Development Consequences (and Causes) of HIV/AIDS By Prof. Alan Whiteside Director, HEARD Institue of Public Policy Research London, 5 th November, 2004

Why has the development community failed to take cognisance of HIV/AIDS? Why have governments failed to respond to the crisis?

Presentation Outline Scale and future trends Impacts –Demographic –Political –Economic Conclusions

Freedom! 2 nd Democratic Election HIV Prevalence South Africa Women Attending Public Antenatal Clinics FREEDOM! 2 nd General Election

National trends in HIV prevalence Women attending Public Antenatal Clinics

Epidemic Curve: HIV 27Aug01-Report I:Epidemgy& Lit.p.27 T 1 T 2 Time Numbers A 1 A 2 HIV prevalence A B

Epidemic Curves: HIV and AIDS

Epidemic Curve: HIV, AIDS and Impact 27Aug01 -Report I:Epidemgy & Lit. p.27 T 1 T 2 Time Numbers A 1 A 2 HIV prevalence B 1 A B AIDS - cumulative Impact

A model of future AIDS and non-AIDS Deaths

All orphans & orphans due to AIDS by HIV prevalence Uganda million 1 million 1.5 million 2 million Total Number 0 6% 12% HIV Prevalence Total Orphans AIDS Orphans HIV Prevalence

Impact of HIV/AIDS Demographic Political Economic

Changing life expectancy in African countries with high and low HIV prevalence: Source: UNAIDS, Report on the global HIV/AIDS epidemic

Population Structure, South Africa 2000 and 2010 Source: Actuarial Society of South Africa

By-Elections in Zambia Source: IDASA

Non-registration HIV prevalence _ _ + + Pearsons r =.7 Level of analysis: the nine provinces Non-participation by young women in South Africa

Estimates of the impact of AIDS on economic growth, Source: (1) Botswana, Lesotho, Namibia data: Sackey and Raparla, (2) South Africa data: Arndt and Lewis (3) Botswana data: Greener, Jefferis and Siphambe, (4) 30 Countries data: Over, (5) Cameroon data: Kambou et al, % -1.50% -1.00% -0.50% 0.00% Cameroon**30 Countries*Botswana***South Africa**Botswana, Lesotho, Namibia* Methodology: * Demographic and economic modelling ** CGE Simulations *** Economic 2004 Report on the Global AIDS Epidemic (Fig 14)

By 2010 orphans will account for 15-25% of all children in 12 countries in SAA Source: UNICEF

Conclusions 1 Prevention Care and treatment Mitigation

World HIV Chart 2001 Percent adults living with HIV (log) 0.1 Annual income per person in US dollar (ppp & log) Algeria Angola Argentina Armenia Australia Austria Azerbaijan Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Botswana Brazil Bulgaria Burundi Cambodia Cameroon Canada Central African Rep. Chad Chile China Colombia Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Dominican Rep. Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Georgia Germany Ghana Greece Guatemala Guinea- Bissau Guyana Haiti Honduras Hungary Iceland Indonesia Ireland Israel Italy Jamaica Japan Jordan Kenya Republic of Korea Latvia Lesotho Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Mauritius Mexico Mongolia Morocco Mozambique Namibia Nepal Netherlands New Zealand Nicaragua Nigeria Norway Pakistan Panama Papua New Guinea Peru Philippines Portugal Romania Russia Rwanda Senegal Sierra Leone Singapore Slovenia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Tajikistan Thailand Togo Trinidad & Tobago Turkey Turkmenistan Uganda Ukraine United Kingdom United States of America Uruguay Uzbekistan Venezuela Yemen Zambia Zimbabwe Burkina Faso India AIDS deaths per year Africa Americas Arab countries Asia Europe Continents

