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According to the International Partnership against AIDS in Africa (IPAA ) the epidemic is not simply a health issue, but one that is also of vital importance across a spectrum of issues, including development, security, food production and life expectancy. With the epidemic being a major threat to society, the IPAA contends that AIDS must be incorporated into a wide range of issues such as national sovereignty, respect for the diversity of cultures, and maintenance of respect for human rights and equal access to treatment. Economies tend to react more dramatically to economic restructuring measures, a sudden fuel shortage, or an unexpected change of government, than to long, slow difficulties such as those wrought by AIDS. But there is growing evidence that as HIV prevalence rates rise, both total and growth in national income - gross domestic product, or GDP -fall significantly. African countries where less than 5% of the adult population is infected will experience a modest impact on GDP growth rate. As the HIV prevalence rate rises to 20% or more, GDP growth may decline up to 2% a year.
In South Africa, the epidemic is projected to reduce the economic growth rate by 0.3-0.4 % annually, resulting by the year 2010 in a GDP 17% lower than it would have been without AIDS and wiping US$22 billion off the country's economy. Even in diamond-rich Botswana, the country with the highest per capita GDP in Africa, in the next 10 years AIDS will slice 20% off the government budget, erode development gains, and bring about a 13% reduction in the income of the poorest households.
Evidence show that the large expenditure on health care at the household level
may have an impact on savings. It can be assumed that at the agricultural sector
for businesses, firms will have to increase costs as a result of AIDS-related
medical and funeral expenses too. In the public sectors, an education model
developed by UNAIDS and UNICEF in 2000 shows how increasing mortality rates
due to AIDS lead to discontinuity in teaching, with many pupils losing or having
a change in their teachers.
During the past year much progress has been made in the areas of political
and financial mobilization and in the development of National Strategic Plans.
However, countries must focus on the implementation of programmes that take
into account the poverty factor and which try to fight it in order to eradicate
The HIV epidemic has its origins in African poverty and unless and until poverty is reduced there will be little progress either with reducing transmission of the virus or an enhanced capacity to cope with its socio-economic consequences.
Poverty, and the absence of access to sustainable livelihoods, are factors in labour mobility which itself contributes to the conditions in which HIV transmission occurs. Mobile populations, which often consist of large numbers of young men and women, are isolated from traditional cultural and social networks and in the new conditions they will often engage in risky sexual behaviours, with obvious consequences in terms of HIV infection.
Also, many of the poorest are women who often head the poorest of households in Africa. Inevitably such women will often engage in commercial sexual transactions, often on an occasional basis, as survival strategies for themselves and their dependents. The effects of these behaviours on HIV infection in women are only too evident, and in part account for the much higher infection rates in young women who are increasingly unable to sustain themselves by other work in either the formal or informal sectors.
There are increasing numbers of children infected with HIV through perinatal transmission (from mother to child). This reflects the large numbers of pregnant women who are HIV positive. Perinatal transmission is largely preventable through appropriate access to drugs (AZT) but these drugs and the necessary infrastructure for their delivery are more or less unattainable for most African women. Limitation of access to AZT is not confined to the poor although they account absolutely for most of the women who have the greatest need.
A related problem is the transmission of HIV through breast milk where there is now clear evidence that significant numbers of babies are infected by this route. This is avoidable and poverty is a clear factor in access to the methods for prevention of transmission to babies through breast milk. To prevent transmission through breast milk requires the ability to buy baby formula and access to clean water, plus an understanding of why these changes in practise are needed. Neither clean water nor the income for purchasing formula are available to the poor, so they are unable because of their poverty to adopt a form of prevention known to be successful as a means of limiting HIV transmission. This problem is resolvable through relatively inexpensive programme activities backed up by community mobilisation to ensure support to families. There are, therefore, no good reasons why action in this area are not being undertaken by governments, NGOs and donors.
Poor nutrition leads to poor health which is an important cause of low labour productivity and thus the persistence of low incomes for the poor. Poor and damp housing is a major factor in causing illnesses such as TB which is itself exacerbated by the HIV epidemic (where there is now a dual epidemic underway in Africa). These children will continue to experience poor health status over their lifetimes with all kinds of social and economic consequences for them and their families.
The next step has to be the development of policies and programmes that address
the inter-relationships between poverty and development and to actually put
in place those activities that can make a difference for development outcomes.
Central to these activities are programmes that address poverty today so as
to facilitate future socio-economic development tomorrow. For unless the intergenerational
effects of HIV are addressed now then it is optimistic in the extreme to assume
that Africa will become a pole of development in succeeding decades.