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4. HIV/AIDS, State Capacity, and National Security: Lessons from Zimbabwe

This chapter is based in part on Price-Smith and Daly 2004.

Published onApr 16, 2020
4. HIV/AIDS, State Capacity, and National Security: Lessons from Zimbabwe

The HIV/AIDS pandemic continues to spread inexorably throughout the developing countries, proliferating from its established base in subSaharan Africa to infect millions in India, Eastern Europe, and East Asia. In 2005 the pandemic claimed 2.8 million lives and generated 4.1 million new infections, bringing the number of people currently infected to 38.6 million.1 Despite the increasing production of anti-viral therapies, access to them remains limited in the developing countries, and resistant strains of HIV have begun to proliferate.

According to UNAIDS’ 2006 Report on the Global AIDS Epidemic, the contagion is showing signs of slowing as increases in incidence begin to plateau in certain countries. However, a deeper analysis of UNAIDS’ annual data on incidence and prevalence suggests otherwise. Specifically, while there may be selected geographically specific pockets of stabilization (and even amelioration) of HIV, the larger story is one of a pandemic that continues to expand into new geographical domains even as it remains entrenched within its epicenter in sub-Saharan Africa. UNAIDS’ interpretation of the data is unusual, as UNAIDS prefers to emphasize the point that the epidemic appears to have slowed its expansion (in terms of prevalence as a percentage of population). However, this is a function of both aggregate population growth and the fact that mortality from HIV/AIDS now equals or exceeds the rate of new infections. Thus, stabilized prevalence does not necessarily equate with an epidemic that has reached an epidemiological equilibrium or “plateau”; it is simply killing more people faster than ever before. (See figure 4.1.)

Globally, the HIV/AIDS pandemic resulted in 4.3 million new infections in 2006, and over 39.5 million people are now HIV positive.2 Using UNAIDS data on incidence of HIV, I have calculated the rate of increase and decrease from 2003-2006, as a percentage, and as defined by geographic region.3 Enormous variation in incidence has occurred in recent years, the most significant percentage increases occurring in Eastern Europe and Central Asia (68.75), North Africa and the Middle East (25.92), and South and East Asia (11.62). Conversely, the greatest declines were observed in North America and Europe (−53.84), the Caribbean (−44.12), and Oceania (−21.12). Despite the positive nature of such regional declines, certain data are cause for concern. The dramatic gains in incidence across Asia and Eastern Europe indicate that the virus is conquering new territory in the greatest population pools on the planet. This is reflected in the total growth rate, which indicates a substantial 10.25 percent increase globally from 2003 to 2006. Therefore, while the pandemic is certainly declining in certain regions, it continues to accelerate throughout much of the developing world.

<p><strong>Figure 4.1</strong><br>Percentage changes in global HIV incidence, 2003-2006. Source: UNAIDS, 2006 Report on the Global AIDS Epidemic.</p>

Figure 4.1
Percentage changes in global HIV incidence, 2003-2006. Source: UNAIDS, 2006 Report on the Global AIDS Epidemic.

Figure 4.2 illustrates regional mortality associated with HIV/AIDS (2003-2006), and the data indicate that the pandemic is far from a state of decline. Calculations indicate that the percentage increase in deaths (2003-2006) was most alarming in Eastern Europe and Central Asia, which saw an increase of 300 percent over that time period. Several other regions also saw increasing death rates (Oceania 73.91, Latin America 58.54, Asia 26.6), while a notable decline was observed in the Caribbean (−47.37). Despite the stabilization of the mortality rate in North America and Europe and the decline in the Caribbean, the aggregate global mortality rate increased over that period by 11.53 percent. This suggests that, in addition to continuing transmission, anti-retroviral therapies are still not reaching many in the developing countries who are infected. Therefore, one must take the ebullient claims of the Joint United Nations Programme on HIV and AIDS (UNAIDS) and the World Health Organization (WHO) with a grain of salt, and conclude that in fact the epidemic shows no distinct indications of slowing transmission on a global scale, nor do we see macro-level reductions in mortality (despite regional pockets of improvement).

Once the greatest success story in Africa, Zimbabwe now totters on the brink of economic and political collapse. The country is now beset by political violence, electoral fraud, foreign wars, and seizures of land from minority whites.4 Zimbabwe is also beset with a declining GDP, high rates of inflation, persistently high rates of unemployment, increasing poverty, and attenuated drought. Finally, Zimbabwe has one of the highest levels of HIV/AIDS seroprevalence in the world, with approximately 20 percent of the population currently infected with the human immunodeficiency virus.5

<p><strong>Figure 4.2</strong><br>Percentage changes in global AIDS mortality, 2003-2006. Source: as for figure 4.1.</p>

Figure 4.2
Percentage changes in global AIDS mortality, 2003-2006. Source: as for figure 4.1.

This case study employs process tracing6 to illustrate the effects of HIV/AIDS on the various domains of economics, governance and security. Within such complex bio-political systems effects may take the form of complex feedback loops and exhibit non-linear properties.7 Indeed, Margaret and Harold Sprout noted this principal of “connectivity” across domains, stating that “any substantial change in one sector of the milieu is nearly certain to produce significant, often unsettling, sometimes utterly disruptive consequences in other sectors.”8 Moreover, Jervis argues that complex systems exhibit the following properties: “Many crucial effects are delayed and indirect; the relations between two actors (or domains) are often determined by each one’s relations with others; interactions are central and cannot be understood by additive operations; many outcomes are unintended; regulation is difficult.”9

This chapter provides initial empirical evidence of the epidemic’s ability to compromise prosperity, political stability and national security in seriously affected regions over the longer term. Given the complex mix of factors working to destabilize Zimbabwe, the HIV/AIDS epidemic should be regarded as a powerful stressor that undermines the prosperity and political stability of that country. In particular I argue that in the context of poor governance (i.e. low levels of political will and state capacity) HIV/AIDS reinforces a vicious spiral within affected societies to threaten the stability of the state.

