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AIDS IN AFRICA Public Policy Challenges Joel Samoff

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Title: AIDS IN AFRICA Public Policy Challenges Joel Samoff


1
AIDS IN AFRICAPublic Policy ChallengesJoel
Samoff
2
Adults and children estimated to be living with
HIV/AIDS as of end 2001
Eastern Europe Central Asia 1 million
Western Europe 560 000
North America 940 000
East Asia Pacific 1 million
North Africa Middle East 440 000
South South-East Asia 6.1 million
Caribbean 420 000
Sub-Saharan Africa 28.1 million
Latin America 1.4 million
Australia New Zealand 15 000
Total 40 million
Total 40 million
3
Estimated number of adults and childrennewly
infected with HIV during 2001
Eastern Europe Central Asia 250 000
Western Europe 30 000
North America 45 000
East Asia Pacific 270 000
North Africa Middle East 80 000
South South-East Asia 800 000
Caribbean 60 000
Sub-Saharan Africa 3.4 million
Latin America 130 000
Australia New Zealand 500
Total 5 million
Total 5 million
4
Estimated adult and child deaths from HIV/AIDS
during 2001
Eastern Europe Central Asia 23 000
Western Europe 6 800
North America 20 000
East Asia Pacific 35 000
North Africa Middle East 30 000
South South-East Asia 400 000
Caribbean 30 000
Sub-Saharan Africa 2.3 million
Latin America 80 000
Australia New Zealand 120
Total 3 million
Total 3 million
5
Children (lt15 years) estimated to be living with
HIV/AIDS as of end 2001
Eastern Europe Central Asia 15 000
Western Europe 4 000
North America 10 000
East Asia Pacific 7 000
North Africa Middle East 20 000
South South-East Asia 200 000
Caribbean 20 000
sub-Saharan Africa 2.4 million
Latin America 40 000
Australia New Zealand lt 200
Total 2.7 million
Total 2.7 million
6
Estimated deaths in children (lt15 years) from
HIV/AIDS during 2001
Eastern Europe Central Asia lt 100
Western Europe lt 100
North America lt 100
East Asia Pacific 1 500
North Africa Middle East 6 000
South South-East Asia 40 000
Caribbean 5 000
sub-Saharan Africa 500 000
Latin America 8 000
Australia New Zealand lt 100
Total 580 000
Total 580 000
7
Estimated number of children (lt15 years) newly
infected with HIV during 2001
Eastern Europe Central Asia 1 000
Western Europe lt 500
North America lt 500
East Asia Pacific 3 000
North Africa Middle East 12 000
South South-East Asia 65 000
Caribbean 6 000
sub-Saharan Africa 700 000
Latin America 10 000
Australia New Zealand lt 100
Total 800 000
Total 800 000
8
Cumulative number of children estimated to have
been orphaned by AIDS at age 14 or youngerat
the end of 1999
Eastern Europe Central Asia 500
Western Europe 9 000
North America 70 000
East Asia Pacific 5 600
North Africa Middle East 15 000
South South-East Asia 850 000
Caribbean 85 000
Sub-Saharan Africa 12.1 million
Latin America 110 000
Australia New Zealand lt 500
Total 13.2 million
HIV-negative children who have lost their
mother or both parents to AIDS before the age of
15 years
9
Adult and children estimated to be living with
HIV/AIDS as of end 1998
sub-Saharan Africa 22.5 million
Global total 33.4 million
World Health Organization
UNAIDSAddisMay 1999
10
Spread of HIV in sub-Saharan Africa, 1987
Estimated percentage of adults (1549) infected
with HIV
16.0 32.0 8.0 16.0 2.0 8.0
0.5 2.0 0 0.5 trend data
unavailable outside region
World Health Organization
UNAIDSAddisMay 1999
11
Spread of HIV in sub-Saharan Africa, 1997
Estimated percentage of adults (1549) infected
with HIV
16.0 32.0 8.0 16.0 2.0 8.0
0.5 2.0 0 0.5 trend data
unavailable outside region
World Health Organization
UNAIDSAddisMay 1999
12
Projected changes in life expectancy in selected
African countries with high HIV prevalence,
19952000
65 60 55 50 45 40 35
Average life expectancy at birth, in years
Botswana
Zimbabwe
Zambia
Uganda
Malawi
projections
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
Source United Nations Population Division, 1996
World Health Organization
UNAIDSAddisMay 1999
13
Increase in mortality among men 1560 between
1986 and 1997, selected African countries
80
Probability of dying from all causes
1995/96
70
60
1994
1993
50
1991
1990/91
1989
40
1995
1986
30
1990
1988
20
10
Country and survey date
0
Zimbabwe
Tanzania
Malawi
Uganda
Zambia
Source Timaeus I, London School of Hygiene and
Tropical Medicine, from Demographic and Health
Survey data
World Health Organization
UNAIDSAddisMay 1999
14
Estimated impact of AIDS on under-5 child
mortality rates Selected African countries, 2010
with AIDS
per 1000 live births
250
without AIDS
200
150
100
50
0
Botswana
Kenya
Malawi
Tanzania
Zambia
Zimbabwe
Source US Bureau of the Census
World Health Organization
UNAIDSAddisMay 1999
15
Orphans due to AIDS, 19902010
2.5
Millions
South Africa
2.0
1.5
1.0
Zimbabwe
0.5
0
1990
1995
2000
2005
2010
projections
Source Metropolitan Life Scenario 80
UNAIDSAddisMay 1999
16
Economic Growth Impact of HIV (1990-97)
Figure 2 Growth Impact of HIV (1990-97) (80
developing countries)
0
-0.2
-0.4
-0.6
Reduction in growth rate GDP per capita (, per
year)
-0.8
-1
-1.2
-1.4
-1.6
0
5
10
15
20
25
30
35
HIV Prevalence Rate ()
Source R. Bonnel (2000) Economic Analysis of
HIV/AIDS, ADF2000 Background paper, World Bank
17
Impact of HIV/AIDS on urban households, Côte
dIvoire
General population
Families living with AIDS
30 000 Francs CFA
25 000
Monthly income per capita
20 000
15 000
Monthly consumption per capita
10 000
5 000
Savings/Disavings
0
5 000
Source Simulation-based on data from Bechu,
Delcroix and Guillaume, 1997
UNAIDSAddisMay 1999
18
Expected AIDS treatment costs as a share
government health spending
70
of MOH Budget
60
50
40
30
20
10
0
Ethiopia, 2014
Kenya, 2005
Zimbabwe, 2005
Source Stover Bollinger, 1999
UNAIDSAddisMay 1999
19

