Methoden und Konzepte der Internationalen

Entwicklungszusammenarbeit

Vorlesung WS 2005/6

HIV/AIDS - IMPAKT

Literatur zur Vorlesung UNDP; Bericht über die menschliche Entwicklung (HDR) 2003 (Handbibliothek)

und 2005 www.undp.org

UNICEF, MI: Damage Assessment Report www.unicef.org

UNICEF: Facts for Life www.unicef.org

UNAIDS/WHO: Report on the Global AIDS Epidemic 2004 www.unaids.org

UNAIDS: Sexual behaviour change for HIV: Where have theories taken us?

1999 UNAIDS Best Practice Collection www.unaids.org

Barnett, T. & A. Whiteside: AIDS in the Twenty-First Century.

Disease and Globalisation. 2002 (Handbibliothek)

Worldbank: Confronting AIDS. Public Priorities in a Global Epidemic. 1999

Revised Edition. www.worldbank.org (Handbibliothek)

Todaro, M: Economic Development (8. Ausgabe) 2003 (Handbibliothek)

Auswirkungen von HIV/AIDS

Auf die Menschliche Entwicklung

1. Lebenserwartung

Adults and children estimated to be living Adults and children estimated to be living with HIV as of end 2004with HIV as of end 2004

Total: 39.4 (35.9 – 44.3) million

Western & Central Europe

610 000610 000[480 000 – 760 000][480 000 – 760 000]

North Africa & Middle East540 000540 000

[230 000 – 1.5 million][230 000 – 1.5 million]

Sub-Saharan Africa25.4 million25.4 million

[23.4 – 28.4 million][23.4 – 28.4 million]

Eastern Europe & Central Asia1.4 million 1.4 million

[920 000 – 2.1 million][920 000 – 2.1 million]

South & South-East Asia7.1 million7.1 million[4.4 – 10.6 million][4.4 – 10.6 million]

Oceania35 00035 000

[25 000 – 48 000][25 000 – 48 000]

North America1.0 million1.0 million

[540 000 – 1.6 million][540 000 – 1.6 million]

Caribbean440 000440 000

[270 000 – 780 000][270 000 – 780 000]

Latin America1.7 million1.7 million

[1.3 – 2.2 million][1.3 – 2.2 million]

East Asia1.1 million1.1 million

[560 000 – 1.8 million][560 000 – 1.8 million]

00002-E-5 – 1 December 2003

Changes in life expectancy in selected African countries

with high and low HIV prevalence: 1950-2005

with high HIV prevalence:ZimbabweSouth AfricaBotswana

with low HIV prevalence:MadagascarSenegalMali

Source: UN Department of Economic and Social Affairs (2001) World Population Prospects, the 2000 Revision

30

35

40

45

50

55

60

65

Lif

e e

xp

ecta

ncy (

years

)

1950– 1955

1955- 1960

1960-1965

1965-1970

1970-1975

1975-1980

1980-1985

1985-1990

1990-1995

1995-2000

2000-2005

0 10 20 30 40 50 60 70

Cambodia

Haiti

Mozambique

Rwanda

Côte d'Ivoire

Zambia

Kenya

South Africa

Zimbabwe

Botswana

Life expectancy at birth (years)

Predicted life expectancy Loss in life expectancy due to HIV/AIDS

Predicted loss in life expectancy Predicted loss in life expectancy due to HIV/AIDS in children born in 2000due to HIV/AIDS in children born in 2000

Source: U.S. Census Bureau, 2000

Projected population structure with and Projected population structure with and without the AIDS epidemic, Botswana, 2020without the AIDS epidemic, Botswana, 2020

80757065605550454035302520151050

020406080100120140 0 20 40 60 80 100 120 140

Males Females

Deficits due to AIDS

Projected population structure in 2020

Population (thousands)

Ag

e in

yea

rs

Source: US Census Bureau, World Population Profile 2000

Auswirkungen von HIV/AIDS

Auf die Menschliche Entwicklung

- verschiedene Ebenen

Impact of HIV/AIDS on urban households, Côte d’Ivoire

Impact of HIV/AIDS on urban households, Côte d’Ivoire

General populationGeneral population Families living with AIDSFamilies living with AIDS

Monthly income per capitaMonthly income per capita

Monthly consumptionper capita

Monthly consumptionper capita

00

5 0005 000

10 00010 000

15 00015 000

20 00020 000

25 00025 000

– 5 000– 5 000

30 000 Francs CFA30 000 Francs CFA

Savings/DisavingsSavings/Disavings

Source: Simulation-based on data from Bechu, Delcroix and Guillaume, 1997

Impact of HIV/AIDS on agricultural production in Ethiopia

Hours spent by women on agricultural tasks:

HIV/AIDS affected households:

11.6 - 16.4 hours/week

Non-HIV/AIDS affected households:

33.6 hours/weekSource: A. Baryoh, 1994, unpublished.

Reduction in production in a household

with an AIDS death, Zimbabwe

Source: Stover & Bollinger, 1999

•

•

•

•

•

Crops Reduction in output

Maize

Cotton

Vegetables

Groundnuts

Cattle owned

49%

37%

29%

47%

61%

Impact at the Household LevelImpact at the Household Level

Production & Production & earningsearnings

Investment and Investment and consumptionconsumption

Household health Household health and compositionand composition Psychic costsPsychic costs

