The Socioeconomic Impact of AIDS

What sectors of society does HIV/AIDS affect?

• Households and families
• Education
• Health care
• Labor
• Agriculture and food security
• Overall economic growth

The human cost of the AIDS epidemic is clear from the staggering number of deaths the disease causes, especially in developing countries (see 10 HIV/AIDS Facts). The economic and social costs of AIDS are less obvious, but no less dramatic, and should not be overlooked. HIV/AIDS has the power to destroy affected communities by systematically wiping out social institutions and hard-won economic progress in the developing world.

“Only the most naive can continue to believe that they are not going to be directly or indirectly affected by HIV/AIDS, because of its being allegedly limited to the poorer reaches of our nation, or those with particular sexual orientations. HIV/AIDS has placed me on my knees and destroyed my family, in spite of the lifestyle stringently maintained by my wife and I and the social status we enjoyed.“

Because HIV is a “slow virus” (see Infection, Progression, and Treatment), most AIDS victims are adults. This means the disease’s devastating impact falls on fully-formed families. Effects include:

A Huge Number of Orphans due to AIDS:
In 2005, over 1 million children were orphaned due to AIDS in Uganda (1,000,000), Kenya (1,100,000), Zimbabwe (1,100,000), Tanzania (1,100,000), and South Africa (1,200,000). (source)
Worldwide over 40 million children stand to lose one or both parents to AIDS over the next 13 years. (source)
Weakened family networks:
Healthy family members must take over sick or dead family member's domestic work. As a result, many individuals become over-burdened and children drop out of school to assume greater responsibility within the household.
A study of rural South Africa suggested that households where an adult had died from AIDS were four times more likely to dissolve than those where no deaths had occurred. (source)
Poverty:
Many AIDS-affected households drop below the poverty line because of lost earnings and increased costs for medical care and funerals.
In Cote d'Ivoire, studies have shown that the income of HIV-affected households is halwww.unaids.org/en/HIV_data/epi2006/f that of the average household income. (source)
Another study in three countries, Burkina Faso, Rwanda and Uganda, has calculated that AIDS will not only reverse progress in poverty reduction, but will increase the percentage of people living in extreme poverty (from 45% in 2000 to 51% in 2015). (source)
Generations that do not benefit from their elders' knowledge:
AIDS undermines the sustainability of development by killing off infected individuals before they can pass on expertise to the next generation.
In Kenya, 93% of agricultural households headed by orphans had inadequate knowledge of agricultural production. (source)

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“Without education, AIDS will continue its rampant spread. With AIDS out of control, education will be out of reach.“

Generations of children have lost the chance to get a good education because of HIV/AIDS. This is considered one of the most serious issues related to the AIDS epidemic. HIV/AIDS has resulted in:

• A shortage of qualified teachers.
• In Tanzania, if current infection and prevalence remains constant, 3,600 teachers will die every year for the next four years. Tanzania has the capacity to train 1,200 teachers a year. (source)
• Decreased enrollment and productivity among children from AIDS-affected households.
• Parents' AIDS illnesses lead to a loss of household income
• Children drop out of school because they can no longer afford to pay school fees or buy uniforms and supplies
• A study in Kenya revealed that girls who were granted free school uniforms- which normally cost $6- were significantly less likely to drop out of school and become pregnant or infected with HIV. (source)
• Children drop out of school so they can get a paying job to support the family
• Children must stop going to school in order to care for an HIV positive parent.
• Children who remain enrolled in school are less productive pupils due to the excess stress and responsibility of dealing with HIV positive family members.
• "The chance that the children themselves will contract the disease in adulthood makes investment in their education less attractive, even when both parents themselves remain uninfected." (source)
• More HIV positive children who do not survive the years of schooling.
• 14% of all AIDS deaths are accounted for by children. However, children constitute a mere 6% of treatment recipients. (source)
• In high-income nations, infants who become infected with HIV through their mother often survive into adulthood. But globally, at least 25% of infected newborns die before age 1, 60% before age 2, and almost all die before age 5. (source)
• Studies have suggested that young people with little or no education may be 2.2 times more likely to contract HIV as those who have completed primary education. (source)

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Because of its scope, the AIDS epidemic demands a huge amount of resources. This includes doctors, other health care professionals, and money. As a result, fewer resources are available for dealing with other serious health problems. In addition to the problem of limited resources, the death rate among healthcare professionals is high due to their close contact with HIV/AIDS patients. These conditions augment the health crises of the developing world.