Bed occupancy required for AIDS patients, Zimbabwe
1990
2000
AIDS beds
  • Non-AIDS beds

Source UNAIDS, 2000
20
AIDS care costs vs. Ministry of Healthand Child
Welfare budget Zimbabwe
2 500 2 000 1 500 1 000 500 0
Z millions
MOHCW Budget
AIDS care
1992
1995
2000
2005
projections
Source HIV/AIDS in Zimbabwe, 1998
UNAIDSAddisMay 1999
21
Impact of AIDS on employee benefits in South
Africa
percent of salary
20
Disability pension
18
16
Spouses pension
14
12
10
Lump sum at death
8
6
4
2
0
1995
2000
2005
projections
Source Southern African Economist, 1997
UNAIDSAddisMay 1999
22
Change in per capita GDP caused by AIDS, Kenya
6 200 6 000 5 800 5 600 5 400 5 200 5 000 4 800
K. Sh.
No-AIDS scenario
With-AIDS scenario
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
projections
in 1985 Kenyan Shillings
Source AIDSCAP, 1996
UNAIDSAddisMay 1999
23
Production in households with an AIDS death in
Zimbabwe
  • Crops
  • Maize
  • Cotton
  • Vegetables
  • Groundnuts
  • Cattle owned

Reduction in output 61 47 49 37 29
Source P. Kwaramba 1997
24
Impact of AIDS on Human Development Index (HDI)
in South Africa
0.65 0.60 0.55 0.50
HDI
without HIV
with HIV
1995
2000
2005
2010
projections
Source HIV/AIDS Human Development South
Africa, UNAIDS UNDP
UNAIDSAddisMay 1999
25
HIV prevalence in Nigerian military personnel
according to years of duty as peacekeepers, 1998
- 1999
16
14
12
HIV prevalence ()
10
8
6
4
2
0
1
2
3
Years of duty as peacekeepers
Source Adefolalu A. 3rd All African Congress of
Armed Forces and Police Medical Services,
1999, Pretoria
26
Funeral expenses, commercial farm, Kenya

Source Rugalema et al. 1999
27
From Health Issue to Development Crisis
  • Destruction of social capital
  • Knowledge base of society
  • Production sectors agriculture, industry
  • Weakening of institutions
  • Governance, civil service, judiciary, armed
    forces, education, health
  • Inhibition of private sector growth
  • Wider, deeper poverty

28
HIV/AIDS changes the welfare of countries
  • In 1998 UNDP estimated that the Human Development
    Index (HDI) of South Africa would be 15 lower
    due to AIDS in 2010.
  • Source HIV/AIDS Human Development South
    Africa, UNAIDS UNDP, 2000

29
Impact at the Household Level
Production earnings
Investment and consumption
Household health and composition
Psychic costs





Reduced

Medical costs

Health maintaining
Disutility to
income
activities reduced
individual

Funeral costs




Reduced
Loss of deceased
Grief of



productivity

survivors
Legal fees



Poor health of



Reallocation of
survivors

Dissavings
labour land



Dissolution of
Changes in

household
consumption
investment
Source Terminology - S. Kongsin, 2000
30
Household Impact of HIV/AIDS in Rwanda
  • In a four health facility survey
  • Annual per capita use of outpatient health
    services was 11 visits per year for PLWHA
    compared with 0.3 visits in the general
    population
  • Annual per capita health expenditures in
    households were 63 for HIV/AIDS patients comped
    to 3 for households on average
  • Fewer than 30 of households were able to meet
    the costs of health care from their own resources

