IMPACT OF HIVAIDS

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IMPACT OF HIV/AIDS

• By
• Rafiqul Huda Chaudhury
• August 2003

2

• 1.0 Concern for Care and Support for PLWAS and
  their Families i.e., Impact Mitigation A
  Historical Perspective
• 1.1 Dilemma of "disaster prevention" versus
  "impact mitigation
• As the epidemic natures and the burden of
  providing care and support grows heavier, there
  is a justified concern that its impact will
  undermine improvements in health status of
  countries.
•  
• Consequently this will act as drag on economic
  growth, thereby increasing poverty, or slowing
  its decline and delaying achievement of the
  over-reaching Millennium Development Goal on
  poverty reduction.

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1.2 Relationship between poverty and HIV/AIDS

• There exists a two-way relationship between
  poverty and HIV/AIDS in which the former affects
  the later and the later in turn is affected by
  the former.

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• Poverty can contribute to HIV/AIDS by
• (a) reducing accessibility to preventive
  interventions
• (b) increasing nutritional deficiency and
  shorting the incubation period between HIV
  infection and the onset of full-blown AIDS
• (c) reducing accessibility to affordable care
• (d) reducing access to information on AIDS by
  limiting access to education.
•  

5

• HIV/AIDS can also contribute to poverty by
• (a) increasing the cost of HIV related illness
  and death (i.e., costs of treatment and care,
  care for AIDS orphans, friends, prevention and
  testing, and health system upgrading) and
  diverting resources from productive investment,
• (b) increasing dependency burden,
• (c) labour force and human capital erosion,
• (d) reducing labor productivity, and
• (e) reducing national income.

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• 2.0 Demographic Impact
•  2.1 World trend
•  
• By the end of 2001, more than 60 million persons
  had been infected by HIV and about 40 million
  were still alive.
• HIV/AIDS has become the fourth most important
  cause of death in the world and leading cause of
  death in Sub-Saharan Africa.
•  

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• Detrimental impact of the HIV/AIDS epidemic is
  more strongly felt in developing countries, where
  94 percent of those infected with HIV lived at
  the end of 2001.
• With more than 28 million persons infected by
  that date, Sub-Saharan Africa remains the region
  where the highest prevalence level predominate.
•  

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• 2.2 HIV/AIDS pandemic in Asia
•  
• It is estimated that by the end of 2001 Asia and
  Pacific region had more than 7 million persons
  infected with HIV.

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• With 62 percent of the world's population, the
  Asia and Pacific region accounted for 17 percent
  of all HIV/AIDS cases in the world.
• Currently, it is the region with the second
  highest prevalence in the world next to Africa.

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•  The highest national HIV prevalence rates among
  adults (15-49 years) were estimated to be in
  three continuous countries of South-East Asia
  Cambodia (2.7 percent), Myanmar (2.0 percent) and
  Thailand (1.8 percent), followed by the Russian
  Federation (0.9 percent) and India (0.8 percent).
• But even low rates in countries with large
  population can mean very high numbers of people
  infected. In terms of absolute numbers of adult
  persons living with HIV/AIDS (PLWAS) India has
  3.8 million PLWAS.
•  

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• 3.0 Impact on Overall Mortality
•  
• UNAIDS estimated total AIDS-related deaths for
  the Asia and Pacific region to be around 490,000
  in 2000, over 60 percent of which were attributed
  to deaths in India.
• The affected 4 countries of Asia are expected to
  experience about 11 million excess deaths during
  2000-2020, about 78 percent or 8.6 million of
  which will take place in India.

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• Crude death rates in 2015-2020 will be about 7
  percent higher than they would have been without
  AIDS in these countries.

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• 3.1 Impact on age-specific mortality
•  
• For the 4 affected countries in Asia, 8.9 million
  excess deaths in ages 15-49 are expected for the
  period 2000-2020.
• The number of excess deaths among children and
  among older persons will be also significant.

