'Life Is Too Short Here to Worry About HIV'

Roger Bate | 11 Mar 2005
TCS Daily

Zimbabwe's rapidly escalating humanitarian disaster, which has manifested itself in chronic shortages of food, medicine, fuel, electricity and hard cash, has driven over three million Zimbabweans into South Africa, Botswana and other neighbouring states. Prior to the crisis, Zimbabwe's population estimate was 12 million, which means that over 25 percent of the population is now living elsewhere.

The diaspora of Zimbabweans into neighbouring countries either to escape political victimisation by President Mugabe's regime or to find work is substantially worsening the AIDS problem in southern Africa. Many refugees report being assaulted or raped on arrival and destitute young women frequently end up as prostitutes.

African leaders have been reluctant to address this politically induced humanitarian disaster, but their own populations are now further threatened with disease. To act, regional leaders need support from the international community, which is trying to combat the AIDS pandemic. Unless political stability is restored in Zimbabwe and the refugees go home, all efforts to control the AIDS epidemic in the region may be worthless. And with an election at the end of March, now is the time to step up the pressure.

Mugabe the Despot

Robert Mugabe, the only leader Zimbabwe has ever known, is the last "hero" of the African struggle for independence still clinging to power. From the mid 1980s he was hailed internationally for improving health and education. But latterly and especially since 2000, he has thrown nearly every white farmer off the land, politicized the distribution of food, banned independent media and established a Hitler youth movement known as the Green Bombers. The fledgling opposition party, the Movement for Democratic Change, probably would have won the 2002 election had it been fair; instead the opposition has been intimidated into virtual silence.

After Mugabe's ruling Zanu-PF party claimed victory, officials spoke openly of "taking the system back to zero" and halving the country's population in a chilling echo of what the Khmer Rouge did in Cambodia in the 1970s. Didymus Mutasa, the organisation secretary of President Mugabe's Zanu PF government, said: "We would be better off with only six million people, with our own people who support the liberation struggle."

As a result of the turmoil, the economy has halved in value over the past five years. With inflation rampant, bank notes are printed on only one side and carry an expiry date. Unemployment is over 80 percent. Food production in 2004 was less than half that of 2000 when the land invasions began; it is forecast to be 15 percent of normal this year. President Mugabe says that everything is fine, claiming that the country had a record maize crop of 2.4 million tons in 2004 and does not need food aid. However, a report released by the parliamentary portfolio committee on lands and agriculture admitted that by October last year the Grain Marketing Board had only received 388,558 tons.

The US-funded Famine Early Warning Systems Network (FEWS NET) released an "emergency" status report on 6 January which predicts that malnutrition and related diseases are expected to rise, peaking in March. Their November report estimated that the food insecure rural population alone was higher than 3.3 million people. The World Food Program estimates that the total number of Zimbabweans short of food is over 5 million.

According to FEWS NET, neither the social protection nor targeted feeding programs established to address the food needs of the aged, orphans, chronically ill and other welfare cases can adequately address the food insecurity problem facing both urban and rural communities. The humanitarian community faces a difficult working environment, with relations between western donors and the government severely strained. Recently passed legislation confirms that the government wants food aid groups out of the country so that it can continue to manipulate food relief for political benefit ahead of the crucial election in March.

Much media coverage has focused on the 4,500 white farmers and their families who have fled Mugabe's reign of terror. While the collapse of the commercial farming sector has probably cost the country 25 percent of its foreign exchange earnings, an even greater danger to the region is the ill health of the black diaspora.

Zimbabwean HIV - probably the worst in the world

Twenty years ago, life expectancy in Zimbabwe was 58; in 2002 it was 33 and dropping. The official HIV/AIDS rate in 2002 was about 27 percent (the third highest in the world), but the real rate is probably much higher. With no hope for treatment, and little for long term survival, behaviour rapidly worsens. According to one survey, over a third of Zimbabwean men who are aware they are HIV positive do not tell their partners they have the disease. And astonishingly 79% of women surveyed said they would not tell their partner if they had HIV. As one put it to me -- 'life is too short here to worry about HIV'.

