Demographic and poverty dynamics with high AIDS mortality Ian M. Timæus London School of Hygiene & Tropical Medicine

Intellectual justification The project examines the impact of the AIDS epidemic and measures to mitigate it in sub-Saharan Africa Most demographic analyses treat socioeconomic status as an exogenous explanation of demographic phenomena Likewise, microeconomic analysis usually treats demographic change as exogenous or even ignores it entirely. The challenge to welfare posed by the HIV/AIDS epidemic in Africa demands a more sophisticated understanding of inter- relationships between demographic and poverty dynamics The response to both demographic and economic shocks can be demographic as well as economic

AIDS and population change DEMOGRAPHY HIV AND AIDS ECONOMY HIVAIDS HOUSEHOLD AND FAMILIAL IMPACTS LIVELIHOODS AND ACTIVITIES POVERTY MORTALITY

Objectives To synthesize economic and demographic perspectives in order to: Improve the measurement of poverty dynamics Understand better the impact of deaths of working-age adults on household welfare, households responses, and the determinants of differential vulnerability and resilience Examine the effects of demographic change, including the AIDS epidemic, on poverty dynamics across the life course in South Africa Assess social policy interventions designed to mitigate impact and their distributional implications across the life course.

Longitudinal data on AIDS impact Phase 1 – analysis of two complementary longitudinal population-based studies from KwaZulu-Natal – ACDIS and KIDS (KwaZulu-Natal Income Dynamics Study) Longitudinal studies provide data on people who later get sick and die They allow analysis of changes in social and economic behaviour that follow shocks such as AIDS and AIDS deaths One can compare movements into and out of poverty in affected and unaffected households and distinguish transitory from chronic poverty Finally, they can document both early responses to and the longer-term consequences of AIDS sickness and deaths Phase 2 – development of a micro-simulation model in order to assess different social policy interventions for a population affected by AIDS Qualitative study of how households cope with illness and death

Africa Centre DSS (ACDIS) Surveillance of the entire population of part of the Hlabisa sub- district of KwaZulu-Natal Run by the Africa Centre for Health and Population Studies part of the University of KwaZulu-Natal principal funder: The Wellcome Trust Data collection started in January ,000 household members (88,000 individuals) 11,000 households Two rounds of data collection per year births deaths a verbal autopsy is conducted for all deaths moves demographic and health data socioeconomic module (every 2nd/3rd round)

Africa Centre for Health and Population Studies

KwaZulu-Natal Income Dynamics Study Panel study based on 1354 African and Indian households interviewed in KZN in 1993 Uses a World Bank LSMS-style questionnaire with detailed expenditure data 2 nd wave of interviews in 1998 and 3 rd wave in 2004 Interviews all branches of households that have split and households established by the next generation as well as the original households Although the panel has suffered substantial attrition (38%), in aggregate its characteristics remain broadly representative of those of the province according to the 2001 Census

Location of KIDS 2004 households

Deaths by age in 1998 and year, KIDS (* prorated to a full calendar year)

ADaPT – a multidiscipinary team The project builds on existing partnerships between: Centre for Population Studies (CPS), LSHTM Ian Timæus (demography) Alessandra Garbero (demography, economics) School of Development Studies (SDS), UKZN Julian May (economics, social policy) Lucia Knight (demography, sociology – PhD student) Africa Centre for Health and Population Studies, UKZN Vicky Hosegood (demography, social policy) The core partners are supported by specialist expertise from: University of Southampton Jane Falkingham (demography, economics, social policy) University of Cape Town Ingrid Woolard (economics)

Work plan and collaborative mechanisms Three-year project (October 2006 – October 2009) Funded under a joint initiative of the UKs Economic and Social Research Council and Department for International Development North-South collaboration with annual project workshops and periods of intensive face-to-face work Exchange sabbaticals in Durban and London in 2007 and 2008 Full-time research assistant and linked PhD studentship for a young South African researcher, both based at LSHTM Final dissemination workshop in South Africa

Household size and expenditure KIDS – 1993, 1998 and 2004 waves (Child weights: aged 0-6 = 0.5, aged 7-13 = 0.75; θ = 0.75) Median household size 5

Adult death and poverty dynamics

Depending on what an adult who died contributed to their household the impact of premature deaths on per capita expenditure may be negative or positive. A straightforward regression model mixes together these two different regimes The effect is a data-weighted average of these two regression relationships, which we estimate as negative but, unsurprisingly, insignificant. To allow for heterogeneous effects of premature deaths, we modify a basic fixed effects regression equation as follows: where the coefficient 2 allows the impact of a premature adult mortality to change with the households level of initial economic well-being. A heterogeneous effects model of the impact of premature adult deaths

Impact of premature adult mortality (PAM) on estimated livelihood trajectories