It is now 20 years since the first cases of acquired immune deficiency syndrome (AIDS) were discovered in sub-Saharan Africa. At the beginning of the third decade of the global pandemic, AIDS has reversed gains in life expectancy and improvements in child mortality in many countries; mortality among the population aged 15–49 has increased manyfold, even in countries with modest epidemics.1 AIDS is the leading cause of mortality among adults (WHO, 2004). According to estimates by the Joint United Nations Programme on AIDS (UNAIDS), as of the end of 2003, over 20 million people had died of AIDS. Some 38 million people are estimated to be living with the human immunodeficiency virus (HIV), the virus that causes AIDS, the overwhelming majority of whom—over 90 percent—are in the developing world.
Any discussion of the impact of acquired immune deficiency syndrome (AIDS) on health care systems must distinguish between treatment of the opportunistic illnesses associated with AIDS and treatment directed at the underlying cause, namely, the human immunodeficiency virus (HIV). Treatment of opportunistic illnesses can alleviate suffering but typically extends life by only months. Treatment that controls the HIV in the patient’s body, called antiretroviral therapy or ART, can be much more successful, adding years to life expectancy.
The intrinsic links between climate change and the COVID-19 pandemic have elevated global calls for policymakers to take immediate action on both fronts. Fiscal stimulus supporting recovery from the pandemic can be designed to simultaneously address climate change. In turn, this could help reduce the spread of future pandemics as climate change is a threat multiplier for pandemics. Destruction of the environment and biodiversity makes pandemics more likely while pollution and other man-made factors driving climate change weaken the health of human beings, raising their vulnerability to viruses and other diseases.
In many countries, the HIV/AIDS epidemic has attained a scale at which the impact on the economy and, even more broadly, on societies, is both evident and very serious. Through its broad economic impact, HIV/AIDS thus becomes an issue for macroeconomic analysis, and policies to prevent the spread of the virus have direct implications for key economic indicators such as economic growth and income per capita,1 and for economic development more generally. However, because the impact is very uneven across individuals or households, an analysis that captures only the main aggregate economic variables would miss many of the microeconomic effects of HIV/AIDS on living standards, which also matter for public policy and which, in turn, affect the main aggregate economic variables, for example through the accumulation of physical and human capital.
Every second, the region has averaged 106 new internet users.1 This fast-paced digital revolution holds the promise of transforming economies and people’s lives. It takes on added importance as countries across the region grapple with the unprecedented health and socio-economic fallout of the COVID-19 pandemic. All policy levers are being deployed to protect lives and livelihoods. Digital solutions have helped to provide more resilience and allowed for rapid, flexible, and inclusive policy responses to the pandemic.
In his book Plagues and Peoples, McNeill (1976) views history as the interplay between an array of parasites and their human hosts—a struggle in which communicable diseases and human responses to them have profound social, economic, and cultural effects. Following the outbreak of the AIDS epidemic in the 1980s, humanity must now contend with a new great plague, the scale and character of which will surely put McNeill’s thesis to the test. One vital lesson to be drawn from his account is that any attempt to understand the effects of the AIDS epidemic must take a long-term perspective. That is a salient feature of the approach we adopt here: we will argue that, from modest beginnings, the economic damage caused by AIDS can assume catastrophic proportions over the long run, and thereby threaten the social fabric itself.
Among the great challenges of development, education continues to take pride of place. In this chapter we highlight some of the channels by which the AIDS pandemic in Africa may affect the continent’s ability to produce education and to use it effectively for growth and poverty reduction. Our assessment is preliminary; we hope here to sketch a larger research agenda rather than to dispose of it.
Most studies on the economic impact of HIV/AIDS focus on such variables as GDP growth or income per capita. Early studies, incorporating the impact of HIV/AIDS in a one-sector neoclassical growth model, found that although the impact of HIV/AIDS on GDP growth is substantial, the impact on GDP per capita may well be small. Later studies refined this approach, for example by considering a larger number of sectors, including some demand-side effects, or allowing for an impact of changes in life expectancy on individuals’ decisions.1
The HIV/AIDS epidemic has resulted in significant increases in mortality rates in the affected countries, and it is now the leading cause of death in southern Africa. In Botswana, one of the worst-affected countries, with an adult HIV prevalence rate of 37.3 percent, mortality among the working-age population had increased to 3.8 percent a year (of which 3.7 percentage points, or 96 percent, is HIV/AIDS related) by 2004. Correspondingly, life expectancy has decreased substantially, frequently wiping out gains achieved over several decades. For example, life expectancy at birth is now estimated at less than 40 years for Botswana and Zambia (declines of 41 and 17 years, respectively, compared with a no-AIDS scenario).1
HIV/AIDS is a serious challenge to economic development. Increasing mortality and morbidity reduce living standards directly and have repercussions that affect all areas of the economy. Individuals and households face increasing risks, both directly through the risk of infection, and indirectly as formal and informal social insurance mechanisms are eroded. Companies face productivity losses and increasing costs of medical and death-related benefits. At the macroeconomic level, economic growth declines as the population grows more slowly and as reduced national saving, rising costs, and declining economic prospects deter investment.1