Soewarta Kosen National Institute of Health Research & Development, Jakarta, Indonesia


• Despite increased global commitment to control HIV/AIDS Pandemic in the last decade, the virus continues to transmit at alarming speed • At present about 65 million people have contracted the HIV virus globally • Over 22 million people have died from HIV related illness • In South Saharan Africa and in countries such as Botswana, Swaziland and Zimbabwe; the epidemic produces illness, death, poverty and misery • In that region, 57 % of those


• With only 10 % of the world’s population, it accounts for 66 % of all HIV infections worldwide and more than 75 % of AIDS related deaths • Beside killing people, HIV/AIDS imposes a heavy burden on families and communities; and on agricultural sustainability, business, the health sector, education and national economic growth • The disease diminishes the capacity of African countries to maintain the previous


• Across African continent, HIV/AIDS manifests itself as an immediate crisis and a systemic condition • A crisis, because of the high speed of transmission; infection rates have increased from 4 to 20 % or more among adult population in a decade • A systemic condition, since it impacts heavily on the prime (productive)


• With HIV seropositivity levels reaching 35 % or more in countries (e.g. Botswana, Zimbabwe and Swaziland); urge the national governments to focus not only on the crisis condition, but also to focus on the systemic characteristic of the epidemic • The disease is already having a devastating impact on African

Demogra phic impact of HIV/AIDS

• A devastating demographic impact has been resulted in loss of life and population • The UN in 2002 after incorporating the effects of HIV/AIDS for the 53 hardest-hit countries (where 90 % of the adults living with HIV); estimated that the annual number of excess deaths reached 1 million in early 1990s, and over 4

Demograph ic impact of HIV/AIDS

• About 100 million additional deaths are expected in 38 most affected African countries by 2025 as a result of the HIV epidemic; this means those countries will have 14 % fewer inhabitants than without HIV Epidemic • Outside Africa, the demographic effects are relatively moderate. Prior to 2025, AIDS is expected to cause 31 million additional deaths in India and 18 million in China • By 2020-2025, nearly ten years of of life expectancy will be lost in those 38 countries • Significant reduction of life expectancy will also be experienced by developing countries outside Africa, such as

Demograph ic Impact of HIV/AIDS

• Botswana, at present has the highest HIV prevalence rate in the world, with the current LE around 40 years as a result of deaths related to AIDS (LE was 65 years in 1990-1995) • Similar conditions are also experienced by Zimbabwe, Angola, Lesotho, Malawi, Mozambique, Rwanda and Zambia • A severe deficit of working age people will be experienced by 2025 • Population pyramid have a

The Populati on Chimne y

The SocioEconomi c Impact of HIV/AIDS

Many studies predict that the disease will substantially reduce economic growth in Africa and hit on several fronts at once, resulting in:
– Reduced savings & investment – Loss of experienced labor & lowered productivity – Excessive absenteeism – High health care & death benefits costs – Reduced returns on investments in health &

The SocioEconomi c Impact of HIV/AIDS

• HIV/AIDS is a serious threat to the economic productivity and profitability of countries with high infection rates • The most damaging impact are the younger and productive population • The loss of trained and skilled workers in their prime has severe implications for development and business: reduce economic growth and alter the economic structure • Stigma, prejudice, ignorance and discrimination cause difficulties in raising

The SocioEconomi c Impact of HIV/AIDS

• HIV/AIDS has changed from a “health issue” to a “development crisis” • Ability of countries to improve economic condition and social wellbeing is threatened • The scale of infection in many African countries has economic implications at households, national budgets and businesses • Sustainable development is feasible if countries can tame the diseases that disempower people, to prevent the damaging of social fabric, diminishing agricultural and industrial production, undermine political, social and economic stability and contribute to regional & global insecurity

Househol d Level Implicatio ns

• Increased cost of medical care • Decreased ability of a family to earn income or undertake productive and domestic work • In Zimbabwe (UNAIDS 2000), agricultural production in households with an AIDS death decreased significantly: Crops: Reduction in output: Maize 67 % Cotton 47 % Vegetables 49 % Groundnuts 37 % Cattle owned 29 %

Househo ld Level Implicati ons

• Increased AIDS related poverty • Rising numbers of orphan children; taking in orphaned children will add burden of the poor households • Destroys human capital selectively (people with accumulated experiences, job skills and knowledge) • Threat of worsening inequality • Standards of living fall

Structur al Implicati ons

• The need to replace lost staff in public service • Loss of experienced labor • Lower quality of work • Problems in human resource planning of various sectors to maintain essential public services • The need to keep economic development on track and to ensure national security • Mitigating gender dimension of the epidemic