Literature Review

Historians have long understood the deleterious effects of epidemic disease on the stability of states and societies. The historian William McNeill was explicit on this subject:

The disruptive effect of such an epidemic is likely to be greater than the mere loss of life, severe as that may be. Often survivors are demoralized, and lose all faith in inherited custom and belief which had not prepared them for such a disaster. Population losses within the twenty to forty age bracket are obviously far more damaging to the society at large than comparably numerous destruction of the very young or the very old. Indeed, any community that loses a significant percentage of its young adults in a single epidemic finds it hard to maintain itself materially and spiritually. . . . The structural cohesion of the community is almost certain to collapse.10

In recent years infectious disease has gained recognition as a threat to international development and to national security, spurring the development of the nascent field of “health security.”11 Despite the increasingly sophisticated analysis, few studies have assessed the threat as it affects both state and society across domains at the micro and macro levels.12 Prior analyses have concluded that HIV/AIDS threatens the efficacy of military forces,13 effective governance,14 and the macro economy15 that underpins the preceding variables. The balance of evidence presented herein illustrates that HIV/AIDS constitutes both a direct and an indirect substantive threat to Zimbabwean governance and national security.16

Health and State Capacity

I hypothesize that states with relatively low levels of capacity, but governed well, can respond with reasonable efficacy to the epidemic and control its further spread. This has occurred in Thailand, which saw political elites use their power to mobilize civil society in a bid to reduce risky behavior.17 Both of those countries have seen their seroprevalence levels of HIV infection decline significantly over the past decade. However, countries with middling to low levels of capacity, combined with poor governance, have been ineffective at containing the spread of the contagion, and in mitigating its adverse economic and political effects (e.g., Zimbabwe).

In the context of the HIV/AIDS epidemic this is of utmost importance as it helps to explain differential outcomes in the ability of governments to respond to the epidemic and maintain economic and political stability. For example, Botswana has much better political leadership and higher empirical levels of state capacity than Zimbabwe,18 despite having a slightly higher HIV seroprevalence rate. It is probable that this combination of effective political leadership and higher endogenous capacity (due to revenues from mineral exports) has moderated the negative effects of the pandemic, whereas Zimbabwe is seeing significant socio-economic destabilization as a result of HIV/AIDS.

This chapter draws on the preliminary finding that there is a strong positive empirical association between population health and state capacity.19 Population health is measured through indicators of Life Expectancy and Infant Mortality. In an empirical cross-national study of 20 countries, utilizing 40 years of data, Price-Smith demonstrated that public health is a major driver of state capacity. That prior work also revealed the existence of a feedback loop between population health and state capacity, wherein a 15-year lagging of the variables demonstrated that health is a stronger driver of capacity than the obverse. Altogether this suggests that significant declines in population health (regardless of the source of decline) will therefore generate significant declines in downstream state capacity. Given adult seroprevalence rates of 20.1 percent, the HIV/AIDS epidemic has dramatically eroded life expectancy in Zimbabwe and significantly compromised the welfare of the population as a whole.

One might reasonably ask why Zimbabwe seems to be reeling under the epidemic while its neighbor Botswana (possessing a marginally higher adult HIV seroprevalence rate of 24.1 percent) remains generally stable. It seems reasonable to assume that state capacity is an intervening variable between the independent variable of political will on the one hand, and the dependent variable of political stability on the other. Botswana is an interesting case because it is a relatively prosperous rentier state with significant mineral wealth, high per capita income (US$3,100 per annum), and therefore relatively higher levels of state capacity than Zimbabwe. Moreover, Botswana possesses relatively effective political leadership in President Festus Mogae, an Oxford-trained economist who is engaged in efforts to blunt the negative effects of the epidemic on the people of Botswana. The Mogae administration has provided significant leadership in mobilizing communities to reduce endogenous transmission, and has promised that infected persons will receive free antiretroviral therapy to prolong their lifespan and their productivity. Thus, Botswana possesses several critical advantages over Zimbabwe, higher capacity, better political leadership, and greater levels of legitimacy in the eyes of its people.

Health and National Security

The definition of national security has changed over the years to include terrorism, resource scarcity, migration, and now threats to population health. During the first session of the United Nations Security Council of July 17, 2000, the UN adopted Resolution 1308 (2000) and declared the HIV/AIDS pandemic a threat to global security. This represents the first time in history that an issue of public health has been elevated to such status, and it illustrates the recent transformation in thinking about new threats to security in the post-Cold War era.

Robert Ostergard argues, correctly, that security studies have been tainted by an ethnocentric bias that grew particularly acute during the Cold War. Given the bi-polar animosity between the superpowers, Realist theory and praxis emphasized matters of European or North American security, deterrence, polarity, and the relationships between great powers.20 However, such definitions of security were of little relevance to the peoples of the developing countries, where poverty, disease, famine, and resource scarcity have proved to be perennial threats to “security.”

Thus, any agent (e.g., pathogens) that directly threatens to destroy a significant proportion of a state’s population base constitutes a significant threat to that state’s national security. Insofar as HIV/AIDS is projected to kill more than 30 percent of Zimbabwe’s population from 2005 to 2015, it is reasonable to conclude that the epidemic constitutes both a direct and an indirect threat to the national security of Zimbabwe.

While it is now increasingly understood that the AIDS pandemic constitutes a threat to the prosperity, cohesion, and perhaps the security of countries, the process by which the disease destabilizes societies, economies, governance structures, and the national security apparatus remains opaque. Let us delineate the mechanisms by which the contagion undermines prosperity, effective governance, and security. First, the pandemic has dramatically reduced Zimbabwean life expectancy and quality of life, and has produced significant cohorts of orphans, who are extremely vulnerable to radicalization. Second, the destruction of the country’s endogenous stock of human capital results in the systematic erosion of the economy through declining productivity, depletion of savings, and a soaring debt. Third, the pandemic is systematically eroding the institutions of governance (such as police and military forces) while depleting aggregate state capacity, thus dramatically narrowing the range of policy options available to policy makers. Fourth, the above factors may combine to exacerbate conflict between elites, classes, and ethnicities, or may foster violence by an increasingly draconian state against its own people in order to maintain control.

