Development Impacts of HIV/AIDS M. J. Kelly, Lusaka, Zambia mjkelly@zamnet.zm

1. MTT 2004 Annual Winter SchoolDurban, 10th August 2004Mitigating the Impacts of HIV/AIDS on Education Systems Development Impacts of HIV/AIDS M. J. Kelly, Lusaka, Zambia mjkelly@zamnet.zm

2. The Impacts of HIV/AIDS on People and Societies • In all of our countries, HIV/AIDS is • Reversing decades of health, economic and social progress • Reducing life expectancy • Slowing economic growth • Deepening poverty • Contributing to and exacerbating food shortages • Creating a growing human capacity crisis • Enhancing gender inequities by affecting women and girls more than men and boys

3. Are the Impacts Due to AIDS? • Fairly clear that illness and death may be due to AIDS (though AIDS may not be acknowledged as the cause) • The same with orphanhood • But in many cases it may be very difficult to separate out what is due to other factors and what is due to HIV/AIDS • AIDS impacts entangled with those of poverty, female disadvantage, poor economies, climate, public corruption, unbalanced North-South relationships • But HIV/AIDS increases the scale of almost every existing problem, making it more difficult to deal with —just as HIV makes it difficult for the body to deal with infections it would otherwise be able to manage

4. What We are Up Against in HIV/AIDS • HIV/AIDS confronts us with two situations: • The disease: the medical conditions of HIV infection and/or AIDS in individuals • The social and developmental problem: the social and developmental conditions and impacts that follow on from the disease, especially when it becomes widespread with infected individuals being found throughout a community and eventually across a country or region

5. Global Emphasis on Medical and Behavioural Approaches • Current dominant global models focus on HIV/AIDS • EITHER as a medical issue that requires a biomedical response; • OR as a condition resulting from human behaviour practices and hence requiring a response that focuses on aspects of human behaviour • Both points of view are valid but whether taken separately or together they deal with only part of the AIDS problem • This limitation has contributed to global failure to respond adequately to the epidemic

6. Behavioural Approaches to Prevention • The majority of current approaches are based essentially on the modification of individual behaviour • They address the obvious risks of sex and injecting drug use, and factors that increase personal vulnerability (e.g., ignorance or peer pressure) • They follow a logical pattern, as if HIV risk-reducing decisions were always rational and seldom emotional • They take almost no account of non-western world views—their uniform context is that of the homogenised, individual, western cultural world • They deal only marginally with the underlying issues & contextual features of joblessness, helpless economies, female disadvantage, responding to youth needs, facing up to poverty, grassroots voicelessness

7. Taking a Holistic Approach • An adequate conceptual framework for the developmental impacts of HIV/AIDS (and for responding to them) must take due account of the economic, social, cultural, environmental and political factors that render individuals and communities vulnerable • This implies going beyond the symptoms of infection, sickness and behaviours that contribute to these and looking to the factors that underlie the infection, sickness and behaviours • It means asking about the roots of the problem • Instead of focussing narrowly on HIV/AIDS as a stand-alone issue, there is need to see it as arising within the complexities of poverty, gender inequalities, cultural determinants, religious understandings, environmental questions

8. HIV/AIDS Impacts on Various Aspects of Society HIV/AIDS spreads into the general population = Epidemic, with a variety of impacts ECONOMY EDUCATION GOVERNANCE LABOUR CULTURE, VALUES, BELIEFS MANAGEMENT AGRICULTURE SOCIAL DEVELOPMENT ---------------------- HEALTH ENVIRONMENT

9. Development • Initially, attention focused on economic development—the movement (at individual or national levels) from a low economic status to one that was higher • But although very important, economic development is only one aspect of development • Today, development is seen more in terms of increasing choices and enlarging freedoms • Development means advancing human freedoms by increasing the capabilities and opportunities for individuals to lead a life they have reason to value (based on Amartya Sen) • Because HIV/AIDS limits & does not advance human freedoms, it works against development