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• For the 4 affected Asia countries about 0.5
  million and about 1.5 million excess deaths are
  expected in ages 0-4 and 50 years above between
  2000 and 2020.
• In the four countries of Asia, the impact of AIDS
  on infant mortality is weak, adding at most one
  death per 1,000 live births during 1990-95 to
  2015-20.
• However, under five mortality is expected to be 2
  percent higher than it would have been without
  AIDS between 2000 and 2020.
•  

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• 3.2 Impact on life expectancy
•  
• The impact of these excess deaths will be lower
  on life expectancy at birth because of low
  prevalence rate in India.
•  

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• 3.3 Population size and growth
• AIDS affects population growth through two
  mechanisms
• (a) increase in the number of deaths and
• (b) reduction in fertility among infected
  women and reducing the number of potential
  mothers by dying during the reproductive
  periods.

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• In 2020 the population of 4 affected countries of
  Asia is expected to be 15 million less than in
  the absence of AIDS.
•  
• This will amount to a reduction of annual growth
  rate by 3 percent between 2000 and 2020.

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• 4.0 Economic Impact
•  
• 4.1 Macro-level impact
•  
• Most of the macro-economic toll of HIV/AIDS comes
  from the high health cost, which diverts
  resources from productive investments.
•  
• Although indirect costs far outweigh the direct
  costs, it is difficult to estimate.
•  

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• The direct costs of HIV-related illness and death
  includes costs of treatment and care, care for
  AIDS orphans, funerals, prevention and testing,
  and health system upgrading.
• The most important indirect costs stem from the
  private losses to households, extended families
  and communities due to pre-mature death of young
  adults of prime working age.

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• The cost implications of treatment and care
  include both treatment of people living with
  HIV/AIDS and the prevention of AIDS among those
  who are HIV positive.
• Additionally, the HIV epidemic increases the
  number of cases of active TB, both among
  HIV-positive, HIV-negative population.

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• TB carriers who become infected with HIV face a
  30 to 50 fold increase in their risk of
  developing active TB.
•  
• About 25 percent of HIV-negative persons dying of
  TB in the coming years worldwide would not have
  infected with the bacillus in the absence of
  HIV/AIDS epidemic World Bank.

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• Most countries in Asian and Pacific region can
  expect an increase in HIV-related TB cases of 5
  to 10 percent.
•  
• The cost of basic palliative care and treatment
  of opportunistic infections (not ART) can place a
  heavy pressure on health budgets and systems.
•  

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• One year cost of basic medical treatment can
  amount to two to three times the per capita GDP
  in many developing countries World Bank.
• In Thailand, annual cost for basic medical care
  of one PLWA averages around US 1,000 per
  persons, or about 25 times the government's
  current per capita health expenditure.

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• Making free zidovudine (ZDV) and didanosine
  widely available to patients would require a
  public subsidy amounting to six times Thailand's
  entire AIDS budget.
•  
• Furthermore, patients would still have to pay
  around US 500 a year for the related health
  care.

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• 4.2 Long term impact
•  
• A long-term macro-economic effect of the epidemic
  stems from (a) labour force shortage, (b) human
  capital erosion, (c) increase in dependency
  ratio, and (d) loss of labour productivity.
•  
• Increased morbidity and mortality levels affect
  national economies by reducing the volume of
  savings available and changing the ways savings
  are used, ultimately affecting GNP growth rate.

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• National studies of two African countries with 39
  and 33 percent adult prevalence indicated that
  their economics would grow by 2.5 and 1.1
  percentage points less, respectively than in the
  absence of AIDS.
•  
• A global study estimated that national HIV
  prevalence rates of 20 percent prevalence would
  reduce annual GDP by 2.6 percentage points.
• However, it is not possible to generalize the
  African and global findings to the countries in
  the ESCAP region.
•  

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• 4.3 Household level impact
•  
• Impact of the on household welfare can be
  devastating, particularly the poor households by
• Drastic increase in the health care expenditures,
  which depletes private savings. Medical expenses
  for an AIDS patient are typically higher than for
  non-AIDS patient.

