The Foreign Service Journal, December 2004

HIV/AIDS epidemic will create a lost generation — a sea of youth who are disadvantaged, vulnerable, underedu- cated and lacking both hope and opportunity. What we are seeing here are the seeds of crisis.” It is esti- mated that, by 2010, sub-Saharan Africa alone will have more than 10 million AIDS orphans. Undermining National Stability As Atwood notes, HIV is much more than a social or developmental threat — it is a concrete threat to stability and security. Nelson Mandela, in a speech before the World Economic Forum in 1997, hinted of the potential for conflict and instability to emerge when a people realize that their government is unable to meet their needs when he noted that, “South Africans are beginning to under- stand the cost [of HIV/AIDS] … observing with grow- ing dismay its impact on the efforts of our new democ- racy to achieve the goals of reconstruction and devel- opment.” In addition to eroding the link between people and their government, infectious epidemics have a more pernicious ability to pit people against each other with- in societies. As the resource base begins to shrink, competition among surviving groups for access to and control over the levers of power and influence increas- es. This competition often results in social and politi- cal fragmentation and ethnic, racial or socio-economic conflict. David Gordon of the United States National Intelligence Council, one of the first policy analysts to recognize the connection between health and security, noted in his ground-breaking 2000 “National Intelligence Estimate” the potential for intra-state con- flict resulting from epidemic disease. Gordon noted that, “[t]he severe social and economic impact of infec- tious diseases … and the infiltration of these diseases into ruling political and military elites and middle class- es of developing countries are likely to intensify the struggle for political power to control scarce state resources.” The global nature of the threat HIV/AIDS repre- sents becomes immediately clear when we pause to remember how interconnected and mobile we all are. Richard Holbrooke, the former United States ambassador to the United Nations, warned members of the Security Council in 2000 that, “if it [HIV/AIDS] is not dealt with, it will clearly wreck the economies of Africa and the subcontinent. [AIDS] will spread; you can’t draw a wall around Africa and commit continental triage.” Indeed, HIV is spreading daily — hourly — reaching epidemic levels of infection throughout the developing world. While currently concentrated primarily in sub- Saharan Africa, the disease is already emerging as a security threat in other countries, including some thought of as economically well-developed. Peter Piot, director of UNAIDS, has commented: “We have every reason to assume that the epidemic in Southeast Asia will soon be just as widespread as it is in Africa, and that East Africa’s experience — a slowdown of its economy — will be replicated in Eastern Europe and the devel- oping countries of Asia and Latin America.” UNAIDS, the main advocate for global action on the epidemic, is tasked with preventing transmission of HIV, providing care and support, reducing the vulnerability of individ- uals and communities to HIV/AIDS, and alleviating the impact of the epidemic. A recent study by the Center for Strategic and International Studies identified five nations as the “Next Wave,” ripe for an explosion of HIV infection rates rivaling those of sub-Saharan Africa: Nigeria and Ethiopia (together representing over a quarter of that already ravaged continent’s population), Russia, China and India. The last three nations, which collectively contain close to a third of the Earth’s population, are all nuclear-armed countries beset with ethnic and social strife and burdened by economic and political pres- sures that threaten to erupt into internal conflict. The addition of HIV/AIDS, with its demonstrated ability to disrupt society at all levels, will only increase the poten- tial for regional conflict and instability. The Will to Act The world community, led in many respects by the United States and the United Nations, has made the beginnings of a response to this global health and secu- F O C U S D E C E M B E R 2 0 0 4 / F O R E I G N S E R V I C E J O U R N A L 27 The list of infectious diseases threatening human survival changes over time, but never diminishes in number.