AIDS and Violent

Conflict in Africa

B r i e f l y. . .

• In sub-Saharan Africa the re are mo re than 25 million Afric a ns infected with HIV/AIDS

(70 perc e nt of the world’s cases) and 17 million dead; on its curre nt tra j e c t o r y, by

2010 the disease will de c rease life ex p e c t a ncy on the cont i ne nt to levels fo u nd at the

b e g i n n i ng of the last cent u r y.

• Ma ny go v e r n me nt s, int e r na t io nal org a n i z a t io ns, and NGOs have joined a UN-led

mo v e me nt to address the causes and effects of AIDS in Africa. It now appears that

t he int e r na t io nal community is fully cons c ious of the need to commit re s o u rces to

turn the tide against this plague.

• T he de c a de of the 1990s witnessed a steady climb in vio l e nce across sub-Sahara n

A f r ica, with the number of states at war or with sig n i f ic a nt lethal conflicts do u b l i ng

f rom 11 in 1989 to 22 in 2000.

• T he re l a t io nship of the AIDS pande m ic to vio l e nt conflict in Africa is far too complex

to be ex p ressed in simple cause-and-effect terms. Instead it must be addressed in

t e r ms of: (1) how the ex p l o s ion of HIV/AIDS may contribute to further instability and

c o n f l ict on the cont i ne nt in coming years, and (2) how instability and vio l e nc e

e nc o u ra ge cond i t io ns fa v o rable to the spread of the HIV virus.

• AIDS most fre q u e ntly strikes at the most pro ductive members of socie t y, those 15–45

years old that are critical to the de v e l o p me nt of the African state and the stability of

t he African fa m i l y.

• As AIDS advances in a society it weake ns the state’s econo m ic capacity, stealing away

its hu man capital, cutting into its tax base, and dr y i ng up fo re ign investme nt. Po w e r

struggles over the state’s limited re s o u rces inc rease the like l i hood of vio l e nt conflic t .

• T he disease leaves in its wake an ex p l o s ion of the orphan population, the reby inc re a si ng the ranks of poverty-stric ken children in Afric a .

• Wa r fa re is an amplifier of disease, cre a t i ng ideal cond i t io ns for its spre a d, inc l udi ng poverty, fa m i ne, de s t r uc t ion of health and other vital infra s t r uc t u re, large popu l a t ion mo v e me nt s, and the bre a kdown of family units and thus pro t e c t i v e

networks for wome n .

• T he pre v a l e nce of HIV infection in a number of African militaries is ex t ra o rd i na r i l y

h igh, perhaps up to 60 perc e nt in Angola and the Demo c ra t ic Republic of the Congo .

w w w. u s i p . o rg

S P E C I A L R E P O R T

1200 17th Street NW • Washington, DC 20036 • 202.457.1700 • fax 202.429.6063

October 15, 2001

AB O U T T H E RE P O R T

In lig ht of two disturbing tre nd s — t he spread of

HIV/AIDS and inc reases in vio l e nt conflic t — w h ic h

a re do m i na nt features of today’s Africa, the Un i t e d

States Institute of Peace bro u g ht toge t her a pane l

of specialists in May 2001 to exa m i ne an of t e n

o v e r l o o ked aspect of the pande m ic: the nex u s

between conflict and AIDS. This report is a

s y nt hesis of the most salie nt points bro a c hed 

du r i ng this brie f i ng combined with pertine nt 

s u p p o r t i ng info r ma t ion. It conc l udes with nine

p o l icy re c o m me nda t io ns.

Pa r t ic i p a t i ng in the panel were David Gordo n ,

na t io nal int e l l ige nce of f icer for econo m ic and global issues, Na t io nal Int e l l ige nce Council; Tho ma s

Ho me r - D i xon, director of the Peace and Conflic t

S t udy Pro g ram, University of To ro nto; Princ e t o n

L y man (mo de rator), fo r merly U.S. ambassador to

South Africa and curre ntly executive dire c t o r, 

Global Int e rde p e nde nce Initia t i v e, Aspen Institute; 

M i l l ic e nt Obaso, ma na ger of the Africa Initia t i v e,

A me r ican Red Cross; and Andrew Price-Smith, assist a nt professor of go v e r n me nt and int e r na t io na l

a f fa i r s, University of Southern Florida .

T he panel was organized by Institute staff me m b e r s

T i mo t hy Docking and Joseph Klaits, Je n n i ngs Randolph Pro g ram for Int e r na t io nal Pe a c e, and She r y l

B rown and Burton Edw a rd s, Office of Commu n ic at io ns. The report was written by Docking .

The views ex p ressed in this report do not necessarily reflect those of the United States Institute of

Pe a c e, which does not advocate specific policies.

UNITED STATES INSTITUTE OF PEAC E

CO N T E N T S

AIDS in Afric a 2

C o n f l ict in Afric a 4

T he AIDS-Conflict Cont i nu u m 4

T he AIDS Epide m ic and

Na t io nal Security 4

L i n k i ng AIDS and Conflic t 5

C o n f l ict as a Ve c t o r 8

C o nc l u s io n 9
• S ex ual hara s s me nt and ex p l o i t a t ion of mobile populatio ns by soldiers and others is

c o m monplace while re f u gees often have no recourse to legal or social pro t e c t io ns. 

AIDS in Africa

T he December 2000 report “AIDS Epide m ic Update” (United Na t io ns AIDS Fund / Wo r l d

Health Org a n i z a t ion) described the stark hu man tra ge dy caused by the HIV/AIDS pande m ic: 36 million people infected worldw ide, 22 million dead since the ide nt i f ic a t ion of

t he disease some 20 years ago, ind ic a t io ns of ex p o ne nt ial growth of HIV infection in the

R u s s ian Fede ra t ion, and an escalating AIDS epide m ic in As ia .

Ho w e v e r, no w he re is the pic t u re as bleak as in sub-Saharan Africa: mo re than 25 mill ion Afric a ns infected with HIV/AIDS (70 perc e nt of the world’s cases) and 17 millio n

dead; on its curre nt tra j e c t o r y, by 2010 the disease will de c rease life ex p e c t a ncy on the

c o nt i ne nt to levels fo u nd at the beginning of the last cent u r y. These most re c e nt da t a

far surpass the most pessimistic pre d ic t io ns about the effects of the disease in Afric a

ma de just five years ago (C. J. L. Mu r ray and A. D. Lopez, eds., The Global Burden of Dise a s e, World Health Org a n i z a t ion and the World Bank, 1996).