Affects to Private Sector

• The private sector ability to compete with large numbers of sick workers has been reduced drastically • National economy is affected due to the illness & death of producers and diversion of resources to care • The costs include:
 Absenteeism  Replacement workers  Reduced productivity  Family pensions

The impact on health care systems

• Inadequate health care systems even before the epidemic • The epidemic creates enormous demands of the health care, straining health budgets and health insurance schemes • Health care workers also suffer and die • The supply of available health services and hospital resources are depleted, while the demand increases • Rising health care costs for HIV/AIDS and the opportunistic

Table: The direct costs of AIDS and non-AIDS deaths in Tanzania
Cause of death HIV/AIDS Other diseases Injuries
Expenditure (US$): Median Expenditure on medical care Expenditure on funeral Total expenditure 44 114 Mean 70 31 71 Median Mean 49 31 72 41 22 50 Median Mean 28 38 66 28 42 42 0

The impact on educati on

• Hindrance for maintaining or achieving universal primary education • Failure to afford children’s educational requirement costs • Weakens educational systems and decreased school attendance due to caring the sick family member or taking over domestic duties • Decreased quality of education, since it is

The impact on econo mic growth

• Annual reductions of GDP from 2 to 4 % • More appropriate than GDP, larger negative impact on welfare and development: children’s education, nutrition and health • Lowered investment in the human capital • Exacerbate income inequality


• The epidemic has continued to spread, but much less quickly in countries where national policies have taken the AIDS epidemic seriously, that is Brazil, Mexico, Senegal, Thailand and Uganda • Countries need to combat the AIDS epidemic more urgently to prevent progressive economic collapse within several generations • Impact on economic growth and development, added with the direct impact of increased mortality and morbidity on the lives of the poor, makes

Successf ul UGANDA’ s HIV preventi on program

• Strong political commitment • Intervention to empower women & girls • A strong focus on youths • Active efforts to fight stigma and discrimination • Emphasis on open communication about HIV/AIDS • Engagement of the religious leaders • Creation of confidential VCT interventions • Emphasis on STI control & prevention

Lesso ns Learne d

The effective successful programs had features in common, namely: • high level political leadership • active engagement of civil society and religious leaders • population based programs to change social norms & promote safe behaviors • condom promotion • surveillance & control of STD • programs to combat stigma and discrimination • interventions targeting key “bridge” populations • extension of mass media IEC

Mitigation of the Socioecono mic Impact

• An effective policy framework is critical for harmonizing and focusing the national response to the impact • The comprehensive national policy on mitigation of the impact shall provide the framework in which all stakeholders involved in mitigation will work • Existing sectoral policies need to be adjusted, to be in line with the national

Mitigation of the Socioecono mic Impact

• Effective engagement of civil society is important to the success of mitigation interventions • Advocacy initiatives need to be developed and implemented to increase awareness of the disease impact and the need for comprehensive mitigation action by

Future Impact

The future impact of the HIV epidemic depends on: • Educating people about the dangers of the virus and the behavior change • Finding effective ways to prevent the virus from spreading further • Discovering new medicines & treatment protocol • Mobilizing the financial & human resources to

General Assembly WHO (2001) Declaration of Commitme nt on HIV/AIDS

“the global HIV/AIDS epidemic, through its devastating scale and impact, constitutes a global emergency and one of the most formidable challenges to human life and dignity, as well as to the effective enjoyment of human rights, which undermines social and economic development throughout the world and affects all levels of society: national, community, family and individual”

Discussi ons

• It is clear that people afected by HIV/AIDS have difficulties accessing basic services and protecting their rights, including access to health care, shelter, education, food and land rights • HIV/AIDS undermines development across all sectors of the country • Community organizations and local institutions need to be strengthened and empowered; to be able to cope with the impact of HIV/AIDS, including caring and provide education for orphans • The socioeconomic impact of HIV/AIDS on livelihood and social security at national level, in communities, families and individuals need to be assessed

Discussi ons

• HIV/AIDS will impact on education through lowering of demand for education • Burden on the health care system due to the epidemic is increasingly obvious • Mobility and tourism increasing the risks of HIV/AIDS transmission • Despite the low impact at macroeconomic level, a strong political commitment to fight

Conclusio ns

The course of the HIV/AIDS epidemic is not predetermined In order to conquer HIV/AIDS, greater efforts and resources will be required The eventual course depends on how individuals, communities, nations and the world respond to the HIV/AIDS threat

Thank You