We all have AIDS: HIV/AIDS is everyone's problem — a global public-health threat of staggering proportions. Wayne Ellwood investigates the social inequalities which nurture the deadly disease - This Month's Theme AIDS/Keynote

New Internationalist, June, 2002 by Wayne Ellwood

They are the dead who walk again: the Lazarus men. Invisible to most of us, these are the gay males, now in their 30s and 40s, who first contracted the HIV virus 10, 15 and even 20 years ago. Through a combination of raw courage, determination and powerful new drug therapies, they have managed to keep the disease at bay.

Steve Mueller is one of those survivors. He is a warm, articulate 42-year-old with sharp, sculpted features, a halo of black curls and a hacking cough - the legacy of a battle with HIV which is not yet over. We're sitting in a crowded lunch spot in the heart of Toronto's Little Italy, straining to hear each other amidst the jangle of crashing cutlery and the hum of animated conversations ricocheting around the room. 'I could fill these tables with guys who are gone,' he nods, glancing quickly across the crowded restaurant.

Steve has been through a lot since he discovered he was HIV positive back in the early 1990s. Then he was teaching psychology at a small community college in the city, enjoying life, financially secure, with a partner who was an affluent executive in the advertising business. Life was good, he was living 'by the rules'.

Then he got sick and his world shattered. He lost his job; his partner, also HIV positive, died within a year. And then Steve contracted meningitis, one of the often deadly 'opportunistic diseases' that strike the battered immune systems of people with HIV.

'The doctors told me in June 1995 that I was unlikely to see Christmas. I'd gone from 180 to 120 lbs and I was still losing weight. Then I started on the AIDS cocktail; it literally pulled me back from the edge. They called guys like me, who were dying and then bounced back, the Lazarus men.'

Steve's life, and the lives of many other people with HIV/AIDS (PHAs), was turned around by the discovery of effective 'antiretroviral' medications (ARVs) a decade ago. These drugs are not a cure for HIV but they can be a way of controlling the virus, enabling many people to work and lead otherwise normal lives again.

But as important as they've been in the West, they have made scarcely a dent in those parts of the world where HIV rages unchecked. Soon after HIV was identified in North America it leapt from the homosexual to the heterosexual community, and then from the gay 'ghettos' of Seattle and New York to the slums of Port-au-Prince, Bangkok and Mumbai.

Today, the disease once branded as a 'gay plague' has become, overwhelmingly, a heterosexual disease: 75 per cent of worldwide HIV transmission is now due to heterosexual sex. And while the spread of HIV across the North has slowed due to vigorous treatment and prevention campaigns, the virus continues to cut a widening swath across the South.

The numbers are brutally stark. Twenty-two million people dead from AIDS-related illnesses since the disease was first discovered just 20 years ago -- more people than died in Europe during the Black Death of the Middle Ages. Three million people dead last year alone. Thirty-six million people are now infected -- 25 million in sub-Saharan Africa where the disease threatens to hobble human development for decades. In Botswana, 36 per cent of adults have the HIV virus, in South Africa more than 5 million people are infected -- 20 per cent of the adult population. (1)

AIDS is eroding economic progress and fracturing social stability across sub-Saharan Africa and will do so in other parts of the world unless urgent action is taken. Average life expectancy in more than a dozen African countries has dropped by 17 years due to AIDS -- from 64 to 47 years. Zimbabweans have to cope both with the septuagenarian autocrat, Robert Mugabe, and with an AIDS epidemic which has shaved 26 years off their average life span. Families without breadwinners are thrown into a downward spiral of poverty and hunger. A quarter of all families in Botswana can expect to lose a wage earner in the next 10 years, slashing household income and forcing those who remain to do whatever they can to make ends meet. According to the UN Food and Agricultural Organization (FAO) more than 16 million farm workers will die from AIDS in the next 20 years with incalculable impact on food production and hunger. The Zambian Government says it has lost one-in-three teachers to AIDS. (1)

'Let us not equivocate,' warns Nelson Mandela, 'AIDS today in Africa is claiming more lives than the sum total of all wars, famines and floods, and the ravages of such deadly diseases as malaria. It is devastating families and communities.'

Millions of people are being cut down in their prime leaving a continent of old people and orphans. There are more than 13 million AIDS orphans in Africa -- Zambia alone has a million kids who have lost their parents to the virus. With the adult workforce so depleted, more kids are forced to leave school to support brothers and sisters. The Tanzanian sociologist, Gabriel Rugalema, reports that in the province of Kagera in Northwest Tanzania orphans make up nearly 20 per cent of the population. Rugalema worries that AIDS is upending the tribal clan structure and tearing apart the social fabric. It's a catastrophe in the making, a breeding ground for crime and social chaos.