Reducedincome

Reducedproductivity

Reallocation oflabour & land

Medical costs

Funeral costs

Legal fees

Dissavings

Changes inconsumption& investment

Health maintainingactivities reduced

Loss of deceased

Poor health ofsurvivors

Dissolution ofhousehold

Disutility to

individual

Grief ofsurvivors

Source: Source: Terminology - S. Kongsin, 2000Terminology - S. Kongsin, 2000

Household Impact: Caring for OrphansHousehold Impact: Caring for Orphans

A study from Uganda shows that 25% of households

are providing for an orphan Source: Lyons, M. 1997

A study from Tanzania shows that 21% of the families in

Bukoba district were fostering an orphanSource: Rugalema, 1999

A study from Uganda shows that 25% of households

are providing for an orphan Source: Lyons, M. 1997

A study from Tanzania shows that 21% of the families in

Bukoba district were fostering an orphanSource: Rugalema, 1999

Percentage of workforce lost to AIDS by 2005 and 2020 in selected African

countries

0

10

20

30

40

50

%

2005 2020

BotswanaCameroon

CAR

Côte d’IvoireEthiopia

Guinea-Bissau

MozambiqueNigeria

South Africa

TogoUR Tanzania

Zimbabwe

Sources: ILO (2000) POPILO population and labour force projection; UN Department of Economic and Social Affairs, Population Division (1998) World Population Prospects: the 1998 Revision

Newly diagnosed AIDS cases Newly diagnosed AIDS cases and medical expenditure on an agricultural estate and medical expenditure on an agricultural estate

in Kenya, 1989 to 1997in Kenya, 1989 to 1997

0

20

40

60

80

100

120

Nu

mb

er o

f n

ewly

dia

gn

ose

d

AID

S c

ases

0

5

10

15

20

25

Med

ical

exp

end

itu

re

(KS

h m

illi

on

s)

1989 90 91 92 93 94 95 96 1997

new AIDS casesmedical spending

Source: Rugalema et al. HIV/AIDS and the commercial agricultural sector of Ken UNDP/FAO, 1999

Hours lost to Sickness and Funerals,Hours lost to Sickness and Funerals,Chilanga-Works(Source Ministry of Health-Chilanga-Works(Source Ministry of Health-

Zambia)Zambia)

0

10,000

20,000

30,000

40,000

50,000

92-93 93-94 94-95

Funerals

Sickness

HIV prevalence in military personnel in Africa

Nigeria: 11% among peacekeepers returning from

Sierra Leone and Liberia vs 5% in adult population

South Africa: 60-70% in military vs 20% in adult

population

Source: Nigeria AIDS bulletin No 15, May 20, 2000; The Mail & Guardian, Pretoria, March 31, 2000; UNAIDS/WHO 1999 estimate

Economic Growth Impact of HIV (1990-97)Economic Growth Impact of HIV (1990-97)

Figure 2: Growth Impact of HIV (1990-97) (80 developing countries)

-1.6

-1.4

-1.2

-1

-0.8

-0.6

-0.4

-0.2

0

0 5 10 15 20 25 30 35

HIV Prevalence Rate (%)

Re

du

cti

on

in

gro

wth

ra

te G

DP

p

er

ca

pit

a (

%,

pe

r y

ea

r)

Source: R. Bonnel (2000) Economic Analysis ofHIV/AIDS, ADF2000 Background paper, World Bank

Estimated impact of AIDS on under-5 child Estimated impact of AIDS on under-5 child mortality rates, selected African countries, 2010mortality rates, selected African countries, 2010

Botswana Kenya Malawi Tanzania Zambia Zimbabwe

0

50

100

150

200

250Deaths per 1,000 live births

Without AIDS

With AIDS

Source: US Census Bureau

Projected reduction in size of primary-school-age

population by 2010, in selected African countries

0

5

10

15

20

25

30

Zimbabwe Zambia Kenya Uganda

% r

ed

ucti

on

Source: World Bank, 2000

Success stories

00002-E-22 – 1 December 2003

Trends in HIV prevalence among pregnant women

in Kampala, Uganda: 1991-2000

Source: STD/AIDS Control Programme, Uganda (2001) HIV/AIDS Surveillance Report

0

10

20

30

40

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Perc

en

tag

e

Prevalence among pregnant women in major urban areas, Uganda

Source: Uganda National AIDS Programme

0

5

10

15

20

25

30

35

1985 86 87 88 89 90 91 92 93 94 95 96 97 98 99 2000

Pre

vale

nce

HIV prevalence rate among 13 to 19-year-HIV prevalence rate among 13 to 19-year-olds olds

Masaka, Uganda, 1989 to 1997Masaka, Uganda, 1989 to 1997

Source: Kamali et al. AIDS 2000, 14: 427-434

0

1

2

3

4

5

1989/90 1990/91 1991/92 1992/93 1993/94 1994/95 1995/96 1996/97

Girls

Boys

HIV

pre

va

len

ce

(%)

Increase in reported condom use with non-regular

partners in selected districts in Uganda: 1996-2000

Source: STD/AIDS Control Programme, Uganda (2001) HIV/AIDS Surveillance Report

0

20

40

60

80

% c

on

dom

use

1997 1999 1996 1999 1997 2000 1997 2000

Mbara Mpigi Masindi Pallisa

00002-E-26 – 1 December 2003

Condom use among men with non-regular partners

in selected sub-Saharan African countries: 1994-2000

Source: Macro International (1994-2000) Demographic and Health Surveys; Measure Evaluation

20

30

40

50

60

1994 1995 1996 1997 1998 1999 2000

Malawi United Rep. of Tanzania

Uganda Zambia

%

70

10

0

00002-E-27 – 1 December 2003

Scenario of the epidemic in Thailand, had there been

no intervention through 2020, and observed epidemic curve

0

2,000

4,000

6,000

8,000

10,000

Number of HIV infections (thousands)

1985 1990 1995 2000 2005 2010 20202015

ObservedNo Intervention

Source: Division of AIDS, Ministry of Public Health in Thailand; Thai Working Group on HIV/AIDS Projection (2001)HIV/AIDS Projections for Thailand: 2000-2020