HIV/AIDS: Insight Into Its Impact Part-I Prasanta K. Saha, M.Sc., CSTAT (UK), FRSS (UK). Chartered Statistician [RSS-UK], Visiting Fellow: University of Hawaii [EWC], USA. Ex-Professor: Asia-Pacific Institute of Management, New Delhi. Former Additional Director General (rank of Additional Secretary): Ministry of Program Implementation & Statistics, Govt. of India, New Delhi. Beforehand Chief Director: Ministry of Health & Family Welfare, Government of India, Nirman Bhawan, New Delhi 110011. M: +91.9836315936. E-mail: prasanta.saha2@gmail.com , prasant20012001@yahoo.co.in

HIV/AIDS: Insight Into Its Impact INTRODUCTION Before we analyze impact of HIV/AIDS, we need to discuss important features, concepts and definitions of this pandemic. Very Interesting Features: HIV/AIDS: predominately a sexually transmitted disease First concept surfaced in 1981. ____________________________________________ The phenomenon of HIV/AIDS surfaced first in the US in the June 5, 1981 issue of ‘Morbidity and Mortality Weekly Report’ published by US Center of Disease Control, Atlanta.

HIV/AIDS: Insight Into Its Impact Death rates among young people caused by HIV/AIDS are of extraordinarily high: perhaps first time in the history of mankind. Similar most deadly epidemic spreading all over the world was Plague. Plague destroyed adverse feudal systems in economic growth thus increasing demand of labor.

Introduction-Contd. A very interesting aspect of AIDS epidemic: it has spread globally so rapidly due to excellent means of communications in the modern world. Risk of HIV/AIDS follows inequality between the rich and the poor. In the analytical review of impact, a long perspective will be of importance. In respect of socio-economic impact of the AIDS epidemic, the impact is relevant in short and long range of time scale.

Introduction-Contd. Impact is generally measured at 4 levels: Individual Household Community National

Introduction-Contd The Horrific Impact AIDS may, it is feared, change the history of many poorest countries. It may ruin development of human society achieved in about 5 decades. Development now is to be reviewed in association with HIV/AIDS keeping in view the following: Incident of HIV infection Incident of TB: most well known epidemic Incident of AIDS illness Phase of Impact: poverty, orphaning and other effects.

Important Concepts & Definitions of Epidemic Epidemic: an unusually high rate of disease affecting a large number of people in a short time. An epidemic is a relative concept. Epidemics do not just happen. They are not random events. The disease has been used to stigmatize various groups. Stigmatization is itself an important part of the history of any particular epidemic.

Concepts & Definitions of Epidemic-contd Epidemiology: It is defined as the study of the distribution and determinants of health-related conditions and events in population and the application of this study to the control of health problems. It examines pattern of disease in totality. It displays geographical distribution and dynamics of a disease.

Concepts & Definitions of AIDS AIDS: It is difficult to define AIDS. It is not one disease but a phenomenon of a number of diseases. In the initial stage it was recognized as a Gay-Related Immune Deficiency [GRID] as it was found among homosexual men. Gradually it was identified among Injecting Drug Users [IDU] and infants born to mothers who were users of drugs. It was renamed as ‘Acquired Immunodeficiency Syndrome’ or AIDS.

Concepts & Definitions of AIDS -continued It belongs to the class of viruses known as retroviral. In many countries there is no facility or capacity to count CD4 cells, the abode of the AIDS virus. If CD4 cells counts in an individual fall below 200, the individual is called as AIDS patient. In the countries where the capacity of scientific tests of counting CD4 cells does not exist, AIDS is defined clinically.

Concepts & Definitions of AIDS -continued Experts’ opinion: HIV/AIDS was not solely a clinical-medical problem but needs to be understood through a much broader perspective. So one is to see the relation between HIV/AIDS, health and human rights. HIV/AIDS epidemic is more deeply seated. It reveals many of the fractures, stresses and strains in a society.

Concepts & Definitions of AIDS -continued Epidemiology with reference to AIDS: Epidemiology of AIDS can not be easily recognized because of lack of relevant data unsatisfactory quality of data preparation of data is based on certain assumptions biased interpretation by people of politics.