Mo re o v e r, new reports are beginning to describe the full ex t e nt of this Afric a n

t ra ge dy. One study (“AIDS Poverty Reduc t ion and Debt Relief: Implic a t io ns for Po v e r t y

R e duc t ion” by UNAIDS and the World Bank, Ma rch 2001) has fo u nd that HIV-induc e d

de c l i nes in gross do me s t ic pro duct (GDP) levels in sub-Saharan Africa are severely unde rm i n i ng poverty re duc t ion efforts in de v e l o p i ng count r ie s. Ac c o rd i ng to the report, the

p a nde m ic is shaving off up to two perc e nt of annual econo m ic growth in the worst

affected count r ie s. Some count r ies will see their gross na t io nal pro duct (GNP) shrink by

up to 40 perc e nt within 20 years. On the who l e, the study sugge s t s, Africa’s inc o me

g rowth per capita is being re duced by about 0.7 perc e nt per year because of HIV/AIDS.

A no t her study conc l udes that by 2010, per capita inc o me in South Africa, Africa’s mo s t

robust econo my, will drop by 7–10 perc e nt while the GDP will be 17 perc e nt lower than

it would have been without AIDS (Je f f rey D. Lewis and Channing Arndt, “The Ma c ro

I m p l ic a t io ns of HIV/AIDS in South Africa: A Pre l i m i nary As s e s s me nt,” Africa Regio n

Wo r k i ng Paper no. 9, December 2000).

Two African states struggling to cope with the disease are Botswana and Zimbabwe.

In these count r ies life ex p e c t a ncy is expected to fall by as much as 30 years, and as

much as one - q uarter of the respective populatio ns could die by 2010, accord i ng to the

U.S. Census Bureau. The inc rease in mortality effectively strips fa m i l ies of bre a dw i n ne r s,

f ield labor, and pare nts and is alre a dy pro duc i ng a hu ge group of “AIDS orphans” (David

G o rdon, “Na t io nal Int e l l ige nce Estimate: The Global Infectious Disease Threat and It s

I m p l ic a t io ns for the United States,” Na t io nal Int e l l ige nce Council, Ja nuary 2000, p. 35). 

A l t hough it has taken two de c a des since the virus was ide nt i f ied in the United States,

it now appears that the ma g n i t ude of the disease—its impact on Africa and the risk it

poses to the rest of the world—has been accepted by a wide array of go v e r n me nts and

i nt e r na t io nal bodie s. Inde e d, over the past year the HIV/AIDS crisis has received sig n i fic a nt and sustained attent ion both in the United States and on the int e r na t io nal stage.

Ma ny go v e r n me nt s, int e r na t io nal org a n i z a t io ns, and NGOs (no n - go v e r n me ntal org a n i z at io ns) have joined a United Na t io ns–led mo v e me nt to address the causes and effects of

AIDS in Africa. It now appears that the int e r na t io nal community is fully cons c ious of the

need to commit re s o u rces to turn the tide against this plague. 

T he re c e nt coalescence of the int e r na t io nal community on the AIDS issue, mo s t

notably re p re s e nted at the June 2001 United Na t io ns Gene ral Assembly Special Sess ion (UNGASS) on HIV/AIDS convened at the urg i ng of UN secretary ge ne ral Kof i

A n nan, gives cause for optimism. Yet doubts re main conc e r n i ng the level of fina nc ia l

c o m m i t me nts to the re c e ntly established UN AIDS Fund (now called the Global AIDS

a nd Health Fund), which is de s ig ned to attract i nt e r na t io nal fina nc ial support in the

2

AB O U T T H E IN S T I T U T E

T he United States Institute of Peace is an indep e nde nt, nonpartisan fede ral ins t i t u t ion cre a t e d

by Cong ress to pro mote the pre v e nt ion, ma na geme nt, and re s o l u t ion of int e r na t io nal conflic t s.

E s t a b l i s hed in 1984, the Institute meets its cong re s s io nal ma ndate through an array of pro g ra ms,

i nc l ud i ng re s e a rch gra nt s, fellowships, prof e s s io na l

t ra i n i ng pro g ra ms, confere nces and worksho p s,

l i b rary servic e s, public a t io ns, and other educ a -

t io nal activitie s. The Institute’s Board of Dire c t o r s

is appointed by the Pre s ide nt of the United 

States and confirmed by the Sena t e.

BOA R D O F DI R E C TO R S

Chester A. Cro c ker ( C h a i r man), Ja mes R. Schlesinge r

P rofessor of Stra t e g ic Stud ie s, School of Fore ign Servic e,

G e o rgetown University • S eymour Martin Lipset ( V ic e

C h a i r man), Hazel Professor of Public Po l ic y, George

Mason University • Betty F. Bumpers, P re s ide nt, Pe a c e

L i n k s, Wa s h i ngton, D.C. • Holly J. Burkhalter, Ad v o -

cacy Dire c t o r, Phy s ic ia ns for Hu man Rig ht s, Wa s h i ng t o n ,

D.C. • M a rc E. Leland, Esq., Pre s ide nt, Ma rc E. Leland &

As s o c ia t e s, Arlington, Va. • M o ra L. McLean, E s q . ,

P re s ide nt, Afric a - A me r ica Ins t i t u t e, New York, N.Y. •

María Otero , P re s ide nt, AC C ION Int e r na t io na l ,

S o me r v i l l e, Ma s s. • B a r b a ra W. Snelling, State Sena t o r

a nd fo r mer Lie u t e na nt Governo r, She l b u r ne, Vt.

• S h i b l ey Te l h a m i , A nwar Sadat Chair for Peace and

D e v e l o p me nt, University of Ma r y l a nd 

• Harriet Zimmerman, V ice Pre s ide nt, Ame r ican Is ra e l

P u b l ic Affairs Committee, Wa s h i ngton, D.C.

