Genocide's creditors
Three years later, we still know too little about one of the biggest genocides in human history. In less than three months, one million Rwandans were exterminated, simply because they were or were thought to be Tutsis. Tens of thousands of Hutus were also killed: political opponents of the regime and people who refused or might have refused to join in the genocide. With few exceptions, neither the authors of the genocide nor those who carried it out have been brought to trial. The victims' families face terrible material and psychological conditions. The direct complicity of (in particular) the French and Belgian authorities is being covered up or is simply denied. The deadly role of the macrocan strike a bargain with multi-lateral lending institutions, to protect their privileges and pass the social costs of the structural adjustment program onto the poor. Another dimension is that under the aegis of this Council, the President has improved his own standing vis-à-vis the office of the Prime Minister and has concentrated more power in his own hands. There are tensions between the Chief of the Army Staff, General Jahangir Karamat and the President on this score. General Karamat may suspect the President is trying to undermine the role of the military through the Council. The military has strengthened its vice like grip over the country and the Nawaz Sharif government knows it. • The caretaker government appointed a Pakistani vice-president at the World Bank, Shahid Javed Burki, as Special Economic Advisor. This unelected technocrat introduced the economic reform program which has been inherited by the new government.
The World Bank and Pakistani governments have a long relationship going back to the early 1950s when economic policies were framed by the Harvard School of Economics. Harvard university had a scholarship scheme through which it attracted the brightest Pakistani students and economic policies imposed by the multilateral financial institutions -World Bank and IMF - is also being obscured. The patent failure of non-governmental organisations is being whitewashed.' Perhaps worst of all, the "international community" is forcing survivors to pay for the weapons that were used to massacre their families and neighbours. Eric Toussaint* The anti-Tutsi genocide was planned in the early 1990s by the authoritarian regime of General Habyarimana. This regime produced a genocidal ideology that was steadily exuded at every level of the system, from the central committee of the National Revolutionary Movement for Development (MNRD) -a sort of single ruling party consolidated by Habyarimana and his entourage over the course of 20 years - to key cells inside the
Key dates
1947-57 Multi-party system with
Muslim League and Republican Party.
1958 - 1969 Field Marshall Ayub
Khan's martial law regime.
1969-71 Ayub Khan forced out by popular movements and hands power to new army chief, General Yahya Khan
1971-77 Zulfikar Ali Bhutto's Pakistan
Peoples Party comes to power.
1977-85 Bhutto ousted in military coup (later executed). General Zia-ul-
Haq becomes Martial Law Administrator
1985-88 Non-party elections. Zia becomes President. Martial law lifted.
1988-90 Zia dies in plane crash.
Benazir Bhutto's PPP comes to power.
1990-93 Benazir Bhutto's government dismissed by President. Caretaker government of Moeen Qureshi takes over. Nawaz Sharif's Muslim
League elected.
1993-96 Nawaz Sharif's government dismissed by the President. Benazir
Bhutto returns to office. In November
1996, Bhutto government dismissed by
President. The care-taker government is headed by Prime Minister Meraj
Khalid though many believe that
President Farooq Leghari holds real power.
1997 Nawaz Sharif is elected.
disciplined, hierarchically controlled state bureaucracy. The size of the army was increased eightfold from 1990 to 1993. The creation of the Interahamwe militias ("those who fight together") in 1992 was the finishing touch to the arrangements. At the end of 1993 the killing machine was in place: in each of Rwanda's 146 municipalities, 200300 armed men, about one for every ten families, were ready to act. In the rural, hilly areas, everybody knows everyone else: the militias drew up lists identifying the "lukewarm" ones, the "suspicious" ones, and the "avowed Tutsis"
In the capital, Kigali, the plans were drawn up even more carefully. In early 1994, municipal employees double-checked who lived in each house. They put red signs on some houses, green signs on others. "It's for the census" ", they assured the surprised inhabitants. In April 1994 the killing teams would know exactly which houses they had to stop at. To complete the arrangements, the Free Radio and Television of the Thousand Hills (TLM) was set up in 1993. The famous "Radio of Death" or "Radio Machete" was born. It was housed across from the presidential offices and supplied with electricity from across the street.