Demographic Projections

The HIV/AIDS epidemic has seen significant increases in adult prevalence from an estimated 12 percent of the Zimbabwean population in 1990, peaking at an estimated 33.7 percent in 2001, but declining in recent years to circa 20.1 percent. HIV/AIDS-induced deaths reached their apex in 2001 at an estimated 200,000, and continued at that level through 2003, declining marginally to 180,000 in 2005. More than 800,000 Zimbabweans have died from the disease since 1998. More than 1.7 million Zimbabweans are now infected with HIV, up from 1.6 million in 2003.21 More than 600,000 have full-blown AIDS, and more than 2,500 die each week as a result of the disease. The epidemic continues to expand throughout the Zimbabwean population, with little evidence of abatement. Within the country the distribution of HIV infection exhibits significant variance, with Masvingo province at 49.4 percent, the midlands at 45.1 percent, and Harare and Bulawayo each at 30 percent.22

Zimbabwean life expectancy at birth declined precipitously from 52 years in 1970 to 37 years as of 2006, and it is predicted to fall to 27 years by 2010 according to UNICEF. Indeed, the average Zimbabwean life span decreased by 7.8 years between 1990 and 2006.23 Infant mortality increased from a rate of 53 deaths per thousand in 1990 to 79 per thousand in 2006, and the mortality of children below the age of 5 increased from 80 per thousand in 1990 to 129 per thousand in 2006, much of which may be attributed to the AIDS epidemic.24

As a result of the dramatic winnowing of the adult population, the national population distribution is expected to transform from a pyramidal shape to that of a chimney-type form perched on a large base of children and adolescents. Fourie and Schonteich argue that this demographic shift, and the resultantly large cohort of orphans, has significant negative ramifications for societal stability, as young people are more often involved in criminal activity than older people.25 Moreover, impoverished and disaffected young people may be convinced to join various radical and destabilizing movements such as militias, paramilitaries, and terrorist organizations.


Given that HIV/AIDS generates significant mortality with the 15-45 age range of the population, one might expect the pandemic to generate significant cohorts of orphans who have lost one or both parents to AIDS. UNAIDS estimates the number of Zimbabwean children who have lost one or both parents to AIDS at 1,100,000 as of 2005 (up from 600,000 in 2000).26 In 2000 the US National Intelligence Council report concluded:

With as much as a third of the children under fifteen in hardest-hit countries expected to comprise a “lost orphaned” generation by 2010 with little hope of educational or employment opportunities, these countries will be at risk of further economic decay, increased crime, and political instability as such young people become radicalized or are exploited by various political groups for their own ends; the pervasive child soldier phenomenon may be one example.27

Schonteich has argued that the AIDS epidemic will directly increase the frequency and severity of crime in Zimbabwe in the decades to come, primarily as a function of the inexorably growing population of AIDS orphans: “Growing up without parents, and badly supervised by relatives and welfare organizations, the growing pool of orphans will be at greater than average risk to engage in criminal activity.”28

The drain of orphaned populations on state coffers will become onerous in the years to come and has the capacity to further strain Zimbabwe’s already overtaxed budget. The other portion of the burden will fall on extended families to care for the children, placing additional strains on declining household incomes and savings. Therefore, such a large cohort of orphans threatens to overwhelm already flimsy existing support systems. The majority of these children will grow up impoverished, poorly educated, prone to criminal behavior, and disenchanted with society. As the AIDS epidemic continues to expand, it will destabilize governments throughout the region. Such weakened states may provide fertile breeding grounds for terrorist organizations to move in, set up shop, and recruit from the disaffected, particularly from such enormous orphan populations. This is particularly worrisome given that terrorist organizations are active in eastern Africa and are moving into Southern Africa to set up bases of operations and recruit personnel. Thus, the AIDS orphan problem threatens not only to create governance problems within affected states, but also to contribute to problems of global governance (particularly terrorist activity) in the future.


Zimbabwe exhibits high levels of income inequality, with approximately 20 percent of the population receiving 60 percent of the income. Roughly 60 percent of the population lives below the poverty line, with the poor spending between 33 percent and 50 percent of their total annual expenditure on food and health care.29 Zimbabwe is also beset with shortages of foreign exchange, and significant arrears on its foreign debt. What is not often understood is that the HIV/AIDS epidemic has been contributing to the decline of the Zimbabwean economy for some time, exacerbating income inequalities, undermining societal productivity, and generating capital flight out of the country.

Micro-Level Impacts

At the household level, AIDS has a dramatic negative effect on production and earnings, resulting in reduced income, declining productivity, and the reallocation of labor and land to deal with debilitation or death of breadwinners. AIDS-induced debilitation generates a number of negative demand-side and supply-side shocks to households, including the loss of income from infected breadwinners, significant expenditures for medical expenses, and the loss of employment as healthy individuals must care for ill family members. Premature AIDS-induced mortality results in permanent loss of income, large funeral costs, and permanent labor substitution as children are removed from school to generate income for the family. Furthermore, widows may lose their land when their husbands die of AIDS, as male relatives may lay claim to the dead individual’s belongings (including their spouses) according to custom. Because most Zimbabwean women lack legal certificates (such as wills or marriage certificates), their rights are not protected.

Moreover, the burden of disease falls unequally on classes, with poorer populations bearing a disproportionate share of the costs relative to their incomes.30 The indigent may be forced into sexually exploitive situations in order to generate income to make ends meet. The poor will also be most vulnerable to infection given their lower levels of nutrition and lower basal health conditions, and will be unable to afford anti-retroviral therapies that may slow the progression of the disease.

Considerable decline has been witnessed across important sectors ranging from 25 percent of manufacturing capacity since 1998, a loss of 20 percent of mining output volume since 1999, and a decline in earnings from tourism of roughly 50 percent since 1999.31 This is not to suggest that the AIDS epidemic is responsible for this entire decline in productivity, yet it certainly is a significant factor in limiting the productive possibilities of the Zimbabwean economy. Debilitation and death induce a scarcity of skilled workers and a decline in returns to training. Thus, at the macro level HIV is eroding the endogenous stock of human capital in Zimbabwe. Counter-intuitively, AIDS-induced debilitation and mortality will not dramatically lower the unemployment rate of approximately 45 percent, because as the macro economy contracts this will lower the demand for labor, even as the labor supply diminishes as a result of disease-induced morbidity and mortality. Moreover, there is a pre-existing shortage of skilled labor in the country, and as the epidemic erodes human capital it will only serve to increase the shortage of skilled workers.

Human Capital

Economic development should be regarded as a “generalized process of capital accumulation”32 wherein capital consists of both physical and human capital and institutions. The epidemic’s pernicious influence on the formation and consolidation of human capital within Zimbabwean society is significant. AIDS will take the lives of a significant proportion of the brightest minds of Zimbabwe. This in turn will hamper efforts toward economic development and impede the consolidation of democratic government. It is important to recognize that the HIV/AIDS epidemic simultaneously drains reserves of human capital and prevents its accumulation, combining to weaken a society’s institutional capital.

The net outcome of HIV-induced decline in a society’s stock of human capital is stagnation of economic development, which over time results in serious economic decline. As government funding is diverted from education to the health-care sector, this dearth of funds will impede the development of human capital, as the young will be increasingly devoid of skills and adequate literacy. McPherson argues that the HIV-induced decline of savings and loss of efficiency is very much like “running Adam Smith in reverse”:

As an increasing number of workers become debilitated and drop out of the labor force, many of the advantages of specialization and the division of labor are lost. Moreover, the loss of labor is a direct reduction of the nation’s productive capacity.33

Thus, the HIV/AIDS epidemic will have a pronounced effect on the accumulation and consolidation of knowledge and skills within the Zimbabwean population while simultaneously depleting the pre-existing stock of human capital through the premature mortality of skilled workers. This long-term process of AIDS-induced human capital erosion will result in significant long-term negative outcomes for Zimbabwean prosperity.

Macroeconomic Impact

As AIDS depletes the national reservoir of human capital and impedes its formation, it will limit the long-term development potential of Zimbabwe. AIDS-induced shortages of skilled workers will result in higher domestic production costs, which will in turn erode international competitiveness. According to estimates by Haacker, the HIV/AIDS epidemic will result in a loss of output per capita (−7.3 percent per annum) resulting from a change in total factor productivity of −1.3 percent.34 Bonnel estimates that current levels of adult HIV seroprevalence (34 percent) will slow the growth rate of the macro economy, such that disease-induced morbidity and mortality will reduce GDP growth by approximately 1.5 percent per annum.35 While this may not sound like a significant decline, for the developing countries of southern Africa a 1.5 percent annual decline in GDP growth is an economic catastrophe in the making.

As the rate of population growth declines and the economy contracts, personal incomes, corporate profits, and consumption all will decline. Government revenues are also projected to decline as the tax base stagnates. Simultaneously, the government will attempt to increase expenditure in the health sector, which will result in a deteriorating national fiscal balance. This may result in increased deficit spending in the wake of a contracting endogenous revenue base. Zimbabwe’s Gross Domestic Product has declined from US$8.6 billion in 1991 to US$7.2 billion in 2000, which may reflect HIV’s increasing drag on national productivity. Similarly, gross domestic investment (as a percentage of GDP) declined precipitously from 20.8 percent in 1981 to 7.8 percent in 2001. Gross domestic savings (as a percentage of GDP) declined over the same period from 14.3 percent to 9.0 percent, while Gross National Savings declined from a high of 12.5 percent in 1991 to 7.4 percent in 2001.This generally reflects the depletion of individual savings by AIDSinduced costs generated by debilitation and premature mortality. Simultaneously, total debt as a percentage of GDP has grown from 39.8 percent in 1991 to 55.8 percent in 2000, although much of this is attributable to excessive borrowing on the part of President Robert Mugabe’s regime.36

Under the Mugabe regime, Zimbabwe experienced moderate economic success through the 1980s, with GDP growth from 1981 to 1991 averaging a 3.6 percent increase per annum. However, concurrent with the onset of massive infection rates throughout the early and mid 1990s, the annual growth rate of GDP declined to −4.9 percent in 2000, and −8.4 percent in 2001. Moreover, the growth rate of GDP per capita declined from 0.3 percent in 1991 to −7.7 percent in 2000, and to −10.1 percent in 2001. Inflation increased from 32 percent in 1998, to 59.4 percent in 1999, to 108 percent as of late 2001.37 To offset declining domestic productivity and increased government spending, the Mugabe regime incurred an enormous debt load. The total external debt of Zimbabwe in 2001 was pegged at US$4.45 billion, with debt servicing costs as a percentage of exports running at 69 percent.38

In sum, the HIV/AIDS epidemic has already begun to generate serious negative outcomes for the Zimbabwean economy, including declining GDP and GNP in terms of both absolute and per capita measures. It also promises diminishing national and individual savings, declining productivity, and falling rates of foreign investment. The overall picture is one of sustained economic stagnation and accelerating contraction of the economy. Slowing of national economic growth, decline in savings, chronically high levels of unemployment, and declining real per capita GDP will intensify the poverty experienced by the middle and lower classes. The burgeoning epidemic has had a significant negative impact on the economy, and one might reasonably expect HIV-induced economic contraction to intensify in the years to come. Nonetheless, owing to the Mugabe government’s increasingly suboptimal economic and political decisions from 1995 to 2008, it is difficult to empirically establish the exact proportion of Zimbabwe’s economic decline as a direct result of the contagion. Subsequent studies will require further analysis of this issue.

Foreign Investment

The AIDS epidemic also has had a profound negative effect on the foreign investment climate for Zimbabwe. Prudent foreign investors grow increasingly wary of Zimbabwe’s increasingly gloomy economic future, and as a result of the expanding AIDS epidemic they are likely to pull their capital investment out of the Zimbabwean economy.

Alternatively, foreign investors may simply forgo investing in Zimbabwe in favor of countries with lower risk exposures. Significant levels of HIV infection (i.e., seroprevalence exceeding 10 percent) are likely to result in declining levels of foreign investment within seriously affected regions. Notably, the HIV/AIDS epidemic has increased the risk profile for investment in the Southern African region, with investors requiring a premium rate of return exceeding 25 percent throughout Southern Africa.39 The great uncertainty regarding the ultimate economic effects of the epidemic (attributable to a paucity of information) worsens the investment climate for Zimbabwe, as investors are prudently leery of the unknown. McPherson concurs:

Investors are more likely to wait (defer investment) when they have information indicating that the spread of HIV/AIDS will affect adversely the cost structure of any investment they are contemplating. As the perceived costs of dealing with the spread of HIV/AIDS rises, the rate of investment tends to decline. This has reinforced the decline in the supply of investible resources, already under pressure through falling productivity due to the spread of HIV/AIDS. Thus, while the spread of HIV induces the need for higher rates of investment to help maintain worker productivity, it erodes the means by which such investment can be financed.40

As AIDS induces the contraction of the national economy, it will intensify competition between economic and political elites for control over increasingly scarce fiscal resources. This may contribute to substantial governance problems, including increasing the potential for political violence. While detractors of the Mugabe regime might support such political instability as a means of regime change, it is important to understand that any democratic successor regime would also face a similar scenario of continuing economic and political destabilization as the epidemic continues to rage unabated.

National security does not occur in a vacuum, and economic resources are fungible in that they may be readily translated into military power through the acquisition of materiel and the training of forces. Because the AIDS epidemic has the potential to generate significant long-term constraints on the Zimbabwean economy, it will by default place increasing limitations on Zimbabwean military power into the foreseeable future. It is patently impossible to field a modern, well-trained, well-equipped fighting force without a substantial national economic engine to power it. Perversely, this may be a good thing, as the Mugabe regime may be compelled to withdraw its weakening armed forces from foreign theatres of conflict. The AIDS epidemic, with its attendant long-term damage to Zimbabwe’s economic base, promises a reduction in the absolute (and perhaps the relative) power of the country over the long term.


Zimbabwean society today faces immense barriers relating to the practice of good governance. The Mugabe government and its Zimbabwe African Nation Union-Patriotic Front (ZANU-PF) party have systematically implemented strategies to confound democratic governance processes, such as the allowance of basic human rights, the practice of transparency in governmental operations, and free and fair elections.

Suppression of fundamental democratic principles such as freedoms of the press, speech, and public assembly is widespread and is increasing. Recent legislation has further suppressed democratic expression and action. Notably, the Zimbabwean government’s Access to Information and Protection of Privacy Act effectively criminalizes free speech, the Public Order and Security Act (POSA) outlaws public meetings, and the Law and Order Maintenance Act (LOMA) prohibits the publication of anything “likely to cause alarm and despondency.”41 This has resulted in the effective censorship of the media and the crushing of dissent within the country.

The Mugabe government employs torture as a tool of political control. It is often used against members of the Movement for Democratic Change (MDC), the main opposition party to the ZANU-PF. Torture, however, is not used only to control opposition party activities. According to Tony Reeler, clinical director for Zimbabwe’s Amani Trust, “probably 20 percent of the entire population has had intimate experience with torture.”42

Governance in Zimbabwe, already exhibiting a significant potential for violence and institutional instability, likely will experience further declines as a result of the AIDS epidemic. The nature of socio-political instability experienced in Zimbabwe today will result in an increasingly demoralized population. This, coupled with rising levels of mortality and morbidity resulting from AIDS, magnifies the sense of hopelessness and despair within the citizenry, and diminishes perceptions of governmental legitimacy. This will create rising individual and collective frustration that will be expressed through increasing acts of lawlessness, personal behavioral recklessness, and callousness toward fellow Zimbabweans. Under these circumstances, one should anticipate growing crime levels, including more aggressive crimes of violence, such as murder and rape.

From 2005 to 2015 Zimbabwe will also lose a substantial portion of its law-enforcement personnel. The Zimbabwe Republic Police serve the needs of Zimbabwe’s eight provinces and its two major “provincial” cities, Harare and Bulawayo. Premature loss of personnel will undermine law enforcement’s capacity to maintain local peace and tranquility at the community level. The confluence of high and rising unemployment, rampant poverty, rapidly growing cohorts of orphans, severe food and fuel shortages, and an economy in a state of hyperinflation, coupled with the prevalence of HIV, has induced rapidly increasing crime rates.

A comparison of 2001 Interpol crime statistics (the latest available) with those in 1995 exemplifies the degradation that has occurred in Zimbabwe. The population grew 15.5 percent between 1995 and 2001. One might anticipate comparable boosts in crime tied to the growth rate. The incidence of crime grew substantially during this period, as reported murders increased by 68.7 percent during this period, sexual assaults by 26.9 percent, and the incidence of rape by 58.5 percent. Some of this increase might well be tied to the mistaken regional belief that a man can rid himself of HIV by having sexual intercourse with a virgin. The incidence of rape of young girls has soared because of this myth; in some instances, females 5 years old and even younger have been victimized. Other notable increases in criminal activity also occurred during this period include: robbery and violent theft went up 89.8 percent, auto theft 49.1 percent, and aggravated theft 37 percent.43 These dramatic increases point to a society spiraling into greater lawlessness and social chaos. The growing tendency among the citizenry to shun assistance from law enforcement warrants equal concern. Many victims in Zimbabwe do not report incidents, believing that their calls for aid will be ignored. This is particularly true for those with known affiliations to political, media, or labor factions out of favor with the Mugabe government. The future of effective governance through law enforcement is at risk in Zimbabwe, owing in part to increasing attrition among police personnel. Decline in law enforcement’s credibility as a primary source of intervention and assistance to victims of crime explains the growing lack of confidence in this institution.

HIV’s Effect on Public Service

The AIDS epidemic affects Zimbabwe’s ability to sustain and deliver quality public services for its citizens. Since the early 1990s the Zimbabwean government has been under increased pressure to reform its civil service systems. The World Bank and the International Monetary Fund have linked continued funding to the imposition of structural changes that would reduce Zimbabwe’s bloated civil service. Makumbe characterized Zimbabwe’s civil service as follows: “weak government capacity to ensure minimal services, highly compressed wages, inability to attract and retain skilled manpower resources, and a large civil service (192,000) absorbing 18 percent of GDP in salary and wages by 1990/91.”44 Recent IMF estimates (October 2000) place Zimbabwe’s public service employment at 194,500.45

The HIV/AIDS epidemic also has a profound impact on the delivery of public goods and services to the citizenry. Clearly, citizens will pressure the government to spend a greater proportion of national revenue on health provisions. In a country as impoverished as Zimbabwe, there is little elasticity for shifting funds from one revenue source to another.

HIV/AIDS will induce a gradual degradation of the quality of services provided by the bureaucracy. Traditionally, in developing countries like Zimbabwe, educated elites have chosen careers initially in public service. Such employees are often the most highly educated in underdeveloped societies, many having received graduate education from European or American universities. Moreover, these professionals, because of their high incomes, high status in society, and consequently high levels of sexual activity, were earlier victims of HIV than the general population.46 HIV/AIDS will erode the human capital of Zimbabwe’s professional civil service. Costly losses in professional fields (civil engineering, medicine and health care, education, financial administration, developmental planning) are of particular concern.

A significant issue for institutions of governance involves finding adequate replacements to fill the professional lacuna caused by AIDS-induced mortality and morbidity. Certainly, anticipated professional losses ranging as high as 40 percent create great concern about the efficacy of government. Nevertheless, the loss of human capital resulting from HIV/ AIDS-related illnesses explains only part of the attrition problems that the Zimbabwean government faces in seeking to maintain institutional viability.

Losses also will result from the voluntary separation of talented public servants who are aware that their HIV status is negative. In part, this exists among individuals who fear that their pensions will have dwindled away by the time they reach their “full-benefits” retirement eligibility status. The political scientist John Daly argues that this occurred in Swaziland, where highly placed public servants with notable marketability chose to leave government service early and opted for early retirement and reduced benefits. This occurred because of fears regarding the long-term solvency of their pension plan resulting from the rising numbers of premature medical retirements due to HIV/AIDS.47

The crisis identified above attests to the fact that Zimbabwe’s government is rapidly witnessing the erosion of its endogenous state capacity. Zimbabwe’s level of state capacity determines the scale of adaptive resources that the country could mobilize to mitigate the negative effects of HIV/AIDS. In this instance, the Zimbabwean government has clearly failed the task. Therefore, its society faces a vicious spiral in the form of a positive feedback loop. As the AIDS epidemic progressively takes its toll, Zimbabwe’s state capacity declines, and as Zimbabwe’s state capacity declines its ability to institute creative AIDS intervention strategies correspondingly diminishes.

The government’s ability to deal effectively with the AIDS epidemic is also hampered by its declining financial capacity. Realistically, under the best of financial conditions, Zimbabwe would have a difficult time developing adaptive strategies to curtail effectively its HIV/AIDS epidemic. Burdensome debt obligations to international financiers, including the World Bank and the International Monetary Fund, stunt the implementation of effective health interventions and progressive educational awareness initiatives. These debts divert monies away from health programs toward repayment schemes. At the beginning of 2000, for example, Zimbabwe expended 25 percent of its export earnings to service its debt, even as an estimated 28 percent of its population was infected with HIV/AIDS.48 The combination of declining fiscal health and state capacity render successful endogenous adaptive HIV/AIDS strategies by the Zimbabwean government unlikely in the near future. This decline in capacity, coupled with a government and an economy on the verge of collapse, suggests that exogenous assistance from developed countries, UN agencies, and major private sector donors will be necessary to avert further degradation of Zimbabwe’s socioeconomic and political structures.

As HIV erodes state capacity, it undermines the state’s ability to provide public goods to the population (e.g., health care, education, law enforcement), which in turn accelerates HIV proliferation in a negative spiral. Therefore, purely endogenous strategies to build capacity and curb the spread of the epidemic are unlikely to be successful, and capacity will have to be imported from exogenous sources (such as foreign aid). Thus, the desire for purely “African solutions” to the HIV epidemic, while understandable, have been of limited utility, as advocates fail to acknowledge the epidemics inexorable and negative effect on endogenous state capacity. Furthermore, with many societies in sub-Saharan Africa now reeling under the strain of HIV/AIDS, the cumulative effect will be to erode the capacity of the region as a whole. Affected states will find it increasingly difficult to come to each other’s aid.

In a climate of increasing lawlessness, a stagnant or contracting economy, increasing institutional fragility, and declining tax revenues, the capacity of the state will be, at a minimum, strained. There are increasing demands on the state from all sectors to deal effectively with the epidemic, even as the epidemic inexorably erodes the state’s capacity to respond effectively. Simultaneously, as the population becomes increasingly infected, morbidity and mortality will grow, poverty will deepen as people deplete their savings, and crime will increase. All of this will result in increased feelings of relative deprivation and injustice on the part of the people, who increasingly perceive the government as illegitimate. It is precisely this combination—a weakening state and increasing real and/or perceived deprivation—that increases the probability of political violence within that society, and between society and the state.49

History has shown that outbreaks of epidemic disease often result in the curtailing of civil liberties.50 Thus, HIV/AIDS may induce a shift from democratic to more authoritarian modes of government, particularly in unstable nascent democracies. Indeed, in a climate of disease-induced disorder, scarce resources, and declining government legitimacy, the state may increasingly resort to violence against competing factions within its own population in an attempt to maintain order.51 Epidemic disease has generated stigmatization and conflict between rival ethnicities over the centuries, typically with the scapegoating of minority populations, such as the whites in Zimbabwe. While there is little evidence that the Shona and the Ndebele consider white populations to be the cause (or the principal carriers) of the disease, affluent white populations have been targeted for political violence as the majority sinks deeper into poverty and chaos. As the epidemic continues to intensify and generate increasing deprivation for the majority, there is every reason to believe that violence against white minority populations will increase, particularly if the Mugabe regime continues to employ such tactics as a means to distract the people from their many grievances. Notably, in December 2000, Mugabe publicly stated to a ZANU-PF Congress: “Our party must continue to strike fear in the heart of the white man, our real enemy.”52

Increasing disease-induced deprivation combines with a weakening state to generate an increasing probability of violence within the society, either among ethnic groups, among classes, or among political elites. It may also foster the deliberate use of violence by the state against its own citizens in an attempt to retain control. This phenomenon is widely observed throughout Zimbabwe. As the state becomes increasingly unable to satisfy the demands of the people, it is seen as increasingly illegitimate. It is apparent that the Mugabe government is resorting to violence against the population. Thus, as the epidemic intensifies, one would expect an intensification of authoritarian rule as the government becomes ever more desperate to hold onto power.

National Security

The “securitization” of HIV/AIDS has become an issue of significant debate between the paradigms of “national security’53 and “human security.”54 Orthodox conceptualizations of national security are overly militaristic and myopic, ignoring a plethora of issues (such as environmental change, disease, and migration issues) that threaten states in the modern era. Conversely, while human security arguments may be intuitively appealing, Roland Paris has argued that they present significant conceptual and analytical hurdles.55

In relative terms, the absolute mortality that AIDS has induced within the Zimbabwean population vastly exceeds deaths resulting from any armed conflict in the recorded history of that country, and it is increasingly common to hear Zimbabweans refer to the epidemic as a “holocaust.” Moreover, the epidemic’s contribution to demographic contraction, economic destabilization, and sclerosis in governance directly threatens the material interests of the state, and of Zimbabwean society. Thus, HIV/AIDS has a direct negative effect on Zimbabwean security.

