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VULNERABILITY AND HIV/AIDS

VULNERABILITY AND HIV/AIDS. PROF. TIM QUINLAN HEARD (Health Economics and HIV/AIDS Research Division) UNIVERSITY OF NATAL. DEFINITIONS (COMMON USEAGE IN HIV/AIDS RESEARCH). RISK - Probability of infect ion . e.g. Biological : women more than men; Age : ‘youth’ (15-24 yrs old)

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VULNERABILITY AND HIV/AIDS

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  1. VULNERABILITY AND HIV/AIDS PROF. TIM QUINLAN HEARD (Health Economics and HIV/AIDS Research Division) UNIVERSITY OF NATAL

  2. DEFINITIONS (COMMON USEAGE IN HIV/AIDS RESEARCH) RISK - Probability ofinfection. e.g. Biological : women more than men; Age : ‘youth’ (15-24 yrs old) Occupational categories: sex workers; truckers SUSCEPTIBILITY - infected Risk plus Context (living conditions, lifestyles and behaviour) Why some people have a higher chance of being infected than others (e.g. not all sex workers are equally at risk of being infected) VULNERABILITY -affected - how & why HIV/AIDS affects many people’s lives and livelihoods including those not infected; - why some are not able to cope; - why & how changes in lifestyle and behaviour (susceptibility indic.) Purpose: Identify conditions that contribute to the spread of HIV/AIDS; where to focus interventions.

  3. BACKGROUND SERO-PREVALENCE &DEMOGRAPHY

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  8. A model of futureAIDS and non-AIDS Deaths

  9. Number of people living with HIV/AIDS in sub-Saharan Africa, 1980-2001 30 Millions 25 20 15 10 5 0 1980 1983 1986 1989 1992 1995 1998 2001 Source: UNAIDS, 2002

  10. Numbers infected, sick and dead, ASSA2000

  11. By 2010, orphans will account for 15-25% of all children in 12 countries in SSA

  12. AGGREGATE EMPIRICAL EVIDENCE ON DEMOGRAPHIC IMPACTS Survival from HIV sero-conversion is about 8 years Risk of infection is greater for women than men Age is a significant factor Different patterns (mortality rates; socio-economic impacts) due to variation in maturity of each national epidemic Current AIDS impacts represent incidence rate of about 10 years ago Surveys in Tanzania and South Africa suggest that mortality patterns are unique to Africa.

  13. SOCIO-ECONOMIC IMPLICATIONS IMPACT AND VULNERABILITY

  14. Channels of Economic Impact INDIVIDUAL Smaller local pop. Slower national pop. growth HOUSEHOLD MORTALITY LABOUR MARKET MACRO ECONOMY Change in age structure HIV/AIDS FIRM/SECTOR MORBIDITY GOVERNMENT

  15. Individual level • Incubation period • 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 • While the cost of care increases

  16. What makes women more vulnerable to infection? Biological: • Larger exposed mucosal surface. • Semen has a higher concentration of HIV • Young girls mucosal surface is immature. • STD infections are asymptomatic. • Semen stays in the vagina.

  17. What makes women more vulnerable? SOCIO-ECONOMIC FACTORS: • Women are economically dependent on men • Burden of care falls on women • Girls may be withdrawn from school • ‘Revival’ of ‘traditional’ social norms about subordinate role of women challenges ‘empowerment’ and ‘emancipation’ interventions

  18. Household Impacts • 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

  19. Rural household responses to being infected/affected by HIV/AIDS

  20. Household with stronger safety net Household with weaker safety net Vulnerability Line Early stages Frequent hospital visits Bedridden Death /Burial Care for orphans Effect of HIV on Household Security

  21. INDICATORS & INTERCONNECTIONS Morbidity and mortality: determinants of socio-economic impacts on families and households (variation in income levels, likely to suffer severe poverty; household dissolution and child migration) Gender and the position of the deceased family member in the household are significant indicators of HIV/AIDS effect on household economic and social viability Illness and death of mother an indicator of child mortality (under 5-mortality increasing) Extended effects of HIV/AIDS are highlighted in the impacts on organisations: (e.g. Loss of experience and skills, Lower productivity; higher absenteeism and leave rates)