ME M B E R S E X O F F I C I O

Lorne W. Cra n e r, As s i s t a nt Secretary of State for Demo cra c y, Hu man Rig ht s, and Labor • Douglas J. Fe i t h , Unde r

S e c retary of Defense for Po l icy • Paul G. Gaffney II, V ic e

Adm i ral, U.S. Navy; Pre s ide nt, Na t io nal Defense Un i v e r -

s i t y • R i c h a rd H. Solomon, P re s ide nt, United States

I nstitute of Peace (no n v o t i ng)
3

Adult HIV/AIDS rates in Africa (adapted from UNAIDS, 2000)

1 5 % – 3 6 %

5 % – 1 5 %

0 . 1 % – 5 %

0 . 0 % – 0 . 1 %

Not Av a i l a b l e

P revalence Rate
4

f ig ht against HIV/AIDS, tuberc u l o s i s, and ma l a ria while stre ng t he n i ng health care syst e ms and infra s t r uc t u re. Me a nwhile the discourse about prio r i t ies in tre a t me nt and

p re v e nt ion is still taking shape. 

Conflict in Africa

T he de c a de of the 1990s witnessed a steady climb in vio l e nce across sub-Saharan Afric a ,

with the number of states at war or with sig n i f ic a nt lethal conflicts do u b l i ng from 11

in 1989 to 22 in 2000 (S. Mullen and J. Wo o d s, Cohen and Woods Int e r na t io nal, Wa s hi ngton, D.C., Ja nuary 2001). Full-blown re g io nal wars grew out of conflicts in Liberia ,

R w a nda, and Za i re in the mid-‘90s; simme r i ng tens io ns boiled over between Ethio p ia

a nd Eritrea and led to a major interstate war; de c a des-old civil wars in Angola and Suda n

c o nt i nued to claim hu ndreds of tho u s a nds of lives; and ethno p o l i t ical hatred in Rwanda led to the ge no c ide of nearly one million people. Curre nt l y, over one - q uarter of subS a h a ran African states are eng a ged in either civil or interstate conflict, or both. Severa l

mo re (inc l ud i ng Nige r ia and Ivory Coast) are thre a t e ned by immine nt political, re l ig io u s,

or ethnic division that could erupt into vio l e nt conflict at any time. The post–Cold Wa r

de c a de, which held out the promise of an “A f r ican re na i s s a nc e,” de t e r io rated ra p idly int o

s e v e re instability across the cont i ne nt that shows no sign of abating .

The AIDS-Conflict Continuum

While re c e nt fo ra and reports like those stemming from the June UNGASS me e t i ng have

r ig htly pointed to poverty, the lack of educ a t ion, and ge nder ine q uality as important

factors in the AIDS pande m ic, few have linked AIDS in Africa to vio l e nt conflict. 

In the lig ht of these two disturbing tre nd s — t he spread of HIV/AIDS and inc re a s e s

in vio l e nt conflic t — w h ich are do m i na nt features of today’s Africa, the United States

I nstitute of Peace bro u g ht toge t her a panel of specialists in May 2001 to exa m i ne an

often overlooked aspect of the pande m ic: the nexus between conflict and AIDS.

T he Institute event ex p l o red the multiple and cro s s - c u t t i ng conne c t io ns between the

i nc ide nce of HIV/AIDS and vio l e nt conflict on the cont i ne nt. The panel also attempted

to develop a set of broad policy re c o m me nda t io ns for the U.S. go v e r n me nt and the

i nt e r na t io nal commu n i t y. 

T he panelists were in agre e me nt that the re l a t io nship of the AIDS pande m ic to viol e nt conflict in Africa was far too complex to be ex p ressed in simple cause-and - e f f e c t

t e r ms. Instead the panel addressed the “A I D S - c o n f l ict cont i nuum” in discussing: (1)

how the ex p l o s ion of HIV/AIDS may contribute to further instability and conflict on the

c o nt i ne nt in coming years, and (2) how instability and vio l e nce enc o u ra ges cond i t io ns

fa v o rable to the spread of the HIV virus.

The AIDS Epidemic and National Security

A major the me addressed by the panel is the linka ge between AIDS and Ame r ican stra t eg ic int e rest. The de v a s t a t ion associated with the pande m ic has prompted both the Bush

a nd Clinton adm i n i s t ra t io ns to treat the AIDS epide m ic as a na t io nal security issue with

t he potent ial to threaten the United States and Ame r ican int e rests worldw ide.

By far the most outspoken Bush adm i n i s t ra t ion of f ic ial on the threat of AIDS has

been Secretary of State Colin Powell who quickly ma de the pande m ic one of the cent e r p iece issues of the State Departme nt. Inde e d, du r i ng his week-long trip to Afric a

in Ma y, Powell re t u r ned to the the me of AIDS repeatedly and unde r s c o red the pande m ic’s threat to the African cont i ne nt and global security. While touring one he a l t h

The post–Cold War decade,

which held out the promise of

an "African re n a i s s a n c e," 

d e t e r i o rated rapidly into seve re

i n s tability across the continent

that shows no sign of abating.

The Institute event ex p l o red 

the multiple and cro s s - c u t t i n g

connections between the

incidence of HIV/AIDS and 

violent conflict on the

c o n t i n e n t .

A major theme addressed by 

the panel is the linkage

b e t ween AIDS and American

s t rategic interest. 
5

c e nter outside of Na i robi, Powell stated, “The re is no war causing mo re death and

de s t r uc t ion, the re is no war on the face of the earth rig ht now that is mo re serio u s,

that it is mo re gra v e, than the war we see he re in sub-Saharan Africa agains t

H I V / A I D S . ”

T he nexus between AIDS and U.S. na t io nal security was ide nt i f ied in go v e r n me nt circles as far back as 1994. Writing of the risks AIDS poses to state stability and pro s p e ri t y, then Unde r s e c retary of State for Global Affairs Timo t hy Wirth wrote: “HIV/AIDS has

p o t e nt ially de v a s t a t i ng impacts on whole sectors of socie t ie s. In the most vulne ra b l e

na t io ns, these tre nds could have de v a s t a t i ng cons e q u e nces for sustainable de v e l o p me nt

a nd contribute to conflict and ins t a b i l i t y. We must unde r s t a nd the pande m ic for its ability to affect the social, econo m ic, and political fa b r ic of ma ny na t io ns and thu s, its

i m p l ic a t io ns for U.S. fo re ign polic y, Ame r ican leadership, and global coopera t io n .

V iewed in the cont ext of na t io nal security int e re s t s, ma ny count r ies are today waging

( a nd losing) a war with this infectious disease” (fo re w o rd to K. Hamilton, G l o b a l

H I V / A I D S , C S IS, 1994, p. vii).

P re s ide nt Clinton subsequently appointed the Na t io nal Scie nce Council on Eme rg i ng

a nd Re-Eme rg i ng Infectious Diseases to de t e r m i ne the direct and ind i rect threat that

p a t ho ge ns posed to U.S. na t io nal security and pro s p e r i t y. In Ja nuary 2000, Vice Pre s ide nt Al Gore placed the issue on the U.S. na t io nal security age nda when he stated at

t he special UN Security Council Session on AIDS in Africa: “When 10 people in subS a h a ran Africa are infected every minute; when 11 million children have alre a dy become

o r p h a ns, and ma ny must be raised by other children; when a single disease thre a t e ns

e v e r y t h i ng from econo m ic stre ngth to peaceke e p i ng—we clearly face a security thre a t

of the greatest ma g n i t ude. ”

Also in 2000 the Na t io nal Int e l l ige nce Council (NIC) pro duced its “Na t io nal Int e l l ige nce Estimate: The Global Infectious Disease Threat and Its Implic a t io ns for the Un i ted States.” The report was an important milestone in the policy discussion about AIDS

a nd other infectious diseases in systema t ically linking them to U.S. na t io nal security. It

f u r t her described the catastro p h ic set of circ u ms t a nces confro nt i ng the hardest hit states

in sub-Saharan Africa, which may be re p l icated in As ia and other areas as the AIDS pande m ic cont i nues to spre a d. 

Linking AIDS and Conflict

At the core of this important report is the link between cont a g ion and socio e c o no m ic

i ns t a b i l i t y. At the Institute brie f i ng David Gordon, the author of the NIC report, ex p l a i ne d

t he linka ge between na t io nal security and infectious diseases. He suggested four are a s

of concern about the HIV/AIDS virus: the impact on U.S. public health; the effect on

U.S. and int e r na t io nal troops and peaceke e p i ng opera t io ns; the slowing of econo m ic

de v e l o p me nt in states whe re the United States has sig n i f ic a nt stra t e g ic and econo m ic

i nt e rests; and the de s t a b i l i z a t ion of African socie t ie s.

A closer exa m i na t ion of these points illustrates the ra t io nale behind Gordon’s arg ume nt. AIDS is not just Africa’s health crisis. Diseases don’t respect na t io nal borde r s, be

t hey flu, tuberc u l o s i s, or evolving stra i ns of AIDS. As a writer in the New York Times Magazine re c e ntly said, “The stra i ns of HIV running ra m p a nt in Africa, if left unc he c ke d, are

s u re to gain novel ma l e v o l e nce that would allow them to spread elsewhe re and overw helm whatever re s o u rces we have devoted to de f e a t i ng our western-bred stra i ns ”

( Na t a l ie Ang ie r, “To ge t he r, in Sic k ness and in Health,” May 6, 2001).

Mo re o e v e r, AIDS has the potent ial to weaken U.S. and fo re ign militaries and ma ke mo b il i z a t ion of int e r na t io nal fo rces difficult. It has been estimated that 40 perc e nt of the military in South Africa and up to 60 perc e nt in Angola and the Demo c ra t ic Republic of the

C o ngo (DRC) are HIV-positive, as are ma ny soldiers serving in African peace opera t ion fo rc e s.

R ic h a rd Ho l b ro o ke, then U.S. ambassador to the United Na t io ns, warned last year that

AIDS is not just Africa’s 

health crisis. Diseases don’t

respect national bord e r s, be

t h ey flu, tuberc u l o s i s, or 

evolving strains of AIDS.
6

p e a c e keepers need better educ a t ion about AIDS. “It would be the cruelest of iro n ie s,” he

s a id, “if people who had come to end a war were spre a d i ng an even mo re deadly disease. ”

F i na l l y, in highly affected re g io ns, HIV/AIDS also places hu ge stra i ns on state ins t it u t io ns and the econo my. AIDS most fre q u e ntly strikes at the most pro ductive me m b e r s

of socie t y, those 15–45 years old. It is also a disease that often strikes teachers and

o t her wage earners that are critical to the de v e l o p me nt of the African state and the stability of the African fa m i l y. The re fo re, Gordon ma i nt a i ns, acute impact of the AIDS pande m ic may result in the wide s p read econo m ic and political de s t a b i l i z a t ion of socie t ie s,

s t a t e s, and ent i re re g io ns.

G o rdon’s analysis thus portends a spiral of de s t a b i l i z a t ion re s u l t i ng from the impact

of HIV/AIDS. Families become impoverished as bre a dw i n ners sic ken and die. With the

s p read of disease and death, social bonds within and between fa m i l ies are weake ne d.

T he disease leaves in its wake an ex p l o s ion of the orphan population. This and the sho r ta ge of teachers due to AIDS contribute to the disruption of educ a t ion patterns and

i nc rease the like l i hood that children will leave school early. Ero s ion of all the eleme nt s

of civil society is inevitable in the face of the epide m ic, weake n i ng one of the ma i n

b ra kes on go v e r n me ntal excesses in Africa. With the loss of population, the econo my

l a ng u i s hes and growth becomes impossible. Fina l l y, power struggles over the state’s limited re s o u rces inc rease the like l i hood of vio l e nt conflict. 

G o rdon conc l uded that the AIDS pande m ic thre a t e ns to overwhelm alre a dy fra g i l e

s t r uc t u res and will exacerbate all of the cond i t io ns that have ma de Africa ex t ra o rd i na rily vulne rable to vio l e nt conflict in the past. “If na t io nal security is de f i ned as pro t e ct ion against threats to a country’s population, territory, and way of life, then AIDS

certainly pre s e nts a clear and pre s e nt da nger to much of sub-Saharan Africa, and a gro wi ng threat to the vast populatio ns of As ia and Eura s ia, which have the world’s steepest

HIV infection curves.” 

