Foreign Relations of the United States, 1981–1988, Volume XLI, Global Issues II

25. Information Memorandum From Acting Assistant Secretary of State for African Affairs (Freeman) and the Assistant Secretary of State for Oceans and International Environmental and Scientific Affairs (Negroponte) to Secretary of State Shultz¹

Washington, April 10, 1987

SUBJECT

• AIDS and the Death of Modern African Societies

SUMMARY:

The World Health Organization (WHO) estimates that between 5–10 million people in every region of the world are currently infected with AIDS. The enormity of the AIDS pandemic is just now beginning to be realized. While most American attention has naturally been focussed on our own situation and that in Western Europe, a far greater calamity is unfolding in a swath of a half-dozen countries across central Africa, including several important and influential friends and allies, such as Zaire, Zambia, and Tanzania. It is difficult to overstate the impact on these societies of the likely loss of much of their modern sectors, but that is precisely what a number of them are facing. The problem is made more intractable by African defensiveness and unwillingness to face up to it, and by Soviet-generated allegations that AIDS originated in U.S. germ warfare experiments. For the U.S., there are important policy questions that need urgently to be addressed. Can we stimulate African leaders to quickly take necessary steps to retard a further spread of the disease? What is our role in a humanitarian crisis brought on by a disease that is both incurable and invariably fatal? Does it make sense to continue to support economic development efforts and technical and military training programs in countries that may be doomed to social and economic collapse in the near term? If not, how should our assistance be refocussed? We will have further comments from our ongoing study of this rapidly developing situation. This “heads-up” is intended to signal the magnitude of the problem and some of its implications for US interests.

END SUMMARY.

It is hard to be sure of the extent of AIDS in Africa. WHO estimates, which are based on what they get from Africa’s rudimentary public health and statistical services, appear grossly to understate the problem. But data we are now receiving from private researchers in touch with some of our African posts suggest that up to one-third of all adults in many urban areas of Central and East Africa may now be infected with AIDS.

Throughout Africa, men and women are infected in equal proportions. Although in the West, infection rates tend to be highly-concentrated among specific groups (in the US, approximately 90% of all AIDS patients are either homosexuals, IV drug users, or both), the disease is much less so highly-defined in Africa. Fairly uniformly-characteristic of the disease in most African countries, however, is that its incidence seems to be highest among young sexually-active professionals—those with education, wealth and power and those in close contact with them—the post-independence elites and their associates—politicians, civil servants, businessmen and women, soldiers, intellectuals, transport workers, and prostitutes. The evidence so far suggests that among such African elites the rate of infection is at least double that of the general urban population.

In Dar es Salaam the infection rate (those showing antibodies for HIV virus) among the general urban population is reportedly 34%; in Lusaka 27%; in Rwanda’s capital of Kigali, 31%; in Kampala, an almost astonishing 54%. The general rate of infection approaches 10–15% along major transport routes out of these cities. Peasant farmers, with less wherewithal for promiscuous sexual activity, seem to be less infected (but at rates which are still double or more those in the U.S.).

AIDS was discovered only this decade, and we are just now beginning to be able to predict mortality rates. The most recent clinical studies in the advanced countries of the West suggest that as many as 50% of those who test seropositive for HIV (i.e., who evidence the tragically useless antibodies generated by the body’s immune system once it has been invaded by the AIDS virus) will die within five years. 75% will die within seven. After ten years, the data agree, death rates begin to approach 100%. Mortality rates during the earlier periods of infection are higher still in countries that do not have modern public health systems and medical facilities. As the gradual collapse of the body’s immune system proceeds, those with AIDS become more and more vulnerable to other diseases that are endemic in Africa, such as malaria and tuberculosis.

What this means, unless our data are fundamentally wrong, is that by the mid-1990s two-thirds or more of the modern, educated elite and perhaps half the overall urban population in highly infected countries such as Burundi, Rwanda, Tanzania, Uganda, Zaire and Zambia will probably have died.

We have little historical experience with death rates of this magnitude. At the dawn of the Christian era, China’s urban population was cut by four-fifths as the result of an outbreak of bubonic plague. In the XIVth century, Europe lost two-thirds of its population to the “black death.” The result in each case was a collapse of organized society and its economy accompanied by a paroxysm of religious fanaticism and xenophobia. Historians speculate that classical Mayan civilization may have been shattered by a similarly catastrophic outbreak of disease.

