Correspondence | Published:

Debt and poverty turn a disease into an epidemic

Nature volume 407, page 13 (07 September 2000) | Download Citation


Sir — Many of the scientists attending the Durban conference on AIDS1,2,3,4 have warned that South Africa's AIDS crisis can be attributed in part to President Thabo Mbeki's consultation with ‘dissidents’. But are the president's words and those of his colleagues really products of denial and confusion supported by pseudoscience? President Mbeki's central point is clear: alleviating poverty and social inequalities will play a pivotal role in conquering the African AIDS crisis.

Scientists at Durban asked a reasonable question: if treatments are necessary to conquer AIDS, why hasn't President Mbeki purchased drugs? Certainly, AIDS drug costs have received considerable attention, but the lack of public-health infrastructure in Africa remains largely ignored. Why is health infrastructure so poor in these countries? The answer, again, links AIDS with poverty. World Bank figures indicate that average healthcare spending on an African person is US$14 a year, compared with $2,673 for the average US citizen.

In the 1960s, when public health was considered a priority by emerging independent states, investments in social spending were rewarded with declines in infant mortality and a corresponding rise in life expectancy. But by the 1980s, many African countries had plunged into an economic crisis, firmly entrenching current trends of increasing poverty, hunger and HIV infection.

Oddly, the international response to these concerns was to slash healthcare programmes as part of austerity measures called ‘structural adjustment programmes’ (SAPs), imposed by the World Bank and the International Monetary Fund. As the benefits of SAP-led economic growth failed to trickle down to the poor, conditions for HIV infection among native populations worsened. One example of SAPs creating the conditions that favour the spread of HIV infection is the displacement of young women to cities where they resort to commercial sex work5.

As AIDS establishes a stranglehold in South Africa, President Mbeki's government is struggling to pay more than $24 billion to the World Bank, and thus remains unable to begin carrying out the public-health initiatives it has planned.

Given the strong correlations between poverty and AIDS, one might question the priorities of those scientists who have chosen to battle with dissident colleagues rather than making the main thrust of their campaign the epidemiology of a disease worsened by sustained indebtedness.


  1. 1.

    Nature 406, 3 (2000).

  2. 2.

    Nature 406, 15– 16 (2000).

  3. 3.

    Nature 406, 113 (2000).

  4. 4.

    Nature 406, 223 (2000).

  5. 5.

    , & AIDS 9, 539–546 (1995).

Download references

Author information


  1. Institute for Health and Social Justice, Department of Social Medicine, Harvard Medical School, 643 Huntington Avenue, Boston, Massachusetts 02115, USA

    • Sanjay Basu
    • , Kedar Mate
    •  & Paul E. Farmer


  1. Search for Sanjay Basu in:

  2. Search for Kedar Mate in:

  3. Search for Paul E. Farmer in:

About this article

Publication history




By submitting a comment you agree to abide by our Terms and Community Guidelines. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate.

Newsletter Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing