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msJAMA
October 2, 2002

Understanding the Threat of HIV/AIDS

Author Affiliations
 

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JAMA. 2002;288(13):1649. doi:10.1001/jama.288.13.1649-JMS1002-3-1

In April 2000, the United States government declared HIV/AIDS a threat to American national security, marking the first time ever a disease had been entrusted to the National Security Council.1 Less than 3 months later, the United Nations Security Council affirmed Resolution 1308, which delineated the dangers that HIV/AIDS posed to the "maintenance of international peace and security."2 Most recently, at the 14th International AIDS Conference in July 2002, UNAIDS Executive Director Peter Piot noted the beginning of "a new era: the era of AIDS as a global political issue."3 Amid all this discourse intertwining a virus with domestic and world affairs, it is paramount to understand the threat created by HIV/AIDS to political, economic, and personal security.

Security has been broadly defined as both the freedom from fear and the freedom from need.4 Under this definition, HIV/AIDS threatens the security of governments and economies around the world because of its ability to simultaneously endanger political stability and depress current levels of prosperity. According to one study, a significant decrease in life expectancy is the strongest risk factor for ethnic conflict, genocide, failure of fledgling democracies, and revolutionary wars.5 In sub-Saharan Africa, for instance, average life expectancy rates will drop 25% in the next few decades from 59 years to less than 45 years, solely due to HIV/AIDS.6 Stable leadership may collapse if death rates continue to rise among public and private elites, including the police force and the military, where HIV prevalence rates have reached 60% in countries such as Angola and the Democratic Republic of the Congo.7

The damaging effects of HIV on countries' economic infrastructures stems from the demographics of the populations it affects. In contrast to most adult diseases, the highest rates of HIV transmission occur during the most productive years of life, in both men and women, and in all socioeconomic strata. A direct correlation has been shown between a country's HIV prevalence and reduction of its gross domestic product.8 Furthermore, agricultural productivity declines as workers die; farmers sell their livestock to cover medical and funeral expenses, and women leave the fields to trade sex for food in order to survive.4 Younger governments may be at greatest risk, including the former Soviet republics, where the next major epicenter for HIV is forming, and yet the least information exists on how HIV/AIDS will change the political and economic landscape there.9

The effects wrought by HIV/AIDS may help quantify the perils of this virus to world leaders, but to the over 40 million people currently living with HIV/AIDS, numbers fail to describe adequately how this disease affects their own security and that of their families. The absence of a vaccine or curative treatment, the growing infection rates in many countries worldwide, and the slow pace at which costly antiretroviral therapies are becoming available in HIV endemic zones all mean that mortality rates from AIDS will continue to rise in the near future.8 The repercussions of these deaths have already extended to a generation of over 13 million orphaned children who, without a family or social support structure, are burdened by economic and social disadvantages before reaching adulthood.8 Furthermore, people living with HIV/AIDS and their loved ones have been met with unmatched stigma and discrimination, and many continue to be physically attacked, chased out of their homes, and even stoned to death in communities all over the world.4

Threats to the security of individuals underlie the larger political and economic ramifications of this disease. When children, workers, and government elites alike are affected by HIV/AIDS, the financial and administrative security of countries consequently come into doubt, and the disease turns into a politicized issue. The discussions over the last 2 years have made it clearer how HIV/AIDS threatens not only the health security of individuals, but also the economic and political security of communities and countries. However, as Peter Piot has pointed out, "the issue is not just to draw attention to the problem, but to do something about it."4 Still absent from the politicized discussions about HIV/AIDS is a full knowledge of how ameliorating this disease can significantly improve the personal, economic, and political security of families and countries at risk. The responses the world formulates against the HIV/AIDS pandemic in the coming years will determine if and how this question is answered.

References
1.
Not Available, US treats AIDS as a threat to security. Nature. 2000;4059Article
2.
United Nations Security Council, Resolution 1308. Available at: http://www.un.org/Docs/scres/2000/res1308e.pdf.
3.
Piot  P Keeping the promise.  Speech at: Opening Ceremony of the XIV International AIDS Conference July 7, 2002 Barcelona, Spain
4.
Piot  P AIDS and human security.  Statement at: United Nations University October2 2001; Tokyo, Japan
5.
National Intelligence Council, United States Government, The Global Infectious Disease Threat and its Implications for the United States. National Intelligence Estimate, January 2000 Washington, DC United States Government Central Intelligence Agency2000;
6.
Population Division, United Nations, and Joint United Nations Program on HIV/AIDS, The Demographic Impact of HIV/AIDS.  Report of Technical Meeting November 10, 1998 New York, NY
7.
Hsu  L HIV Subverts National Security.  Bangkok, Thailand UNDP South East Asia HIV and Development Program2001;
8.
Piot  PBartos  MGhys  PDWalker  NSchwartlander  B The global impact of HIV/AIDS. Nature. 2001;410968- 973Article
9.
De Cock  KMJanssen  RS An unequal epidemic in an unequal world. JAMA. 2002;288236- 238Article
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