The strain on the healthcare system
In Tanzania, health workers spend 65% of their time caring for AIDS-related illnesses.
Over 70% of admissions to medical wards in Zimbabwe~s major hospitals are patients with HIV and AIDS related opportunistic infections such as tuberculosis and other pneumonias. (source)
In Sub-Saharan Africa, people with HIV-related diseases occupy more than half of all hospital beds. (source)
The cost of treatment of AIDS and related infections is expected to exceed 30 percent of the Ministry of Health budget in Ethiopia by 2014, and 50 percent and 60 percent in Kenya and Zimbabwe, respectively, by 2005. (source)
In Tanzania it has been estimated that providing treatment to all those who need it would require the full-time services of almost half the existing health workforce. (source)
Government-funded research in South Africa has suggested that, on average, HIV-positive patients stay in hospital four times longer than other patients. It is predicted that patients affected by HIV and AIDS will soon account for 60-70% of hospital expenditure in South Africa. (source)
Health care workers who are themselves infected with HIV/AIDS
Countries with HIV prevalence rates of 15 percent can be expected to lose 30% of their healthcare workforce within a 10-year period. (source)
Botswana lost 17% of its healthcare workforce due to AIDS between 1999 and 2005. (source)
A study in one region of Zambia found that 40% of midwives were HIV-positive. (source)

Healthcare workers are already scarce in most African countries. Excessive workloads, poor pay and the temptation of migrating to richer countries once trained are factors that have played a role in this shortage. (source)

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“As illness forces workers to leave the jobs, valuable skills and experiences are lost. Along with lower productivity and profitability, tax contributions also decline while the need for public services increases.“

Sickness and death due to HIV/AIDS reduces both the skilled and unskilled labor force. This leads to decreased productivity. It also makes goals of sustainable development and reduced poverty nearly impossible to reach. Worst of all, AIDS affects individuals in the prime of their working years - ages 15 to 49. As the economic burden falls upon children and the elderly, overall output declines sharply.

• Employee absenteeism accounts for as much as 25 to 54% of company costs for many African businesses. (source)
• A Botswana diamond company found that the proportion of retirements due to AIDS increased from 40% to 75% from 1996 to 1999. In this same time period, the proportion of employee deaths due to AIDS increased from 37.5% to 59%. (source)
• The Food and Agriculture Organization of the United Nations estimates that the agricultural labor force of the 10 African countries most affected by AIDS will decrease 11 to 26 percent by 2020. (source)

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In the most affected nations, up to 80 percent of the population depends on agriculture for their subsistence. Because the economy of sub-Saharan Africa relies heavily on agriculture, AIDS~ toll on the rural poor has widespread effects. The AIDS epidemic negatively affects many aspects of agriculture, including availability, access, stability, and utilization. This, in turn, leads to:

Food insecurity because of loss of labor.
Food consumption has been found to drop by 40 percent in homes afflicted by HIV/AIDS. (source)
A recent study in Kenya demonstrated that food production in households where the head of the family died of AIDS were affected in different ways depending on the sex of the deceased. As in other Sub-Saharan African countries, it was generally found that the death of a male reduced the production of ~cash crops~ (such as coffee, tea and sugar), while the death of a female reduced the production of grain and other crops necessary for household survival. (source)
In Ethiopia, a study found that AIDS-afflicted households spent 50-66 percent less time on agriculture than households that were not afflicted. (source)
In Tanzania, researchers found that women spent 60 percent less time on agricultural activities because their husbands were ill. (source)
Malnutrition because of decreased food availability.
AIDS-affected families usually have lower incomes, which leads to decreased food availability.
"HIV/AIDS is cutting people down in the prime of their productive years, leaving a growing number of households headed by grandparents, single parents, and children, and increasingly unable to produce food."(source)
In Zimbabwe, 18 per cent of households have removed one or more children from school as a coping mechanism in response to the lack of food. (source)
In South Africa, almost half of AIDS-affected households reported having insufficient food at times. (source)
In addition to food insecurity problems as a whole, people with HIV/AIDS are severely affected by the shortage of food. "People living with HIV/AIDS have greater energy and protein requirements. Depending on the stage of the illness, they use higher amounts of micronutrients and are unable to absorb fats and carbohydrates effectively. Food rations must be adapted to the specific needs of people living with HIV/AIDS." (source)

