Today we will study a big problem for LEDC’s, but can you Guess what it is?

Disease How do we approach it?

Prevention Relative To Treatment and Management of Disease Case Study HIV/AIDS in South Africa

Objective The syllabus says... Discuss the geographic factors that determine the relative emphasis placed by policy-makers, in one country or region, on prevention as opposed to treatment of disease and evaluate the management strategies that have been applied in any one country or region for one disease.

Let’s analyse some exam questions Referring to one or more diseases, discuss the factors that determine the relative importance of policies of disease prevention as opposed to policies of treatment. Evaluate the management strategies that have been applied in any one country or region for one disease.

Objectives: Find out the details relating to HIV/AIDS in South Africa Discuss ways in which HIV/AIDS epidemic is being approached with regard to prevention (as well as treatment)

ways to look at Healthcare Prevention or treatment? There are 2 different ways to look at Healthcare Which is better Prevention or treatment?

Prevention Versus Treatment If prevention measures are not used, illness can become established in an area. It is often more expensive to treat an illness or condition that has developed, rather than prevent it's establishment in the first place.

What is HIV/AIDS? Fill in the spaces on your worksheet as you watch the following video on HIV/AIDS

What is HIV/AIDS HIV stands for Human Immunodeficiency Virus. It is a disease which reduces the ability of the body to fight off other diseases. It reduces the efficiency of the body’s immune system. AIDS stands for Acquired Immune Deficiency Syndrome. HIV and AIDS are related, but not the same. A person only has AIDS in the final stages of HIV- after their immune system can no longer defend itself.

Development - Brainstorm Which countries do you think suffer from the AIDS virus? Make a list of the ways you think people might be affected by HIV and AIDS? Focus on LEDCs. Do you think that people in MEDCs and LEDCs are affected by the virus differently? Why?

How does HIV affect life expectancy?

How do we find out more?

Case Study: HIV in South Africa

2/3 of all people infected with HIV/AIDS live in Sub-Saharan Africa: over a million adults a year die from the disease, despite improvements in treatments including antiretroviral drugs (ART). Access to these drugs is not equal, and millions of people who would benefit from these treatments don’t receive them. One in four schoolchildren in South Africa lives with the impact of HIV / AIDS.

HIV prevalence by age group South Africa Looking at HIV prevalence rates by age ranges, it becomes clear that it is the economically active and socially reproductive sections of the population who are worst affected. Women between the ages of 20 and 29 years have the highest prevalence rates - in the year 2000, these were hovering close to an alarming 30%. The graph also shows that there are seemingly fewer teenagers contracting HIV in 2000 than in the previous two years. One possible explanation (as offered by the South African Department of Health) is behavioral changes such as increased condom use amongst adolescents, which is supported by studies documenting changes in condom usage. However, this trend in reduced prevalence is not sustained later in life, therefore although the lower prevalence in the under 20 age group is encouraging it indicates a delay rather than avoidance of the onset of HIV. If a similar graph was constructed for males, HIV prevalence would be highest amongst the 30 - 39 years age groups. Source:National HIV and Syphilis Sero-Prevalence Survey of women attending Public Antenatal Clinics in South Africa 2000.

HIV Positive South Africans Mathematical models such as those developed by the Actuarial Society of Southern Africa (www.assa.org.za) and other institutions enable us to extrapolate data from women attending ANC to the general population and then produce models depicting the likely future course of the epidemic. The above graph represents the Scenario 325 model created by Metropolitan Life. In 2001 it was estimated that 4.7 million South Africans (2.5 million women and 2.2 million men) were infected with HIV. It is projected that these figures will rise to 6 million by the year 2010. The implications and impact of such infection rates are serious, and will be felt at all levels and in all sectors. More information on the Metropolitan Life models can be obtained from their website: www.redribbon.co.za Source: Metropolitan Life

Demographic Impact Demographic Impact HIV/AIDS will impact on South Africa’s population in both form and structure.

AIDS and non-AIDS Deaths in South Africa The above graph represents the Metropolitan Life projections made about future AIDS and non-AIDS deaths. Deaths due to non-AIDS are predicted to remain relatively constant, however deaths due to AIDS are predicted to rise steadily and rapidly between 2000 and 2015. By 2015 over half of all deaths will be AIDS-related. Models such as this are important as they provide planners and policy makers with some indications of possible future circumstances. These models also provide statistics for phenomenon not usually measured because of a lack of data. For further information on AIDS related adult mortality in South Africa see the Medical Research Council’s “The impact of HIV/AIDS on adult mortality in South Africa”, available at www.mrc.ac.za/bod/

Forecast Mortality South Africa As noted previously, it is the economically active sectors of the population who are infected and dying. In the graph above the pale blue represents the distribution of deaths by age group that would have occurred in the absence of an HIV/AIDS pandemic. In 1995 (in yellow) AIDS mortality becomes noticeable, escalating dramatically, until 2010 (in red) where AIDS mortality amongst those aged 35-39 years is nearly 8 times what it would have been in the absence of HIV/AIDS. AIDS mortality will peak 5 to 8 years after HIV prevalence peaks because of the incubation period of the virus. Source: Metropolitan Life

AIDS Orphans in South Africa Sadly, the large numbers of economically active people of reproductive age who die as a result of the AIDS pandemic will leave behind a trail of orphans. In the developing world it is estimated that in 2010, 44 million children will have lost one or both parents to HIV/AIDS; 95% of these children will be from countries in the sub-Saharan African (SSA) region. The above graph represents the Metropolitan Life Scenario 325 projections of the numbers of AIDS orphans in South Africa. By 2010 it is estimated that there will be approximately 2 million AIDS orphans in this country. It is thought that approximately 500 000 of these orphans will be living in KwaZulu-Natal. Source: Metropolitan Life

Economic Impact Economic Impact The economic impact will also be significant, and will not remain at an individual level – it will fan out to communities, workplaces, sectors, and eventually, to the macroeconomy.

