TWENTY TWO million people the world live with the knowledge they are suffering from AIDS. Six million people have already died from the disease.
In Zambia alone 500 people are, infected every day. Approximately 90 per cent of all new infections are taking place in developing countries.
In southern Africa the epidemic is spreading at an alarming rate and the economic and social impact of the disease is becoming increasingly evident. At the recent conference on AIDS/HIV in Malawi, representatives of the European Union and the 12 southern African developing community countries (SADC), as well as from international aid organisations and private sector bodies, agreed on an action plan to respond to the crisis in the region.
"In Ireland we have been able to treat AIDS almost exclusively as a health issue but in southern Africa that is just not possible," said Mr Brian O'Shea, Ireland's Minister of State for Health, who co chaired the three day conference as president in office of the European Council. "The issue touches, on almost all aspects of society.
In the SADC countries the number of AIDS cases is put at 210,000 with three to four million people believed to be infected by HIV. Independent studies put the figures much higher.
"It's very hard to put a true figure on the extent of the problem," said Dr Vincent O'Neill, a health adviser to the Department of Foreign Affairs. "People in Africa do not report the symptoms of AIDS for many reasons and when they die, doctors rarely put down AIDS as the cause of death."
Dr Olive Shisana, the South African director general for health, agreed. "Our estimates are based almost entirely on anonymous blood tests carried out on pregnant women attending antenatal clinics," she said.
Employers complain that they are finding it more and more difficult to tackle the side effects of AIDS and HIV as they affect the work environment. Workers engaged in mining, for example, which employs at least 700,000 of the 62 million people in the region, are particularly vulnerable to the disease: governments want to know why.
Officials say the tourism industry may also be a contributory factor to the spread of the disease. The action plan recommends establishing prevention and treatment facilities for sexually transmitted diseases in tourist areas. But officials warn the industry could also suffer significant financial losses should the region be seen as a genuine health risk.
"You'd be surprised how uneducated foreign visitors actually are about how the disease is transmitted," complained Dr Sheila Tlou, chairperson of the Society for Women and AIDS in Africa.
Decisions about employment insurance and medical benefits for HIV infected workers have important consequences for the labour market warned Mr MacDonald Chorwa, the general manager of Medical Aid in Zimbabwe. Already the Zambian banking sector, for example, has seen an increase in the mortality rate of senior staff from 0.4 per cent to 2.2 per cent over the last five years.
On a tea and coffee estate in Malawi it was similarly estimated that the cost of HIV/AIDS for the previous 12 months amounted to 1.1 per cent of total expenditure, and 3.4 per cent of the gross profit. This was due largely to medical services costs, death in service benefits and costs due to absence.
South Africa is predicting a threefold increase in the death rate of young adults in formal employment by the year 2000 and similar reports are emerging throughout the region.
Consequently, the SADC countries plan to implement a regional code of conduct on HIV/AIDS and employment. This is intended to establish guidelines for employers on issues such as benefits and sick leave.
The action plan also envisages developing life skills education for young people and encouraging regional co operation on AIDS education measures. But there is growing concern that the issue of gender in African education should be given high priority.
"The female factor is crucial in trying to stem the spread of AIDS in Africa," Dr Tlou argues, explaining that illness and death in the family often result in girls being removed from school to help at home. With the rise in HIV and AIDS cases such demands on the female members of the family are set to increase. "This will mean girls will continue to have less skills and less opportunity to be economically independent and this in turn can lead them to prostitution and the continued dependency on men. This serves to perpetuate the" problem," she said.
Among other things, there are plans for regional financial and cost sharing in relation to essential drugs. There is also a mechanism for regional co operation in procuring, distributing and storing drugs. Other recommendations are intended to reduce taxes on raw materials and essential drugs, and to review barriers to trade and tax incentives in an effort to make drugs more affordable.
However, almost a year will pass before the SADC Ministers will formally discuss these proposals. Aid organisations are expressing frustration at the slow process. Others question the power of SADC governments to make any real inroad into the disease despite significant international funding. (SADC countries receive about 120 million Ecus from the EU and this is set to increase.)
"TB, malaria and respiratory diseases are still killing more people in Africa than AIDS and yet they've been around for decades," said one delegate from an international aid organisation.
But Mr O'Shea is more hopeful. "I have been very impressed with the political will to tackle the cultural, economic and social factors, which are contributing to the spread of the disease here in southern Africa," he said. "These are hard decisions but I think they can translate words into action."