E m p i r ical re s e a rch attributing vio l e nt conflict to the AIDS pande m ic is scant y. Ho we v e r, the re is a stro ng corre l a t ion between enviro n me ntal stress and conflict. The

re s e a rch of Professor Tho mas Ho me r - D i xon, a leading scholar in this fie l d, has establ i s hed a re l a t io nship between conflict and de c re a s i ng levels of water, fuel wood, fo o d,

a nd arable land. Ho me r - D i xon suggests that the epide m io l o g ical stress created by AIDS

will have similar de l e t e r ious ra m i f ic a t io ns. At the Institute brie f i ng he applied his mo de l

of enviro n me ntal stress and conflict to the new analysis of conflict and AIDS.

In his book, Environmental Scarcity and Violence ( P r i nceton University Pre s s, 1999),

Ho me r - D i xon fo u nd that stress on the enviro n me nt leads to a series of int e r me d ia t e

s o c ial effects that have an ind i rect causal re l a t io nship to conflict. These inc l ude de c l i ni ng agric u l t u ral and econo m ic pro duc t ion thro u g hout the socie t y, weake ned state capacity to deal ins t i t u t io nally with int e r nal divisio ns, inc re a s i ng mig ra t ion ra t e s, and

de e p e n i ng social cleavages exa c e r b a t i ng ethnic/class divisio ns.

Ho me r - D i xon sees clear parallels between the effects of enviro n me ntal scarcity and

t he unfo l d i ng AIDS crisis in Africa. In partic u l a r, he pre d icted that de c l i n i ng econo m ic

p ro ductivity and weake n i ng state ins t i t u t io ns would be two of the most pro m i ne nt cond i t io ns that eme rge in AIDS-ra v a ged socie t ie s. “AIDS,” he sugge s t e d, “will drain of f

hu man capital while simu l t a neously inc re a s i ng the need for inno v a t ion, scie nt i f ic capaci t y, econo m ic struc t u re s, political systems, and collective actio ns initia t i v e s.” “Inde e d, ”

Ho me r - D i xon cont i nu e d, “the [most severely infected] socie t ies we are looking at in

A f r ica are ent e r i ng a do w nw a rd spiral [as conc e r ns] hu man capital.” And this result will

be compounde d, he arg u e d, by “syne rg i s t ic factors” that affect social de v e l o p me nt and

i nc rease the like l i hood of conflict, such as long s t a nd i ng ethnic divisio ns, corruption, the

a b u nda nce of lig ht weapons, and ma r ket fa i l u re. The stre ngth of these socio - e c o no m ic

fa c t o r s, he conc l ude d, will ultimately de t e r m i ne if the pande m ic is associated with an

o u t b reak of vio l e nc e.

T he re fo re, Ho me r - D i xon pointed out, it will be difficult to establish a direct corre l at ion between disease and conflict: “Disease is not go i ng to lead directly to vio l e nc e, it

In highly affected re g i o n s,

HIV/AIDS also places huge

s t rains on state institutions

and the economy.

The disease leaves in its wa k e

an explosion of the orphan 

population. 

Empirical re s e a rch attributing

violent conflict to the AIDS

pandemic is scanty. Howeve r,

t h e re is a strong corre l a t i o n

b e t ween enviro n m e n tal stre s s

and conflict.

H o m e r - D i xon sees clear 

p a rallels between the effects 

of enviro n m e n tal scarcity 

and the unfolding AIDS crisis 

in Africa. 
7

is go i ng to have ind i rect effects,” princ i p a l l y, he arg u e d, through its “tre me ndous capacity to weaken the state.” 

T hu s, as the pande m ic de g ra des hu man capital the state’s ability to ma ke ra t io na l

de c i s io ns will de c l i ne, so too will the state’s fiscal capacity from lost tax re v e nu e s. Ye t

fiscal pre s s u re on the state will be met with inc reased fiscal de ma nd to confro nt the ma la dy, which will further exacerbate the problem. Similarly, Ho me r - D i xon points out that

just as the crisis posed by AIDS he ig ht e ns the imperative for African inno v a t ion and

i nge nu i t y, the disease diminishes the int e l l e c t ual capacity of socie t y. To ge t he r, he ma i nt a i ne d, these factors illustrate the perverse socio - e c o no m ic effects of AIDS and sugge s t

w hy the disease must be seen as a deeply de s t a b i l i z i ng threat on the cont i ne nt .

O ne of the few scholars exa m i n i ng the conne c t ion between AIDS and conflict, Prof e ssor Andrew Price-Smith is the author of the fo r t h c o m i ng book, The Health of Nations:

Infectious disease, Environmental change, and Their Effect on National Security and Development (MIT Pre s s, 2001). Like Gordon, Price-Smith argued persuasively that the re is linka ge between AIDS-related de a t hs amo ng the 15–45 year olds (the most heavily infected

a nd most pro ductive segme nt of a population), the comme ns u rate loss of hu man capital,

a nd re s u l t a nt fa l l i ng GDP levels in Africa. He re a s o ned that, as AIDS skims off the do ct o r s, teache r s, pare nt s, lawyers, ent re p re ne u r s, judge s, and polic y ma ke r s, it leads to ins t it u t io nal and societal fra g i l i t y. This point illustrates the stress that AIDS places on socia l

s y s t e ms and suggests why poor count r ies often with low levels of educ a t ion and a sma l l

p rof e s s io nal class will be mo re greatly affected than mo re affluent na t io ns. 

He went on to suggest that AIDS-induced poverty will further inc rease the risk of ethn ic vio l e nce as ind i v iduals and groups blame others and scapegoat mino r i t ies for the i r

i nc re a s i ng econo m ic de p r i v a t ion. The net effect of an AIDS-depleted socie t y, Pric e - S m i t h

a rg u e d, is a ho l l o w i ng out of the state and social networks that are alre a dy under pre ss u re from poverty and sundry other conc o m i t a nt varia b l e s.

F u r t he r mo re, in heavily AIDS-affected socie t ies inc re a s i ng levels of poverty coupled

with inc re a s i ng weakness of the state pro duce greater inc e ntive and opportunity fo r

p o l i t ical vio l e nc e, as challeng i ng elites seek to replace those in power and capture

d i m i n i s h i ng econo m ic re s o u rc e s. This dy na m ic, Price-Smith conc l ude d, poses a gra v e

t h reat to na s c e nt de mo c ra c ies and could lead to mo re autho r i t a r ianism and even state

fa i l u re in heavily affected African states.

