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close this bookThe HIV Epidemic and Sustainable Human Development (UNDP, 1998, 13 p.)
close this folderB. WHAT IS THE RELATIONSHIP BETWEEN THE HIV EPIDEMIC AND SHD?
View the document(introduction...)
View the document1. POVERTY, INEQUALITY AND GENDER
View the document2. MEASURING THE IMPACT OF THE EPIDEMIC ON SHD - THE UNDP HUMAN DEVELOPMENT INDEX
View the document3. INCLUSIVE AND EXCLUSIVE PROCESSES

2. MEASURING THE IMPACT OF THE EPIDEMIC ON SHD - THE UNDP HUMAN DEVELOPMENT INDEX

The HDI of UNDP is widely used as an aggregate measure of progress with human development and is a useful proxy for assessing the performance of countries. It has some disadvantages as do all weighted indexes. In the usual from the HDI is an index which combines life expectancy, a measure of educational attainment and GDP per capita - all clearly important indicators of human development. There are obviously problems with the measurement of the different components of the index where there is a great deal of country variance in the coverage and quality of the basic data. There are other problems such as the absence of distribution indicators, most obviously in the use of GDP per capita which provides a poor indicator of the distribution of income (and no direct indication of the inequality of wealth which may be increasing). There are also major problems with setting the weights for such a index where there is an element of arbitrariness in their selection.

Nevertheless in spite of all of the caveats the HDI is probably the best general indicator we have of human development. Clearly no-one believes that SHD is achievable without rising per capita GDP - economic growth is a necessary if not sufficient requirement for reducing poverty and improving the standard of living. But unfortunately for a number of reasons the HIV epidemic is likely to reduce average rates of increase in GDP (in economic growth). This will happen through the effects of losses of human resources due to morbidity and death; to reduced national savings as resources are diverted away from productive uses and into consumption (especially rising expenditure on health and other social expenditure), and through losses of social capital (as society experiences the effects of changes in values and losses in the efficiency of institutions affected by the epidemic). The evidence from high prevalence countries in Africa who are experiencing more mature epidemics is that growth rates of GDP may be reduced by 0.5 to 1.0% per annum due to the epidemic. These losses may be much larger where the skilled, highly educated and experienced form a significant proportion of those infected with HIV, and when account is taken of the general effects of the epidemic on the efficient functioning of the economy.

· So the evidence is that rates of GDP growth are adversely affected by the HIV epidemic and that these losses can be very significant over time depending on the structure of economies, on the distribution of the infection in the population and its incidence, and on the aggregate effects of the losses of human resources on the efficiency of the production system - in both the formal and informal sectors.

It is unclear what the effects of the HIV epidemic will be on educational attainment which accounts for one-third of the HDI. What seems to be happening in many countries is that enrollment in formal education is reduced as households respond to the pressure on resources by withdrawing children from school. There is a clear gender bias to the response of many parents when making choices: girls are much more often taken out of school when family coping mechanisms are placed under pressure by the epidemic. There are many reasons for this gender bias - in part it is income related, where attendance at school has direct costs (fees and uniforms etc.) and in part it is opportunity costs (the labour of children - especially girls - becomes more valuable to the family as incomes are even more constrained by the epidemic, including also the diversion of women to caring roles, and/or the additional burdens on the household caused by greater expenditure on health, transport, etc., directly related to illness in the family).

Whatever the explanation it seems that one consequence of the epidemic will be a reduction in educational achievement, especially of girls and young women, which will impede the achievement of one of the main goals of SHD. That is the achievement of greater gender equality as both an end in itself and as a means for achieving higher living standards for all. Unfortunately the HIV epidemic has the potential for increasing gender inequality in many ways, not least in reducing the access of girls to education and also to better health where education is an important factor in understanding how to live a more healthy life.

· It follows that educational attainment which is already gender biased in the region will become more so as a result of the HIV epidemic rather than less. This will make it even more difficult to achieve greater gender equality for women in spite of this being a core objective of SHD.

Finally there is the effect on the HDI of changes in life expectancy directly and indirectly attributable to the HIV epidemic. Here the evidence is only too clear; the epidemic has the capacity to drastically increase adult mortality rates - raising these by factors of 5 or 6 times what they would be without AIDS. Since the epidemic is concentrated on the working age groups of 15-45 where mortality would generally be low the effects of HIV (and TB) are disastrous - these groups would otherwise tend to have low mortality rates. To give an example from Africa where the epidemic is more advanced; in Tanzania HIV and AIDS are now the largest causes of death for both men and women in the age group 15-59.

Figures 1 and 2 present data on life expectancy for a selected number of countries in sub-Saharan Africa where the epidemic is more mature than it is in the Asia and Pacific region. The projections for the year 2010 should be seen more as scenario predictions given the difficulties in estimating the likely trends in HIV over a period as long as 15 years. What is apparent is that the effects on life expectancy of the epidemic are already apparent in many countries in Africa, with highly significant falls in LE in many countries in the region. Thus in Zambia the Without AIDS LE in 1996 would have been approximately 60 years, whereas the With AIDS LE in 1996 is estimated to be about 35 years. The projected data on LE for 2010 represents an even more serious situation, with further declines in many countries in the Africa region. In some countries the situation is no less than disastrous. In Zimbabwe, to take one example, LE is predicted to be almost 70 years in the Without AIDS scenario, but declines to about 32 years in the With AIDS case.

FIGURE 1

LIFE EXPECTANCY RATE* WITH AND WITHOUT AIDS IN AFRICA: 1996

East Africa


Fig.

Southern Africa


Fig.

West and Central Africa


Fig.

B.F. - Burkina Faso
C.A.R. - Central African Republic
C.I. - Cd'Ivoire

* Life expectancy is the number of years an individual is expected to live.

Source: International Programs Center - Population Division U.S. Bureau of the Census, Washington, D.C.

FIGURE 2

LIFE EXPECTANCY RATE* WITH AND WITHOUT AIDS IN AFRICA: 2010

East Africa


Fig.

Southern Africa


Fig.

West and Central Africa


Fig.

B.F. - Burkina Faso
C.A.R. - Central African Republic
C.I. - Cd'Ivoire

* Life expectancy is the number of years an individual is expected to live.

Source: International Programs Center - Population Division U.S. Bureau of the Census, Washington, D.C.

The effects of HIV/AIDS on life expectancy are already apparent. Similar effects must already be underway in those countries in Asia and the Pacific with highest prevalence and most mature epidemics (such as Thailand and Myanmar).

· The effects on life expectancy of the HIV epidemic are potentially disastrous as the epidemic intensifies in the Asia and Pacific region and adult mortality rates increase. It is possible that life expectancy may over the next 25 years be reduced very significantly with enormous consequences on the potential for achieving SHD. A central objective of SHD is to increase life expectancy through improvements in the standard of living of the population, but the HIV epidemic has the potential for drastic reductions in this crucial indicator of human development.

It is possible to make calculations of the effect of the HIV epidemic on the HDI so as to assess the effect of the epidemic on human development - to measure the impact of the HIV epidemic on SHD. It is rather easier to assess the effects of changes in life expectancy on the HDI than the other two components of the index. Doing this can demonstrate how significant the effects of the epidemic will be on sustainable development in the region; and the evidence is that these can build-up to very significant effects indeed.