HIV/AIDS: Insight Into Its Impact

1
HIV/AIDS Insight Into Its Impact
Part-I Prasanta K. Saha, M.Sc., CSTAT (UK),
FRSS (UK). Chartered Statistician
RSS-UK, Visiting Fellow University of Hawaii
EWC, USA. Ex-Professor Asia-Pacific
Institute of Management, New Delhi.Former
Additional Director General (rank of Additional
Secretary) Ministry of Program Implementation
Statistics, Govt. of India, New Delhi. Beforehand
Chief Director Ministry of Health Family
Welfare, Government of India, Nirman Bhawan, New
Delhi 110011. M 91.9836315936.
E-mail prasanta.saha2_at_gmail.com ,
prasant20012001_at_yahoo.co.in
2
HIV/AIDS Insight Into Its Impact

• INTRODUCTION
• Before we analyze impact of HIV/AIDS, we need
  to discuss important features, concepts and
  definitions of this pandemic.
• Very Interesting Features
• HIV/AIDS predominately a sexually transmitted
  disease
• First concept surfaced in 1981.
• ____________________________________________
• The phenomenon of HIV/AIDS surfaced first in the
  US in the June 5, 1981 issue of Morbidity and
  Mortality Weekly Report published by US Center
  of Disease Control, Atlanta.

3
HIV/AIDS Insight Into Its Impact

• Death rates among young people caused by HIV/AIDS
  are of extraordinarily high perhaps first time
  in the history of mankind.
• Similar most deadly epidemic spreading all over
  the world was Plague.
• Plague destroyed adverse feudal systems in
  economic growth thus increasing demand of labor.

4
Introduction-Contd.

• A very interesting aspect of AIDS epidemic it
  has spread globally so rapidly due to excellent
  means of communications in the modern world.
• Risk of HIV/AIDS follows inequality between the
  rich and the poor.
• In the analytical review of impact, a long
  perspective will be of importance.
• In respect of socio-economic impact of the AIDS
  epidemic, the impact is relevant in short and
  long range of time scale.

5
Introduction-Contd.

• Impact is generally measured at 4 levels
• Individual
• Household
• Community
• National

6
Introduction-Contd

• The Horrific Impact
• AIDS may, it is feared, change the history of
  many poorest countries.
• It may ruin development of human society achieved
  in about 5 decades.
• Development now is to be reviewed in association
  with HIV/AIDS keeping in view the following
• Incident of HIV infection
• Incident of TB most well known epidemic
• Incident of AIDS illness
• Phase of Impact poverty, orphaning and other
  effects.

7
Important Concepts Definitions of Epidemic

• Epidemic an unusually high rate of disease
  affecting a large number of people in a short
  time.
• An epidemic is a relative concept.
• Epidemics do not just happen.
• They are not random events.
• The disease has been used to stigmatize various
  groups. Stigmatization is itself an important
  part of the history of any particular epidemic.

8
Concepts Definitions of Epidemic-contd

• Epidemiology
• It is defined as the study of the distribution
  and determinants of health-related conditions and
  events in population and the application of this
  study to the control of health problems.
• It examines pattern of disease in totality.
• It displays geographical distribution and
  dynamics of a disease.

9
Concepts Definitions of AIDS

• AIDS It is difficult to define AIDS.
• It is not one disease but a phenomenon of a
  number of diseases.
• In the initial stage it was recognized as a
  Gay-Related Immune Deficiency GRID as it was
  found among homosexual men.
• Gradually it was identified among Injecting Drug
  Users IDU and infants born to mothers who were
  users of drugs.
• It was renamed as Acquired Immunodeficiency
  Syndrome or AIDS.

10
Concepts Definitions of AIDS -continued

• It belongs to the class of viruses known as
  retroviral.
• In many countries there is no facility or
  capacity to count CD4 cells, the abode of the
  AIDS virus.
• If CD4 cells counts in an individual fall below
  200, the individual is called as AIDS patient.
• In the countries where the capacity of scientific
  tests of counting CD4 cells does not exist, AIDS
  is defined clinically.

11
Concepts Definitions of AIDS -continued

• Experts opinion HIV/AIDS was not solely a
  clinical-medical problem but needs to be
  understood through a much broader perspective.
• So one is to see the relation between HIV/AIDS,
  health and human rights.
• HIV/AIDS epidemic is more deeply seated.
• It reveals many of the fractures, stresses and
  strains in a society.

12
Concepts Definitions of AIDS -continued

• Epidemiology with reference to AIDS
• Epidemiology of AIDS can not be easily recognized
  because of
• lack of relevant data
• unsatisfactory quality of data
• preparation of data is based on certain
  assumptions
• biased interpretation by people of politics.