The militias began carrying out mastrained them. The two most recent Caretaker governments in 1990 and between November 1996 and February 1997 have been effectively headed by current employees from senior levels of the World Bank.
This has paved the way for the introduction of anti-poor austerity measures which even nominally democratic governments could not afford to bring in. This advisor, Shahed Javed Burki wrote a book extremely critical of the economic record of the Zulfikar Ali Bhutto government (1971-77) Burki argued that if any democratically elected government tried to revert to the populist policies of that period it would be ruined.
When he finally got his shot at handling the economic portfolio. Burki was shuttling between Islamabad and Washington DC to plead with the World Bank to release more İoans for Pakistan which they didn't do. However what they did give him was a blueprint for any incoming government.
A few days before the election, Burkı briefed Nawaz Sharif on this economic plan, and made it clear that he would be expected to stick to and implement it once in office.
The foreign debt is now US$30 billion and debt-servicing consumes45% of the budget. The Caretaker government removed state subsidies for necessities. The price of sugar increased four times in those few months, from Rs. 10 per kilo to Rs. 31 per kilo. [60Rs. =1 US dollar] The price of ghee
[cooking oil] has reached Rs. 80 per kilo. Prices of wheat flour, milk-powder, cement, electricity, gas, bus fares and rail fares all increased. You can see the effects on the faces of the poor. They are so hard pressed that they find it difficult to even breathe. • Privatisation will be accelerated by the new government. How are trade unions responding?
There hasn't been widespread opposition to privatisation. Many trade unionists see the floating of the Allied Bank of Pakistan as a model. Workers and management bought a majority stake in the bank and its financial situation has improved. Trade unionists see this as a future strategy. A way to protect jobs while maintaining profitability.
There is a small core of independent trade unions and left wing activists who are trying to mobilise on anti-privatisation issues and they have formed a loose network which is a promising start. Aside from this there was also an electoral coalition formed at these elections based upon progressive trade unionists and left wing groups? It stood on a clearly workers agenda. Historically the Pakistani Left* has always been entangled with bourgeois parties and more recently in the Peoples Party. We are at an embryonic stage but this is a welcome break. The road ahead is long. General Zia-ul-Haq crushed popular opposition and de-politicised the
Rwanda sacres as early as 1992-93. By the beginning done 1002. By the beginning of 1993 2,000 people had already been assassinated. Each action was preceded by a meeting, often organised at the highest level: the chief of state and his wife took part. During these meetings the targets were painstakingly defined. The necessary means were put at the killers' disposal: petrol coupons, vehicles - often cars or trucks belonging to the municipality - and weapons. The gendarmerie or the army provided the operation's cover: uniformed men closed off the roads, finished off the work or got rid of inconvenient witnesses. In January 1993 the Rwandan Federation for Human Rights published a report that stated, "The preconditions are present for genocide." French advisors, right from the start General Habia had diparatory pease, During this whole preparatory phase, enjoyed very considerable international support. French authorities were front and centre. The Interahamwe militias were trained by French troops stationed in Rwanda. According to Janvier Afrika, who took part himself in massacres in the early 1990s, "The French taught us how to catch people and how to tie them up. There were also Frenchmen in the registration centre' in youth. This generation knows nothing about politics and left wing ideologies. Instead they understand politics only along ethnic, clan and regional and religious sectarian lines. * Arif Azad was a student activist and leader while at medical college in Lahore and involved in protests against the martial law regime of General Zia-ul-Haq. He was on the executive council of the Pakistan Medical Association and a contributor to the left-wing Pakistani magazine Viewpoint. Notes 1. The Awami National Party is a successor to the National Awami Party, a left-wing