World HIV Chart 2001 Percent adults living with HIV (log) 0.1 Annual income per person in US dollar (ppp & log) Algeria Angola Argentina Armenia Australia Austria Azerbaijan Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Botswana Brazil Bulgaria Burundi Cambodia Cameroon Canada Central African Rep. Chad Chile China Colombia Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Dominican Rep. Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Georgia Germany Ghana Greece Guatemala Guinea- Bissau Guyana Haiti Honduras Hungary Iceland Indonesia Ireland Israel Italy Jamaica Japan Jordan Kenya Republic of Korea Latvia Lesotho Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Mauritius Mexico Mongolia Morocco Mozambique Namibia Nepal Netherlands New Zealand Nicaragua Nigeria Norway Pakistan Panama Papua New Guinea Peru Philippines Portugal Romania Russia Rwanda Senegal Sierra Leone Singapore Slovenia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Tajikistan Thailand Togo Trinidad and Tobago Turkey Turkmenistan Uganda Ukraine United Kingdom United States of America Uruguay Uzbekistan Venezuela Yemen Zambia Zimbabwe Burkina Faso India AIDS deaths per year Africa Americas Arab countries Asia Europe Continents X 200 ?

World HIV Chart 2001 Percent adults living with HIV (log) 0.1 Annual income per person in US dollar (purchasing power) Log Algeria Angola Argentina Armenia Australia Austria Azerbaijan Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Botswana Brazil Bulgaria Burundi Cambodia Cameroon Canada Central African Rep. Chad Chile China Colombia Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Georgia Germany Ghana Greece Guatemala Guinea- Bissau Guyana Haiti Honduras Hungary Iceland Indonesia Ireland Israel Italy Jamaica Japan Jordan Kenya Republic of Korea Latvia Lesotho Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Mauritius Mexico Mongolia Morocco Mozambique Namibia Nepal Netherlands New Zealand Nicaragua Nigeria Norway Pakistan Panama Papua New Guinea Peru Philippines Portugal Romania Russia Rwanda Senegal Sierra Leone Singapore Slovenia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Tajikistan Thailand Togo Trinidad and Tobago Turkey Turkmenistan Uganda Ukraine United Kingdom United States of America Uruguay Uzbekistan Venezuela Yemen Zambia Zimbabwe Burkina Faso India AIDS deaths per year Africa Americas Arab countries Asia Europe Continents X 20 =200

Public expenditure on health as percent of general government expenditure in African countries, 1998

Conclusions 2 The role of policy and development practitioners Economics Social Political commitment

The Free By Five Declaration

HIV Epidemic – Determinants and Responses – A Medical View Determinants Biomedical Virus sub -types Stage of infection Presence of other STDs Gender Circumcision Other HIV Infection Aids

HIV Epidemic – Determinants and Responses – Sexual Behaviour Determinants Biomedical Virus sub -types Stage of infection Presence of other STDs Gender Circumcision Other HIV Infection Aids Sexual behaviour Rate of partner change Concurrent partners Sexual mixing patterns Sexual practices Condom use Other

HIV Epidemic – Determinants and Responses – Upstream Causes Determinants Biomedical Virus sub -types Stage of infection Presence of other STDs Gender Circumcision Other HIV Infection Aids Sexual behaviour Rate of partner change Concurrent partners Sexual mixing patterns Sexual practices Condom use Other Micro- environment Mobility Urbanisation Access to health care Levels of violence Womens rights and status Other Macro- environment Wealth Income distribution Culture Religion Governance Other

HIV Epidemic – Where we responded Determinants Biomedical STD treatment Blood safety Anti-retroviral therapy during pregnancy Provision of condoms Sexual behaviour Behaviour change communication Condom Promotion and marketing Micro- environment Macro- environment Interventions

HIV Epidemic – Where we should respond Determinants STD treatment Blood safety Anti-retroviral therapy during pregnancy Provision of condoms Behaviour change communication Condom promotion and marketing Micro- environment Social Policy Economic Policy Legal Reform Employment legislation Macro- environment Social policy – redistribution Legal Reform Human Rights Taxation Debt relief Terms of Trade Interventions Sexual behaviourBiomedical