III. Socio-Economic Impacts of HIV/AIDS
February 16, 2001
AIDS, while continuing to be an important health issue, has evolved into a complex social and economic emergency. HIV primarily affects young adults, cutting a broad path through society's most productive layer and destroying a generation of parents, whose death leaves behind orphans, desocialized youth and child-headed households. AIDS has a significant impact on the more educated and skilled segments of society because HIV primarily infects productive young adults rather than children or the elderly. The stigma attached to HIV and AIDS adds to the impediments encountered in mounting a response to AIDS, in addition to the discrimination already faced by infected individuals. HIV also increases social and economic vulnerability among women.
In the hardest-hit regions, AIDS is now reversing decades of development. It changes family composition and the way communities operate, affecting food security and destabilizing traditional support systems. By eroding the knowledge base of society and weakening production sectors, it destroys social capital. By inhibiting public and private sector development and cutting across all sectors of society, it weakens national institutions. By eventually impairing economic growth, the epidemic has an impact on investment, trade and national security, leading to still more widespread and extreme poverty. In short, AIDS has become a major challenge for human security.
The lifetime risk of dying of AIDS is far higher than the general prevalence rate would suggest. For example, where prevalence is 15 per cent and rates continue to apply through their lifetime, over half of today's 15-year olds will die. In Botswana, which has a prevalence rate of 36 per cent, over three quarters would die of AIDS. In some countries, these trends are reshaping the traditional population pyramid into a new population chimney," with a narrowing base of young people and children. The most dramatic change in the pyramid occurs when young adults, infected early, begin to die of AIDS. Only those adults who escape HIV infection can expect to survive to middle and old age. Also, recent studies among various African populations indicate that rates of HIV infection in young women aged 15 to 19 may be five to six times higher than in young men.
Households and FamiliesHouseholds and families bear the brunt of the misery caused by AIDS. Those who fall ill become unable to work, forcing family members to care for them rather than producing food or income. According to studies of rural families in Thailand and urban families in Côte d'Ivoire, farm output and income fell between 52 and 67 per cent in families affected by AIDS. Families are also subject to discrimination if they have members who are HIV-positive, often facing reduced access to publicly available social and economic benefits.
GenderThe gender dynamics of the epidemic are far-reaching due to women's weaker ability to negotiate safe sex and their generally lower social and economic status. More women than men are caretakers of people with AIDS, which may saddle them with the triple burden of caring for children, the elderly and people living with AIDS -- as well as financial responsibility for their family's survival. Girl children or older women may find themselves at the head of households, and many girls from families facing poverty risk exploitation, especially sexual exploitation, when trying to bring in additional income. Mother-to-child transmission is also a concern.
EducationWhere AIDS is widespread, education -- an essential building block of development -- is being impaired. The epidemic is eroding the supply of teachers and diluting the quality of education. AIDS also reduces the amount of money available for school fees, and forces an increasing number of children -- more girls than boys -- to drop out of school in order to help at home. As teachers become ill and unable to work, some schools are closing. In parts of Southern Africa, one fifth of teachers and secondary school students are estimated to be HIV-positive.
Health ServicesSince the beginning of the epidemic, 21.8 million people have fallen sick and died of AIDS, placing ever-increasing demands on health services in the worst-affected countries. Often, this increased demand stretches already over-burdened public health systems. In 1997, public health spending on AIDS alone exceeded 2 per cent of gross domestic product (GDP) in seven of 16 African countries sampled, a staggering amount for countries whose health expenditure for all diseases accounts for 3 to 5 per cent of GDP. Adding to these increased demands is the crushing burden of AIDS on health workers themselves. A study in Zambia showed that in one hospital, deaths among health-care workers increased by a factor of 13 over a decade, largely because of HIV. Overburdened public health systems may also further marginalize minority, disabled and elderly women with HIV/AIDS. HIV-positive people also lack access to medicines and to health care, often facing discrimination from hospital staff or health-care systems.
OrphansAIDS has a dramatic impact on children, particularly through the emergence of an entire generation of orphans to families affected by HIV. To date, the epidemic has left behind 13.2 million orphans, children who before the age of 15 have lost either their mother or both parents to AIDS. Studies have shown that children orphaned by AIDS are at greater risk of malnutrition, illness, abuse and sexual exploitation than children orphaned by other causes. The stigma and discrimination they face can also deprive them of basic social services and education. Today, in many African countries 20 to 25 per cent of all households are fostering orphans. The long-term consequences of such shifts in socialization are incalculable.
Human Development IndexThe Human Development Index (HDI), a generally accepted measure of development based on economic and social indicators, is also affected by AIDS. In Namibia, for example, the HDI is predicted to fall 10 per cent by 2006 and in South Africa by 15 per cent before 2010 because of AIDS.
Economic GrowthGrowing evidence suggests that AIDS is having a devastating effect on economic growth and incomes. According to the World Bank, had average national HIV prevalence in sub-Saharan Africa not reached 8.6 per cent in 1999, per capita income on that continent would have grown 1.1 per cent, nearly three times the actual growth rate of 0.4 per cent achieved during 1990-1997. In the case of a typical sub-Saharan African country with a prevalence rate of 20 per cent, overall GDP growth would be 2.6 per cent lower each year. At the end of 20 years, the economy would be two thirds smaller than it would otherwise have been.
WorkersAIDS reduces the number of healthy workers, especially experienced workers in their most productive years. This raises dependency, diminishes human capital, and may cut productivity growth by as much as 50 per cent in the hardest hit countries.
Public SectorIn the public sector, AIDS reduces government revenues and puts severe strain on budgets as spending on health and social welfare mount. Scarce capacity is depleted, and the return on other public investments falls.
GovernanceGovernance suffers as a result of the epidemic: HIV/AIDS has a disastrous impact on the capacity of Governments, especially on the delivery of basic social services. Human resources are lost, public revenues reduced and budgets diverted towards coping with the epidemic's impact. Similarly, the organizational survival of civil society institutions is under threat, with a corresponding impact on democracy.
Private SectorIn the private sector, firms face higher costs in training, insurance, benefits, absenteeism, medical costs, sick leave, funerals and pensions. At the same time, the average experience of their labor force falls, reducing accumulated knowledge within firms. The most seriously affected businesses are those that are labor-intensive, such as transport. Companies in Africa have already felt the impact of AIDS on their bottom line. One sugar estate in Kenya quantified the cost of HIV infection as 8,000 days of labor lost to illness in two years, a 50 per cent drop in processed sugar recovered from raw cane in four years, and a tenfold increase in health costs. The company estimated that more than three quarters of all illness was related to HIV infection.
AgricultureAIDS also threatens the basic livelihood of people living in developing countries, especially the poor. In many countries, agriculture provides a living for as much as 80 per cent of the population. As adults in rural areas fall ill, productivity drops off dramatically. Patterns of cropping shift from cash crops to subsistence farming, reducing household income and forcing the family to sell such assets as equipment or cattle to get by. Children may be withdrawn from school to help with work or tend to the sick, impairing their own development. In some areas, women dominate agricultural labor -- up to 80 per cent -- and this requires a gender-sensitive response to HIV/AIDS.
There is now broad acknowledgement that AIDS has become a global development crisis, potentially affecting national security in some countries. Armed conflict and associated population movements provide fertile ground for the spread of AIDS, while the epidemic itself can be seen as a risk factor in the breakdown of social cohesion and in social and political instability, in addition to a threat to security forces.
This article was provided by UNAIDS. It is a part of the publication Review of the Problem of HIV in All Its Aspects. Visit UNAIDS' website to find out more about their activities, publications and services.