In many countries, military and law-enforcement forces serve as control mechanisms to ensure and sustain the peace within society. In Zimbabwe, however, these units also function as instruments of terror. President Mugabe and the ZANU-PF party use them to prop up and fortify an illegitimate government, which faces claims that it stole the national presidential election in March 2002 through corruption, vote rigging, and voter intimidation.56 Moreover, the Mugabe regime apparently continues such practices as it subverted the democratic process in the March 2008 general elections and kept the MDC from attaining power.

The nascent literature on health security views AIDS-induced destabilization as contributing to intra-state and inter-state conflict. Elbe and Ostergard have argued that AIDS-induced mortality and morbidity jeopardize the efficacy of military institutions and may thereby promote conflict between states.57 Elbe argues that AIDS is eroding the functional efficacy of African military institutions along four dimensions:

[AIDS generates] the need for additional resources for the recruitment and training of soldiers to replace those who have fallen ill, have died, or are expected to die. . . . Additional resources are also required to provide health care for soldiers who are sick or dying. Second, the spread of HIV/AIDS is affecting important staffing decisions. High HIV prevalence rates lead to (1) a decrease in the available conscription pool from which to draw new recruits (2) deaths among officers higher up the chain of command, and (3) a loss of highly specialized and technically trained staff who cannot be easily or quickly replaced. Third . . . it can result in increased absenteeism and reduced morale. Fourth, HIV/AIDS is generating new political and legal challenges for civil-military relations. . . .58

A 2001 estimate by South Africa’s Institute for Security Studies places the respective sizes of the Zimbabwe National Army (ZNA) and the Air Force of Zimbabwe (AFZ) at 35,000 and 4,000.59 Historically, military and paramilitary organizations have also served as primary vectors for the spread of sexually transmitted pathogens, including HIV. In 2001, according to estimates by the political scientist Lindy Heinecken, Zimbabwe’s armed forces had an aggregate seroprevalence rate of 55 percent.60 Extensive planning will be needed now to replace the losses of more than 1,000 professionally trained personnel per year just to maintain minimal levels of professional competency. In Zimbabwe, HIVrelated military attrition will create a loss of continuity at the command level and in the ranks as experienced higher-ranking officers are forced into early medical retirement. The military analyst Rodger Yeager of the Civil-Military Alliance to Combat HIV and AIDS notes that military staff attrition also results in “increased recruitment and training costs for replacements, and a general reduction in preparedness, internal stability, and external security. In this sense, HIV/AIDS can easily serve as a domestic and regional destabilizer and a potential war-starter.”61 Thus, Mugabe’s military strength, which serves as an instrument of control over legitimate democratic processes, will slowly and almost invisibly erode over the next decade. Losses of more seasoned and experienced military staff through HIVand AIDS-related attrition will induce institutional fragility in the apparatus of coercion.

In 1998, Zimbabwe dispatched military personnel and arms to fortify the Democratic Republic of the Congo (DRC) in support of the regime of Laurent Kabila.62 By 2001, 8,000 members of the Zimbabwe military were deployed to the DRC.63 Deployment of Zimbabwean military personnel further compounds the transmission of HIV, as separation from one’s family often results in increased sexual contact with prostitutes and other high-risk partners. The fact that other sexually transmitted diseases often go unchecked within this group, especially during active military conflicts, exacerbates the problem. Estimates have placed HIV seropositivity levels of the Zimbabwe servicemen returning from the DRC as high as 80 percent.

Zimbabwe’s Air Force also will degrade substantially without a plan that overcomes likely human capital losses caused by HIV and AIDS. Compulsory HIV screening, mandated for US military personnel, is not utilized in Zimbabwe’s Army, but it is selectively utilized in its Air Force. For example, Air Force aircrew and medical officers receive regular testing. HIV-positive pilots and medical officers are subject to grounding, reassignment, and eventual discharge.

Beyond the loss of gifted professionals and seasoned military leaders, the AIDS-induced erosion of human capital creates broader problems for Air Force and Army operations. It creates major gaps for sustaining crucial operational aspects of these services. For example, morbidityand mortality-induced losses of technical talent (e.g., airplane mechanics, computer and information specialists, accountants, procurement officers) weaken the service and the mission of these organizations. According to John Daly, AIDS-induced losses in the Zimbabwe Air Force (AFZ) from 2004 to 2014 will range from 1,300 to 2,600.64

In the case of Zimbabwe, the progression of AIDS will weaken the military and its capacity to sustain national security. Although AIDSinduced mortality has certainly weakened the power of the Zimbabwean state relative to its regional rivals, there is no empirical evidence that the rising levels of contagion will precipitate war between sovereign states. This results from the fact that other proximate states are also confronting the operational difficulties associated with the contagion, such that external military adventures are becoming prohibitively costly for all affected states in the region. Further, those states that exhibit lower rates of infection, and therefore increasing relative power, will be reluctant to conduct martial campaigns in affected territories, fearing the infection of their soldiers. Moreover, the subsequent demobilization may intensify transmission within the aggressor state. This is not to say, however, that the rising levels of disease will equate with pacific relations within the state.

Violent Intra-State Conflict

HIV/AIDS will have a significant long-term negative effect on the prosperity and the quality of life of the majority of the Zimbabwean people, generating increasing levels of relative deprivation throughout the population. Relative deprivation will increase for the lower and middle classes, which bear a relatively greater cost of AIDS-induced morbidity and mortality. All Zimbabweans will experience absolute deprivation as the economy stagnates and begins to contract. Increasing deprivation generates increasing frustration and aggression in both individuals and collectivities, increasing the probability of social violence and political chaos.65 However, if deprivation were the sole sufficient and necessary condition to generate political violence, the majority of states in the world would be perpetually consumed within the fires of internal rebellion. This is certainly not the case. Collective violence against the state tends to occur when stressors (such as the HIV/AIDS epidemic) create both the incentive and the opportunity for citizens to engage in violent collective action against the status quo. Thus, the strength or weakness of the state apparatus is a major factor in whether men decide to rebel against their political masters. When increasing deprivation is combined with declines in state capacity and legitimacy, these factors act together to increase the probability of collective violence against the state, or societal factions affiliated with the state.

