Saturday, August 30, 2008


HIV/AIDS and Poverty continue.

They include poverty and economic marginalization, poor nutrition, opportunistic infection, migration, sexual networking and patterns of sexual contact, armed conflict, and gender inequality. Some of these are discussed below.
Poverty as a key transmission factor:

The relationship between poverty and HIV transmission is not simplistic. It should be emphasized that poor segment of the population who are infected with HIV are considerably more likely to become sick and die faster than the non-poor since they are likely to be malnourished, in poor health, and lacking in health attention and medications.
In effect, all factors, which predispose people to HIV infection, are aggravated by poverty, which creates an environment of risk;

1. Deep-rooted structural poverty, arising from such things as, land ownership inequality, ethnicity and geo-graphical/political isolation, and lack of access to services.
2. Developmental poverty, created by unregulated socio-economic and demographic changes such as rapid population growth, environmental degradation, rural-urban migration, community dislocation, slums and marginal agriculture.
3. Poverty created by war, civil unrest, social disruption and refugees. High levels of rape and the breakdown of traditional sexual mores are associated with military destabilizations, refugee crisis and international influences on local communities.

All three have severe effects on individuals’ and communities’ vulnerability to the spread of HIV, their ability to handle risks, and opportunity to participate in prevention and care activities. The experience of HIV/AIDS by poor individuals, households and communities is likely to lead to an intensification of poverty, push some non-poor into poverty and some of the very poor into destitution. In turn, poverty can accelerate the onset of HIV/AIDS and tends to exacerbate the impact of the epidemic. Thus, as a result of the effect on mortality, morbidity, life expectancy and population growth, HIV/AIDS is having a direct negative impact on poverty, especially as experienced by poor rural households. In the 2001 report on the Special Session of the General Assembly on HIV/AIDS, the United Nations Secretary-General warned that HIV/AIDS was reversing decades of development in the hardest-hit regions of the world:

HIV/AIDS changes family composition and the way communities operate, affecting food security and destabilizing traditional support systems. By eroding the knowledge base of society and weakening production sectors, it destroys social capital. By inhibiting public and private sector development and cutting across all sectors of society, it weakens national institutions. By eventually impairing economic growth, the epidemic has an impact on investment, trade and national security, leading to still more widespread and extreme poverty. The most devastating consequences of HIV infection arise not simply because many people will die but because the deaths will occur mainly among adults between the ages of 25 and 45 years, the very people who work to support families and should be most productive economically. Therefore HIV/AIDS is changing the contours and dynamics of poverty through its demographic and socio-economic impacts, which may:
•Create inter-generational poverty by impoverishing surviving orphans (often forcing them out of school, thus limiting their livelihood options), by fragmenting or dissolving households and by decimating the fragile asset base of the poor;
•Alter the age structure and composition of the poor, by decimating the young adult population while impoverishing an increasing number of children and elderly people;
•Result in irreversible survival mechanisms for the poorest as what is to some extent unique about HIV/AIDS is that the shock it inflicts is one from which many households are unable to recover. In particular, the erosion of the household asset base tends to be permanent;
•Intensify discrimination and marginalization of poor people living with HIV/AIDS as well as their families. This is especially the case with women who are often perceived to be responsible for transmitting the HIV virus;
•Increase the prevalence of poor female-headed households (young widows with small children as well as elderly grandmothers looking after grandchildren) and thus the feminization of poverty and agriculture;
•Exacerbate unequal asset distribution (land, livestock, labor) leading to landlessness and de-stocking. Once land and livestock are sold, the recovery potential of these households is severely diminished. Destitution is the culmination of this process of asset depletion; and
•Intensify poverty-driven labor migration as a coping strategy, thereby increasing the risk of HIV infection among the survivors.

As often is the case, many of these strategies involve people migrating from their homes to other places, usually urban or rural centers, where they hope to find employment. For some women, the pressures of poverty may lead them to engage in sexual transactions in order to support themselves. Therefore migration and commercial sex work are two activities closely associated with risk for HIV infection, two issues that require closer elaboration as they often form central options in the multiple livelihood strategies developed by rural households.

The conceptualization of the factors contributing to the spread of the epidemic and linking it to issues such as poverty, migration in search of labor, income inequalities, and gender relations are crucial to an understanding of HIV/AIDS and its impact on society and the household in particular. From the discussion it is clear that poverty increases vulnerability to HIV infection and poverty is compounded by HIV/AIDS. The latter is a result of the shocks, which result from HIV/AIDS-related deaths and infection that intensify the usual problems associated with severe poverty. As a result, options such as commercial sex work that affected households may be forced to adopt in the face of the epidemic and increasing levels of poverty becomes inevitable. This indicates the need for a more focused discussion around the household and the multiple livelihood strategies that are constituted for survival in an increasingly difficult economic context.

HIV/AIDS and its impact on the Economy:

Economies tend to react more dramatically to economic restructuring than to long, slow corrosions as those wrought by AIDS. However, it is clear that the epidemic has profound implications for economies in affected regions as primary wage earners and caretakers fall sick, require care, and eventually dies, usually consisting of individuals of prime working age.

Macro-Economy and HIV/AIDS:

The impact of HIV/AIDS on the macro economic environment takes two dimensions, namely the direct and indirect costs. The former refers to the cost of treatment associated with HIV related illness, which has serious implications for health care budgets around the region. Those segments of the population that are poverty-stricken stand to lose the most as pressures on the health budgets increases resulting in higher medical costs. Indirect costs are more difficult to measure as the refer to loss of value of production, the loss of current wages, the loss of the present value of future earnings, training cost of new staff, high staff turn-over, cost of absenteeism, higher recruitment costs, the drainage of savings, lower labor force; Lower labor productivity through absenteeism and illness; Cost pressures for companies through benefit payments and replacement costs; Lower labor income, as employees bear some of the AIDS-related costs; Increased private sector demand for health care services; Higher government expenditure on health care services amongst others.

It should be emphasized that the impact on human and social development will be much more profound than can be reflected in limited indicators such as GDP or per capita GDP. These impacts would be felt throughout the economy, from the macro-level to the household, particularly as wage opportunities become scarcer.
The impact of HIV/AIDS at the household level also negatively impacts on the macro-economic context. The repercussions of HIV/AIDS is felt most acutely at the household level, with the burden weighing most heavily on the poorest households, those with the fewest resources with which to cushion the economic impact. The burden of HIV/AIDS and other related consequences readily translates into an overall cost on national development and the macro economies of individual countries, a situation aggravated by the fact that the portion of the population most affected by HIV/AIDS is the most economically active.

Ownership or access to rural land is a key part of many families’ well-being and livelihood. It is, however, only a small part in some contexts: small-scale agriculture in many parts of the world has been shown over the past decades to have become impossible without inputs from labor migrant remittances. This indicates that rural livelihoods are complex and aimed at managing risk, reducing vulnerability and enhancing security and are therefore based upon environmental stability. It is therefore important to have a sense of both the role of land and the broader labor market and macro-economic environment, which often underpin the incomes within the rural economy and the diverse livelihood strategies. These all come under increasing pressure with the broad impact of HIV/AIDS.


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