A new challenge?
HIV/AIDS as a development issue
AIDS
• AIDS (acquired immune deficiency syndrome): a
weakening of the immune system by the human
immunodeficiency virus, HIV.
• The sufferer loses the ability to fight infection, and
may fall victim to illnesses such as pneumonia,
diarrhoea, and tumours.
• It was first identified in the early 1980s, but the first
case of the disease may have occurred much
earlier - in Africa in the late 1950s (BBC 2005).
Source: UNAIDS.org
Source: UNAIDS.org
Source: Millennium Development Goals
e.g. South Africa
• 1990 <1% adult HIV infection, risen to c.25% by
2000
• 2004: HIV prevalence among pregnant women
attending antenatal clinics: 29.5% tested positive
• Deaths amongst people 15 years of age and older
increased by 62% from 1997-2002
AIDS & Development in Sub-Saharan Africa
• Sub-Saharan Africa has just over 10% of the
world’s population
• But more than 60% of all people living with HIV
(25.8 million) live there.
• In 2005, an estimated 3.2 million people in the
region became newly infected, while 2.4 million
adults and children died of AIDS.
Why is Africa so badly hit?
• governments were slow to respond
• cultural values
• inoculation campaigns
• exacerbated by poverty, illiteracy, weak educational
and public health systems and the low social status
of women.
AIDS as a development crisis
1. changes to population structure
• dramatic change around 10-15 years after
people become sexually active
• typically half become infected before they turn
25, acquiring AIDS and dying before 35
 get population chimney rather than a pyramid
New life expectancies—e.g. Zimbabwe, chance of dying
before 50:
• Man who was 15 in 1983 had a 15% chance
• Man who was 15 in 1997 had a 50% chance
(Rates for women are lower but growing faster)
• often not much support available from government
 relying on traditional support networks
2. social & economic effects
(a) education
• 5 million children have been
infected with the HIV virus
• 15 million children under age 18
have lost one or both parents to
AIDS. More than 12 million are in
sub-Saharan Africa
• The chances of orphans going to
school is halved—so far AIDS has
left behind 13.2 million orphans
• needed to stay at home and look
after sick parents or go and make
money
• erosion of number of teachers
(b) health sector
• new drugs are very expensive
• 85% of South Africans who needed antiretroviral
drugs were not getting them in 2005; same for 90%
or more of people in Ethiopia, Ghana, Lesotho,
Mozambique, Nigeria, Tanzania and Zimbabwe
• BUT, at least 33% receiving it in Botswana and
Uganda; 10-20% in Côte d’Ivoire, Kenya, Malawi
and Zambia
• mid 1990s 66% health spending in Rwanda was on
people with HIV; >25% in Zimbabwe
This has implications for society as a whole:
• mortality amongst those with other diseases also
increases
• increasing deaths amongst doctors and nurses—in
Zambia, deaths in health care workers increased 13x
1980-1990
(c) agriculture
• important to large number of people (subsistence)
• may not be able to sell crops at market or may not
produce enough for household survival
• by exacerbating poverty it makes populations more
vulnerable to the spread of HIV.
 vicious circle
(d) business
• Stigma and discrimination can threaten the
fundamental rights of employees living with HIV.
• losing workers, and work through sick days—sugar
estate owners in Kenya reckoned that 75% of all
illness due to HIV/AIDS
• evidence from other parts of the world that
businesses which provide support are seeing an
effective decrease in HIV rates
• e.g. South African gold mines; Volkswagen in Brazil—
after 3 years, cases down by 90% and HIV/AIDS
costs down by 40%
Volkswagen - Brazil
AIDS CARE PROGRAM
CASE DISTRIBUTION
BY AGE - Up to June/1996 - 115 cases
20 %
8%
5%
52 %
15 %
STABLE
85%
19 - 29
30 - 39
40 - 49
50 - 59
> 60
BETTER
12%
WORSE
3%
PRESENT CLINICAL CONDITION
Volkswagen - Brazil
AIDS CARE PROGRAM
QUALITATIVE OUTCOMES
 Better clinical control of patients.
 Prevention and retard of the appearing of disease
manifestations in the HIV(+) patient.
 Better life quality - reintegration in society and in
work.
 Better level of the employee's satisfaction at the
company.
(e) AIDS and Security
• During armed conflict, people often face displacement
and human rights abuses, including sexual violence, and
left in conditions of poverty and powerlessness that
might force some individuals to sell sex to survive.
• Infrastructure may be destroyed, and prevention and
curative health services disrupted. Such conditions put
populations at increased risk of HIV infection
• Women and children are especially vulnerable.
• Civil and international conflicts help spread HIV as
populations are destabilized, and armies move across
new territories.
African success stories? Uganda
• Since 1992/93 the rate of HIV infection
has been dropping.
• political will and community involvement
• education campaign.
“One Aids campaigner told
me that Uganda had been
fighting while three-quarters
of Africa had been asleep”.
BBC 2005