Concepts & Definitions of AIDS -continued Role of Reliable Data is extremely important: Sources: Governments, NGO, academic institutions, private sector: 2 main bodies- UNAIDS and US Bureau of Census. In most countries AIDS is not a notifiable disease: medical staff are not legally required to report cases. Data on AIDS cases need to be collected consistently and in sufficient quantities.

Concepts & Definitions of AIDS -continued Data-contd. : Most social or economic statistics have political ramifications AIDS case data have always been political Data from sentinel surveillance: Collected from pregnant women attending Ante-Natal clinics.

HIV/AIDS: IMPACT ANALYSIS Impact of an epidemic may change the history of human society. Lives get finished, some who survive get incapacitated. In the end, a society has to follow a path different from that which it would have followed previously.

HIV/AIDS: IMPACT ANALYSIS Thus we see the impact Vis-à-vis macroeconomic indicators. Research has demonstrated that it is not always possible to measure the impacts of AIDS with precision.

HIV/AIDS: IMPACT ANALYSIS As a result, projections have focused on -increased medical costs, depletion of labor force, and the slowing of national or sector specific economic growth in the long run. Lack of empirical evidence and the need for broad assumptions have placed considerable limitations on research.

HIV/AIDS: IMPACT ANALYSIS As we see, the importance of past epidemics is frequently referred to and discussed by experts. But there is some sort of insensitiveness towards impact of AIDS which is damaging many societies now.

HIV/AIDS: IMPACT ANALYSIS It is found that the macroeconomic effects of HIV are on the size and productivity of labor, level of net savings and rate of economic growth (Cohen 1992). _____________________________________ Since AIDS affects those in their most productive years, related morbidity and mortality reduce the quantity and quality of labor.

HIV/AIDS: IMPACT ANALYSIS Depending on the type of labor affected, the impact on the national economy could occur more in the medium or short term, such as the case of shortages in export sectors leading to difficulties in balance of payment problems.

HIV/AIDS: IMPACT ANALYSIS Thus Impact of AIDS results in Increased spending on health care decreasing net savings: public and private. Declined savings rates as life expectancy is decreased, Less perceived need for savings for future consumption (Mahal 2004).

HIV/AIDS: IMPACT ANALYSIS Impact on GDP or National Income: Evidence of the impact of AIDS on GDP and real per capita income has had mixed results. Overall, a large impact has not been discerned. It had demonstrated a lowered rate of annual growth of real GDP by nearly 2 percent [in some African Countries].

HIV/AIDS: IMPACT ANALYSIS A more comprehensive analysis in South Africa has also found growth of real GDP and per capita real GDP to be affected as a result of enhanced expenditure in health sector

HIV/AIDS: IMPACT ANALYSIS Econometric estimates between HIV/AIDS and national economic performance, such as by (Bloom and Mahal 1997) have found that AIDS has a statistically insignificant effect on the growth of real per capita income.

HIV/AIDS: IMPACT ANALYSIS Poverty: Although AIDS is unlikely to increase overall poverty rates, it will affect health – which is inextricably linked to poverty. A significant literature attests to the aggregate impacts of health status on real GDP; morbidity related to AIDS may follow the same pattern.

HIV/AIDS: IMPACT ANALYSIS Lastly, the impact of AIDS on life expectancy can be linked to overall human capital investments and value and the individual and national level.

HIV/AIDS: IMPACT ANALYSIS Relationship between poverty and the development of epidemics ________________________________ There is an undoubted relationship between poverty and the development of epidemics of communicable disease and at the same time epidemic disease, like any illness, has the potential to increase poverty (Stillwagon, 2001).

HIV/AIDS: IMPACT ANALYSIS Overall Economic Impact Economically far more damaging __________________________________________ According to a new World Bank study released in New York in July, 2003 ( Berthelsen 2003), while the world has focused on the human tragedy of AIDS, the fact is that economically it is far more damaging than had been thought earlier, and could result in the outright collapse of some economies if it is not checked. This study says that if AIDS were to continue unchecked, it could wreck a society in three generations.

HIV/AIDS: IMPACT ANALYSIS Sector - level Impact: Health: The health sector is likely to encounter Higher bed occupancy, Increased public health spending and A potentially overwhelmed system. _____________________________________ Example: Africa and Indian states with more concentrated epidemics are likely to experience such an impact.

