Preparing for the Future of HIV/AIDS in Africa A Shared Responsibility (2011) / Chapter Skim
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4 The Burden of HIV/AIDS: Implications for African States and Societies
4 The Burden of HIV/AIDS: Implications for African States and Societies
Pages 70-105
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From page 70... ...
. Between December 2008 and December 2009, 961,000 patients in Africa began receiving antiretroviral therapy (ART)
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From page 71... ...
, 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)
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From page 72... ...
study of income mobility and poverty in poor HIV/AIDS-affected households in South Africa reveal these starting-point dynamics. Comparing outcomes in a cohort of HIV/AIDS-affected households with outcomes in a control group, Booysen demonstrates an association between HIV/AIDS-related morbidity and mortality and downward income mobility in affected households.
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From page 73... ...
point out that HIV/AIDS impacts food security beyond agricultural households, extending into a wider system of family exchanges of food and cash remittances. Whether the negative effects of HIV/AIDS on household food security produce negative effects at the community level has been questioned (Frayne, 2006)
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From page 74... ...
suggests that orphanhood and coresidence with a chronically ill or HIV-positive adult may not be the best indicator of children's vulnerability. Based on surveys from 36 African countries, their data show that a parent's AIDS-related death or chronic illness could not consistently be tied to hunger, lower school attendance, or first sexual experience at an early age.
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From page 75... ...
Placing just 1 percent of the 508,000 Burundian orphans in such insti tutions would cost $3.5 million each year. For most African countries, this cost per child rules out institutions as the preferred option for scaling up of orphan care (Csáky, 2009)
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From page 76... ...
A recent review of studies in Tanzania and Uganda (Seeley et al., 2010) confirms lasting negative impacts on household poverty and on children, but does not confirm large societal impacts of the order predicted by Bell and colleagues (2004)
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From page 77... ...
Given that enterprise surveys in Africa typically find turnover rates among unskilled workers of around 11 percent per year in the absence of HIV/AIDS, a very high HIV prevalence is required to substantially increase annual hiring costs. Thus, the question of whether a high prevalence of HIV infection reduces per capita economic growth remains pertinent.
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From page 78... ...
All these factors have a long-lasting effect on social and economic development and make it difficult for southern Africa to attain the Millennium Development Goals of eradicating poverty and achieving sustainable development. Influence of Treatment on Household and Economic Well-Being Whether for assessing ART's effect on preventing orphanhood and vulnerability in children or on averting affronts to African economies, understanding the influence of treatment on the socioeconomic impacts of HIV/AIDS has now become imperative.
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From page 79... ...
The injection of resources for HIV/AIDS care, while providing tremendous opportunity to respond more effectively to the epidemic, also presents critical dilemmas con cerning the sustainability of service provision over time and the future direction of HIV/AIDS policies and programs. This section reviews some of the challenges and possible trade-offs faced by the health sector in African countries in planning and managing responses to the epidemic.
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From page 80... ...
. Some scholars question the applicability of Brazil's experience with cost savings for those African countries most challenged by HIV/AIDS (Over, 2004)
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For African countries whose HIV/ AIDS treatment and care programs are largely or wholly dependent on donor aid, a pressing concern now is how to manage the transition in the face of stagnating
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From page 82... ...
Considered the gateway for HIV prevention, treatment, and care, HIV testing has provided a foundation for African countries' management of their epidemics. A negative test result presents an opportunity for primary prevention through test-linked counseling and education; a positive result presents an opportunity for secondary prevention and referral to support, treatment, and care services for patients and affected families.
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From page 83... ...
, except for South Africa, the mean ratios for countries that have these medical special ists are 1 neurologist for 1 million to 2.8 million people (versus 4 per 100,000 in Europe) ; 1 psychiatrist for 900,000 people (versus 9 per 100,000 in Europe)
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From page 84... ...
commissioned a study to assess the opportunities for and constraints on building the social work workforce within the child welfare sector in Africa (USAID, 2009)
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From page 85... ...