T he ma c ro e c o no m ic costs of AIDS and other associated infectious diseases thus pose

an ex t ra burden on socie t ie s. As the sic k ness strikes at the labor fo rce it takes a toll on

p ro duc t i v i t y, prof i t a b i l i t y, and fo re ign investme nt in the future. As David Gordon point s

out, some senior of f ic ials within the World Bank cons ider AIDS to be the single big ge s t

t h reat to econo m ic de v e l o p me nt in sub-Saharan Africa (Gordon, “Na t io nal Int e l l ige nc e

E s t i ma t e,” p. 57).

As AIDS advances in a society it thus weake ns the state’s econo m ic capacity, steali ng away its hu man capital, cutting into its tax base, and dr y i ng up fo re ign investme nt .

This confluence of econo m ic factors further limits state capacity to re s p o nd to the epide m ic through health and educ a t ion pro g ra ms. Furthe r mo re, as fa m i l ies lose bre a dw i nners and mo re adults die, children are often the worst affected. Pa nel mo de ra t o r

P r i nceton Lyman cautio ned at the Institute brie f i ng that the inc re a s i ng ranks of

o r p h a ned and poverty-stric ken children in Africa inc reases the risk that mo re of Afric a ’ s

v u l ne rable youth will be fo rced to take up arms as child soldie r s.

E xa c e r b a t i ng the disease-induced de c l i ne of some African econo m ies and the conc o m i t a nt fall in African living cond i t io ns has been a tre nd amo ng Western na t io ns to

scale back fo re ign de v e l o p me nt aid to the cont i ne nt. Aid from rich count r ies to the 28

c o u nt r ies with the hig hest adult HIV pre v a l e nce rates (exc l ud i ng South Africa) have fa l len by nearly one - t h i rd since 1992, from U.S. $12.5 to U.S. $8.6 billion (Int e g ra t e d

R e g io nal Info r ma t ion Network, “New Fig u res on Developme nt Costs of HIV/AIDS,” June

28, 2001).

O t her factors compound i ng the impact of the epide m ic on the African cont i ne nt over the

As the pandemic degra d e s

human capital the state’s 

ability to make ra t i o n a l

decisions will decline, so to o

will the state’s fiscal capacity

f rom lost tax reve n u e s. 

In heavily AIDS-affected 

societies increasing levels 

of poverty coupled with 

i n c reasing weakness of the

s tate produce greater 

i n c e n t i ve and opportunity 

for political violence.

E xacerbating the diseaseinduced decline of some 

African economies and the 

c o n c o m i tant fall in African

living conditions has been a

t rend among Western nations to

scale back fo reign deve l o p m e n t

aid to the continent.
8

past de c a de inc l ude the fa i l u re of ma ny leaders to ackno w l e dge the problem and take de c isive action to stop its spre a d. Inde e d, in some of the worst infected are a s, for example in

South Africa, Zimbabwe, and Ke nya, Pre s ide nts Mbeki, Mu g a b e, and Moi have at times been

slow to even accept the link between the HIV virus and AIDS, let alone to pro mote prev e ntive me a s u res against it within their socie t ie s. The vital importance of such leade r s h i p

can be seen in cases whe re leaders took up the challenge, for example in Uganda, Thailand,

a nd Brazil, and sig n i f ic a ntly re duced the infection ra t e s.

T he pic t u re painted above leaves a dire ima ge: HIV/AIDS is ra v a g i ng the African cont i ne nt, causing eno r mous hu man suffering and unde r m i n i ng state capacity and stability

at an alarming ra t e. Yet, while the AIDS pande m ic can be linked to the de v e l o p me nt of

a conflic t - i nduc i ng socio - e c o no m ic clima t e, we cannot at this time directly correlate the

dreadful cond i t io ns left in the wake of the disease to war. Inde e d, no ne of the ex p e r t s

fo resee the outbreak of vio l e nce in the world’s most stric ken na t ion, Botswana. Ag a i n ,

t he experts on the panel agreed that while AIDS has a tre me ndous capacity to weake n

t he state and to otherwise establish the cond i t io ns for vio l e nt conflict, the ultima t e

effects of the disease will be no n - l i near and difficult to pre d ic t .

Conflict as a Ve c t o r

A l t hough some mig ht question the sig n i f ic a nce of AIDS as a contributor to conflict, no one

de n ies the role of conflict in the spread of the virus. As Andrew Price-Smith points out,

w a r fa re is an amplifier of disease, cre a t i ng ideal cond i t io ns for its spread: poverty, fa m i ne,

de s t r uc t ion of health and other vital infra s t r uc t u re, large population mo v e me nt s, and the

b re a kdown of family units and thus protective networks for women. In a re c e nt artic l e,

Helen Epstein illustrates this point when she describes how the course of the AIDS epide m ic in Uganda has paralleled the country’s passage from chaotic conflict in the 1980s,

w hen HIV inc ide nce began to rise dra ma t ic a l l y, to the impressive de c l i ne of AIDS cases in

t he relatively calm early and mid - 1 9 9 0 s, to a new upsurge of both vio l e nce and infectio n

in re c e nt years ( “AIDS: The Lessons of Uganda,” New York Review of Books, July 5, 2001).

At the Institute semina r, Millic e nt Obaso pointed out that soldiers have been ide nt if ied as a principal vector of the AIDS epide m ic in Africa. Inde e d, this group is one of the

most highly infected on the cont i ne nt. A 1999 Defense Int e l l ige nce Age ncy study estimated that the pre v a l e nce of HIV infection in a number of African militaries is ex t ra o rd i narily high, perhaps up to 60 perc e nt in Angola and the DRC. Inde e d, in a re c e nt

i nt e r v iew Nige r ia’s pre s ide nt Olusegun Obasanjo ex p l a i ned that one of the watershe d

e v e nts for his go v e r n me nt’s approach to the epide m ic came when tests of the Nige r ia n

military revealed a high inc ide nce of the disease: “When I took over the re i ns of go ve r n me nt in Nige r ia, HIV/AIDS had not been given the type of attent ion it should be

given. It was still a sort of hu s h - hush affa i r. What really spurred me on was when I go t

back some of our soldiers from Sie r ra Leone, . . . we fo u nd that they were, on avera ge,

about 11 perc e nt infected (a rate twice the na t io nal avera ge). That really gave me cause

for alarm” (Barbara Cro s s e t t e, New York Times, J u ne 28, 2001, p. A- 1 0 ) .

