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Socio-Economic Impacts of HIV/AIDS

AIDS, while continuing to be an important health issue, has evolved into a complex social and economic emergency. HIV primarily affects young adults, cutting a broad path through society's most productive layer and destroying a generation of parents, whose death leaves behind orphans, desocialized youth and child-headed households. AIDS has a significant impact on the more educated and skilled segments of society because HIV primarily infects productive young adults rather than children or the elderly. The stigma attached to HIV and AIDS adds to the impediments encountered in mounting a response to AIDS, in addition to the discrimination already faced by infected individuals. HIV also increases social and economic vulnerability among women.

In the hardest-hit regions, AIDS is now reversing decades of development. It changes family composition and the way communities operate, affecting food security and destabilizing traditional support systems. By eroding the knowledge base of society and weakening production sectors, it destroys social capital. By inhibiting public and private sector development and cutting across all sectors of society, it weakens national institutions. By eventually impairing economic growth, the epidemic has an impact on investment, trade and national security, leading to still more widespread and extreme poverty. In short, AIDS has become a major challenge for human security.

A. Demographic Impacts

AIDS deaths are premature deaths. In countries where HIV spreads mainly through unsafe sex between men and women, the majority of infected people acquire HIV in their twenties or thirties and will die of AIDS on average a decade later. In a number of countries, AIDS has resulted in increased mortality among children under five, and is now wiping out half a century of development gains, including increases in life expectancy at birth, particularly in southern Africa, where life expectancy increased from 44 years in the early 1950s to 59 in the early 1990s. Between 2005 and 2010, it is expected to fall to 45 years and even lower in some countries.

The lifetime risk of dying of AIDS is far higher than the general prevalence rate would suggest. For example, where prevalence is 15 per cent and rates continue to apply through their lifetime, over half of today's 15-year olds will die. In Botswana, which has a prevalence rate of 36 per cent, over three quarters would die of AIDS. In some countries, these trends are reshaping the traditional population pyramid into a new population chimney," with a narrowing base of young people and children. The most dramatic change in the pyramid occurs when young adults, infected early, begin to die of AIDS. Only those adults who escape HIV infection can expect to survive to middle and old age. Also, recent studies among various African populations indicate that rates of HIV infection in young women aged 15 to 19 may be five to six times higher than in young men.

B. Social Impacts

The premature death of large numbers of young adults has an inevitable impact on those societies most affected by AIDS.

Households and Families

Households and families bear the brunt of the misery caused by AIDS. Those who fall ill become unable to work, forcing family members to care for them rather than producing food or income. According to studies of rural families in Thailand and urban families in C�te d'Ivoire, farm output and income fell between 52 and 67 per cent in families affected by AIDS. Families are also subject to discrimination if they have members who are HIV-positive, often facing reduced access to publicly available social and economic benefits.

Gender

The gender dynamics of the epidemic are far-reaching due to women's weaker ability to negotiate safe sex and their generally lower social and economic status. More women than men are caretakers of people with AIDS, which may saddle them with the triple burden of caring for children, the elderly and people living with AIDS -- as well as financial responsibility for their family's survival. Girl children or older women may find themselves at the head of households, and many girls from families facing poverty risk exploitation, especially sexual exploitation, when trying to bring in additional income. Mother-to-child transmission is also a concern.

Education

Where AIDS is widespread, education -- an essential building block of development -- is being impaired. The epidemic is eroding the supply of teachers and diluting the quality of education. AIDS also reduces the amount of money available for school fees, and forces an increasing number of children -- more girls than boys -- to drop out of school in order to help at home. As teachers become ill and unable to work, some schools are closing. In parts of Southern Africa, one fifth of teachers and secondary school students are estimated to be HIV-positive.

Health Services

Since the beginning of the epidemic, 21.8 million people have fallen sick and died of AIDS, placing ever-increasing demands on health services in the worst-affected countries. Often, this increased demand stretches already over-burdened public health systems. In 1997, public health spending on AIDS alone exceeded 2 per cent of gross domestic product (GDP) in seven of 16 African countries sampled, a staggering amount for countries whose health expenditure for all diseases accounts for 3 to 5 per cent of GDP. Adding to these increased demands is the crushing burden of AIDS on health workers themselves. A study in Zambia showed that in one hospital, deaths among health-care workers increased by a factor of 13 over a decade, largely because of HIV. Overburdened public health systems may also further marginalize minority, disabled and elderly women with HIV/AIDS. HIV-positive people also lack access to medicines and to health care, often facing discrimination from hospital staff or health-care systems.

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