13
Concepts Definitions of AIDS -continued

• Role of Reliable Data is extremely
  important
• Sources Governments, NGO, academic institutions,
  private sector 2 main bodies- UNAIDS and US
  Bureau of Census.
• In most countries AIDS is not a notifiable
  disease medical staff are not legally required
  to report cases.
• Data on AIDS cases need to be collected
  consistently and in sufficient quantities.

14
Concepts Definitions of AIDS -continued

• Data-contd.
• Most social or economic statistics have political
  ramifications
• AIDS case data have always been political
• Data from sentinel surveillance Collected from
  pregnant women attending Ante-Natal clinics.

15
HIV/AIDS IMPACT ANALYSIS

• Impact of an epidemic may change the history of
  human society.
• Lives get finished, some who survive get
  incapacitated.
• In the end, a society has to follow a path
  different from that which it would have followed
  previously.

16
HIV/AIDS IMPACT ANALYSIS

• Thus we see the impact Vis-à-vis macroeconomic
  indicators.
• Research has demonstrated that it is not always
  possible to measure the impacts of AIDS with
  precision.

17
HIV/AIDS IMPACT ANALYSIS

• As a result, projections have focused on
• -increased medical costs,
• depletion of labor force, and
• the slowing of national or sector specific
  economic growth in the long run.
• Lack of empirical evidence and the need for broad
  assumptions have placed considerable limitations
  on research.

18
HIV/AIDS IMPACT ANALYSIS

• As we see, the importance of past epidemics is
  frequently referred to and discussed by experts.
  But there is some sort of insensitiveness
  towards impact of AIDS which is damaging many
  societies now.

19
HIV/AIDS IMPACT ANALYSIS

• It is found that the macroeconomic effects of HIV
  are on the
• size and productivity of labor,
• level of net savings and
• rate of economic growth (Cohen 1992).
• _____________________________________
• Since AIDS affects those in their most productive
  years, related morbidity and mortality reduce the
  quantity and quality of labor.

20
HIV/AIDS IMPACT ANALYSIS

• Depending on the type of labor affected, the
  impact on the national economy could occur more
  in the medium or short term, such as the case of
  shortages in export sectors leading to
  difficulties in balance of payment problems.

21
HIV/AIDS IMPACT ANALYSIS

• Thus Impact of AIDS results in
• Increased spending on health care
• decreasing net savings public and private.
• Declined savings rates as life expectancy is
  decreased,
• Less perceived need for savings for future
  consumption (Mahal 2004).

22
HIV/AIDS IMPACT ANALYSIS

• Impact on GDP or National Income
• Evidence of the impact of AIDS on GDP and real
  per capita income has had mixed results.
• Overall, a large impact has not been discerned.
• It had demonstrated a lowered rate of annual
  growth of real GDP by nearly 2 percent in some
  African Countries.

23
HIV/AIDS IMPACT ANALYSIS

• A more comprehensive analysis in South Africa
  has also found growth of real GDP and per capita
  real GDP to be affected as a result of enhanced
  expenditure in health sector

24
HIV/AIDS IMPACT ANALYSIS

• Econometric estimates between HIV/AIDS and
  national economic performance, such as by (Bloom
  and Mahal 1997) have found that AIDS has a
  statistically insignificant effect on the growth
  of real per capita income.

25
HIV/AIDS IMPACT ANALYSIS

• Poverty
• Although AIDS is unlikely to increase overall
  poverty rates, it will affect health which is
  inextricably linked to poverty.
• A significant literature attests to the aggregate
  impacts of health status on real GDP
• morbidity related to AIDS may follow the same
  pattern.

26
HIV/AIDS IMPACT ANALYSIS

• Lastly, the impact of AIDS on life expectancy can
  be linked to overall human capital investments
  and value and the individual and national level.

27
HIV/AIDS IMPACT ANALYSIS

• Relationship between poverty and the development
  of epidemics
• ________________________________
• There is an undoubted relationship between
  poverty and the development of epidemics of
  communicable disease and at the same time
  epidemic disease, like any illness, has the
  potential to increase poverty (Stillwagon, 2001).

28
HIV/AIDS IMPACT ANALYSIS

• Overall Economic Impact
• Economically far more damaging
• __________________________________________
• According to a new World Bank study released
  in New York in July, 2003 ( Berthelsen 2003),
  while the world has focused on the human tragedy
  of AIDS, the fact is that economically it is far
  more damaging than had been thought earlier, and
  could result in the outright collapse of some
  economies if it is not checked. This study says
  that if AIDS were to continue unchecked, it could
  wreck a society in three generations.

29
HIV/AIDS IMPACT ANALYSIS

• Sector - level Impact
• Health The health sector is likely to encounter
• Higher bed occupancy,
• Increased public health spending and
• A potentially overwhelmed system.
• _____________________________________
• Example Africa and Indian states with more
  concentrated epidemics are likely to experience
  such an impact.