Dr. Mark Dixon from Mpilo Hospital in Bulawayo says that 70 percent of the patients he treats for any reason carry the HIV virus. A possible explanation for this extraordinary number is the high incidence of unprotected sex (usually rape) in Mugabe's youth camps. The president established these camps ostensibly to reorient the education sector, but according to all the Zimbabweans I spoke with during a week in the country last fall, including a couple who had escaped from the camps, their real purpose is to indoctrinate young men and women against the opposition party and white people.

Over 250,000 Zimbabweans now die from AIDS annually. The worst cases are tragic; the sufferers have no drugs and no future. Many are too sick to travel and seek treatment abroad. The only good thing about this is that they won't carry the virus elsewhere. Younger Zimbabweans, who are generally healthy though malnourished, leave if they possibly can. This is exactly the age group that carries the highest HIV burden -- estimated to be as high as 40 percent -- and they take the virus with them wherever they go. According to Amnesty International, Zimbabwean refugees are constantly abused in transit and where they end up. Since they are not recognized as legitimate asylum-seekers, they live precarious lives on the edge. No neighboring state acknowledges the despotism of the Mugabe regime, so none accepts these migrants as political refugees. Peril awaits the majority, with many women lured into prostitution.

A few are lucky enough to reach safe havens, places like Bishop Paul Verryn's church in downtown Johannesburg, where I met some of the 55 refugees who live there and sell wares to parishioners and passersby. But most of the Zimbabwean refugees in South Africa lead an existence that is nasty and brutish, though not short enough to prevent transmission of HIV. To make matters worse, some of the Zimbabwean strains of HIV are probably resistant to drugs that were used in frequently interrupted trials in Zimbabwe.

Even so, South Africa, with its 42 million people, is perhaps big enough and rich enough to accommodate these Zimbabwean neighbors. Other countries are not so well placed. According to figures from nongovernmental organizations working in the region, Botswana, with just over a million people, now probably hosts more than 200,000 illegal Zimbabwean immigrants. And that allows for the thousands of Zimbabweans who are unofficially deported from Botswana back to Zimbabwe every week (official figures talk of only 1,600 per month, but NGOs say it's far higher).The permanent and temporary influx has caused terrible strains, leading to conflict, rape, and the possibility of increasing the HIV rate from an already staggering 38 percent. As a result, President Festus Mogae of Botswana has been the most outspoken southern African critic of the Mugabe regime. The AIDS situation in other nearby countries is becoming clearer. The HIV infection rate in Zambia and Mozambique is worsening. Currently at 16.5% and 12.2% respectively, neither country has the level of border control enjoyed by Botswana and hundreds of thousands of HIV-positive Zimbabweans may well be entering both countries. Given the time lag for HIV to take its fatal toll, the Zimbabwean influx into neighboring states will take time to really show its worst effects, but the worst is what we should expect.

Despite the impact on the region, few non-Zimbabweans, especially political leaders, will openly criticize Mugabe. This vacuum leaves it to the international community to act on the Zimbabwean catastrophe, as it has acted in Darfur. It's not too late -- the refugees I spoke with would like to return home, but given the beatings and torture, they never will while Mugabe is president.

An African solution is needed. Only South African president Thabo Mbeki has the clout to provide it. And, while Mbeki continues with his strategy of "quiet diplomacy", the corpses of those who die of AIDS related diseases and kwashiorkor -- caused by acute malnutrition -- continue to pile up in Zimbabwe's mortuaries. Also piling up are the bodies of murder victims since there are no longer any qualified personnel left in the country to conduct forensic post mortem examinations. Until the pathology tests are done, relatives of the victims cannot bury their dead.

With Western help, an exit strategy for Mugabe could be devised. And with Western pressure, a message could be driven home: that all of Mbeki's talk of an African Renaissance of democracy is worthless if South Africa tolerates the dictatorship on its northern doorstep.

Roger Bate, a health economist, is a fellow at AEI and a director of Africa Fighting Malaria. AFM releases its paper 'Despotism and Disease: The danger to Southern Africa of Zimbabwe's HIV Positive Diaspora' in early March.