When populations are on the move and the basic security of life is threatened, HIV risks rise. Women, in particular, may often find themselves in circumstances where they are subject to sexual violence, or forced to trade sex for food. The challenge therefore is to make sure that emergencies are the focus for interventions to reduce HIV risks.

We need to find innovative ways to make this happen -- I am delighted for example that the World Food Program is looking to use their networks and logistic capacity in responding to AIDS. They will help community groups and others expert in HIV interventions to have a presence in emergency situations. They are also dealing with another of the very specific HIV risks that comes along with emergencies -- by making sure that their contract truck drivers receive intensive HIV prevention education and condom supplies.

The second, related challenge is how to break the vicious cycle between food insecurity and HIV vulnerability. As well as dealing with the immediate impacts of AIDS, we must continue to pay attention to sustainability and overcoming long-term vulnerability. Are less labor-intensive crops available that are still good food sources? How do we keep children at school against the pressure for them to replace the labor of sick or dying parents?

Health security

More than 20 million people have died worldwide since the beginning of the epidemic, three quarters of them in sub-Saharan Africa. Globally, HIV/AIDS is now well established in the list of the top five leading causes of death. It is only surpassed by disease groups such as ischiaemic heart disease, cerebrovascular disease, and lower respiratory infections -- whose predominance is largely because they are typical causes of death for old people. In sub-Saharan Africa, AIDS is responsible for 1 out of 5 deaths, twice as many as for the second leading cause of death.

The demographic impact of AIDS is unique for two reasons. First, unlike most other causes of death, AIDS deaths will continue to rise in the coming years as a result of infections that have already occurred. Second, HIV infection is highest in young women and men in their most productive years, including in the best educated and skilled sectors of populations, as well women of child bearing age, together with attendant transmission to children. In the worst affected countries, in twenty years time the standard population pyramid will have turned upside down, with more adults in their 60s and 70s than those in their 40s and 50s.

Current prevalence data do not convey the full picture facing individuals in high HIV prevalence populations. Because prevalence is a measure of current infection levels amongst living individuals, it does not capture infections amongst those who have already died or who have not yet become infected but will be in the future. On the basis of current incidence and mortality patterns, it is possible to estimate the lifetime risks of contracting HIV and dying from AIDS faced by young people embarking on the sexually active phase of their lives. In a country such as South Africa, or Zambia, where prevalence in the year 2000 has reached about 20 per cent, a 15-year old teenager faces a lifetime risk of HIV infection and of death from AIDS of over 50 per cent, unless the current rate of new infections drops dramatically.

Personal security

The impact of the AIDS epidemic on personal security is both direct and indirect.

Directly, people who are living with HIV or affected by HIV have often been the targets of physical violence, as well as suffering the psychological violence of stigma and discrimination.

We only have to recall the care of Gugu Dalmini to understand the extremes of violence that HIV can provoke. Gugu Dalmini was murdered in December 1988, only two weeks after she stood in front of a World AIDS Day meeting in a South African township, disclosing that she was living with HIV. Her murder must never be forgotten as testimony to the suffering of people living with HIV, and her legacy must be that we all redouble efforts against to fight HIV-related stigma.

As well as its direct effects, the AIDS epidemic has an indirect impact on personal security by its contribution to social instability. In particular, because HIV is transmitted mainly sexually, it is most prevalent among young adults. Therefore when AIDS starts causing illness it is often people with young families who find themselves dealing with the additional burden of AIDS.

The impact of a generation of young people who have not had the support they need from their parents, and many of whom are themselves HIV infected, is having serious effects on social cohesion. These are the same age groups that have historically been most vulnerable to involvement with crime.

The results are already being felt. The issue of crime, street violence and instability as a result of the AIDS epidemic has already emerged as a serious concern in a number of countries, particularly in sub-Saharan Africa.

One group of young people most affected by the HIV/AIDS epidemic is the children left behind when their parents die. Already, 13 million children have been orphaned by AIDS, losing either their mother or both parents before the age of 15. AIDS has had a dramatic affect on the global number of orphans, and in particular in Africa, which accounts for 90% of the total number of AIDS orphans. In developing countries, before AIDS around 2 per cent of children were orphaned, but now in many countries, 10 per cent or more of children are orphans.

The war in Sierra Leone left 12,000 children without families. AIDS in Sierra Leone has already orphaned five times that number.

How will families and communities cope? How many orphaned boys, and particularly girls, will not go to school because there is no one to pay their school fees, or no one to dress them and get them out of the house in the morning, or because they have to help grow the food to feed the remaining family? What does it mean for society to have a significant proportion of desocialized youth? How many will end up desperate and easy prey for militias and warlords? These are all hugely important issues, yet we have barely begun even to raise them, much less address their solutions.

Community security

AIDS affects the very fabric of society. Community structures break down. Coping capacity reduces. Policing capacity reduces. Communal conflict increases. Public administration, governance and social services become unsustainable.

In many of the worst affected countries, civil services are having to recruit two or three people to fill one job, to cover inevitable absences for sickness, death and funerals -- and where there is not the money or the people available, essential public service task are left undone. Police services are heavily affected in Namibia the police earlier this year stated that AIDS has become a heavy burden for the police, and in Kenya it accounts for 75 per cent of all deaths in the force over the past two years.