30
HIV/AIDS IMPACT ANALYSIS

• Sector - level Impact
• Labor
• Agriculture - decreased productivity
• Absenteeism
• Added recruitment training costs
• ___________________________________________
• Labor intensive sectors, on the other hand,
  may be adversely affected by the HIV epidemic in
  several ways. In agriculture, for example,
  decreased productivity could potentially
  translate into a decline in labor inputs and
  increased expenses related to morbidity and
  mortality (Bloom et al 2004).

31
HIV/AIDS IMPACT ANALYSIS

• Labor sector continued
• ________________________________________
• The workforce is likely to be affected by
  absenteeism, health care and added
  recruitment/training costs, lost knowledge and
  damaged morale (Bloom et al 2004). Increased
  expense on insurance, depending on company policy
  for HIV-infected individuals, may also affect
  private industry.

32
HIV/AIDS IMPACT ANALYSIS

• Household Sector
• Morbidity
• Mortality of HIV-positive adults
• Lower long-run accumulation of human capital.
• __________________________________________
• Preliminary research demonstrates that
  morbidity and mortality of HIV-positive adults
  inflict a cost that cannot be measured simply by
  loss of income. Members of HIV/AIDS affected
  households may have lower long-run accumulation
  of human capital as measured by education and
  health (Bloom et al 2004 and citations therein).

33
HIV/AIDS IMPACT ANALYSIS

• Time of impact-consequence
• Individual Early death illness
• Household Early orphans and elderly affected
• Community Early, middle late orphans, elderly
  affected local social service provision
  affected
• Production unit/institution Middle late
  evidence of loss
• Sector Late no evidence so far found
• Nation Late no evidence so far found .

34
HIV/AIDS IMPACT ANALYSIS

• Demographic Impact
• It is a quite plausible conjecture that
  extraordinary magnitude of untimely deaths caused
  by AIDS will affect (a) mortality rate, (b) life
  expectancy and thereby (c) population structures
  after a few decades.
• Specific studies yet to be undertaken.
• Some improvement needed in assessing demographic
  impacts
• In registration of deaths, systems are not fully
  reliable in many developing countries in terms of
  coverage and recording causes of deaths.

35
HIV/AIDS IMPACT ANALYSIS

• Demographic Impact-continued
• Another problem concerns the frequency with
  which demographic changes are measured census is
  conducted every 10 years.
• Life Expectancy AIDS has direct and immediate
  impact on life expectancy. The ability to have
  children and see them grow up is the basic
  expectation of most people. AIDS stymies these
  expectations.

36
HIV/AIDS IMPACT ANALYSIS

• Other issues
• There is a very long period of twenty years into
  the epidemic
• disgraceful lacuna in what we know about HIV and
  poverty,
• both the ways that the epidemic exacerbates
  poverty and the reverse.
• in fact, very little is known about the more
  general relation between infectious disease and
  poverty.
• __________________________________

37
HIV/AIDS IMPACT ANALYSIS

• Acknowledgement
• Prof. Tony Barnett, Professor, School of
  Development Studies, University of East Anglia
  and Prof. Alan Whiteside, Director, Health
  Economics HIV/AIDS Research Division,
  University of Natal, South Africa Authors of
  the famous book titled AIDS in the Twenty-First
  Century Disease and Globalization, Publisher
  PALGRAVE Macmillan, Hampshire. According to me,
  this is one of the best books in the world so far
  as most comprehensive analysis is concerned in
  the field of very complex subject called
  HIV/AIDS. I very sincerely express my heartfelt
  gratitude to Prof. Barnett and Prof. Whiteside
  stating that I have collected some very relevant
  materials from your book in preparing my present
  lecture note which is absolutely honorary and in
  the interest of the readers globally.

38
HIV/AIDS IMPACT ANALYSIS

• References
• 1. Barnett, Tony and Whiteside, Alan (2006)
  AIDS in the Twenty-First Century Disease and
  Globalization PALGRAVE Macmillan, Hampshire.
• 2. Bloom D.E. and Mahal, A. (1997) Does the
  AIDS epidemic threaten economic growth? Journal
  of Econometrics.
• 3. Cohen D. (1992) The Economic Impact of the
  HIV Epidemic. New York United Nations
  Development Programme.

39
HIV/AIDS IMPACT ANALYSIS

• References-continued
• 4. Kambou G., Devarajan S., and Over M. (1992)
  The Economic Impact of AIDS in an African
  Country Simulations with a Computable General
  Equilibrium Model of Cameroon. Journal of
  African Economies.
• 5. Mahal A (2004) Economic Implications of
  Inertia on HIV/AIDS and Benefits of Action.
  Economic and Political Weekly.
• 6. Saha, Prasanta K. and Pradhan, Basanta
  K.(2006) HIV/AIDS in India A Review of
  Literature, National Council of Applied Economic
  Research (NCAER), New Delhi, India

40
HIV/AIDS INSIGHT INTO ITS IMPACT Part-I

• THANKS