For many African countries, new attention to these essential system components represents catching up to basic standards as much as meeting special demands for managing HIV/AIDS patients. Moreover, while more evidence is needed on the impact of HIV/AIDS programs on service delivery in other health areas, data from Rwanda (Price et al., 2009)
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From page 86... ...
. For example, HIV in health workers is a contributing factor to absenteeism, resulting not just from the pri mary HIV infection but also from immunocompromised workers' increased risk of occupationally acquired illnesses such as tuberculosis (including its multi- and extensively drug-resistant forms)
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From page 87... ...
Predicting the difficult questions and trade-offs now confronting African countries with severe epidemics and high treatment burdens, Over (2004) suggests that "to the extent that HIV-positive groups assist in reducing new infections, they will help ensure the affordability of continued treatment and thus serve their own long-term interests." IMPLICATIONS FOR THE STATE A product of the world's most recent, efficient, in many ways brutal, and short-lived colonial encounters, modern African states have long faced challenges to their security, capacity, and attempts at democracy (Young, 1994)
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One review of data from 21 African countries found that in all cases, the prevalence of HIV/AIDS was similar or higher in military samples compared with the general population, and in some countries dramatically so (Ba et al., 2008)
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. One important exception is HIV/AIDS treatment activism in South Africa (Patterson, 2006)
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. While the causes of death among MPs are unknown, Chirambo notes that in the mid1990s, many southern African countries recorded significant losses of MPs to natural, undisclosed illness.
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exploration is unique and important for fully understanding the implications of HIV/AIDS for African states and societies. His anal ysis of the interaction between HIV/AIDS and political and electoral governance, in particular, provides a starting point for understanding the implications of the epidemic for African countries' transition to democratic forms of government.
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From page 92... ...
Using Uganda, Swaziland, South Africa, and Zimbabwe as comparative case studies, Patterson (2006) examines leadership on dimensions of centralization of power, neopatrimonialism, state capacity, and security concerns to determine how these elements affect HIV/AIDS policies in those countries.
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From page 93... ...
Possessing all of these characteristics and further bolstered by linkages to global networks, South Africa's Treatment Action Committee is one prominent example of the success of civil society participation in Africa, according to Patterson. Where resources are available and leadership development has been supported, community mobilization can also produce an effective response.
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From page 94... ...
To ensure the most effective use of future resources in the fight against HIV/AIDS, understanding the multiple and variable elements of good governance will be critical for both African countries and donors. More and better documentation of the links between good governance practices and outcomes and impact on the African epidemic is also in order.
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From page 95... ...
. Training for HIV/AIDS Professional Support Staff In addition to doctors and nurses, the HIV health workforce includes clinical officers, pharmacists, laboratory technicians, epidemiologists, phlebotomists, counselors, program managers, statisticians, data clerks, ancillary staff, and community health workers.
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A recent survey conducted by the African Union on the state of TVET in 18 African countries suggests a number of priority areas for such training in Africa (African Union, 2007)
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African countries should invest in, evaluate, and apply more efficient models of HIV/AIDS care and treatment and promote those models through South−South learning exchanges. Recommendation 4-32: Establish a governance contract.
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2007. Clinical outcomes and CD4 cell response in children receiving antiretroviral therapy at primary health care facilities in Zambia.
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2009. Multiple stressors in southern Africa: The link between HIV/ AIDS, food security, poverty and children's vulnerability now and in the future.
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2010. Human resources in the health sector of Portuguese-speaking African countries: Identical problems, cross-sectional solutions?
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2009. South Africa: Country faces shortage of social workers.
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South African Journal of Medicine 98:468-472. Parkhurst, J
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2010. Economic outcomes of patients receiving antiretroviral therapy for HIV/AIDS in South Africa are sustained through three years on treatment.
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2009. Rapid advice: Antiretroviral therapy for HIV infection in adults and adolescents.
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From page 105... ...
2010. Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector: Progress report 2010.
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