AIDS (Acquired Immune Deficiency Syndrome) is caused by the Human Immunodeficiency Virus (HIV). In order for the virus to attack a person's immune system, it has to enter the bloodstream and there are three ways in which this may occur:
- Through sexual intercourse - this includes both heterosexual and homosexual intercourse, although most infections in the developing world are transmitted heterosexually.
- Directly into the bloodstream through use of contaminated blood or blood products, or sharing of intravenous drug-injecting equipment.
- From mother to child - it is estimated that about one third of infants born to infected mothers will be infected. This may occur prior to birth across the placenta, during birth, or via breast milk.
One of the crucial points that has to be made about the HIV/AIDS epidemic is that it is different from most other epidemics and diseases, and consequently requires a different and much broader response - one which must encompass far more than the health sector. The factors that make it unique are:
- It is a new epidemic. AIDS was first recognised as a specific condition only in 1981 and it was not until 1984 that the cause (and a test to detect it) was identified.
- It has a long incubation period. Persons who are infected by the virus may have many years of productive normal life, although they can infect others during this period. It is not certain how long this latent period is; estimates range from five to fifteen years, with the shorter period being found in the developing world, where people are less healthy and well nourished. It is known that good health and nutrition, and early treatment of opportunistic infections, will extend the period of healthy and productive life. Unfortunately infected children will, for the most part, die before their fifth birthdays.
- The prognosis for people infected with HIV is bleak. At the end of the incubation period, a person will usually experience periods of sickness increasing in severity, duration and frequency, until he/she dies.
- The disease is found mainly in two specific age groups: children under five, and adults aged between 20-40 years. For various reasons there seem, in the developing world, to be slightly more females than males infected, and women develop the disease at a younger age.
- The scale of the epidemic is also different from most other diseases. As Table 1 shows, in some settings, up to 30 per cent of ante-natal clinic attendees are infected. This means that between 20-25 per cent of sexually active adults may be infected.
- HIV is mainly sexually transmitted, which means it is passed on through one of the most fundamental human activities, but one with which we are neither open nor comfortable.
- There are links between HIV and other diseases, most notably tuberculosis, which has further implications for public health.
- In general, the epidemic is still spreading in the developing world, although there are signs that the level of infection may have peaked in some areas.
Table 1. HIV Prevalence, Selected Sites and Countries, Ante-natal Clinic Attenders (% HIV+)
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The result of infection is an increase in morbidity (sickness) and mortality (death). There are few data on increased morbidity but the effect on mortality has been predicted (see Figure 1).
Attempts to predict and plan for the impact of the epidemic have foundered, firstly on the fact that nowhere has it run its course, thus we do not have examples of what might happen. Secondly, there is a paucity of good primary fieldwork and data; and thirdly, like the epidemic, the response is dynamic, thus people evolve coping mechanisms and strategies. Nonetheless, some results have been observed and predictions can be made.
The effect of an infection is felt first and most immediately by the person who falls ill and their family. It then spreads like a ripple out through the household, community, and then through the country as a whole. This interaction is illustrated in Figure 2. It should be remembered that while an individual may not be a producer, he or she will always be a consumer and have social roles. Broad areas of concern for development assistance, where we expect the epidemic to have an impact, are demographic, economic and developmental.
Demographic Consequences AIDS will not stop population growth, nor cause populations to fall, thus any idea that “AIDS is the solution to the population problem” is unfounded. What it will do, in some regions, is to slow the rate of population growth and alter the structure of the population. Of particular concern is the increased mortality in the 20-40 year age group. This has the effect of reducing the working age population and increasing the dependency ratio. Most women will complete their child-bearing before falling ill so the number of orphans will rise.
Economic Effect
AIDS will have an effect on economies at various levels. The most obvious is at the household level. A household with a infected member will find that expenditure increases as the person requires medical care, a special diet and so on. If the infected person is an adult then their labour will be lost, which may affect income if the person was in paid employment or producing goods for sale, and will reduce household welfare.At the sectoral and firm level the impact AIDS has will depend very much on how the sector or firm uses labour, what level of labour is employed, how the workers are treated in terms of benefits, and the importance of experience. In some instances the epidemic may have a significant effect on efficiency and cost, while in others the effect will be minimal.
The macro-economic impact is also uncertain. It is believed that AIDS will affect national economic growth through diversion of savings to care and consumption (thus reducing investment), and through the illness and death of productive members of the society.
There have been attempts to model the economic impact for specific countries. These models show that HIV will probably reduce the rate of economic growth; and, over a period of 20 years, this may be significant (up to 25 per cent lower than it would otherwise have been).
The Effect on Development
It is increasingly argued that development is about more than economic growth and increases in GDP per capita. It is on the development indicators that the impact of the epidemic will be felt first and worst.Particularly vulnerable are the indicators of life expectancy; infant mortality rates; child mortality rates and the crude death rate. Infant mortality rates may nearly double in Zambia and Zimbabwe and increase by 50 per cent in Kenya and Uganda. Child mortality rates will increase even more, as many children survive beyond their first birthday. Life expectancy is predicted to fall by an estimated 9 years in Zaire to more than 25 years in the worst affected countries by the year 2010 (Way and Stanecki, 1994).
The effect of AIDS will be to reverse hard-won development gains and to make people and nations worse off. It is possible that these effects may last for decades. The people who fall ill and die are the parents and leaders in society, which means that a generation of children may grow up without the care and role models they would normally have.
Conclusion
It is clear that HIV/AIDS presents a major challenge to developing countries. The question remains as to what can be done about it. The obvious response is to reduce the number of infections. This includes 'technical solutions', such as making the blood supply safe, treating STIs, and providing condoms, but these interventions will not be successful if they are imposed without an understanding of the social and economic factors that determine both behaviour and the response to the epidemic.The sad reality is that in many countries a significant number of people are already infected. While prevention must remain a priority: - there are those who are as yet uninfected and other who are becoming sexually active - there is a need to plan for the impact of the epidemic. The number of people falling ill and requiring care will increase. The rise in mortality and its consequences will have to be accommodated.
Thus while the first response is prevention, the second is to plan for and mitigate the impact of the epidemic. This is hard to do because: in most settings the impact is not visible; it is incremental rather than catastrophic; AIDS is only one of a number of problems facing policy makers; and there have been only a limited number of ideas as to what can be done.
References:
Lieve Fransen and Alan Whiteside, (eds.), HIV/AIDS and Development Assistance, Workshop Proceedings, Brussels, 13 June 1996.Peter O Way and Karen A Stanecki, The Impact of HIV/AIDS on World Population, US Bureau of the Census, Washington DC, 1994.
World Bank, AIDS Prevention and Mitigation in Sub-Saharan Africa, An Updated World Bank Strategy, Report No. 15569-AFR, Human Resources and Poverty Division, Technical Department, Africa Region, Washington DC, April 20, 1996.
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