‘AIDS: A Darwinian Event?’

by

Alan Whiteside1 & Alex de Waal2

The Centre for AIDS ResearchUniversity of Southampton 1. Director HEARD University of KwaZulu-Natal 2. Research Fellow, Global Equity Initiative, Harvard University

Outline of Presentation

• What do I mean - Darwinian - Event

• Evidence

• Looking back

What do I mean?

Darwinian – that which results in change in our genetic, social, economic or psychological makeup

What do I mean?

Event – something we can measure as we look back or, in the case of AIDS, look forward

Examples

• The Black Death (see Barbara Tuchman ‘A Distant Mirror’)

• The extermination of colonial times – Tasmania

• Slavery?

• SMS texting with mobile phones?

What is AIDS?

HIV / AIDS an historical event – so what is our historical perspective

A candidate as a Darwinian

Event?

Outline of Presentation

• What do I mean - Darwinian - Event

• Evidence

• Looking back

The Scale of the Epidemic

•HIV prevalence of 40%

•Mortality

National trends in HIV prevalenceWomen attending Public Antenatal Clinics

0

5

10

15

20

25

30

35

40

45

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

% H

IV p

osit

ive

Botswana

Namibia

South Africa

Swaziland

0

200000

400000

600000

800000

1000000

1200000

1995 2000 2005 2010 2015

year

num

ber o

f dea

ths

Other deaths AIDS Deaths

A model of future AIDS and non-AIDS deaths

0

10

20

30

40

50

6019

85

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

Mil

lio

ns

Tota

l po

pu

lati

on

0

1

2

3

4

5

6

7

8

9

Mil

lio

ns

Nu

mb

ers

HIV

, AID

S s

ick

and

HIV

dea

ths

Totalpopulation

Total HIV

TotalnumberAIDS sick

CumulativeHIVdeaths

Numbers infected, sick & dead ASSA2000

00001-E-47– 27 June 2000

Lifetime risk of AIDS death for 15Lifetime risk of AIDS death for 15--yearyear--old boys, old boys, assuming unchanged or halved risk of becoming assuming unchanged or halved risk of becoming

infected with HIV, selected countriesinfected with HIV, selected countries

Source: Zaba B, 2000 (unpublished data)

Current adult HIV prevalence rate

Burkina Faso

Cambodia

Côte d’Ivoire

Kenya

South AfricaZambia

Zimbabwe

Botswana

Burkina FasoCambodia

Côte d’Ivoire

Kenya

South AfricaZambia

Zimbabwe

Botswana

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0% 5% 10% 15% 20% 25% 30% 35% 40%

Ris

k of

dyi

ng o

f AID

S

current level of risk maintained

risk halved over next 15 years

Changing life expectancy in African countries with high and low HIV prevalence: 1950-2005

Source: UNAIDS, 2002. Report on the global HIV/AIDS epidemic

South Africa Botswana

Changes in Population Structure due to AIDS – 2000-2025

32

AIDS orphans in South Africa

33

00.5

11.5

22.5

33.5

44.5

2002 -2005

2011 -2015

No AIDS With AIDS

Forecast GDP Growth 2002- 15

27Aug01 -Report I: Epidem’gy & Lit. p. 8

Households are becoming poorer

• Households will try to adapt.

• New forms of household.

• Coping & distress can both be found.

Assets will be sold.

• Households poorer

• Households disappear

Zambia5 year retrospective study of AIDS-

affected families(232 urban +101 rural)

Monthly disposable incomefell by >80%

Rakai, UgandaBicycles & radios in

houses with adult AIDS deathBike Radio

First vist 39 40Last visit 35 36

30

What goes around comes around

Outline of Presentation

• What do I mean - Darwinian - Event

• Evidence

• Looking back

Demography

• Size (decrease, stabilise, grow more slowly)

• Structure male:female, dependency ratios

• orphans

Social/psychological

Selection by • Wealth • Skills• Ability or characteristics eg

artists or entrepreneurs

Wealth and HIV

1000 $

2000 $

3000 $

Per capita 1999

Adult HIV prevalence end 1999

Botswana

South Africa

Namibia

Swaziland

ZimbabweUganda

Cote d’Ivoire

Zambia10

10 20 30

Debswana Diamond Company (Pty) Ltd

HIV Prevalence by Job Band

30.9% 30.7%27.6%

19.3% 18.8%

0

5

10

15

20

25

30

35

A Band B Band C Band D Band F Band

% H

IV p

osi

tiv

e e

mp

loy

ee

s in

eac

h jo

b b

and

Some Populations Harder Hit than Others

*Above average deaths from AIDS(++ high impact, maybe higher numbers)

AIDSepidemic

Young women

Unemployed

Migrants, temp, contract workers

Drivers & mobile workers

Miners/hazardous occupations

Political leaders?

Newly prosperous

Soldiers

Sex workers

Teachers++

Some regions:KZN, Gauteng, Mpu’gaCaprivi – E&WBotswanaSwaziland, Lesotho

Dying*

orphans

Corridors & CrossroadsMaputoBeiraDurbanTrans-Kalahari?

Gov’t workers++

Short-term thinkers

Uncircumcised

AIDSepidemic

High income

Non-migrant families

Settled, long-termemployedTertiary education

Some regions:W. CapeN. CapeSn. NamibiaNorthern Prov.E. Cape

Grandparents

Surviving**

**Below average deaths from AIDS(the foundation of the future)

Long-term thinkers

Isolated areas

Chaste & faithful

Circumcised

Cohesive, candid societies

Intro.

Memetic evolution

Memes are replicable information in the brain.

• Circumcision• Risk taking• Funeral ceremonies• Nepotism and altruism

Is AIDS a Darwinian event?

Yes• Populations decline• Some groups

v.adversely affected• Memetic impact• Economic & social

effects

No• Pop. Decline limited• Epidemic isolated in

certain areas & groups

• The ‘dyers’ don’t matter

• The scale too short

Ozymandias

I met a traveler from an antique landWho said: Two vast and trunkless legs of stone

Stand in the desert. Near them, on the sand,Half sunk, a shattered visage lies, whose frown,And wrinkled lip, and sneer of cold command,Tell that its sculptor well those passions read,

Which yet survive, stamped on these lifeless things,The hand that mocked them, and the heart that fed,

And on the pedestal these words appear:"My name is Ozymandias, King of Kings:

Look upon my works, ye Mighty, and despair!"Nothing beside remains. Round the decayOf that colossal wreck, boundless and bareThe lone and level sands stretch far away.

Percy Bysshe Shelley1792-1822

No Man is an Island

No man is an island, entire of itself every man is a piece of the continent, a part of the main if a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friends or of thine own were any man's death diminishes me, because I am involved in mankind and therefore never send to know for whom the bell tolls it tolls for thee. -- John Donne

HIV/AIDS is an historical event!

A ‘history’ is being written.The responsibilityof historians provide: • ideas, • paradigms & • methodologies for understanding and

responding

And finally

There is an awful predictability about HIV/AIDS and what it has the potential to do.

Historians have the unique experience of seeing an event of unparalleled significance unfold before their eyes. This history can be written in advance.