party led by Maulana Abdul Hamid Bashani, a Maoist. In the North-West Frontier Province, Wali Khan was its best known figure. His father, Ghafar Khan had close ties with the Congress party in India and was dubbed the "Frontier Gandhi" 2. Zardari is accused of the murder of Benazir Bhutto's brother and bitter political rival, Murtaza, killed in a shoot-out with police in September 1996. Few belleve that Zardari ordered the murder. Instead he is a convenient scapegoat. Murtaza Bhutto's Lebanese-born widow, Ghinva, now leads his party (which won only one seat) seeking punishment for his true assailant - the latest in the long line of "widows in politics" in South Asia. 3. Including the Pakistani affiliate of the Committee for a Workers International ("Militant") 4. The Communist Party in post-partition Pakistan was the remnant of the Indian Communist Party which anyway had been weak in those regions. The main leader of the Communist Party migrated from India to rebuild it. However the Cold War environment and the close relationship with the United States of America government contributed to the crushing of this party. In the notorious Rawalpindi Conspiracy case of 1958, the main leaders were rounded up and jailed. The Communist Party never recovered. Trade unions were prominent in the 1960s with the expansion of the industrial working class and a left wing movement. Trade unions and the Left supported Zulfikar Ali Bhutto and propelled him into power. However their militancy was too threatening to him and he curbed them.
April 1997 #287 19
* Rwanda downtown Kigali where the torture sessions took place.... Soon after the training courses began, the first slaughters began, in early 1992. This didn't keep the French advisers from continuing the training. " 2 The Belgian lawyer Eric Gillet also said as early as 1991 that he had seen Frenchmen in uniform observing prisoners' interrogations in the registration centre.?
French support for Habyarimana goes back to 1975, when a first military co-operation agreement was signed by President Valéry Giscard d'Estaing. Before this time Rwanda did not seem to be an active part of France's foreign policy.
In contrast, Belgium, the former colonial power, was omnipresent in Rwanda. It provided military aid to the Rwandan army that was maintained up until the genocide began on 7 April 1994. The Belgian king, Baudouin, and Queen Fabiola considered Juvenal Habyarimana a friend. He regularly visited the royal palace. "Each time he visited, the president rushed to the royal chapel and kneeled with his forehead to the ground, in the great charismatic tradition." 4 When King Baudouin died, Habyarimana attended the
Analysis w There is only one magazine in • the leaders of France's trade union official ceremony (an honour which President Mobutu of Zaire did not have). The MNRD, the ruling party Habyarimana created, was financed and supported on the international political scene by the Christian Democratic International and the Flemish and Walloon Christian Democratic parties. The Elysée's relations with Habyarimana
France greatly increased its military aid after the rebels of the Rwandan Patriotic Front (FPR) launched a military offensive from Uganda in October 1990. François Mitterand quickly sent paratroopers stationed in Bangui (in the Central African Republic) in order to support the Rwandan regime and evacuate foreign residents. "The excellent relations that had developed between JeanChristophe, the French president's son, and Jean-Pierre, the Rwandan president's son, with Mobutu's blessing, did the rest, all the more so because Jean-Christophe ran the
Elysée's African cell at the time. 59 6
The French troops - there would eventually be more than a thousand of them -ith Attitude the English language where left debate how best to articulate the new mood of resistance to public sector cuts and unemployment.
• Tahiti's NGO activists explain why they feel Greenpeace marginalised them during the campaign against French nuclear tests.
• Indian activists argue that we shouldn't ban imports on countries with deficient environmental and labour legislation.
Founded by Ernest Mandel,
International Viewpoint is the world's largest international Marxist news and analysis magazine.
VIEWPOINT abonas
Correspondents in over 50 countries report on popular struggles, and the debates which are shaping the left of tomorrow. Direct from the front line in the fight against neo-liberalism.
This magazine is a window to radical alternatives worldwide.
For a free trial subscription (three issues), call us now, or mention this advert to our local sales agent!
Australia: International Viewpoint, PO Box 1638, Collingwood 3065, Victoria
Britain: Outlook International, PO Box 1009 London N4 2UU © (081) 800 7460
Canada: Socialist Challenge, PO Box 4955, Main P.O, Vancouver V6B 4A6
USA: International Viewpoint, PO Box 1824, New York, NY 10009
2o BP 85, Paris cedex 11, 75522 France © +33 1/43792961
Fax: +33 1/43792961 E-mail: [email protected]
• Australia $33 • Britain £25 • Canada $80 • Denmark 380 DKK • Ireland £25 •
• South Africa R100 • Sweden 400 SEK • New Zealand $35 • USA $70 •
20
International Viewpoint saved Habyarimana's bacon several times between October 1990 and 1993, even though Paris saw where the Rwandan regime was heading. The desire to increase French influence in the region proved decisive. When the Arusha accords were signed in January 1993 - accords for a democratic transition between the Habyarimana regime and the FPR - Mitterand reaffirmed his total support for the regime. In reality he was afraid of what implementing the accords would lead to, since they would mean a reduction of French influence. "Whatever the Elysée may say, its embassy never joins initiatives in support of human rights; on the contrary, it is busy making contacts with extremists inside the regime.' 33 7 The genocide
On 6 April 1994, the signal was given to begin the genocide when a missile destroyed the plane bringing Habyarimana and his Burundian colleague from a negotiating session in Dar-es-Salaam (Tanzania). Within a few hours, hundreds of Hutu political opponents were assassinated according to a minutely prepared plan. The prime minister herself was assassinated. Ten Belgian paratroopers, members of MINUAR - the UN multinational force - were massacred while trying to defend themselves. The MINUAR command let it happen. The provisional government that took over held its meetings in the French embassy. The massacre of opponents and the launching of the genocide was directed from there. Several hundred thousand people died in a few weeks. By the end of June 1994, the genocide was an accomplished fact.
Opération Turquoise was launched by France ten weeks after the massacres began, essentially in order to allow what was left of the Rwandan army and the genocidal militias to retreat into Zaire, bringing hundreds of thousands of civilians with them as hostages. The policies of the multilateral financial institutions
Policies imposed by the international financial institutions, the Habyarimana regime's main funders, accelerated the process leading to genocide.®
In the early 1980s, when the Third World debt crisis broke out,? Rwanda (like its neighbour Burundi) had very little debt. Elsewhere in the world the World Bank and IMF abandoned their active lending policies and preached abstinence. They adopted a different attitude towards Rwanda. The World
Bank and IMF decided to cut off all credits to
Nicaragua, since its authentic revolution had installed a revolutionary regime. By contrast, these institutions took it upon themselves to lend liberally to Rwanda.'*
The dictatorial regime in power since
1973 guaranteed that Rwanda would not adopt policies of progressive, structural change. It was actively supported by Belgium, France and Switzerland. The regime was seen as a potential bulwark against countries in the region that were clinging to old notions about independence and progres-
sive change (neighbouring Tanzania, for example). During the 1980s and up until 1994, Rwanda received many loans, of which Habyarimana appropriated a considerable share.
These loans were meant to insert the Rwandan economy more tightly into the world economy by developing its three main export products - coffee, tea and tin, at the expense of crops meant to satisfy local needs. The model worked until the mid-1980s, when tin prices collapsed, then coffee prices, and finally tea prices. Rwanda was also hard hit by the US-provoked break-up of the coffee cartel. Use of international loans to prepare the genocide
Several weeks before the Rwandan Patriotic Front (FPR) launched its rebellion in October 1990, the Rwandan authorities signed an agreement with the IMF and World Bank in Washington to set in motion a Structural Adjustment Programme (SAP). This SAP took effect in November 1990, whereupon the Rwandan franc was devalued by 67%. In return the IMF granted quick-disbursing credits and hard currency in order to enable the country to keep up the pace of imports. The money lent in this way made it possible to keep the balance of payments in balance. Import prices increased dizzyingly: petrol prices went up by 79%. By selling these imports on the national market, the government was able to finance the pay of the growing number of troop. The SAP forecast a cut in government spending: there was a wage freeze and layoffs in the civil service, but part of this saving was transferred to the army.