HIV/AIDS: IMPACT ANALYSIS Sector - level Impact: Labor: Agriculture - decreased productivity Absenteeism Added recruitment & training costs ___________________________________________ Labor intensive sectors, on the other hand, may be adversely affected by the HIV epidemic in several ways. In agriculture, for example, decreased productivity could potentially translate into a decline in labor inputs and increased expenses related to morbidity and mortality (Bloom et al 2004).

HIV/AIDS: IMPACT ANALYSIS Labor sector continued ________________________________________ The workforce is likely to be affected by absenteeism, health care and added recruitment/training costs, lost knowledge and damaged morale (Bloom et al 2004). Increased expense on insurance, depending on company policy for HIV-infected individuals, may also affect private industry.

HIV/AIDS: IMPACT ANALYSIS Household Sector: Morbidity Mortality of HIV-positive adults Lower long-run accumulation of human capital. __________________________________________ Preliminary research demonstrates that morbidity and mortality of HIV-positive adults inflict a cost that cannot be measured simply by loss of income. Members of HIV/AIDS affected households may have lower long-run accumulation of human capital as measured by education and health (Bloom et al 2004 and citations therein).

HIV/AIDS: IMPACT ANALYSIS Time of impact-consequence: Individual: Early: death & illness Household: Early: orphans and elderly affected Community: Early, middle & late: orphans, elderly affected & local social service provision affected Production unit/institution: Middle & late: evidence of loss Sector: Late: no evidence so far found Nation: Late: no evidence so far found .

HIV/AIDS: IMPACT ANALYSIS Demographic Impact : It is a quite plausible conjecture that extraordinary magnitude of untimely deaths caused by AIDS will affect (a) mortality rate, (b) life expectancy and thereby (c) population structures after a few decades. Specific studies yet to be undertaken. Some improvement needed in assessing demographic impacts: In registration of deaths, systems are not fully reliable in many developing countries in terms of coverage and recording causes of deaths.

HIV/AIDS: IMPACT ANALYSIS Demographic Impact-continued : Another problem concerns the frequency with which demographic changes are measured: census is conducted every 10 years. Life Expectancy: AIDS has direct and immediate impact on life expectancy. The ability to have children and see them grow up is the basic expectation of most people. AIDS stymies these expectations.

HIV/AIDS: IMPACT ANALYSIS Other issues: There is a very long period of twenty years into the epidemic – disgraceful lacuna in what we know about HIV and poverty, both the ways that the epidemic exacerbates poverty and the reverse. in fact, very little is known about the more general relation between infectious disease and poverty. __________________________________

HIV/AIDS: IMPACT ANALYSIS Acknowledgement: Prof. Tony Barnett, Professor, School of Development Studies, University of East Anglia and Prof. Alan Whiteside, Director, Health Economics & HIV/AIDS Research Division, University of Natal, South Africa : Authors of the famous book titled “ AIDS in the Twenty-First Century Disease and Globalization”, Publisher: PALGRAVE Macmillan, Hampshire. According to me, this is one of the best books in the world so far as most comprehensive analysis is concerned in the field of very complex subject called HIV/AIDS. I very sincerely express my heartfelt gratitude to Prof. Barnett and Prof. Whiteside stating that I have collected some very relevant materials from your book in preparing my present lecture note which is absolutely honorary and in the interest of the readers globally.

HIV/AIDS: IMPACT ANALYSIS References: 1. Barnett, Tony and Whiteside, Alan (2006): “AIDS in the Twenty-First Century Disease and Globalization” : PALGRAVE Macmillan, Hampshire. 2. Bloom D.E. and Mahal, A. (1997): “Does the AIDS epidemic threaten economic growth?” Journal of Econometrics. 3. Cohen D. (1992): “The Economic Impact of the HIV Epidemic”. New York: United Nations Development Programme.

HIV/AIDS: IMPACT ANALYSIS References-continued: 4. Kambou G., Devarajan S., and Over M. (1992): “The Economic Impact of AIDS in an African Country: Simulations with a Computable General Equilibrium Model of Cameroon”. Journal of African Economies. 5. Mahal A (2004): “Economic Implications of Inertia on HIV/AIDS and Benefits of Action.” Economic and Political Weekly. 6. Saha, Prasanta K. and Pradhan, Basanta K.(2006) : “HIV/AIDS in India: A Review of Literature”, National Council of Applied Economic Research (NCAER), New Delhi, India

HIV/AIDS: INSIGHT INTO ITS IMPACT: Part-I THANKS