1 Sep

 By Edoamaowo Udeme



In all sincerity of purpose, looking at the destruction of lives, hopes, aspirations and wealth due to HIV/ADIS rampage in sub Saharan Africa I want to cry like babies cry not worrying whose tears will flow, and I want to sing like birds sing not worrying who listens or what they think, but surely my cry and my song hopefully will expose the ignorance and the devastating economic effects of HIV/AIDS in sub Saharan Africa. Ignorance of the disease of HIV/AIDS is one major aspect that denies Africa the much needed pace in addressing the menace/scourge. Ignorance means having a lack of information, or lack of knowledge. It is different from stupidity which is lack of intelligence, and different from foolishness which is lack of wisdom. The three are often mixed up and assumed to be the same by some people. “Knowledge is power,” goes the old saying. Unfortunately, some people in sub Saharan Africa do not know about HIV/AIDS, or may have heard of it but do not know it causes, or channels of getting infected, or how to manage and control it.

According to USAID’s HIV/AIDS Health Profile for Sub-Saharan Africa states that “Comprehensive knowledge of HIV/AIDS remains low in sub-Saharan Africa and is an obstacle to reducing incidence rates. Many people living with HIV in sub-Saharan Africa are unaware of their HIV status”. The percentage of men living with HIV who knew their status in sub Saharan Africa is less when compared to women”. Correct knowledge about HIV prevention (i.e., knowing two major ways of preventing the sexual transmission of HIV, rejecting the two most common local misconceptions about HIV transmission, and knowing that a healthy looking person could have HIV) is still low. There are sizable variations among countries; women are more likely to be aware of their status than men. In sub-Saharan Africa, it is likely that more young women 15 to 24 years old had comprehensive correct knowledge about HIV prevention young men. At this juncture my humble contribution as a journalist aims at providing synthetic knowledge/information on the devastating economic implications of HIV/AIDS in Africa as it relates to African men, women, and children, with the hope that it will help policy makers to take informed decisions on public health issues and intervention designs on HIV/AIDS prevention and control towards the elimination in Sub-Sahara Africa. The benefits are enormous of scaling up the impact of HIV/AIDS coverage interventions, improvement of health system approaches and sustained commitment of stakeholders’ sensitization tips on prevention and control efforts are still necessary in Sub-Sahara Africa. Furthermore, novel integrated control strategies aiming at moving HIV/AIDS from epidemic status to control towards elimination, require solid research priorities both for sustainability of the most efficient existing tools and intervention coverage, and in gaining more insights in the understanding of the epidemiology  and socioeconomic aspects of the disease.
HIV stands for Human Immunodeficiency Virus, it is an infectious agent that causes acquired immunodeficiency syndrome (AIDS), a disease that leaves a person vulnerable to life-threatening infections. HIV transmission or infection occurs when a human being is exposed to body fluids infected with the virus, such as blood, semen, vaginal secretions, and breast milk. There are three primary channels of HIV transmission: (1) sexual relations with an infected person (Sexually Transmitted Infections); (2) Sharing hypodermic needles or accidental pricking by a needle contaminated with infected blood; and (3) Transfer of the virus from an infected mother to her baby during pregnancy, childbirth, or through breast-feeding.
Economic and Social Impacts of HIV/AIDS in Sub Saharan Africa
The HIV/AIDS epidemic set back decades of progress in increasing the life expectancy of the people of sub-Saharan Africa. The vast majority of people in Africa who have HIV/AIDS are between the ages of 15 and 49, and millions of adults are dying young or in early middle age. AIDS-related mortality is increasing among 20 to 49 year olds – adults in their most economically productive years.
When a community have a high HIV/AIDS disease rate, absenteeism is high, productivity is low, and less wealth is created. Apart from the misery, discomfort and death that results from disease, it is also a major factor in poverty in a community. Being well (well-being) not only helps the individuals who are healthy, it contributes to the eradication of poverty in the community.
Here, as elsewhere, prevention is better than cure. The economy is much healthier if the population is always healthy; more so than if people get sick and have to be treated. Health contributes to the eradication of poverty more in terms of preventing HIV/AIDS infection as well as its control.
HIV creates many challenges, particularly for those countries most affected by the epidemic throughout Africa. The HIV epidemic requires responsive health systems and programs to address the health of PLWHA (people living with HIV/AIDS) and to implement effective prevention activities. Governments in tight fiscal environments must try to balance increasing public health expenditures on HIV with expenditures in other sectors. Over time, the pandemic can reduce the labor force and productivity, leading to declining welfare of the population and stagnation of the economy. As posited in ‘African Journal of Agricultural Research.2011’, those countries in Southern Africa lost a significant segment of the labor force due to the Impact of HIV/AIDS on Labor Markets, Productivity and Welfare. In addition to the loss of workers, the cost of caring for AIDS patients has decreased productivity and profitability in the informal and formal sectors.
A look at the household level economic impacts, the epidemic is also reversing progress in poverty reduction. AIDS tends to have an impact on the poor more than the rich due to the costs associated with treatment and the loss of a productive laborer in a household. In a South Africa survey as reported in “Impact of HIV/AIDS on Education and Poverty. UN Chronicle. 2011”, two-thirds of respondents reported a drop in household income due to an HIV-related illness, including the direct loss of income earners, and through increased medical expenses by the household on the AIDS victim. In other sub-Saharan African countries, households reported increased expenditures on health diverted resources away from other requirements.