No one has accurate fig u res on the infection rates of various rebel groups (such as

t he Revolutio nary Unity Fro nt in Sie r ra Leone) or the nu me rous militias that so often circulate in war-torn settings on the cont i ne nt, but the re can be little doubt that suc h

g roups of ins u rge nts are important vectors spre a d i ng the disease in conflict zone s.

Obaso further pointed out that the re are millio ns of re f u gees in Africa toda y, inc l udi ng int e r nally displaced persons in 18 sub-Saharan states. Ma ny of these re f u gees have

been displaced by war or ethnic conflict and face grievous daily circ u ms t a nc e s. While

p o p u l a t ion mo v e me nt is not necessarily a risk factor for HIV/AIDS tra ns m i s s ion, displaced people are often highly ma rg i nalized while in tra nsit or at de s t i na t ion. Sex ua l

h a ra s s me nt and ex p l o i t a t ion of mobile populatio ns by soldiers and others is commo nplace while re f u gees often have no recourse to legal or social pro t e c t io ns. 

Other fa c tors compounding the

impact of the epidemic on the

African continent over the past

decade include the fa i l u re of

m a ny leaders to acknow l e d g e

the problem and take decisive

action to stop its spre a d .

A 1999 Defense Intelligence

Ag e n cy study estimated that

the prevalence of HIV infection

in a number of African

m i l i taries is ex t ra o rd i n a r i l y

high, perhaps up to 60 perc e n t

in Angola and the DRC.
9

In conflict situa t io ns, law enfo rc e me nt, jud ic ial, re l ig io u s, and other state systems that

p rotect ind i v idual rig hts break down. Within this set of circ u ms t a nces the vulne rability of

w o men to sex ual int i m ida t ion is greatly inc re a s e d. Social cont ro l s, vital to the ma i nt e na nc e

of peace and order in weak state setting s, also suffer. Inc ide nce of rape and other fo r ms of

s ex ual coerc ion skyro c ket in such conflict setting s. A re c e nt UNAIDS public a t ion (“Po p u l at ion Mobility and AIDS,” February 2001) conc l udes that war and fo rced mig ra t ion pro mo t e

i nc reased sex ual int i m ida t ion of women: “As phy s ical, fina nc ial, and social security ero de

in the re f u gee setting, women are often fo rced into high-risk sex ual behavio r, . . . by tra di ng or selling unprotected sex for go o d s, servic e s, and cash in order to survive and/or cont i nue their travel.” 

T he impact of this sex ual vic t i m i z a t ion of women on the spread of AIDS is comp o u nded by the ge ne ral absence of condo ms in areas affected by war. The collapse of

e duc a t io nal systems associated with war further exacerbates pro b l e ms and has the do uble effect of curtailing pre v e nt ion efforts taught in the classroom and pulling childre n

away from their stud ie s, often into a chaotic and pre datory enviro n me nt. 

F i na l l y, as Obaso pointed out at the Ins t i t u t e, soldiers and other combatants are no t

only re s p o nsible for spre a d i ng the disease within conflict situa t io ns but also for cont am i na t i ng commu n i t ies and villages upon re t u r n i ng to their ho me village s. Iro n ic a l l y,

de mo b i l i z a t ion thus spreads AIDS infection to pre v iously unaffected are a s.

C o n c l u s i o n

T he twin scourges of conflict and AIDS are tearing apart ent i re re g io ns of sub-Sahara n

A f r ica. Ho w e v e r, although alarm bells have been sounded on both of these pro b l e ms,

a nalysis of their int e r re l a t io nship is inc o m p l e t e. As expert opinion cited in this re p o r t

s ho w s, the links between vio l e nt conflict and the AIDS pande m ic in Africa are becoming

mo re clear. And the risks associated with the plagues of conflict and disease—to U.S.

na t io nal security, econo m ic de v e l o p me nt, and re g io nal stability, as well as the livelihoods of mo re than 700 million Afric a ns — a re serio u s.

T he experts gathe red toge t her at the U.S. Institute of Peace to address this issue prov ided a number of re c o m me nda t io ns for the United States and the int e r na t io nal community as they begin to address these da u nt i ng pro b l e ms :

Po l i cy Recommendations

1 . Experts at the forum agreed that the West should pro v ide mo re funds to stre ng t he n

t he ability of poor go v e r n me nts to address their gro w i ng AIDS crises, as well as techn ical assistance to help highly affected go v e r n me nts bolster their own ins t i t u t io ns to

c o n f ro nt the problem. 

2 . Pa nelists warne d, ho w e v e r, that an inc rease in fund i ng for the fig ht against HIV/AIDS

in Africa must not come at the ex p e nse of alre a dy de c re a s i ng Western (especially U.S.)

de v e l o p me nt budge t s, lest such unde r l y i ng factors as poverty, poor educ a t ion, and

weak infra s t r uc t u re unde r m i ne whatever AIDS effort is unde r t a ke n .

3 . Pa nelists also re c o m me nded that the int e r na t io nal commu n i t y, which has been

focused on non-state actors and their fig ht against the pande m ic, should again think

about eng a g i ng with the African state. Failure of do nors to recognize the long - t e r m

c o ns e q u e nces of the weake n i ng state could have major cons e q u e nces for both stability and de v e l o p me nt. No n - go v e r n me ntal org a n i z a t io ns, while pre s s i ng for pro g ra ms

o u t s ide of go v e r n me nt and for the stre ng t he n i ng of civil socie t y, need to re c o g n i z e

this factor as well.

4 .Wo men, often exc l uded in the de c i s io n - ma k i ng process on the cont i ne nt, must be

involved in the battles against both AIDS and war. Furthe r mo re, all sides in the fig ht

In conflict situations, law

e n fo rcement, judicial, re l i g i o u s,

and other state systems that

p rotect individual rights bre a k

d own. Within this set of circ u ms tances the vulnerability of

women to sexual intimidation 

is greatly incre a s e d .

The risks associated with 

the plagues of conflict and 

d i s e a s e — to U.S. national 

s e c u r i t y, economic deve l o p -

ment, and regional sta b i l i t y, as

well as the livelihoods of more

than 700 million Africans—

a re serious.
1 0

a g a i nst AIDS must cont i nue to fig ht for the econo m ic empowerme nt and hu man rig ht s

of African wome n .

