UNFPAState of World Population 2002
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HOME: STATE OF WORLD POPULATION 2002: HIV/AIDS and Poverty
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HIV/AIDS and Poverty

Overview
Devastating Impacts
Priorities for Action

Devastating Impacts

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 (9).


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.

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