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is too short here to worry about HIV'
March 11, 2005
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.
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.
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 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.
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
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.
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.
HIV - probably the worst in the world
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.
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.
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
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.
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.
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