74 Books & arts The EconomistJune 27th 2020
2 to discourage lovers”. Though some famous Africans,
such as Philly Lutaaya, a Ugandan singer, were honest
about their condition; others, like Fela Kuti, a Nigerian
musician, were not.
The fear of what an hivdiagnosis might mean for
your family, or your position within it, was pervasive.
Some traditional religions saw early deaths as a break
in the ancestral chain. And if you were the first in your
family to test positive, you could be accused of bring-
ing the disease into a household. Since women were
more likely to get tested, and because of the possibility
of transmitting the virus to a fetus, they were at greater
risk of stigmatisation.
It is perhaps unsurprising then that, despite wide-
spread knowledge of hiv/aidsby the 1990s, only a mi-
nority of hivpositive Africans got tested. And why
bother with a test when there was no affordable treat-
ment?hivwas often only one issue among many. Data
from Afrobarometer suggest that hiv/aidshas never
been a major election issue anywhere, bar Botswana.
The result was that hiv/aidsenfeebled workers. A
study of a Kenyan tea-plantation between 1997 and
2002 found that those with hivpicked 4-9kg per day
less than those without. Alan Whiteside, a South Afri-
can economist, found similar results in mines, cement
works and textile factories. Farmers with hivcultivat-
ed less land. The cumulative agricultural effects have
led researchers to wonder whether hiv/aidsintensi-
fied famines in the early 2000s.
Death brought further ruin. Funerals are expen-
sive—nearly a year’s income, according to one study in
Kinshasa. Then there was making do without an earn-
er. A study of Tanzanian families in 2008 found that
consumption over five years was 19% lower in families
where an adult died of aidscompared with the average
family. And the effects on African families go further
than that. In 2012 it was estimated that of the 56m or-
phans (defined as children who lost at least one parent)
in sub-Saharan Africa, 15m were a result of aids.
Orphans on average are enrolled in school later and
pulled out earlier. This can have a doubly detrimental
effect. They receive less education. And there is evi-dence that the longer girls stay in school, the more like-
ly they are to delay having sex, and thus to reduce the
risk of hiv.
hiv/aidsalso had political effects. Most obviously
it killed politicians. There were 59 byelections for Zam-
bian mps between 1984 and 2003, in large part because
of aidsdeaths, versus just 14 in the preceding two de-
cades. The timing of the pandemic in South Africa was
especially cruel. Mandela became president in 1994,
bringing an end to apartheid. But just at that life-af-
firming moment, “aidsweakened the whole of soci-
ety,” says David Harrison of the dgMurray Trust, a
foundation. Mandela himself later apologised for not
prioritising the disease—as president, he barely men-
tioned it. Gains in education, child and maternal
health slowed.
For all its effects, though, hiv/aidsdid not cause
the state and economic collapses that some feared.
There are perhaps three reasons for this. The first is
that prevention efforts were more effective than many
expected at the time. Prevalence in Uganda, for exam-
ple, may have peaked as early as the mid-1980s. In
many countries grass-roots organisations led by “posi-
tive positive” women were crucial. Also important
were increased condom use and male circumcision,
which is associated with a 60% drop in infection risk.
The second reason is that treatment became much
cheaper, and therefore more accessible. The price of
combination therapy fell from at least $10,000 a year to
less than $100 in the early 2000s, after drug firms
bowed to intense public pressure to make it affordable
in poor countries.
Although new infections and death rates are falling,
there is still much to do. The United Nations is signed
up to “end aidsas a public health threat” by 2030, via a
95-95-95 strategy: 95% of those infected globally know-
ing their status; 95% of that group receiving art; and
95% of them having hiveffectively suppressed. On
current trends these goals will not be met, especially if
covid-19 means fewer people seek treatment for hiv.In times of joy, in times of sorrow
The hiv/aidspandemic is therefore likely to remain a
lethal presence. Increasingly its burden falls on the
marginalised—its skewed impact being the third rea-
son why it did not lead to national collapses. There is a
big discrepancy between the economic impact on indi-
vidual families and those on states, notes Markus
Haacker, an economist who has written several books
on hiv/aids. African women continue to deal with
much of the fallout from the pandemic. Janet Seeley,
an anthropologist, suggests that grandmothers in
Uganda and South Africa can feel great guilt when they
do not live up to the popular expectation that they will
heroically care for orphans and the sick.
The idea that the world may have to live with co-
vid-19 for years, if not decades, is hardly a popular one.
But the example of hiv/aidsshows that scientific
breakthroughs can take much longer than people ex-
pect. An hivvaccine has been years away for decades.
And if there is an ultimate lesson, it is that human
behaviour—from safe sex to needle exchanges and the
screening of blood donations—can do much to stop a
pandemic, even if that change is slow. Drugs have sup-
pressed hiv/aidsand societies have adjusted in sub-
tle, often painful, ways. As the world grapples with its
latest great outbreak, hiv/aidssuggests that, while
pandemics do subside, they may not end. 7The example of
HIV/AIDS shows
that scientific
breakthroughs
can take much
longer than
people expect