10. Human Development • Human development is about creating an environment in which people can develop their full potential and lead productive, creative lives in accord with their values, needs and interests • The most basic capabilities for human development are to • Lead long and healthy lives • Be knowledgeable • Have access to the resources needed to maintain a decent standard of living • Be able to participate in the life of the community • HIV/AIDS undermines each of these

11. A Long and Healthy Life • Where HIV/AIDS is prevalent, there is little prospect that people will be able to lead a long and healthy life • Life expectancy falls to dramatically low levels (see next slide) • Child mortality rates remain alarmingly high • AIDS enlarges the impact of other threats to health such as TB or malaria • Coping with AIDS issues overwhelms health services • AIDS claims the lives of numerous medical service personnel • Applying anti-retroviral therapy makes extensive demands on the small number of doctors, nurses and health-care workers in all of our countries • Donor-funded ART programmes may bleed away health practitioners from providing the services that the non-HIV infected public needs

12. Life Expectancy at Birth (Years), 2001 and 2002 Source: The State of the World’s Children, 2003 & 2004 (UNICEF)

13. Be Knowledgeable • The negative impacts of HIV/AIDS on educators, learners and the overall learning environment suggest that the epidemic adversely affects the ability of individuals to become knowledgeable • It also removes a major incentive to becoming knowledgeable—why bother, if life will be too short to use the knowledge, or if the process of acquiring knowledge (usually through schools) means that young people are not available during large parts of the day to help the family or community cope with AIDS impacts, or if the knowledge will not lead to employment, or even if it is believed that the knowledge will increase vulnerability to HIV infection?

14. HIV/AIDS and Human Capacity • HIV/AIDS affects human capacity in different ways: • It robs sectors, enterprises and undertakings of qualified and experienced personnel • It creates the need for additional personnel (e.g. in nursing care) • It creates the need for persons with new understandings and skills • Because of the way it removes young and productive adults, it has negative effects on the transfer of skills

15. Have Access to the Resources Needed to Maintain a Decent Standard of Living • Poverty is widespread and is closely related to HIV/AIDS • However, AIDS is not a disease of poor countries • Neither is it a disease of poor people, but • the poor are at higher risk of HIV infection • the poor are more vulnerable to HIV infection • the disease makes the poor poorer • HIV/AIDS leads to the impoverishment of households and even to their disappearance as units of society • Productivity declines, jobs are lost, and incomes fall • Expenses increase, for medical care and eventually for funerals • Productive assets are sold off to cater for income loss and increased outlays

16. How Poverty and HIV/AIDS Relate to Each Other

17. Impacts on Households and their Economies • Two-thirds of families where the fathers die from AIDS experience an 80% drop in income (Zambia) • In Cote d’Ivoire the household income of AIDS-affected families is about half of the average household income • In Zimbabwe, two-thirds of households that had lost an adult woman ceased to exist; the members dispersed and the households disintegrated • In Botswana, AIDS will lead to a decline of 13% in per capita household income for the poorest quarter of households, while every income earner in this category can expect to take responsibility for four or more dependants

18. HIV/AIDS Increases Costs • Costs of goods and services increase as enterprises raise costs to offset those arising from HIV/AIDS: • lower productivity • smaller markets • increased medical costs • high funeral costs • early payment of terminal benefits • higher insurance costs • in-house HIV/AIDS education programmes • Goods which are in scarce supply because of HIV/AIDS increase in cost

19. HIV/AIDS Reduces Incomes and Resources • Jobs lost (sickness; death; firms collapsing) • Farm production reduced • Smaller volumes of sales • Loans not being repaid • Capital assets being disposed of • Savings drawn down • Lower levels of production in households headed by the elderly or children • Firms losing profitability and paying less • Reduced ability to transact business or manage affairs efficiently (reduced social capital)

20. HIV/AIDS Diverts National and Institutional Resources • Additional national resources absorbed by AIDS care and responses, at the cost of important medical and other needs • Medical, personnel, agency and NGO resources diverted to AIDS issues • Already limited and over-stretched public capacity is further extended with AIDS concerns

