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%

STABLE 85%

BETTER12%

WORSE3%

19 - 29

30 - 39

40 - 49

50 - 59

> 60

15 %52 %

20 %

8 %

5 %

CASE DISTRIBUTION BY AGE - Up to June/1996 - 115 cases

PRESENT CLINICAL CONDITION

Volkswagen - Brazil AIDS CARE PROGRAM

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