HIV/AIDS and Poverty
By 2010, about 40 million children
worldwide will have been orphaned by the pandemic. The
death of young working adults and the increase in widows,
widowers and orphans will increase dependency as well
as poverty. AIDS has already become the major cause
of adult deaths in Africa, and projections suggest that
increased deaths, fewer births and reduced fertility
will slow or even reverse population growth. Life expectancy
is falling, and has already fallen by 10 to 15 years
in some countries. Sub-Saharan Africa will have 71 million
fewer people by 2010 than it would have had without
AIDS. The result is to threaten the economies, social
structures and political stability of entire societies
HEALTH SERVICES DRAINED
In most of Africa, malaria, tuberculosis and, increasingly,
HIV/AIDS overwhelmed the health care system in the 1990s,
at the same time as structural adjustment programmes
forced governments to cut already meagre health budgets
and shift much of the cost of care from the state to
individuals. The result was to deprive many Africans
of any health care at all (10).
At the same time there has been a startling increase in the
incidence of HIV/AIDS among health workers; Malawi and Zambia,
for instance, report five- to six-fold increases in health worker
illness and death rates. This leaves a decimated staff, struggling to
overcome stress, overwork and fear, to confront an exploding crisis.
The costs of new safety procedures and of lost time and labour has
made health care scarcer and more expensive, placing it beyond
the reach of many of the infected and leaving untrained household
members-often older people-to care for sufferers at home.
Differentials in health services
and access to affordable HIV/AIDS treatment determine
survival rates and divide rich and poor countries and
communities. As the struggle to reduce drug prices and
expand treatment continues, public health services will
determine the ability of households and communities
to deal with the epidemic. Failure to provide health
services, whatever the difficulties of meeting the short-term
costs, will spell disaster for development and poverty
eradication efforts (11).
EDUCATION SYSTEMS COLLAPSING
Education helps individuals protect themselves against
HIV infection. In Zambia, for instance, surveillance
data for Lusaka show that the HIV prevalence rate for
women aged 15-19 dropped from 27 per cent in 1993 to
15 per cent in 1998, and that the decline was greater
among those with secondary and higher levels of education.
In the absence of a medical vaccine against HIV infection,
education can provide a "social vaccine" (12).
AIDS is depriving children of their
education. HIV/AIDS is killing teachers and administrators,
draining education of its quality, increasing costs
and weakening demand. Children who lose both parents
to the epidemic are much less likely to continue attending
school (13). Girls
are far more likely than boys to be kept at home to
care for sick relatives, or to do housework to free
older women for nursing. Children may become the household's
only breadwinners if working-age adults are sick and
others are too old or young to work.
In the Central African Republic,
85 per cent of teachers who died between 1996 and 1998
were HIV-positive, and they died on average ten years
before they were due to retire (14).
In Kenya, the death toll among teachers rose from 450
in 1995 to 1,400 in 1999. Côte d'Ivoire and Malawi lose
at least one teacher a day.
A recent forum in Cameroon estimated
that 10 per cent of teachers and 20 per cent of students
could be infected with HIV in the next five years (15).
The forum called for challenges to ignorance, secrecy,
denial and the fear of stigmatization and discrimination
that still pervade schools and colleges. Participants
wanted HIV/AIDS education in schools, despite taboos
and cultural obstacles.
Other recent proposals have included public subsidies to
schools or directly to households in poor or heavily affected areas,
to reduce education costs and keep children in school. If schools
can be kept open and functioning, with a zero level of tolerance of
sexual abuse, they can become focal points for strengthening the
wider community response to AIDS and for providing participatory
leadership within the community.
ECONOMIC IMPACTS HIV/AIDS
is already slowing economic growth and activity in the
worst-affected countries. It is estimated that in the
1990s AIDS reduced Africa's per capita annual growth
by 0.8 per cent. Models suggest that in the worst-affected
countries 1-2 percentage points will be sliced off per
capita growth in coming years. This means that after
two decades, many economies will be about 20-40 per
cent smaller than they would have been in the absence
of AIDS (16). At
the same time, HIV/AIDS calls for additional public
resources to organize prevention efforts, provide treatment,
maintain other health services, and care for orphans
and other dependents.
Sick people work less effectively and are often absent.
Their deaths, apart from the human tragedy, disrupt the workplace,
reduce productivity, annul investment in training and
impose the need to train replacements. Businesses cannot plan
for an uncertain future.
AIDS-related sickness and deaths
follow the HIV infection curve with a lag of several
years, so HIV prevalence can be used to project the
number of future illnesses, deaths and orphans. Data
are less than perfect, but the epidemic is now old enough
to be showing significant costs (17).
In April 2002, one of South Africa's major mining corporations,
GoldFields, estimated that the HIV/AIDS epidemic would
add up to $10 an ounce in gold production costs.
Many enterprises have tried to shift the burden by reducing
benefits, shifting labour to temporary status and seeking to place
the burdens of care and retraining on the state. But this strategy
is ultimately self-defeating, because governments must tax the
private sector to pay their costs.
In addition, it is clear that governments face exactly the same
kind of problems. Staff are falling ill and dying: there are fewer
teachers in the schools, police on the beat, nurses in the clinics
and sanitation workers picking up garbage. Without experienced
staff, government at all levels will break down, threatening
not only economic development, but infrastructure like roads and
airports, mechanisms such as law enforcement and taxation,
and eventually social cohesion itself.
Damage in the rural sector is equally
bad: family farms in Zimbabwe see a 40-60 per cent fall
in the production of maize, peanuts and cotton after
an AIDS death (18).
Not only income is lost: nutritious leafy crops and
fruits are replaced by starchy root crops which require
less labour; livestock may be sold to pay for medicine,
leaving no source of nutritious foods like milk, meat
or eggs. These changes bring on chronic food insecurity
and high levels of protein malnutrition, which further
compromise immune systems and open the path to infection.