21. HIV/AIDS Diverts Personal and Household Resources • Household resources consumed by medical costs, cleaning, transport, funerals, mourning • Limited resources spread more thinly over larger numbers • amalgamated families • orphan care • increased dependency ratio • Labour resources going to AIDS care and away from productive work

22. HIV/AIDS Impacts at the Household Level: Some Issues • Impacts are almost always very severe emotionally—distress, shock, anger, denial, grief, stigma, isolation • The disease has severe implications for household well-being: • Income reduction (job loss; reduced ability of infected person to work and produce; time spent on patient care is time taken from productive activities) • Increased health-related expenditures (medicines, special foodstuffs, soap and cleaning materials, clinic-related use of resources & time—patient transport, getting medicines) • Some households disappear • Impacts may be masked by complex extended family and other relationships between households • Ripple effects—more demands on other households, or less to give to households that had previously been getting assistance • Vulnerability of female-headed and child-headed households

23. HIV/AIDS and Food Security • Remote fields left fallow; poor timing of essential farming operations; lack of resources to purchase agricultural inputs; abandonment of soil conservation measures; dominant need to give priority to immediate survival • Switch from labour-intensive crops to ones that are less demanding, often less nutritious; crop variety declining • Livestock and other farm assets sold to pay the medical costs of AIDS or are used for funeral expenses • Credit for agricultural production diverted for the medical care of sick relatives, funeral expenses, food • Illness and deaths among agricultural extension staff • Result: less food security and increased malnutrition (and hence vicious cycle of increased vulnerability to HIV/AIDS)

24. Girls, Young Women and HIV/AIDS

25. Impacts on the Exercise of Human Rights • HIV/AIDS attacks basic human rights: • Free and equal (female/male; rural/urban, poor/wealthy) • Recognition as a person (PLWHA; orphans) • Life and health (knowledge, supplies, infrastructure) • Marriage (freely entered into; early/forced?) • Property (inheritance rights of widows, orphans?) • Social security (economic, social and cultural rights indispensable for human dignity and personal development) • Rest and leisure (women, child labour) • Education (girls; orphans; poor)

26. Environmental Impacts • Degradation of forest and soil reserves that are nearest to the home • Less soil conservation and maintenance of contour ridges • Boreholes and wells not maintained • Water pollution • Concentration on easy-to-grow crops and reduction in crop varieties • Less transmission of knowledge and skills leading to harmful environmental practices (fishing, bee-keeping, grazing, tillage)

27. Impact on the Future • What kind of adults will orphaned children be? • How will they function as parents when they have never known normal childhood? • Who will look after the next generation of orphans when the present generation of grandparents have died? • Who will communicate traditional skills and skills for life to OVCs? • Will society be very different because a large part of the next generation will not have experienced normal nurturing and affection in a family setting? • Will there be special security problems because so many children are growing up without the supervision of responsible parents or relatives?

28. Role of Education • What role does the formal education system play in mitigating these multiple developmental impacts of HIV/AIDS? • Do educators ever think about or plan for these issues? • Are they preparing young people for the world of the future, with HIV/AIDS and its many consequences? • Or are they locked in the past, preparing learners for the world as it was twenty and more years ago? • Apart from issues relating to HIV prevention, education should also play a role in orientating young people to the likely world of the future, opening their minds to what could possibly be, and preparing them for life in a world with AIDS

29. The Interaction between HIV/AIDS and Development: Exercise • To what extent has HIV/AIDS become an issue in the governance of your country? • Does your country show signs that the epidemic has slowed or reversed social progress? • In what ways has it deepened poverty? • Is there evidence in your country that the epidemic is leading to a growing human capacity crisis? • Has the epidemic had any impact on the exercise of human rights in your country?

30. Education, HIV/AIDS and Development: Exercise • What role could the education sector play in offsetting the negative impacts HIV/AIDS has in such development areas as • Poverty reduction • Better living conditions • Improved agricultural production • Expanding each person’s range of choices?