Source Schneider et al, 2000 paper presented at
IAEN symposium, 2000
31
Orphans A Lost Generation
  • Numbers are large and growing
  • Social support systems are overwhelmed
  • Risk of a lost generation
  • little or no education
  • poor socialization
  • social upheaval
  • economic underclass

32
Household Impact Caring for Orphans
  • A study from Uganda shows that 25 of households
    are providing for an orphan
  • Source Lyons, M. 1997
  • A study from Tanzania shows that 21 of the
    families in Bukoba district were fostering an
    orphan
  • Source Rugalema, 1999

33
Impact on the Business sector
  • The impact on business depends on the benefit
    package offered by individual firms include
  • costs of treatment and funerals,
  • absenteeism,
  • replacement workers,
  • reduced productivity
  • re-training and
  • family pensions

34
Costs to Businesses
  • Costs of HIV to 5 firms in Botswana is estimated
    to rise 7 times between 1996 2004 to equal 5
    of the wage bill
  • Source Greener, R. 1997
  • Production loss as a result of AIDS was shown to
    be more than 3 of gross profit in 1995/96 on a
    Malawi tea estate
  • Source Jones, C. 1997

35
The cost of AIDS to business depends on labor
intensity ( of profit)
16 percent
14
1994
12
2005
10
8
6
4
2
0
Textile
Light Mfg Svcs
Wood processing
Sugar Estate
Transportation
Average
Source AIDSCAP, 1996
36
Demand Supply for Education
  • Demand
  • The school enrollment rate among orphans was 39
    in Central African Republic, two thirds of the
    national rate of 60
  • Source Survey from CAR, UNICEF, 1999
  • Supply
  • 12 of all educators in South Africa were
    estimated to be HIV positive in 2000
  • Source Coombe, C. 2000

37
Children who have lost a teacher to AIDS
  • More than 1 of the children in 19 countries have
    experienced a teacher who has died from AIDS
  • More than 2 of the children in Namibia have
    experienced a teacher who has died from AIDS
  • In Zambia and Zimbabwe, the percentage is more
    than 3
  • In Botswana, with the highest HIV prevalence in
    Africa, 4 of the children have lost a teacher to
    AIDS.

Source UNICEF/UNAIDS, 2000
38
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39
Notwithstanding the image of crisis, there have
been some successes? Uganda?
Sénégal
40
Notwithstanding the image of crisis, there have
been some successes? Uganda public
recognition of HIV/AIDS, public
discussion
41
Notwithstanding the image of crisis, there have
been some successes? Uganda public
recognition of HIV/AIDS, public discussion
HIV/AIDS as a family or community, rather than
individual, issue
42
Notwithstanding the image of crisis, there have
been some successes? Uganda public
recognition of HIV/AIDS, public discussion
HIV/AIDS as a family or community, rather than
individual, issue? Sénégal registration of
prostitutes gtgt free regular medical care gtgt
reduction in STDs gtgt reduced transmission of
HIV/AIDS
43
Notwithstanding the image of crisis, there have
been some successes? Uganda public
recognition of HIV/AIDS, public discussion
HIV/AIDS as a family or community, rather than
individual, issue? Sénégal registration of
prostitutes gtgt free regular medical care gtgt
reduction in STDs gtgt reduced transmission of
HIV/AIDS ? For both Uganda and Sénégal type
and strain of HIV
44
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45
Is there an AIDS crisis in Africa? A
pandemic?? Skepticism about measurement, data,
assumptions There is no AIDS HIV does
not cause AIDS
46
Is there an AIDS crisis in Africa? A
pandemic?? Skepticism about measurement, data,
assumptions ? Critics There is no AIDS
HIV does not cause AIDS
47
How to decide which treatment(s) to use??
Double-blind tests On whom? Under what
circumstances?? Ethics of medical testing
There is no AIDS HIV does not cause AIDS
48
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49
Policy Challenges1. Government role
50
Policy Challenges1. Government role2. Access
to medical care, both preventive and curative,
including drugs
51
Policy Challenges1. Government role2. Access
to medical care, both preventive and curative,
including drugs3. Data gathering what? by
whom? how? accessible to whom?
52
Policy Challenges1. Government role2. Access
to medical care, both preventive and curative,
including drugs3. Data gathering what? by
whom? how? accessible to whom?4. Whatever is
government policy, who is responsible for
implementing it?
53
Policy Challenges1. Government role2. Access
to medical care, both preventive and curative,
including drugs3. Data gathering what? by
whom? how? accessible to whom?4. Whatever is
government policy, who is responsible for
implementing it?
54
(No Transcript)
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