So far, AIDS has been discussed by the world—including by Africans—primarily as a problem of medical research and public health. Clearly, it has implications that transcend either. In Africa, AIDS has the potential to devastate entire societies, erasing the hundred year-old impact of modern European technology and thrusting whole nations back into the early iron age.

Despite a growing awareness of the threat in the most seriously affected African countries (Zambian President Kenneth Kaunda has lost one son to AIDS; another is dying from it), debate in Africa has tended to center on whether or not AIDS originated in Africa. Most African governments have sought to conceal the dimensions of the problem from both foreigners and their own populations. (There are some exceptions: Rwanda and Uganda have faced up to the problem with massive campaigns of public education and condom distribution; “love carefully.”) Africans are resentful of speculation that AIDS may have originated on their continent, and of current scientific linkages to types of “green monkey virus”. The Soviets have fed this resentment with deliberately and assiduously-spread disinformation campaigns insinuating that AIDS may have originated with alleged US military biological/bacteriological warfare experiments at Ft. Detrick, Maryland. But there is now no point in debating where AIDS came from; the relevant question is where it is likely to take us, and what we can do about it.

Aside from the matter of our response to the horrifying humanitarian crisis that AIDS now seems about to visit upon Africa, numerous other policy issues need urgently to be addressed. We need to deal with these carefully, but study them rapidly and without “wasting time” studying them:

—how do we help persuade African governments to abandon their present head-in-the-sand mentality, declining even to discuss the situation, denying known facts, refusing to provide information or statistics?

—and a corollary to this—how do we deal with African suspicions, fed to a degree by the Soviets, that AIDS is a “white man’s creation” developed by the West in order to keep Africa permanently weak—and the corresponding (albeit still relatively low-level) fear in our own society that African students, visitors and professional people are all AIDS carriers about to spread their plague in this country?

—is there any way in which the U.S. can or should attempt to take the lead in providing organizational help to Africans as they try to muster their resources to combat the AIDS problem?

—can cheap and reliable AIDS detection methods be developed that are affordable and usable in the Third World?

—should we continue to support population planning efforts in countries that are about to suffer a catastrophic loss of population? If not, can family planning networks be activated to carry out effective public education and condom distribution campaigns?

—should the U.S. divert its own scarce development assistance resources to those countries which are not likely to be devastated by AIDS (in effect, spending our money in countries that stand a better chance of surviving the AIDS plague)? As an explicit issue, should the US begin testing IV grantees, AID-sponsored trainees, and other USG-funded students and professional visitors for AIDS (with the negative imagery that will provoke), and should HIV seropositivity be grounds for exclusion (either for health reasons or simply to avoid spending scarce resources on individuals who may not be around long enough to make their training pay off); and if the latter, do we simply accept that we will be foreclosed from the “training” business across a fairly wide swath of central Africa—which may, eventually, expand to other areas as well.

—as an overall policy objective, are there things the US can do to avert what now looks fairly certainly like the eventual inevitable collapse of the modern sectors of AIDS-affected societies?

CONCLUSION:

We are in the process of gathering as much information as we can about the expected impact of AIDS on African societies: AF has asked each of its posts to prepare an analysis of the degree to which AIDS is present, and its expected toll on the leadership structures (political, economic, commercial, academic, social) in each country. We are disseminating as much information as we can to the field. We plan to sponsor a series of symposia in the Department, convening recognized authorities on both the disease and its likely impact on African societies.

For the time being, we believe it is important to recognize both the magnitude and impact of the problem as well as the limitations on what we can do. It is, we believe, imperative that the U.S. not give the impression that we can—through a massive “task force” approach to the problem, deal with it by hurling resources into the void. Over the next couple of weeks, we will be considering various options for US action, including specifically demarches, directly or through intermediaries, intended to awaken African awareness to the imperative of immediate action to prevent further spread of the disease. We will also be reviewing the implications of the AIDS problem for our own assistance programs.² We will keep you informed.

1. Source: Department of State, Central Foreign Policy File, P870100–0142. Secret. Drafted by Freeman on April 7; cleared by Stacy, Passage, Benedick, Rouse, and Walsh. A stamped notation on the document indicates Shultz saw it.
2. In a May 12 memorandum to Crocker, Passage provided a breakdown of AIDS infection in African nations and wrote: “Reporting from our Embassies in Africa makes it painfully clear that the AIDS epidemic is spreading in Africa and that in a dozen mainly Central and East African countries the disease has reached epidemic proportions or has the potential to do so.” (Department of State, AIDS, 1984–1987, Lot 89D137, AIDS—Exdis Commander)