The AIDS epidemic will generate increased competition between interest groups for increasingly scarce economic resources, particularly as federal funding is diverted to health care and away from other sectors such as law enforcement, education, and the military. The epidemic has certainly placed rapidly increasing demands on the Zimbabwean government to provide additional services to its population, even as the government’s capacity to provide such additional services is simultaneously reduced by the expanding AIDS epidemic. Furthermore, the federal government may have to significantly increase taxation of the population to restore depleted government coffers. This resulting reduction of services and increasing taxation in a climate of increasing deprivation will further erode the government’s legitimacy. Thus, the AIDS epidemic will simultaneously increase absolute and relative deprivation, increase perceptions of government ineptitude and illegitimacy, and erode state capacity, increasing the probability of internal collective political violence against the state, or intensify violence by the predatory state against its own population. Thus, the HIV/AIDS epidemic may not only kill and impoverish a significant proportion of the Zimbabwean people; it may also contribute to macro-level political and social destabilization that will jeopardize the stability and security of the country.

Effects on Regional Stability

With increasing HIV/AIDS infection throughout sub-Saharan Africa, the pandemic threatens to destabilize many countries in the region, including Botswana, South Africa, Zambia, Angola, Malawi, Namibia, and Mozambique. The epidemic is also burgeoning in Nigeria, Kenya, Tanzania, Swaziland, and Lesotho. As the pandemic crests in the region, it increases the potential for the economic and political destabilization of the Southern Cone of Africa. This bodes ill for the spread and consolidation of democracy and provides fertile ground for the spread and consolidation of radical and/or terrorist operations.

One important element in the discussion of infectious disease’s impact on national security is its possible effect on the relative power of states, particularly within a regional context. Certainly the HIV/AIDS epidemic will reduce Zimbabwe’s absolute power over the long term, with its profound and negative effects on the country’s military and its economy. With respect to Zimbabwe’s relative power (that is, its power relative to other states), the equation will be increasingly complex as a function of varying HIV infection rates throughout sub-Saharan Africa. This means that the pandemic will have a greater negative effect on the relative power of Zimbabwe than on neighboring states such as South Africa and Mozambique, which have lower HIV/AIDS prevalence rates. Zimbabwe’s power relative to Botswana and Zambia (which have similar prevalence rates) will remain essentially unaltered by the AIDS epidemic, even as the absolute power of these countries is diminished by the contagion. The point here is that high levels of lethal epidemic disease can erode a state’s absolute power and, more importantly, erode a state’s power relative to its rivals.66 Though it is unlikely that contagion-induced shifts in relative power will generate interstate war, it is important to note that the epidemic has the long-term potential to alter regional balances of power and the ability to project power. (This finding will become increasingly important as the pandemic intensifies in other states, including India, Russia, Ukraine, and China.)

The AIDS-induced decline of effective governance throughout the Southern Cone will require an increasingly effective military to guarantee the integrity of regional borders. Unfortunately, as was shown above, HIV’s negative effect on the military promises increasing “institutional fragility” for that institution and diminishing levels of tax revenue to direct toward military funding as a result of the declining economy. Thus, while the required demand for military power and efficacy is growing, the supply of military power and efficacy is rapidly declining as a result of the epidemic’s effects on military personnel. As a result, Zimbabwe should be increasingly concerned that the regional epidemic promises increasing insecurity for the country as a result of both internal and external destabilization. The greatest immediate risk is increasing instability throughout border regions as a result of crime, smuggling, and refugee movements.

A frequently asked question is “At what threshold might HIV seroprevalence (as a percentage of population) cause a society to experience the collapse of effective governance?” The answer remains elusive, as it depends on whether the population has access to effective anti-retroviral therapies, whether the government will provide such therapies to infected populations in a comprehensive and non-partisan manner, and to what extent the economy, governmental institutions, and legitimacy have been damaged by the epidemic. It may also depend on regime type, as nascent democracies and authoritarian regimes will likely exhibit different vulnerabilities to disease-induced economic and political destabilization. Established democracies would seem to be more resistant to such diseaseinduced stresses. It is necessary to understand the effects of HIV from the perspective of an “attrition process” entailing slow and inexorable destruction of a country’s economy, institutions, and social mores. The pandemic is an attenuated process, not a temporally constrained event.

The global HIV/AIDS pandemic would also seem to exhibit emergent properties as it involved the zoonotic transmission of a virus (likely from primate populations) into the human ecology, was transmitted globally via rapid air transportation, established local transmission via sexual conduct and drug use, and exploded within dense urban population pools. It was the combination of these pivotal factors that led to the emergence of this pandemic.

This chapter demonstrates the means by which pathogenic infection acts across domains (demographic, economic, and governmental institutions) to compromise governance and ultimately the national security of seriously affected societies. It also provides preliminary evidence that HIV/AIDS-induced declines in population health are generating a significant decline in State Capacity, and increase in political turbulence within Zimbabwe.67 These findings permit the formulation of a set of axioms regarding the effects of HIV/AIDS on governance68:

  • Demographic collapse will generate vast cohorts of orphans, who may then generate crime and/or be radicalized.

  • The burden of illness falls disproportionately on the poor, exacerbating inequities between classes.

  • Economic contraction generated by the HIV/AIDS contagion will lead to competition over scarce resources, fostering competition between elites, classes, and possibly ethnicities.

  • Disease and conditions generated by it foment scapegoating and persecution of ethnic minorities.

  • AIDS-induced mortality erodes the base of endogenous human capital, constraining future economic productivity and generating institutional fragility throughout existing structures of governance.

  • As the contagion withers institutional capacity and erodes the economy, it may alter the relative power of affected states vs. non-affected states, although this does not generate inter-state warfare.

  • The pernicious effects of AIDS radiate across domains to undermine the cohesion of both state and society, and the Zimbabwean government has resorted to the draconian use of lethal force against its own people. This has in turn, inspired further resistance against a state that is widely viewed as illegitimate. This illustrates the persistence of contagionist thought.

In sum, the HIV/AIDS pandemic represents a significant threat to the population of seriously affected societies, particularly those with low levels of state capacity and poor leadership. Thus, the pandemic represents both a direct and indirect threat to the material interests, political stability, and thus the national security of affected states. The persistent lack of effective cooperation among states to check the spread of the pandemic, the political suppression of data, and the opposition by many affected states to external assistance all support a republican theoretical model.


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