While import prices rose, the purchase price paid to coffee farmers was frozen, as required by the IMF. The result was ruin for hundreds of thousands of small-scale coffee producers." Other measures imposed by the World Bank and IMF through the SAP included increased taxes on consumption, lower taxes on companies, higher direct taxes on low-income families through reductions of tax benefits for large families, and cutbacks in credit facilities for peasants."
These farmers and the most impoverished city-dwellers constituted from then on a permanent source of recruits for the Interahamwe militias and the army.
In order to justify use of "quick disbursement" loans, Rwanda was authorised by the World Bank to present old bills for purchases of imported goods. This system enabled the Rwandan authorities to finance massive purchases of weapons for the genocide. Military spending tripled from 1990 to 1992.13 The World Bank and IMF sent several expert missions during this period: the experts stressed various positive aspects of Habyarimana's austerity policies but threatened to suspend payments if military spending continued to grow. The Rwandan authorities perfected tricks to hide military spending: trucks bought for the army were covered by the Ministry of Transport budget; much of the petrol used by militia and army vehicles was covered by the Ministry of Health budget, etc. Finally, the World Bank and IMF turned off the financial aid tap in early 1993. But they did not block the bank accounts that the Rwandan authorities held in major banks abroad; major sums in these accounts remained available for arms purchases. Rising social contradictions
In order for the genocidal project to be set in motion, more was necessary than a regime that conceived it and assembled the tools to carry it out. There also had to be a mass of impoverished, lumpenised people, ready to carry out such a bloodbath. In Rwanda, 90% of the population lives in the countryside, and 20% of the peasant population has less than a half-hectare of land per family. Between 1982 and 1994, there was a massive process of impoverishment of the majority of the rural population, with an impressive accumulation of wealth at the other extreme of society. According to Professor Jef Maton, the richest 10% of the population took in 20% of rural income in 1982, 41% in 1992, 45% in 1993, and 51% in early 1994. The catastrophic social impact of the policies dictated by the IMF and World Bank and the fall of coffee prices on the world market (which also had something to do with the Bretton Woods institutions' policies) played a key role in the Rwandan crisis. The enormous social discontent was channelled by the Habyarimana regime towards genocide. Genocide's creditors
Rwanda's main arms suppliers in 199094 were France, Belgium, South Africa, Egypt and the People's Republic of China. China supplied 500,000 machetes. Egypt -whose deputy minister of foreign affairs in charge of relations with Africa was none other than Boutros Boutros Ghali - offered Rwanda an interest-free loan so it could buy infantry weapons for a total of $6 million. Once the genocide was under way, and although the UN had decreed an arms embargo on 11 May 1994, France and the British firm Mil-Tec supplied arms to the criminal army through Goma airport in Zaire.!
Once Kigali fell to the rebel FPR, several high officials responsible for the genocide were received at the Elysée palace. The Rwandan authorities in exile, with the help of the French army, set up a new headquarters of the Rwandan National Bank in Goma, Zaire. From this office they continued authorising payments for arms sales until the end of August 1994. Private banks - Belgolaise, Générale de Banque, BNP, Dresdner Bank -accepted orders of payment from the perpetrators of genocide and reimbursed the genocide's creditors. 'S
Today, Rwanda's total foreign debt is almost $1 billion, almost entirely contracted by the Habyarimana regime. Beginning in 1998, Rwanda will have to pay back $155 million each year to its creditors, mainly the Bretton Woods institutions. Can we accept that those who survived the genocide will be forced to pay for the weapons with which the crime was carried out?
Rwanda * Source: Article (forthcoming) written in French for Politis La Revue *Eric Toussaint chairs the Brussels-based Committee for Cancellation of the Third World Debt (COCAD). Notes 1. Rwanda used to have the highest density of Western Non-Governmental Organisations per square kilometre of any Third World country. Most of the NGOs that were involved in development projects did not see the genocide coming. Some of them, and not the least of them, find it too distasteful to evaluate their activities critically. 2. Colette Braeckman, Rwanda, Histoire d'un génocide, Fayard, 1994, pp.159-60. 3. Braeckman, op.cit., p. 159. 4. The last Belgian troops that had been serving in the Rwandan army returned to Belgium in mid-April 1994. Until they left Rwanda they wore Rwandan uniforms. 5. Belgium is a federal state; each of the three major Belgian political currents - Christian Democratic, Social Democratic and Liberal - is divided into a Flemish party in the Dutch-speaking region and a Walloon party in the French-speaking region.(trans.) 6. Colette Braeckman, op cit., p. 255. France's African relations have been managed for years in large part by an "African cell" in the presidential palace rather than by the foreign ministry.(trans.) 7. Colette Braeckman, op cit., p. 261. 8. Michel Chossudovsky, "Somalia and Rwanda", in IMF/World Bank/WTO: The Free-Market Fiasco, IIRE Notebook for Study and Research no. 24/25, Amsterdam, 1995; Michel Chossudovsky, "IMF-World Bank Policies and the Rwandan Holocaust" ', Third World Resurgence no. 52, 1994; Charles André-Udry and Jean-François Marquis, "Le Rwanda: escamotage ou rouerie?" ', Dossier CADTM no. 6-7, Brussels, 1992. Among the NGO-connected authors who minimise the World Bank's and IMF's negative role is: David Woodward, "The IMF, the World Bank and Economic Policy in Rwanda: Economic, Social and Political Implications" ", Oxford, Sept. 1996, unpublished ms. 9. The crisis exploded when the Mexican authorities announced in August 1982 that they were no longer able to make their scheduled payments. The origins of the crisis lie further back, however: the mushrooming of Third World debt - and of debt in the rest of the world -took place in the 1970s. The foreign debt of Subsaharan Africa grew from $7 billion in 1970 to $84 billion in 1980, thus multiplying by twelve in this period. The World Bank pushed countries in the South to borrow massively throughout the 1970s. Nor did private banks hang back. The debt burden became unbearable when skyrocketing interest rates coincided in the early 1980s with price decreases for Third World exports. Today the Subsaharan African countries pay back about $10 billion each year in debt service. This is four times the subcontinent's total budget for education and health care. (see Denise Comanne and Eric Toussaint, "Dette, ce nouvel esclavage de l'Afrique: Analyse et proposition" in Banque mondiale, FMI, OMC: Ça suffit!, CADTM, Brussels, 1995) 10. Rwanda's foreign debt was multiplied by twenty between 1976 and 1996. In 1976 it was $49 million; in 1996 it was $1 billion. The country's main creditors are the World Bank, the IMF and associated institutions. The World Bank and IMF played the most active role in getting it into debt. These institutions hold over 75% of Rwanda's foreign debt. 11. Jef Maton, Développement Économique et social au Rwanda entre 1980 et 1993: Le dixième décile en face de l'apocalypse, University of Ghent, Faculty of Economic Sciences, 1994. See also Michel Chossudovsky, op.cit. 12. Marie-Chantal Nduhungirehe, Les programmes d'ajustement structurel: Spécificité et application au cas du Rwanda, Catholic University of Louvain, Faculty of Economic Sciences, 1995. (13) Ibid., p. 130. (14) Eric Toussaint, Nouvelles révélations sur les ventes d'armes aux responsables du génocide au Rwanda, Dossier CADTM no.19, Brussels, 1996. See also François-Xavier Verschave in Billets d'Afrique no.44, Mar. 1997, Paris. (15) See the interviews with Pierre Galand, president of the Belgian National Centre for Development Aid, in the daily newspaper Le Soir, 27 Feb. 1997, and in Télémoustique, Mar. 1997. See also the final declaration of the COCAD international meeting on 25 February 1997, available at the COCAD website. Get in touch with the Committee for the Cancelation of Third World Debt!
