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III. Impact of AIDS

Executive Summary

July 6, 2004

People and Societies

In all affected countries with either high or low HIV prevalence, AIDS hinders development, exacting a devastating toll on individuals and families. In the hardest-hit countries, it is erasing decades of health, economic and social progress -- reducing life expectancy by years, deepening poverty, and contributing to and exacerbating food shortages.


Sub-Saharan Africa has the world's highest prevalence and faces the greatest demographic impact. In the worst-affected countries of eastern and southern Africa, if current infection rates continue and there is no large-scale treatment programme, up to 60% of today's 15-year-olds will not reach their 60th birthday.

The stark differences in access to antiretroviral treatment are reflected in mortality rates. In low- and middle-income countries, such rates among 15-49 year olds are now up to 20 times greater than death rates for people living with HIV in industrialized countries.

In seven African countries where HIV prevalence is more than 20%, the average life expectancy of a person born between 1995 and 2000 is now 49 years -- 13 years lower than in the absence of AIDS. In Swaziland, Zambia and Zimbabwe, without antiretroviral programmes, average life expectancy is predicted to drop below 35.


The epidemic's impact is particularly hard on women and girls as the burden of care usually falls on them. Girls drop out of school to care for sick parents or for younger siblings. Older women often take on the burden of caring for ailing adult children and later, when they die, adopt the parental role for the orphaned children. They are often also responsible for producing an income or food crops. Older women caring for orphans and sick children may be isolated socially because of AIDS-related stigma and discrimination. Stigma also means that family support is not a certainty when women become HIV-positive; they are too often rejected, and may have their property seized when their husband dies.

Poverty and Hunger

In some of the worst-affected countries, the living standards of many poor people were already deteriorating before they experienced the full impact of the epidemic. In general, AIDS-affected households are more likely to suffer severe poverty than non-affected households; this is true for countries with low prevalence as well as those with high rates.

AIDS takes away the income and production capacity of family members that are sick, at the same time as creating extraordinary care needs and rising household expenditure on medical and other costs, such as funeral expenses. On average, AIDS care-related expenses can absorb one-third of a household's monthly income. Families may have to use their savings, sell assets such as land and livestock, borrow money or seek support from their extended family. They also have to reduce spending on housing and clothing.

In South Africa and Zambia, studies of AIDS-affected households -- most of them already poor -- found that their monthly income fell by 66%-80% because of coping with AIDS-related sickness.

AIDS is intensifying chronic food shortages in many countries where large numbers of people are already undernourished. The epidemic is significantly reducing countries' agricultural workforce and families' income with which to buy food. This is especially damaging for people living with AIDS who need more calories than uninfected individuals.

Agriculture and Rural Development

A healthy agricultural sector is essential for the well-being and self-sufficiency of developing countries. It accounts for 24% of Africa's gross domestic product, 40% of its foreign exchange earnings and 70% of its employment. But the epidemic is attacking the agricultural base of many countries, especially those most affected; it is estimated that AIDS will have claimed the lives of one-fifth or more of agricultural workers in southern Africa by 2020.


Globally, AIDS is a significant obstacle to children achieving universal access to primary education by 2015 (a key target of UNESCO's Education for All Initiative and the UN's Millennium Development Goals). An estimated US$1 billion per year is the net additional cost to offset the results of AIDS -- the loss and absenteeism of teachers and demand incentives to keep orphans and other vulnerable children in school.

In many countries -- for example, Kenya, Uganda, Swaziland, Zambia and Zimbabwe -- the epidemic is expected to significantly contribute to future shortages of primary teachers. Without forward planning, there will be great difficulty for these countries meeting their school enrolment targets and an acceptable pupil-to-teacher ratio. As skilled teachers fall sick and die, the quality of education suffers. Many affected countries cannot afford to train more teachers.

Children, especially girls, from AIDS-affected families are often withdrawn from schools to compensate for loss of income through a parent's sickness and related expenses, to care for sick relatives and look after the home. These families may also take their children out of school because they cannot afford school fees.

Health Sector

The epidemic has created a need for robust, flexible health systems at a time when many affected countries have been reducing public service spending to repay debt and conform to international finance institutions' requirements. So already weakened systems are being forced to cope with the extra burden of sickness and the loss of essential staff through sickness and death related to AIDS. In African countries, studies estimate that between 19% and 53% of all government health employee deaths are caused by AIDS. The epidemic is quickly outstripping growth in the supply of health sector workers.


In hard-hit countries, AIDS is likely to reduce the growth rate of the labour force, as it primarily strikes the working-age population. The International Labour Organization projects that the labour force in 38 countries (all but four in Africa) will be between 5% and 35% smaller by 2020 because of AIDS.

The epidemic also affects business in many ways, including increasing costs because of absenteeism, sickness and recruitment; organizational disruption and loss of skills, and increasing health expenses and funeral costs.

Next Agenda

  • More and better research into the socio-economic impact of the epidemic. More than 40% of countries with generalized epidemics have yet to evaluate this impact.
  • Strengthen the coping capacity of AIDS-affected households -- by providing direct financial assistance, home visits from health services, food and nutritional support, and waiving school fees.
  • Implement strategies which take into account the disproportionate impact of HIV on women, girls and orphans including microcredit and income generation schemes, school support and food assistance programmes.
  • Strengthen chronically weak health systems. Provide better protection for the safety of health workers -- targeting health staff for antiretroviral treatment, improving salaries and benefits to retain staff or win back those who have migrated to higher income countries.
  • Support workplace prevention programmes for employees and management, providing healthcare such as access to voluntary counselling and testing and to antiretroviral treatment in workplace settings, and endorsing policies of non-discrimination against employees living with HIV.

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This article was provided by UNAIDS. It is a part of the publication 2004 Report on the Global AIDS Epidemic. Visit UNAIDS' website to find out more about their activities, publications and services.