Individual level Incubation period AIDS 5-8 years from infection until the onset of AIDS very little economic impact during this time AIDS Period of escalating illness Ability to work is reduced The cost of care increases The incubation period of HIV is thought to be about 5-8 years in developing countries such as South Africa, but may be longer in the West. During the incubation period there may be sporadic incidences of ill health/morbidity, but these will have limited economic impact. As individuals become “AIDS sick”, the duration and intensity of illness escalates. Individuals are less productive and the costs associated with their care increase.

Household level Due to the sexual nature of transmission often more than one household member is infected. Infections are concentrated among the primary carers and earners Double impact of reduced income and increased costs of care Given that HIV is sexually transmitted, usually more than one individual in a household becomes infected – all too often, both adult members of the household – usually husband and wife - are infected. These individuals are typically the primary carers and earners. Therefore, at a time when the household most needs care, economic resources become increasingly difficult to secure.

Labor Market AIDS related illness leads to: reduced productivity due to absenteeism, high turnover etc AIDS related death leads to: change in labor force and labour participation change in age structure of labour force change in available skills and experience High HIV prevalence rates within the general population have implications for the labour market, decreasing the labour supply in terms of numbers and productiveness and skill levels. Sheer numbers are reduced because AIDS impacts on the economically active population. As the number of years employees are in the workforce is reduced due to ill-health or death, so the experience and the skill level of the workforce is eroded away. There are also reports of loss of workforce cohesion due to high staff turnover and general loss of morale as work colleagues die.

Government Finance Increased demand on government services Health Welfare Poverty reduction Although demand will increase, the level of spending on services will be determined by policy decisions Government services are similarly affected by the impacts of the epidemic. Government employees are in no way immune to the impacts of HIV/AIDS. This will have implications on the ability of the government to deliver public services. It is exactly at the time when demands for services is going to be greatest that the government may be least able to deliver.

Social Impacts Social Impact HIV/AIDS has resulted in significantly increased demand on the health and welfare system and it is anticipated that this will grow. It is anticipated that social services will find it increasingly difficult to cope as the demand increases whilst staff levels and productivity are affected by the disease. It is anticipated that HIV/AIDS will also impact negatively on the psychological well-being of society due to the cumulative effect of parental death, educator illness, increased death in communities and increasing numbers of AIDS orphans, as well as they inability of traditional arrangements to cope with the impact of the disease.

Why is it such a big problem? Attitudes

Systems Health care Education Increased demand Decreased ability to offer services as a result of staff loss Similar impact on Welfare services Education Reduction in demand Greater reduction in ability to offer services Public services and systems are likely to experience increased demand as individuals, households and companies turn to the public sector to provide services they can no longer provide for themselves. Even though the numbers of people requiring services may reduce, the ability of the systems to provide service is likely to be compromised and therefore many delivery systems are unlikely to cope. An example of this is the education sector. There is already evidence of decreasing school enrolment, however, teacher attrition occurring at a faster rate than reduction in demand. It is therefore likely that there will be a severe shortage of teachers in South Africa in the next 5-10 years (Badcock-Walters, 2001 at www.und.ac.za/und/heard).

HIV and Poverty Poverty can lead to behavior which results in increased risk of infection (unable to purchase condoms, can’t afford basic medical care to treat STDs, poverty may drive women to prostitution) HIV increases poverty The cruel paradox of the situation is that it is usually the poorest in society who are most vulnerable to HIV/AIDS. They are least able to cope with an increased demand on, and ultimate reduction in resources, which increases poverty and therefore vulnerability and susceptibility to further infections. Poor people are often unable to purchase condoms or afford basic medical care to treat sexually transmitted diseases (STDs), thereby increasing the risk of HIV transmission. Poverty may drive women into prostitution and men to become migrant labourers. However, the link between HIV/AIDS and poverty is more complex than this. For example, ‘relative wealth’ in a community can also render individuals more susceptible to the disease, as they can afford to pay prostitutes for sex, and/or often have multiple sexual partners.

Treatment/Management of Diseases Poor people generally: Have less access to health services Are more vulnerable to diseases Treatment of diseases in many developing countries is therefore difficult once an illness is established. A more effective and much less costly way of containing disease is to prevent its occurrence and present barriers to its spread.

Research 2 video’s and one whole internet Research 2 video’s and one whole internet. Find out the treatment strategies to control the spread of HIV/AIDS in South Africa. Compile notes on 1 A4 sheet

Objective The syllabus says... Discuss the geographic factors that determine the relative emphasis placed by policy-makers, in one country or region, on prevention as opposed to treatment of disease and evaluate the management strategies that have been applied in any one country or region for one disease.