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“Keeping infected people alive and well, especially parents, so they can continue to live productive lives and take care of the next generation, is not only the compassionate thing to do, but it is also vital for a country's long-term economic future.“

Because it has infected such a large percentage of the population, the devastating effects of AIDS transcend the health of individuals to impact the macro-economy of sub-Saharan Africa. Since the 1990's, AIDS has changed the entire infrastructure of many African nations. Due to the nature of the disease, AIDS systematically wipes out men and women in the prime of their lives, depleting the nations' workforce and damaging businesses and institutions. Governments face budgetary challenges due to both expensive programs to combat AIDS and diminished revenues as AIDS impacts the national economy, which leads to accumulating foreign debts. Widespread poverty continues to perpetuate the spread of AIDS. If the AIDS epidemic in Africa is not curtailed, it will continue to reverse decades of economic progress.

• By 2020, more than a quarter of the agricultural labor force could be lost in Sub-Saharan African nations. (source)
• By 2010, South Africa~s gross domestic product is expected to be 17% lower than it would have been without AIDS. South Africa accounts for 40% of sub-Saharan Africa~s economic output. (source)
• Studies suggest that the rate of economic growth in sub-Saharan Africa has fallen by 2 to 4% as a result of the AIDS epidemic. (source)
• AIDS seriously weakens a country~s tax base, and reduces its ability to finance public expenditures, including those aimed at accumulating human capital, such as education and health services not related to AIDS. (source)

• Publications:
• HIV/AIDS: Implications for PovertyReduction Loewenson, Rene and Alan Whiteside. (UNDP Policy Paper 2001)
• The Economic Consequences of HIV/AIDS in Southern Africa Haacker M (2002) IMF Working Paper. Washington: International Monetary Funds (Africa Department) WP/02/38.
• The Macroeconomics of HIV/AIDS Haacker, Markus. IMF (November 2004).
• HIV/AIDS and Business in Africa (USAID)
• Mainstreaming the Policy and Programming Response to the HIV Epidemic Cohen, Desmond. (2000)
• The politics of action on AIDS: a case study of Uganda
• Business and HIV/AIDS in Africa: A Regional Snapshot(World Economic Forum, 2004)
• Costs of Care and SupportDesmond C. and T Quinlan. 2002. Costs of Care and Support. In Kelly, K., Parker, W and S Gelb. HIV/AIDS, Economic and Governance in South Africa: Key Issues in Understanding Response. USAID, Johannesburg.
• Changing Role of Business in the HIV/AIDS Crisis Bery, Priya. (Human Rights, Fall 2004)
• AIDS, Economics and Terrorism in Africa Neilson, Trevor (January 2005)
• HIV/AIDS and Work: Global Estimates, Impact, and Response, 2004
• o Business and HIV/AIDS: Commitment and Action? A Global Review of the Business Response to HIV/AIDS 2004-2005 David Bloom, Lakshmi Reddy Bloom, David Steven, Mark Weston. World Economic Forum, Harvard School of Public Health, UNAIDS, January 2005.
• Books:
• The End of Poverty: The Economic Possibilities of Our Time. Sachs, Jeffrey. (New York: Penguin, 2005).
• Guidelines for Studies of the Social and Economic Impact of HIV/AIDS Barnett, Tony and Alan Whiteside. (September 2000), UNAIDS Best Practice Collection.
• Economics of AIDS and Access to HIV/ AIDS Care in Developing Countries, Issues and Challenges Moatti, J-P et al (eds) Agence Nationale de Recherche sur le SIDA (ANRS), Paris, July 2003
• Health and Human Rights : Basic International Documents (Harvard Series on Health and Human Rights) (Marks, Stephen P., 2005)
• Websites:
• Office of the UN High Commissioner for Human Rights: HIV/AIDS
• Human Rights Watch: HIV/AIDS & Human Rights
• Amnesty International USA: HIV/AIDS
• Physicians for Human Rights: Health Action AIDS Campaign
• AVERTing HIV and AIDS
• Other Resources:
• Partners in Health: Summer Internship Institute for Health and Social Justice
• Human Rights Watch Internships for Undergraduate Students

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