As for food and food security, the negative effects of HIV/AIDS are enormous. Agricultural productivity can be impacted due to household illness, adding to food insecurity in many areas. As posited in “Labour Market and Employment Implications of HIV/AIDS; Geneva, June 2002” by Lisk, the Loss of agricultural labor can lead to switching from cash crops to subsistence farming and within subsistence farming to less intensive crops. In Malawi, 16 percent of the deaths of agricultural experts in the Ministry of Agriculture were attributed to AIDS (FAO of the United Nations. AIDS – A Threat to Rural Africa: Fact Sheet; http://www.fao.org/Focus/E/aids/aids6-e.htm.). This is of particular concern for many African nations, where one-third of the gross national product from the most-affected countries comes from agriculture. In MozambiqueBotswanaNamibia, and Zimbabwe, the International Labor Organization estimates that the agricultural workforce loss could be as high as 20 percent by 2020; an estimated 25 percent of the agricultural labor force in sub-Saharan Africa could be lost by 2020 (Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. World Population Prospects: The 2010 Revision. http://esa.un.org/unpd/wpp/index.htm). Therefore, the private sector has a stake in responding to the epidemic, which affects its workforces and can reduce production of and markets for its goods. The economic impacts of HIV/AIDS on human resources if not checked and controlled could bring about lack of skilled manpower in health and education which are critical to human and sustainable development. All sectors, particularly health and education, are affected by loss of skilled labor to HIV. As health workers either die or leave employment to care for sick family members, clinics are left with low levels of qualified staff. In turn, this undermines preventive health measures and increases the burden on public health structures. According to the World Bank, Zambia loses approximately half as many teachers as it trains due to HIV, limiting human capital able to train and educate future generations (The economic impact of AIDS on the education sector of Zambia: application of the Ed-Sida model). HIV/AIDS poses increasingly heavy demands on Africa’s health systems. As demand for services increases, countries are losing their capacity to supply them. Providing ART to those in needs in Tanzania, for example, would require the full-time services of almost half the existing health care workforce (HIV/AIDS, Work and Development in the United Republic of Tanzania. Geneva, 2004). Most health systems in Africa already face labor shortages due to factors such as worker migration to other regions in pursuit of better pay and working conditions. HIV/AIDS is now exacerbating this shortage by affecting large numbers of the remaining health care workers.
Africa is riddled with orphans and vulnerable children resulting from the death of their parents due to HIV/AIDS. Sub-Saharan Africa is experiencing an unparalleled orphan crisis as a result of the HIV epidemic, home to approximately 90 percent of HIV/AIDS orphans globally according to the United Nations. (UNAIDS Report on the Global AIDS Epidemic: 2010. Geneva, Switzerland 2010).
Globally, 56 percent of children orphaned by AIDS live in six countries in sub-Saharan Africa: Nigeria (2.5 million), South Africa (1.9 million), Kenya (1.2 million), Uganda (1.2 million), Tanzania (1.3 million), andZimbabwe (1 million) as reported in “(Impact of HIV/AIDS on Education and Poverty. UN Chronicle.2011)”. Many of these children are raised by their grandparents or live in households headed by other children. Many children orphaned by AIDS lose their childhood and are forced by circumstances to become producers of income or food or caregivers for sick family members. They may be at increased risk for health problems related to inadequate nutrition, housing, clothing, and basic care. They are also less able than other children to attend school regularly. Children who are orphaned by AIDS are less likely to attend school, though school attendance has been increasing in recent years due to scale up in programs to support orphans with basic health and social services. Those who do not attend school further reduce the potential for developing human capital in future generations.
In the area of stigmatization and discrimination, when we dissect the economic impacts of HIV/AIDS, we cannot ignore the devastating effects of stigmatization and discrimination against people infected with scourge. HIV-related stigma and discrimination in sub-Saharan Africa create major barriers to preventing further infection, alleviating impact, and providing adequate care, support, and treatment. Stigma often leads to discrimination and other violations of human rights, which affect the well-being of PLWHA (people living with HIV/AIDS); stigma is also compounded for those individuals who identify with otherwise stigmatized groups or behaviors. People living with HIV are denied the right to health care, work, education, and freedom of movement. There is a continued need for a multi-sectoral response to change social and cultural beliefs and behaviors and modify policies by governments and employers.
As a journalist whose continuous interest in HIV/AIDS issues as it relates to African and humanity in general, my summation in terms of approach to addressing this menace should be on a tripod of; (1) the need to promote African-owned solutions which will reinforce the response to HIV/AIDS is most desirous now than ever before; (2) the imperative of defining clear goals, expected results and defining role and responsibilities for each stakeholder is non-negotiable if we must make significant progress; (3) and this is to be structured around three pillars: HIV/AIDS health governance, diversified financing exclusive prevention advocacy/campaigns, and access to control/medicine administration. The engine room of this tripod and structural pillars are young people who are at the centre of the AIDS epidemic and youth-led initiatives deserve encouragement and support at the national and international level. Effective prevention programmes are an unfailing vehicle that will take us to the elimination of HIV/AIDS transmission amongst young people, mother-to-child transmission and to zero new HIV infections among children. Eliminate stigma and discrimination against people living with and affected by HIV through promotion of laws and policies that ensure the full realization of all human rights and fundamental freedoms.
Critically and most importantly in order to reverse the ugly trend of ignorance and negative economics of HIV/AIDS pandemic in sub Saharan Africa, there an urgent need for political commitment and financial investment of stakeholders in sustaining the scaling up impact of HIV/AIDS prevention and control interventions, networking between African and non-African scientists, and their international partners are urgently needed in upholding the recent gains, and in translating lessons learnt from the control achievements and successes into practical interventions in HIV/AIDS endemic countries in Sub Saharan Africa and elsewhere.
Let’s remember that prevention is better than cure. Prevention from been infected by HIV/AIDS is more effective and less costly than curing or managing or controlling the scourge.

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