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• Reduction in the incomes due to loss of
  productivity of both infected persons and their
  care givers, severely compromising family
  resources.
• Diverting households resources away from the
  productive agricultural inputs, resulting in
  further reduction in household resources.
•  
• As the disease progresses towards its final
  stages, medical expenses rise and household
  resources are diverted by medical treatment and
  eventually funeral costs.

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• Faced with the cost associated with such
  catastrophic illness, households cope by
•  
• Using savings.
• Borrowing money.
• Taking on debt at high rates.
• Searching for additional income (child
  labour).
• Diverting expenditures from other essential
  areas.
• Disposing of non-productive assets and
• Finally disposing productive assets such as
  land, animals and equipment, which can lead to
  ultimate pauperization.

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• 4.4 Salient findings
•  
• 4.4.1 Cost of illness
•  
• India average financial burden of treatment
  accounts for 49 percent of household income.
  Burden is highest on the low income households
  (82 percent), compared to on high income
  households (28 percent).

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• 4.4.2 Loss of income
•  
• On average, 2 person years of lost labour by
  time of death in an AIDS-affected household.

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• Chiang Mai Thailand 48 percent decrease in
  household income. 60 percent of the households
  with an AIDS death used up their savings, 42
  percent reduced their food consumption, 28
  percent sold a vehicle, and 11 percent borrowed
  money.
•  
• The poorer the household, the greater is the
  proportion of available expenditures taken up by
  HIV/AIDS.
•  
• Cambodia HIV/AIDS a significant cause of
  landlessness.

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• 5.0 Impact on Education
•  
• HIV/AIDS intervention with education sector in a
  multiple of way, including through
•  
• Loss of human resources among teachers and
  other school staff (supply of experienced
  teachers and other school staff will be reduced
  by AIDS-related illness and death).

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• Declining demand-fewer and poor children
  (children may be kept out of the school to care
  for sick family members or to work in the fields.
  Children drop out of the school if their families
  cannot afford school fess due to reduced
  household income).
• Reduced financial resources and increased
  costs-competition for public and private funds.

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• Additional tasks demand for HIV/AIDS prevention
  education.
•  
• This poses a direct challenge to the achievement
  of the MDG goal on primary education.

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• 6.0 Impact on Food Security
•  
• Food security and agricultural production will be
  threatened by loss of agricultural labourers,
  reduction in investments in productive
  agricultural inputs due to increased costs of
  care and number of person-years lost labour.
•  
• According to FAO estimates, 7 million
  agricultural workers have died and some 16
  million more would die by 2020.

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• 2 person-years of lost labour by time of death in
  an Aid-afflicted household.
•  
• This represents a direct challenge to efforts
  aimed at achieving the MDG target of halving the
  proportion of people suffering from hunger by
  2015.

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• 7.0 Social Impact
•  
• The social burden of HIV/AIDS tends to fall
  disproportionately on already vulnerable groups
  such as women, children and elderly.

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• 7.1 Impact on women
•   
• Widow's ability to acquire property and land
  rights after her husband's death remains a major
  problem.
• Girls are much more likely than boys to be taken
  out of school.

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• Infection rates have been increasing more rapidly
  among female population, particularly young women
  aged 15-24.
•  
• Increasingly women themselves who are in need of
  care.
•  
• Tendency for families to spend less resources on
  women than on men.

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• 7.2 Impact on children
• Children in HIV/AIDS households suffer in a
  variety of ways that conspire to keep them in
  poverty.
•  
• Schooling may be interrupted for various reasons,
  and hence compromising their potential for
  economic progress.
• Increase food insecurity and malnutrition.
•  

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• Difficult to uphold children's right to land and
  other property in the absence of parents.
• Drastic increase in the number of orphans (1.8
  million as of late 2001 in South and South-East
  Asia, and 85,000 in East Asia and the Pacific).
• Aid orphans are more vulnerable to crime and HIV
  infection.

