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@gmail.com , prasant20012001@yahoo.co.in
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.
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.
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.
Introduction-Contd.
• Impact is generally measured at 4
levels:
• Individual
• Household
• Community
• National
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.
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.
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.
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.
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.
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.
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.
Concepts & Definitions of AIDS continued
Role of Reliable Data is extremely important:
• Sources: Governments, NGO, academic
institutions, private sector: 2 main bodiesUNAIDS 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.
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.
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.
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.
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.
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.
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.
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.
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).
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].
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
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.
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.
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.
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).
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.
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.
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).
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.
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).
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 .
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.
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.
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.
__________________________________
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.
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.
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
HIV/AIDS: INSIGHT INTO ITS IMPACT:
Part-I
THANKS