The impact of HIV & AIDS in AfricaThe Impact on the Health SectorThe Effect on HospitalsHealth Care WorkersThe Impact on HouseholdsHousehold IncomeBasic NecessitiesFood ProductionHealthcare expenses and funeral costsHow do HIV/AIDS affected households cope in Africa?The Impact on ChildrenThe Impact on the Education SectorFewer Children Receiving a Basic EducationThe Impact on TeachersThe Impact on Enterprises and WorkplacesThe Impact on Life ExpectancyThe Economic ImpactThe Future Impact of HIV/AIDSReferencesCopyright © AVERT - http://www.avert.org/aidsimpact.htmThe impact of HIV & AIDS in AfricaTwo-thirds of all people living with HIV are found in sub-Saharan Africa, although this region contains little more than 10% of the world’s population.1 AIDS has caused immense human suffering in the continent. The most obvious effect of this crisis has been illness and death, but the impact of the epidemic has certainly not been confined to the health sector; households, schools, workplaces and economies have also been significantlyaffected. During 2007 alone, an estimated 1.5 million adults and children died as a result of AIDS in Sub-Saharan Africa. Since the beginning of the epidemic more than 15 million Africanshave died from AIDS.2 The Impact on the Health SectorIn all affected countries the AIDS epidemic is bringing additional pressure to bear on the health sector. As the epidemic matures, the demand for care for those living with HIV rises, as does the toll of AIDS on health workers. In sub-Saharan Africa, the direct medicalcosts of AIDS (excluding antiretroviral therapy) have been estimated at about US$30 per year for every person infected, at a time when overall public health spending is less than US$10 per year for most African countries.3 The Effect on HospitalsDoctors at the Rixile HIV clinic treat an ill HIV+ child, Tintswalo. As the HIV prevalence of a country rises, the strain placed on its hospitals is likely to increase. In sub-Saharan Africa, people with HIV-related diseases occupy more than half of all hospital beds.4 Government-funded research in South Africa has suggested that, on average, HIV-positive patients stay in hospital four times longer than other patients. It ispredicted that patients affected by HIV and AIDS will soon account for 60-70% of hospital expenditure in South Africa.5 Hospitals are struggling to cope, especially in poorer African countries where there are often not enough beds available. This shortage results in people being admitted only in thelater stages of illness, reducing their chances of recovery. As the epidemic worsens, more complex cases of HIV and AIDS are likely to arise, taking up more hospital time and further reducing the standard of care provided. Health Care WorkersWhile AIDS is causing an increased demand for health services, large numbers of healthcare professionals are being directly affected by the epidemic. Botswana, for example, lost 17% of its healthcare workforce due to AIDS between 1999 and 2005. A study in one region of Zambia found that 40% of midwives were HIV-positive.6 Healthcare workers are already scarce in most African countries. Excessive workloads, poor pay and the temptation to migrate to richer countries once trained are factors that have played a role in this shortage. Although the recent increase in the provision of antiretroviral drugs (ARVs, which significantly delay the progression from HIV to AIDS) has brought hope to many in Africa, it has also put increased strain on healthcare workers. Providing ARVs requires more time and training than is currently available in most countries – for instance, in Tanzania it has been estimated that providing HIV treatment to all those who need it would require the full-time services of almost half the existing health workforce.7 The Impact on HouseholdsThe toll of HIV and AIDS on households can be very severe. Although no part of the population is unaffected by HIV, it is often the poorest sectors of society that are most vulnerable to the epidemic and for whom the consequences are most severe. In many cases, the presence of AIDS causes the household to dissolve, as parents die and children are sent to relatives for care and upbringing. A study in rural South Africa suggested that households in which an adult had died from AIDS were four times more likely to dissolve than those in which no deaths had occurred.8 Much happens before this dissolution takes place: AIDS strips families of their assets and income earners, further impoverishing the poor. Household IncomeAn HIV positive woman in Joza In Botswana it is estimated that, on average, every income earner is likely to acquire one additional dependent over the next ten years due to the AIDS epidemic. A dramatic increase in destitute households – those with no income earners – is also expected.9 Other countries in the region are experiencing the same problem, as individuals who would otherwise provide a household with income are prevented from working by HIV and AIDS – either because they are ill themselves or because they are caring for another sick family member. Such a situation is likely to have repercussions for every member of the family. Children may be forced to abandon their education and in some cases women may be forced to turn to sex work ('prostitution'). This can lead to a higher risk of HIV transmission, which further exacerbates the situation. Another study in three countries, Burkina Faso, Rwanda and Uganda, has calculated that AIDS will not only reverse progress in poverty reduction, but will also increase the percentage of people living in extreme poverty (from 45% in 2000 to 51% in 2015).10 Basic NecessitiesA study in South Africa found that already poor households coping with members who aresick from HIV or AIDS were reducing spending on necessities even further. The most likely expenses to be cut were clothing (21%), electricity (16%) and other services (9%). Falling incomes forced about 6% of households to reduce the amount they spent on food and almost half of households reported having insufficient food at times.11 "She then led me to the kitchen and showed me empty buckets of food and said they had nothing to eat that day just like other days."12 Food ProductionThe AIDS epidemic adds to food insecurity in many areas, as agricultural work is neglected or abandoned due to household illness. In Malawi, where food shortages have had a devastating effect, it has been recognised that