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• 7.3 Impact on elderly
•  
• With the increasing number of AIDS orphans,
  parents of the victims find themselves resuming
  work as primary care takers of their children,
  instead of being cared for by their children. The
  pandemic thus contributes to creating a category
  of the poorest.
•  

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• 8.0 Policy Recommendations
•  
• 8.1 Averting future impact through prevention
•  
• Formulation of policies and programmes based on
  careful analysis of reliable data from
  comprehensive national epidemiological and
  behavioural surveillance system.
• Prevention intervention should be carefully
  targeted, prioritized and tailored to the stages
  in the epidemic.

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• Replacing ad hoc, donor-driven patch works of
  small-scale scattered projects.
• For cost-effective reasons, HIV prevention
  programmes should be integrated into reproductive
  health programmes and primary health care
  programmes.
•  
• Efforts should focus early on key high-risk
  groups, such as sex workers, IDUs and mobile
  populations (migrants, cross-border populations,
  lorry drivers).

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• HIV sentinel surveillance should be focused on
  female sex workers and STI patients to provide
  adequate warning should extensive hetrosexual HIV
  transmission begin.
•  
• Where MTCT is significant, short course of
  anti-retrovirals during the late pregnancy.
•  
• Generic drug should be actively promoted to
  improve access to ART.

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• 8.2 Alleviating the demographic impact
•  
• Comprehensive care programmes, including improved
  and expanded access to
•   Services
• Clinical care, palliative care, home based
  care
• Referral networks for PLWAS
• Support for affected children
• Alternative community-based service delivery
  through grass-roots organizations.
•  

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• 8.3 Alleviating the economic impact through
  economic support
•  
• Two complementary interrelated strategies of
  building the economic resources of households and
  supporting the creation of social safety net,
  like pensions.

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• Distribution of stable food stuffs to communities
  where the impact of AIDS has been very heavy.
• Assistance should be given in the funding of
  education and training for HIV/AIDS-affected
  children, including orphans.
•  
• Establishment of legal mechanisms to protect
  widows and orphans against loss of inheritance
  and land.

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• Appropriate measures should be taken to counter
  stigmatization and discrimination towards PLWAS
  and protect their rights.
•  
• Affordable treatment targeted to low income and
  below poverty line households.

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• 8.4 Alleviating the socio-psychological impact
•  
• Community based home-care initiations should be
  supported to support families' coping responses.
•  
• Faith based organization should be encouraged to
  provide psychological support to mitigate the
  impact of HIV/AIDS on people's lives.
• Realistic and programmatic integrated responses
  needed to avert larger scale epidemic among the
  population.
•  

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• 9. What should UNFPA do?
•  
• Technical assistance and limited financial
  support on selective basis in national capacity
  building in
• Collecting, analyzing and researching the
  demographic, social and economic impacts of
  HIV/AIDS, including its impact on families and
  communities and
• Capacity for social and behavioural research.

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• Technical and limited financial support on
  selective basis in assessing the impact of
  HIV/AIDS on poverty and development (and vice
  versa).
• Support operationally relevant research and rapid
  assessment studies to complement the quantitative
  findings of survey on HIV/AIDS.

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• Support promotion of evidence-based policy
  dialogues at different levels to operationalize
  the findings of data collection and research
  initiatives on HIV/AIDS related issues.
•  
• Strengthen countries capacity by providing
  guidance and limited financial assistance on
  selective basis to establish surveillance systems
  to follow-up infected people with HIV, as well as
  the spouses and children.

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• Technical assistance in developing cost-effective
  HIV/AIDS programmes.
•  
• Technical assistance in preparation of estimates
  of the numbers, characteristics and place of
  residence of population groups exposed to
  especially high risks of becoming infected.

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G\Rafiqul\Hiv_Aids\Final_Demo_Impact_PP_Shorter_R
HC, 27 August 2003

• Thank You!