In education, AIDS has a negative impact both on the supply of teachers and on the capacity of children to continue in school. Across sub-Saharan Africa an estimated 860,000 children lost their teachers to AIDS in 1999, and in some countries many more teachers die than retire, and the teaching force is being depleted almost as rapidly as new teachers can be trained.

Political security

National security is directly threatened by social and economic instability, lack of predictability, and weakened governance as a result of AIDS.

There are five key ways in which AIDS has a negative impact on national political security.

First, AIDS exacerbates poverty. It forces affected households to use all their economic resources on dealing with illness and death. It causes direct health costs, and detracts from productivity, on a massive scale.

Second, AIDS diverts scare resources, especially in many of the world's least resources countries, which can ill-afford any additional burdens.

Third, AIDS kills elites, including leadership elites. These are the people who are needed to secure the future -- just when they are needed most to help nations cope with the impact of AIDS, they themselves are suffering directly from the epidemic and capacity spirals downwards.

Fourth, in urban areas in particular where there is an expectation that health services will be accessible, a great demand is generated for HIV treatment. Middle and working class pressures on private and public health services become considerable, and if these demands cannot be met, adds to political instability and tension -- just witness the destabilising political effects that claims of 'miracle cures' for AIDS have had, in countries as diverse as Nigeria and many other African countries, India and Thailand.

Fifth, there is pressure on international trade regulation and intellectual property protection. One of the crucial issues facing the future of international trade rounds is whether there the twin demands of global public health and intellectual property regulation can be satisfactorily reconciled, in a way that convincingly protects the sovereign right to make public health protection paramount but at the same time ensures that there are incentives to develop innovative pharmaceuticals and make them accessible where they are needed most.

Adding to these broad effects on political instability, AIDS has a direct effect on military capacity as an issue of national security.

Military forces suffer higher than average levels of HIV infection. The US Armed Forces Medical Intelligence Center in 1999 estimated the level of HIV infections among armed forces in sub-Saharan Africa ranging from 10% in Eritrea, 10 to 20% in Nigeria, to 40 to 60% in Angola and the Democratic Republic of Congo.

Conflict exacerbates the spread of HIV, and in turn, in a vicious cycle, the weakened defenses of nations contribute to international instability.

It has even been suggested by some security analysts that the international capacity for peacekeeping is being weakened because some African countries that have traditionally supported peacekeeping forces have found that AIDS has put so much pressure on their capacity they may no longer be able to fulfill this role.

What to do?

Let me emphasize, that the issue is not just to draw attention to the problem, but to do something about it. One of the main lessons from the last decade of response to AIDS is that we are not powerless to do something to turn back the epidemic. From successful responses in countries as diverse as Thailand, Cambodia, Brazil, Senegal and Uganda we have learnt what works, and what doesn't.

What can be done?

Let me nominate seven features that are essential to an effective global effort to turn tide on HIV.

First, there is a need to build multisectoral responses. Just as we have seen that the impact of the HIV epidemic crossed every part of economic and social affairs, so too the response must involve every part of society in a full-scale mobilization against AIDS.

Second, leadership: the leadership to make AIDS a national priority, for Prime Ministers and Presidents to step in and say that AIDS is not just a health issue -- it is an issue fundamental to development, to progress and to human security, the leadership to tackle stigma and the leadership to marshal the necessary financial resources for the fight against AIDS -- the 7 to 10 billion dollars annually that is needed for an effective response in developing countries.

Third, the need to find ways of strengthening social inclusion. HIV feeds on marginalization and so responses that build social inclusion are necessary -- from protections against discrimination, to developing prevention and care initiatives that fully involve their target groups in program planning and delivery.

Fourth, building stronger coping mechanisms at community level. It is at community level that the battle against AIDS will ultimately be won -- and communities need to feel they are both empowered and enabled to cope with and combat the epidemic. Among other things, that means ensuring that there are efficient mechanisms for decentralization, so that national responses can be truly effective through every part of a nation.

Fifth, we need to provide international assistance and solidarity. Through the lens of AIDS as a human security issue we can see ever more clearly our global interconnectedness. AIDS is truly a global problem that calls out for global responses -- including resources, for example the new Global AIDS and Health Fund that will be operational by the end of this year, and already has one and a half billion dollars pledged to it.

Sixth, we need to address the long-term need to replace depleted human resources. This agenda is barely beginning, but is vital to the long-term response to AIDS. Only when we succeed in restoring and renewing the human capacities that have been battered by the epidemic can we be confident the most affected countries will be able to secure their futures.

And last, building a partnership in the response. The response to AIDS is beyond any one nation or any one agency -- it needs partnership between regions, involving public and private sectors, governments, civil society and business. UNAIDS itself is a unique partnership in the United Nations system, bringing together the joint efforts of eight cosponsoring organizations, focused on the one set of objectives.

Conclusion

AIDS has called into question the fundamental continuity of humanity -- the passing from one generation to the next of basic values, of a legacy of happiness and prosperity, of memories and hopes.

Being able to make preparations for future generations is necessary to any notion of human security. Without the security that allows people to plan for the legacy they will leave to their children and to their community, the very basis of hope in the future is called into question. Security means nothing if there is no future.

But we have the means at our disposal to build this future, to turn back the epidemic.

We must keep hope alive.

Thank you.

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