1. 1 Socio Economic Impact of AIDS in Asia XVII International AIDS Conference Mexico City, Mexico August 5, 2008 Jacques Jeugmans Asian Development Bank presented by

2. 2 Socio Economic Impact of AIDS in Asia Authors: Swarup Sarkar, Ross McLeod, Jacques Jeugmans: ADB Nalyn Siripong: UNAIDS Tim Brown: East West Center and Member of the Commission on AIDS in Asia Opinions are of individual authors and do not necessarily reflect the view point of the organization

3. 3 Objectives Review and Assess Socio-Economic Impacts Data ADB: Evidence-based advocacy Poverty Reduction ADB-UNAIDS: Commission on AIDS in Asia

4. 4 Methodology 1.Mortality - DALY –WHO data – Projected Burden of Diseases –For HIV and AIDS : Asian Epidemic Model (AEM) 2.Economic impact – Effect on Poverty –Macroeconomic impact (not discussed here) –Household level Financial burden (illness – death) Risk of falling into poverty 3.Mitigation Programs Standard elements – Women centered – unit cost

5. 5 Mortality Burden of Disease

6. 6 Largest disease-related killer for 15-44 year-old age group of population

7. 7 With Traffic Accidents for 15-44 year-old age group of population

8. 8 Remarks 15-44 year-old age group Disease-related deaths (not traffic accidents or other injuries) Assuming current low prevention effort and ART coverage

9. 9 Impacts on Households

10. 10 Impacts on households is primarily due to loss of income Other 13% ART 2% Income Loss 85% Income Loss 85% Household financial burden: USD 2 billion by 2020 Financial cost of mortality: USD 5,000 per household

11. 11 Richer Household can cope with loss of income, poorer household fall below poverty line Household consumption expenditure Q2Q1Q3Q4Q5 Households divided into 5 income quintiles drop in h/h expenditure h/h falling deeper below poverty line h/h falling below poverty line Poverty line

12. 12 Additional AIDS Poverty in Asia Based on 5 countries (80% population) –Not more than 5 million new poor by 2015 for Asia (range 1- 4 million in studied countries) Based on simulation: –50% reduction of income in each quintile –Estimation of new poverty due to AIDS –Reduction of poverty due to economic growth

13. 13 Most disease burden on male clients and wives quite early in epidemic Women as main care givers, denied property after their husbands’ death due to AIDS in as high as 80% cases Women bear the burden Men who visit female sex workers are the bulk of HIV infections

14. 14 Impact Mitigation Programs 2. How much will it cost? 1.What interventions? Livelihood support to affected households (women centered) Orphans ART

15. 15 Livelihood support to affected women ‘Positive Partnership‘: micro-financing for affected households (USD 600 loans) 70% repayment rate Lifetime cost of USD 1000/affected household

16. 16 Livelihood support to affected households Unit cost based on ‘Positive Partnership’ program: USD 1000/affected household –lifetime Approximate number of married men newly eligible for ART in countries Cost (in ‘000s USD) Latent epidemic 189 Expanding epidemic208,850 Declining epidemic scenario12,108 Total221,336 Affected women enrolled as soon husbands develop illness

17. 17 AIDS Orphans: care and support Estimated at 100 USD per child per year 1 million children in Asia lost at least one parent to HIV Total cost 100 M USD/yr

18. 18 Treatment: Universal Access is feasible in Asia 10 other Asian countries (121,010 people or 11%) China, India, Myanmar, and Thailand (946,000 people or 89%)

19. 19 Further studies… Socio-economic impact: More representative data needed –income profile of positive people –Income/ expenditure effect –Time period for normalization Simulation do not change conclusions

20. 20 Conclusions Low prevalence – big numbers 15-44 year-old: big(gest) disease-related killer => economic impact on households Socio-economic impact –at household level –due to loss of income –on women and children

21. 21 Recommendations Impact mitigation Feasible and affordable –cost 0.02% of GDP – 4% of regional expenditure Household focused - women centered Thank you, Gracias!.