5 .T he mu l t i t ude of polic ies aimed at HIV pre v e nt ion, both at the na t io nal and int e r nat io nal level, need to be harmonized and actors involved in the struggle against AIDS

must search for avenues to collaborate and to create syne rg ie s. Inde e d, UNAIDS has

only been partially successful in coord i na t i ng the UN effort, and the int ro duc t ion of a

ne w, separa t e, global fund for addre s s i ng the problem, welcome as it is, poses ne w

issues of coord i na t ion that should be addressed at the outset.

6 . Pe a c e keepers involved in missio ns to Africa need to be educated on the risks of

c o nt ra c t i ng / s p re a d i ng the disease, lest they become part of the problem ra t he r

than the solutio n .

7 .T he AIDS orphans problem urge ntly needs to be addressed by the int e r na t io nal commu n i t y. Commu n i t ies need to be helped to adapt tra d i t io nal ex t e nded family arra ngeme nts to the larger and mo re de ma nd i ng dime ns io ns of the orphan problem. This can

be do ne through stre ng t he n i ng local NGOs and community org a n i z a t io ns that share a

c o m mon concern for orphaned children, inc re a s i ng funds for scholarships and othe r

support to orphans, and he l p i ng pare nts pre p a re for this situa t ion when they learn of

t heir positive HIV status. Innovative tra i n i ng and educ a t io nal pro g ra ms will also be

necessary to capture this ge ne ra t ion of orphans befo re they become street children or

recruits as child soldie r s. Like other aspects of the problem, the orphan problem mu s t

be cons ide red int e g ral to the overall strategy of pre v e nt ion, care, and tre a t me nt .

8 . Po l i t ical leadership in the fig ht against AIDS is ke y. While the re c e nt summit in

Abuja, Nige r ia (May 2001)—whe re African leaders pledged to devote 15 perc e nt of

t heir annual public spend i ng to AIDS and other public health prio r i t ie s — a nd the

J u ne 2001 UNGASS me e t i ng — w he re agre e me nt was re a c hed on a compre he ns i v e

p l a t form for addre s s i ng the pande m ic — a re hopeful sig ns of pro g ress on this issue,

much mo re needs to be do ne. Africa’s leaders (especially in the southern Afric a n

re g ion) should be enc o u ra ged to publicly ackno w l e dge the problem and spearhe a d

e f forts to impleme nt effective count e r - me a s u res against the sic k ne s s. The initia t i v e

s hould spur the spread of AIDS educ a t ion pro g ra ms and pre v e nt ion campaig ns similar to those that have partially cont a i ned the ra m p a nt spread of the pande m ic in

B razil, Thailand, and Uganda .

9 . South As ia and Eura s ia deserve new and concerted attent ion from the int e r na t io na l

c o m mu n i t y. The experts agreed that the vast populatio ns of Ind ia, the fo r mer Sovie t

Un ion, and China curre ntly have the steepest HIV infection rate curves. Int e r na t io na l

health org a n i z a t io ns re c e ntly estimated that 1.25 million people in China are infected with the AIDS virus, and these org a n i z a t io ns projected that by 2010 that fig u re

could balloon to 20 million. The panelists felt stro ngly that these alarming new da t a

w a r ra nt a proactive re s p o nse from the int e r na t io nal community so that outbreaks of

t he disease are confro nted through early int e r v e nt ion, lest the ma l a dy ra v a ge the s e

l a nds as it is do i ng in Afric a .

Additional Resourc e s

“AIDS and the Military.” New York: UNAIDS, May 1998. Also check the UNAIDS website

( w w w. u na id s. o rg )

Carballo, Ma nuel, et al. “Demo b i l i z a t ion and Its Implic a t io ns for HIV/AIDS.” Gene v a :

I nt e r na t io nal Cent re for Mig ra t ion and Health, October 2000 (www. c e r t i . o rg / p u b l ic at io ns / P u b l ic a t io ns. htm ).

“HIV/AIDS as a Security Is s u e.” Wa s h i ngton/Brussels: Int e r na t io nal Crisis Group, June

19, 2001.
1 1

“Plague upon Plague: AIDS and Vio l e nt Conflict in Africa.” Curre nt Issues Brie f i ng tra nscript, United States Institute of Pe a c e, Wa s h i ngton, D.C., May 8, 2001 (www. u s i p . o rg ) .

P r ice-Smith, Andre w, ed. Plagues and Politics: Infectious Disease and International 

Po l i c y . L o ndon: Pa l g rave Publishe r s, 2001.
For mo re info r ma t ion, see our web

site (www. u s i p . o rg), which has an

o n l i ne edition of this report cont a i n i ng

links to related web sites, as well as

a dd i t io nal info r ma t ion on the topic.

SP E C I A L RE P O R T 7 5

United States 

Institute of Pe a c e

1200 17th Street NW

Wa s h i ngton, DC 20036

Of Related Intere s t

Ma ny other public a t io ns from the United States Institute of Peace address issues that

relate directly to conflict in Africa. 

Recent Institute reports include:

U.S. Leadership in Resolving African Conflict: The Case of Ethiopia-Eritrea, by John 

P re nde rgast (Special Report, September 2001)

U.S. Human rights Policy toward Africa ( S p e c ial Report, August 2001)

Pe a c e keeping in Africa ( S p e c ial Report, February 2001)

To obtain an Institute report (available free of charge), write United States Institute of

Pe a c e, 1200 17th Street NW, Suite 200, Wa s h i ngton, DC 20036-3011; call (202) 429-

3832; fax (202) 429-6063; or e-mail: usip_re q u e s t s @ u s i p . o rg .

Recent books from USIP Press include:

Burundi on the Brink, 1993–95: A UN Special Envoy Reflects on Preventive Diplomacy, b y

A h me dou Ould-Abdallah (2000)

Watching the Wind: Conflict Resolution during South Africa’s Transition to Democracy, b y

Susan Collin Marks (2000)

A n g o l a ’s Last Best Chance for Peace: An Insider’s Account of the Peace Process, by Pa u l

Ha re (1998)

For book sales and order info r ma t ion, call 800-868-8064 (U.S. toll-free only) or 703-661-1590,

or fax 703-661-1501.