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  1. The impact of HIV/AIDS on the economy and productivity Presentation to the Portfolio Committee on Arts, Culture, Science and Technology September 2002 Dr Debbie Bradshaw Burden of Disease Research Unit Medical Research Council

  2. Adults and children estimated to beliving with HIV/AIDS (end of 2001) Eastern Europe & Central Asia 1 million Western Europe 550 000 North America 950 000 East Asia & Pacific 1 million North Africa & Middle East 500 000 South & South-East Asia 5.6 million Caribbean 420 000 Sub-Saharan Africa 28.5 million Latin America 1.5 million Australia & New Zealand 15 000 Total: 40 million

  3. Trend in antenatal HIV seroprevalence in South African public services

  4. Comparison of empirical age specific rates with 1985 baseline

  5. Numbers infected, sick and dead, ASSA2000

  6. Waves of the AIDS epidemic, ASSA2000

  7. Number infected by stage, ASSA2000

  8. Projected number of deaths in 2000 and 2010, ASSA2000

  9. 2010 Population projection with and without AIDS, ASSA2000

  10. Treatingopportunisticdiseases Africantraditional healers A systems model of the AIDS epidemic – adapted from Whiteside Weather & climate change Education Global competition & economy challenges & influences Mores & customs (multiple sets of these) Aboveaverage survivors scarce educators die Role of women Economicorganisation Social cohesion brings better provides skilled people affect changes affect affect Spiritual & political authority Beliefs Migration & mobility Notions of masculinity Religion Shareholderexpectations & values challenges& influences Circumcision Stable & settled workers Migrant & mobile workers Determinesnature of NGOinvolvement Jobs create affect creates vacancies I n f l u e n c e Housing & land Urbanisation affects uptake of drive Tension of two worlds affects influences sustains Economy Businesssector involvement create provides create sustains Safety, crime & war support Life force, procreation, sex urge perceptions of risk Leadershipin society Improves weakens increases improve affects affect reduces productivity Hazardousoccupations Drain on Reduces demand inhibits promotes risk taking &risk avoidance Incapacity & absenteeism inprivate sector & civil service Drives AIDS testing & counselling Cost of hiring & retraining provides provides Individual Behaviour affects Population stops growing, and ages Self-confidence promiscuity Diet &nutrition AIDS education & awareness Support Chastity,Fidelity Cost to individuals & households : medication, care, burial, & orphans improves reduces Healthy lifestyle Condom use Personal responsibility increases skilledworkersdie Sex industry interventions causes prevents increass extends increaces G i v e s r i s e t o reduces values, profits, patents, prices, research AIDS Deaths(death rate) increases HIVEpidemic(prevalence) LatencyPeriod(avg 8 yrs) HIV Transmission TreatingSTD’s AIDS related Disease reduces Business sector involvement Promote/hamper Increaces?decreases? Govtpolicies reduce reduces prevent Viral mutation hampers prevents extends cures Above average survivors:chaste & faithful, long term thinkers,tertiary educated,non-migrant families,settled LT employees, high income, cohesive& candid societies, grandparents Above average mortality:unemployed, orphans,soldiers, sex workers,hazardous occupations, migrants, temps, contract workers, newly prosperous, young women, uncircumcised men, & partners of all the above Promote/hamper Medical interventions for HIV-AIDS Anti-retroviraltreatment Microbicides Immunisation Motherto childtreatment Funding for health care, infrastructure, sanitation Business sector involvement more orphans

  11. Pathways to economic impact • Morbidity • - reduce productivity • - increase costs (medical care, funerals) • Mortality • - reduce skills • - increased orphans • - reduce population • - age change in population Individual Household Labour market Sector Government • }

  12. Costs in the workplace • Absenteeism – labour lost due to sickness • Lower productivity – even when they are at work, HIV+ persons may not be able to work at full efficiency • Funeral attendance • Higher overtime costs – staff have to work longer hours to fill in for sick co-workers • Ultimately, loss of trained people at all levels – recruitment and training costs

  13. HIV surveillance for strategic planning – MRC HIV Preventions and Vaccine Research Unit • To provide accurate data on current extent of problem • Future projections • Baseline data for HIV and behaviours to monitor interventions • Assist with development of health promotion and other interventions

  14. Sector impacts – Health sector HIV related admissions occupy hospital beds • Explosive increase in tuberculosis (affects 40% of HIV+ people in Africa) • Increased risk of TB infections in HIV- people • Illness and deaths among trained staff

  15. Sector impacts - Education • Teachers are sick or dying • - in Central African Republic between 1996-1998 as many teachers died as retired • - Zambia lost 1300 teachers in 10 months during 1998 (equivalent to the annual output of the country’s teacher training colleges) • Children quit school • - to look after sick parents or siblings • - to raise money

  16. Local Government Identified as key level to put into effect creative and effective HIV/AIDS programmes and policies • Essential to protect services and maintain good governance • Increase and strengthen HIV/AIDS response Thomas et al, 2001

  17. Multisectoral challenges • Fragmentation • Communication and co-ordination • Policy development and implementation • Funding and disbursement • Monitoring and evaluation (and data sharing) Van Rensberg et al, 2002

  18. Core issues • Poverty alleviation • Rural neglect • Capacity development and empowerment • Gender, youth and child mainstreaming Van Rensberg et al, 2002

  19. Priorities • Finding ways to cope with the growing number of orphans • Sectoral impact assessments – and policies and implementation

  20. Acknowledgements Centre for Actuarial Research, University of Cape Town Centre for Health Systems Research and Development, Free State University Health and Development Research Group, Medical Research Council HEARD, University of Natal HIV Prevention and Vaccine Research Unit, Medical Research Council

  21. References Actuarial Society of South Africa. The demographic and AIDS model ASSA2000. Dorrington R, Bourne D, Bradshaw D, Laubscher R, Timaeus I. The impact of HIV/AIDS on adult mortality in South Africa. MRC Technical Report 2001. Thomas L, Crewe M, Walker L, van den Heever A, Bliebaum U. Impact of HIV/AIDS on local Government with specific consideration of INCA’s sphere of business. MRC Report 2001. Johnson L, Dorrington R. Orphans report. UCT Centre for Actuarial Research Report, 2001. Van Rensburg D, Friedman I, Ngwena C, Pelser A, Steyn F, Booysen F, Adendorff T. Strengthening local government and civic responses to the HIV/AIDS epidemic in South Africa. Centre for Health Systems Research and Development Report 2002. Whiteside A. Sectoral impact: what we know, don’t know and need to know: the true costs of AIDS. 14th International AIDS Conference, Barcelona 2002.