* COCAD, Plantinstraat 29, 1070 Brussels, Belgium © +32.2.5234023
<[email protected]> www.linkline.ce/users/cadtm April 1997 #287 21
SOTTAGE AIDS Prejudice, poverty and AIDS
The disease spreads through AIDS has overtaken tuberculosis as the worst pandemic (multiple epi- blood, semen, and mothers' milk. demic) in modern history. Human Im- Elemental elements of life, muno-deficiency Virus (HIV) is now present in all parts of the world. In surrounded and distorted by most countries, the number of infected discrimination, oppression, persons is rising rapidly. HIV affects poverty and inequality. people of every social layer, but with
Cyril Rousseau particularly devastating consequences for the poor and marginal. No treatment has been proved effec- Here it is: the plague of the 21st century. A deadly virus which, unless there is a major tive at stopping the full Acquired Imscientific breakthrough, will not be eradimune Defiency Syndrome (AIDS) from cated for another three or four generations. developing. New treatments seem
A number of factors came together for promising, but they are so expensive that only the richest can afford them. AIDS to appear. "Natural" evolution has Even Britain's National Health Service always led viruses to become less, or more dangerous over time, evolving and mutating refuses to provide the drugs.
into forms that affect different species, incWithout advanced treatment, AIDS luding our own. Then there are the human patients all die, of a range of painful factors: the explosion of international exinfections. No drug has proved cap- changes has allowed this virus to spread like able of eliminating HIV from the body. lightening, compared to earlier epidemics. All that medical science can do is HIV expanded along the main highways of reduce the "viral charge", the number human communications, and flourished in of microbes circulating (p.32), thus the main areas where human beings conextending the lives of people with HIV.
centrate. The closer the better. To begin this report, Cyril Rousseau The economic crisis of the last 25 years and Frank Prouet describe the HIV has also contributed to the spread of HIV. pandemic in the third world, and the Typical left rhetoric? Who can deny that the link between poverty, prejudice, and collapse of health care in many third world infection. Ken Davis' reports on the countries, rural exodus, and the increasing effect of the epidemic on the most vul- numbers of refugees, displaced persons and nerable groups - prostitutes, gay men migrants has encouraged the spread of and intravenous drug users. viruses like HIV? In the second part of the report, acti- Over 30 million people live with HIV. vists in Europe and North America About eight million have developed AIDS. describe how a movement against Every day, 10,000 people catch HIV. The AIDS developed, first in the gay male word epidemic is no longer adequate. this is a communities, but now spanning heterogeneous pandemic: a collection of groups at particular risk from infection. regional or continental epidemics, each with Tavis Barr of Act Up New York ex- their own dynamic, but cross-fertilising. poses the limits of profit-driven medi- HIV has already depressed the democal research, and explains why the graphic, fertility and economic statistics of search for a vaccine has been aban- many third world countries. doned (p.32). Marc Nectar, President The richer countries of the world have of Act Up Paris, explains why it is es- managed to absorb the cost of HIV and AIDS sential to resist the "de-prioritising" of into their health budgets, the rest of the world AIDS prevention, now that (expensive) faces proportionally much higher costs. Not treatments are stabilising the number only is the disease more contagious in the of victims in the richest countries. third world, but the consequences of the loss (p.30) And Lise Theiry looks at the of a wage-earner, the cost of care, and the latest research, and asks whether cost of a funeral are much greater for the spermicide creams can provide the family concerned. same protection as condoms. (p.34) AIDS cannot be understood, let alone Common discriminations controlled, in any one country or con- Pragmatic researchers have come to very tinent alone. Nor can the pandemic be simple conclusions. The evidence reveals a fought effectively, without attacking number of factors which increase the risk of poverty and sexual oppression * HIV infection: poverty, and oppression and discrimination of all kinds against drug Note This dossier was produced by activists from six addicts, women, and "sexual minorities". countries on three continents. It was published in The link between poverty and HIV is as French in Inprecor #410, February 1997. Selected clear in the Latino ghettos of New York as in articles are also available in Spanish.
