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: Millennium Development Goals

e.g. South Africa 1990 <1% adult HIV infection, risen to c.25% by : 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

AIDS & Development in Sub-Saharan Africa Sub-Saharan Africa has just over 10% of the worlds 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 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 expectanciese.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 halvedso 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 dIvoire, 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 nursesin Zambia, deaths in health care workers increased 13x

(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 dayssugar 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 Brazilafter 3 years, cases down by 90% and HIV/AIDS costs down by 40%

CASE DISTRIBUTION BY AGE - Up to June/ cases PRESENT CLINICAL CONDITION Volkswagen - Brazil AIDS CARE PROGRAM

QUALITATIVE OUTCOMES o Better clinical control of patients. o Prevention and retard of the appearing of disease manifestations in the HIV(+) patient. o Better life quality - reintegration in society and in work. o 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