  22. Company costs Timeline Progression of HIV/AIDS in the Workforce Economic Impact on the Company Year 0 Employee becomes infected No costs to company at this stage Morbidity-related costs are incurred (e.g. absenteeism, individual & workforce productivity, management resources, medical care & insurance) Morbidity begins Year 1-5 Termination-related costs are incurred (e.g. payouts from pension or provident fund, funeral expenses, loss of morale, experience, & work-unit cohesion) Employee leaves workforce (resigns or dies) Year 6 or7 Company hires replacement employee Turnover costs are incurred (e.g. recruiting, training, reduced productivity) Year 7 or 8

  23. Government Finance • Increased demand on government services • Health • Welfare • Poverty reduction etc etc • Although demand will increase the level of spending on services will be determined by policy decisions • Decreased Tax Base • AIDS effects most economically active • Government has less resources at its disposal

  24. ANALYTICAL FRAMEWORKS FOR ASSESSING THE IMPLICATIONS OF HIV/AIDS

  25. Treatingopportunisticdiseases Africantraditional healers Weather & climate change Education Global competition & economy challenges & influences Autonomy of HIV in Complex Societies - A systems model of the S’n Africa AIDS epidemic Mores & customs (multiple sets of these) Aboveaverage survivors scarce educators die Role of women Economicorganisation Social cohesion brings better provides skilled people affect changes affect affect Spiritual & political authority Beliefs Migration & mobility Notions of masculinity Religion Shareholderexpectations & values challenges& influences Circumcision Stable & settled workers Migrant & mobile workers Determinesnature of NGOinvolvement Jobs create affect creates vacancies I n f l u e n c e Housing & land Urbanisation affects uptake of drive Tension of two worlds affects influences sustains Economy Businesssector involvement create provides create sustains Safety, crime & war support Life force, procreation, sex urge perceptions of risk Leadershipin society Improves weakens increases improve affects affect reduces productivity Hazardousoccupations Drain on inhibits Reduces demand promotes risk taking &risk avoidance Incapacity & absenteeism inprivate sector & civil service Drives AIDS testing & counselling Cost of hiring & retraining provides provides affects Individual Behaviour Population stops growing, and ages Self-confidence promiscuity Diet &nutrition AIDS education & awareness Support Chastity,Fidelity Cost to individuals & households : medication, care, burial, & orphans improves reduces Healthy lifestyle Condom use Personal responsibility increases Sex industry interventions skilledworkersdie causes G i v e s r i s e t o prevents increass extends increaces reduces values, profits, patents, prices, research Who dies & who survives:(population. Demographics & particularities) increases HIVEpidemic(prevalence) LatencyPeriod(avg 8 yrs) AIDS related Disease & Deaths(death rate) TreatingSTD’s HIV Transmission reduces Business sector involvement Promote/hamper Increaces?decreases? Govtpolicies reduce extends reduces prevent Viral mutation hampers prevents Above average survivors:chaste & faithful, long term thinkers,tertiary educated,non-migrant families,settled LT employees, high income, cohesive& candid societies, grandparents Above average mortality:unemployed, orphans,soldiers, sex workers,hazardous occupations, migrants, temps, contract workers, newly prosperous, young women, uncircumcised men, & partners of all the above cures Promote/hamper Medical interventions for HIV-AIDS Anti-retroviraltreatment Microbicides Immunisation Motherto childtreatment Funding for health care, infrastructure, sanitation Business sector involvement more orphans

  26. Numbers HIV prevalence A 2 A 1 A B T T Time 1 2 27Aug01 - Report I: Epidem’gy & Lit. p. 27 Epidemic Curves, HIV

  27. Epidemic Curves, HIV and AIDS Numbers HIV prevalence A 2 A 1 A AIDS - cumulative B B 1 T T Time 1 2 27Aug01 - Report I: Epidem’gy & Lit. p. 27

  28. Epidemic Curves, HIV, AIDS & Impact Numbers HIV prevalence Impact A 2 A 1 A AIDS - cumulative B B 1 T T Time 1 2 27Aug01 -Report I: Epidem’gy & Lit. p. 27

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

  30. A Virtuous Circle Pre-empts need for treatment Treatment and care HIV Prevention Reduces risk, strengthens communities Makes communities less vulnerable Pre-empts need for future mitigation Makes communities less susceptible Strengthens systems for delivery of care Pre-empts need for future mitigation Mitigation of Impact 42

  31. STRATEGIC PLANNING APPROACHES

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