Economic and Development Problems in South Africa and Africa
Session 12
AIDS
Department of Economics

Faculty of Economic and Management Sciences

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1.
Background information on HIV/AIDS
2.
Where are we in 2011? ( Epidemic update )
3.
Can concurrency explain the AIDS’ severity in
SSA? (Uganda?)
4.
AIDS and the economy
5.
Costs of AIDS?
6.
How best to combat AIDS?

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1.
What we know about AIDS (Nattrass) – good introduction to the biology of AIDS and background of AIDS denialism
2.
The Jagged Tear (Simkins) – more about education (brief section on AIDS)
3.
Still Crazy After All These Years: The Challenge of AIDS
Denialism for Science (Nattrass) – self-explanatory
4.
UN AIDS 2010 Global report – excellent, comprehensive report on the state of AIDS around the world (highly recommnded)
5.
Mitigating the impact of HIV-AIDS on Education (Coombe) –
Also education focused
6.
Children and AIDS – Stocktaking Report (2008)

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Background information on HIV/AIDS
What is AIDS?
• HIV = Human Immunodeficiency Virus
• AIDS = Acquired Immune Deficiency Syndrome
• HIV attacks CD4 cells which are immunologically important
• “The CD4+ T-lymphocyte is the primary target for HIV infection because of the affinity of the virus for the CD4 surface marker (3). The CD4+ T-lymphocyte coordinates a number of important immunologic functions, and a loss of these functions results in progressive impairment of the immune response.”
• If you are HIV+ and your CD4 count < 200  you have AIDS

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So where are we in 2011?
UNAIDS 2010 Global Report

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So where are we in 2011?

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So where are we in 2011?

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So where are we in 2011?

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Hans Rosling...

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Countries in Africa most affected by AIDS

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(ala Epstein, Rosling, Pisani)
- What is concurrency?
-
Overlapping sexual partnerships in which sexual intercourse with one partner occurs between two acts of intercourse with another partner
Using an illustration…

Effects of Concurrency
HIV Negative Male
HIV Positive Viremic
Male
HIV Positive Non-Viremic
Male
HIV Negative Female
HIV Positive Viremic
Female
HIV Positive Non-Viremic
Female
Source: Stewart Parkinson

Concurrency
December

Concurrency
January

Concurrency
February

Concurrency
March

Concurrency
April

Concurrency
May

Concurrency
June

Concurrency
July

Concurrency
August

Serial Monogamy
December

Serial Monogamy
January

Serial Monogamy
February

Serial Monogamy
March

Serial Monogamy
April

Serial Monogamy
May

Serial Monogamy
June

Serial Monogamy
July

Serial Monogamy
August

Early successes: Uganda and “
”

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UNAIDS 2010 Global Report

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20%
15%
10%
5%
0%
40%
35%
30%
25%
15-19 20-24 25-29 30-34 35-39 40-45 45-49 50-54 55+
Males
Females

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• Where is the AIDS epidemic at?
• 2009 1.2 million people received ARV’s (30% inc in 1 year)
• Expanding access to treatment  19% decline in deaths amongst those with HIV (2004-2009)
• BUT - 10 million people living with HIV eligible for treatment but don’t have access
• What are the costs of AIDS? (economic/social?)
• What is the future of AIDS? (AIDS in 2020?)
• What is the best way to combat AIDS?
• Behaviour change? (difficult)
• Make existing behaviour more responsible? (condoms)
• Managing the problem better? (ARV’s)

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Sinosizo case study

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Socio-economic impact of AIDS (Coombe)
• Financial burden of HIV/AIDS 30% > than other deaths
• Often more than one family member infected
• If income-earner(s) infected then:
• Children are removed from school to earn income* or care for the sick
• Fewer resources for education, due to lower income and increased medical costs
“ A common reason that HIV/AIDS-affected children drop out of school, or perform poorly, is lack of material resources to meet basic needs” (p34)
• The poor are particularly vulnerable to AIDS
• Less education about prevention
• More sexual abuse
• More fragile social environments  conducive to early sexual activity

1. Direct costs
AIDS  treatment (including opportunistic diseases like TB)  reduction in savings
 lower accumulation of capital (entrenched poverty).
- For government: higher spending on health, insurance, orphans
2. Indirect costs (short term)
- AIDS  invalidity  reduction in labour participation.
- Depression
3. Deferred indirect costs (long term)
-
AIDS  Alteration of the long-term choices of the agents (households and firms)  lower investment in physical & ‘ human capital (education, knowledge, know-how)
- Opportunity costs of AIDS programmes for other poverty reduction strategies & treatment of other patients
Source: Gavin George HEARD

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AIDS & demand for educational services
1.
Size of learner population
• Increasing deaths among adults of reproductive age
• Declining fertility rates
• Increased child mortality
• “It is anticipated that Zimbabwe will experience a 24.1% reduction in primary school age population by 2010; Zambia 20.4%, Kenya 13.8%, and Uganda 12.2%
(Abt Associates, 2001, p4; World Bank, 2000a, p3)” (see population pyramid)
2.
Demand for education
• Fewer resources & poor performance by affected children
• “In Malawi, during 1999, the % of children in school who had lost one or both parents increased from 12% to 17%. One third of children in one study reported they had missed school in order to care for the sick.”
3.
More complex learner cohorts
• Orphans will make up a significant proponent of children
Source: Coombe

42 Caveat…

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Variations in antenatal HIV - prevalence in Africa

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Provincially?

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• http://www.gapminder.org/world/#$majorMode=chart$is;shi= t;ly=2003;lb=f;il=t;fs=11;al=19;stl=t;st=t;nsl=t;se=t$wst;tts=C
$ts;sp=3.12322580645162;ti=2009$zpv;v=0$inc_x;mmid=XC
OORDS;iid=phAwcNAVuyj1jiMAkmq1iMg;by=ind$inc_y;mmi d=YCOORDS;iid=pyj6tScZqmEfbZyl0qjbiRQ;by=ind$inc_s;un iValue=8.21;iid=pyj6tScZqmEe1GaiYJX2qGA;by=ind$inc_c;un iValue=255;gid=CATID0;iid=phAwcNAVuyj02SA7cGjnRbA;b y=ind$map_x;scale=log;dataMin=394;dataMax=18073$map_y
;scale=log;dataMin=0.0107;dataMax=34$map_s;sma=49;smi=2
.65$map_c;scale=lin$cd;bd=0$inds=i153_h001979adam;i209_ d001981acav;i28_d001979aEaG;i235_d001979aiav

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South Africa’s AIDS awareness program

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Extremely poor HIV/AIDS leadership in SA

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One of the things you can do about it…
Get tested for HIV , even if you KNOW you don’t have it
• Know your status
• Decrease the stigma around getting tested