2009, an estimated 14.8 million children in Africa were estimated to have lost one or both parents to become “AIDS orphans” (UNAIDS, 2010). Beyond this devastating human toll, the high HIV/AIDS burden has compromised the achievement of key Millennium Development Goals in Africa (World Bank and International Monetary Fund, 2008), and many agree that HIV/AIDS has a negative effect on total gross domestic product (GDP) in the most affected countries (Haacker, 2009). Many of the very countries experiencing these declines in GDP growth due to HIV/AIDS are among those that require the most dramatic increases in health care spending to meet their treatment goals (Over, 2004).
The committee was charged with studying the implications of the HIV/AIDS burden for African governments and institutions. This chapter details these implications and some of the major issues confronting many African states and societies in managing their epidemics in the future. Given that the epidemics across Africa range from highly concentrated to highly generalized (Wilson and Challa, 2009), the committee recognizes that significant heterogeneity exists in the extent of the burden of HIV/AIDS and its implications. While all subregions of Africa require continued, long-term commitments that are responsive to the profile of the epidemic in individual countries, this chapter, like the report generally, focuses on the southern African epicenter of the pandemic (Wilson and Challa, 2009). The chapter explores the implications of the projected HIV incidence and overall HIV/AIDS burden (described in Chapter 2 and Appendix A) for four sectors of African society: development, health, the state, and academia.
The negative impact of HIV/AIDS on development outcomes in Africa, especially in high-prevalence countries, is well documented. High rates of HIV-related sickness and premature adult deaths compromise household stability and investment in children; stress extended family and broader social networks; and diminish labor supply and productivity while increasing costs for households, public institutions, and private-sector companies. These observations are generally undisputed. There is, however, less consensus on how these effects translate into overall impact on the welfare and well-being of nations and populations. Debate focuses not only on the long-term effects of the epidemic on economic growth, but also on whether the classic measure of economic performance (GDP per capita) suitably captures the full range of effects of HIV/AIDS on the overall well-being of populations in high-burden countries. Improved availability of treatment has certainly altered the landscape. However, few micro- or macro-level studies to date have considered the development and socioeconomic impacts of HIV/AIDS assuming different treatment access scenarios. This section reviews findings on the disease’s adverse effects on well-being from the household to the national level and presents results of recent studies examining the influence of treatment on mitigating these effects.