La Kenyan shantytown or a Black Sea ports. 22 International Viewpoint
Wherever health care is unavailable, wherever it is hard to test and cure the "minor" sexually transmitted diseases (which increase vulnerability to HIV), and wherever condoms are not available, then all sexually active people are at risk. Alcoholism, prostitution and drug use all increase the risks.
Recent years have seen neo-liberal reforms of health care systems around the world. The result, predictably, is always and everywhere the exclusion of wider and wider categories of patients from health care. In the third world, reforms imposed by the International Monetary Fund often mean that people must pay for access to hospitals. Even Britain's National Health Service does not provide certain, effective anti-protease drugs. A monthly dose costs £240 (US$ 370).
Government repression of drug users and homosexuals only increases the difficulties of effective disease prevention and treatment. France criminalises drug users, Vietnam refuses to admit that homosexuality even exists. The major religions refuse to support prevention campaigns which do not condemn the "sins" of drug use and homosexual activity. The Catholic Church doesn't even authorise the use of condoms to prevent infection during extramarital liaisons. It isn't over till it's over
We have reached an equilibrium in the rich countries. In other words, the number of new infections each year is about the same as the number of deaths. The disease is not spreading faster and faster. But people are still catching it, and still dying. Europe has about 600,000 HIV+ residents.
In Africa, Asia and Latin America, the diseases is still spreading exponentially, thought the rate of growth varies enormously. Africa is the most severely affected region, and the AIDS debate is at the centre of public attention. In other regions of the third world, the catastrophe is still looming. Chinese authorities recently admitted having given contaminated blood products to the country's haemophiliacs. The People's Republic officially records only 150,000 HIV+ residents. The real figure is certainly higher.
No-one knows how fast HIV is spreading in the former Soviet Union. But the socioeconomic catastrophe there is creating all the preconditions for a massive growth in this kind of viruses. The number of recorded cases of syphilis in Russia has doubled every year since 1990.
What now?
The big story in 1996 was the development of new treatments, and evidence of the beneficial effects of the combination of two or three anti-viral treatments. The results are spectacular. But much remains to be done:
developing drugs which patients will be able to tolerate with less side-effects.
The development of a treatment which can stop the virus multiplying, (but not eradicate it) is certainly good news for the sufferer.
And even better news for the pharmaceutical industry. An expensive drug that doesn't cure people, but stops them getting sicker, if they take it for the rest of their lives. Perfect!
OUTAGE
The battle for access to new drugs isn't won, even in the rich countries. The French budget for anti-viral drugs only covers the treatment of 5% of patients. And while 1 in 3 French patients has access to anti-protease drugs, this drops to 1 in 7 in Belgium, 1 in 35 in Spain, and 1 in 42 in Italy.
Medical research has been completely distorted by the short-term profit motives of the major pharmaceutical companies. These profiteers want (need) to extract every dollar of sales value from each product before they introduce the "new improved" version they have already prepared.
For ten years now, these companies have been accumulating "super profits" by developing one anti-viral drug after another. And, of course, Africa's penniless HIV sufferers are of no interest whatsoever to the private drugs companies.
These same companies have actually stopped research work on potential vaccines against HIV, arguing that the research so far is "too hypothetical." There are real challenges in developing a vaccine. But who should decide whether this is a priority or not? The shareholders of the pharmaceutical multinationals?