THE ECONOMIC IMPACT OF HIV/AIDS ON SMALL,MEDIUM AND LARGE ENTERPRISES1

Based on the Bureau of Economic Research (BER's) 2005 HIV/AIDS survey, this paper provides a snapshot view of the nature and the extent of the impact of HIV/AIDS on companies of different sizes in South Africa, as well as their response to the epidemic. Whereas the focus of most of the previous workplace surveys has been on “evaluating workplace responses”, the present study also considers the economic impact of HIV/AIDS. This study provides evidence of the impact of HIV/AIDS on the largest sample of small, medium and large companies in South Africa to date. The survey results suggest that employer responses are strongly linked to company size, with the majority of medium and large companies indicating that they have an HIV/AIDS policy in place and small companies having done little in the way of action against the epidemic.     

艾滋病对我国社会经济影响

基于对我国艾滋病流行较为严重的五个省份进行的问卷调查,对比分析了931户感染者家庭和995户非感染者家庭的相关数据。研究发现,艾滋病对感染者个人及其家庭造成了极大的影响,如导致家庭结构改变、就业机会减少、劳动收入下降、医疗支出明显增大;同时也引发一系列社会经济问题,如贫富差距加大、性别不平等加剧、贫困家庭儿童教育机会减少及社会歧视扩大。最后提出了缓解艾滋病造成影响的对策建议。     

THE IMPACT OF HIV/AIDS ON ECONOMIC GROWTH IN SUB‐SAHARAN AFRICA1

This study investigates the hypothesis that HIV/AIDS epidemic slows down the pace of economic growth. We examine 41 Sub‐Saharan African countries by using the empirical growth equation in an augmented Solow model in which health capital serves as a determinant of human capital. Econometric analysis is based on panel data and covers the period 1997‐2005. We control for a variety of factors possibly correlated with HIV prevalence that might also influence economic growth. As a key result we prove that the epidemic has a significant negative effect on the growth rate of per capita GDP in Sub‐Saharan Africa.     

HIV/AIDS AND POVERTY IN SOUTH AFRICA: A BAYESIAN ESTIMATION OF SELECTION MODELS WITH CORRELATED FIXED‐EFFECTS

In this paper, we estimate the causal impact of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) on monetary poverty using a panel database from South Africa. We treat endogeneity and selection problems associated with HIV/AIDS by a selection model that includes correlated fixed effects both in the level and in the participation equations, which are estimated simultaneously via original Bayesian methods. We model the consequences of the illness on both labour income and income transfers, and disentangle between urban and rural households. While no significant impact of HIV/AIDS on labour income is found because of households' recomposition, we find a substantial fall in received transfers among rural population and a dramatic increase in chronic poverty.     

Livestock as a buffer against HIV and AIDS income shocks in the rural households of Zimbabwe

The objective of this study was to determine the extent to which households use livestock sales to mitigate the impact of HIV/AIDS income shocks. Using survey data from the Muzarabani and Bindura districts of Mashonaland Central Province in Zimbabwe, the econometric analysis indicated that livestock, particularly poultry and small stock, play a significant role in smoothing income fluctuations due to HIV/AIDS. Cattle sales compensate for 71 per cent of income shortfalls due to HIV/AIDS. About 90 per cent of HIV/AIDS-afflicted households, headed mainly by women or children, used poultry and goats as consumption-smoothing strategies when faced with negative income shocks. Government and other stakeholders were advised to support the use of small stock as a strategy for coping with HIV/AIDS economic shock in female- or child-headed households in rural areas.     

Poverty,HIV/AIDS and the old age pension in Bhambayi,Kwazulu-Natal,South Africa

To date the international community has tended to direct HIV prevention programmes, treatment, care and supportive services to young adults and children, with little concern about the impact on older people. Since empirical evidence on the socioeconomic impact of HIV/AIDS on households with older persons is lacking, this paper attempts to fill this gap, using data from a household-based survey conducted in Bhambayi, a mixed formal and informal settlement north of eThekwini, KwaZulu-Natal. The findings highlight the links between the uptake of the South African old age pension, poverty and HIV/AIDS in households with older persons. The paper makes recommendations for both government and non-governmental organisations in respect of community-based support systems for such households affected by HIV/AIDS.     

Child-headed households in South Africa: What we know and what we don't

Household structures in many countries in Africa have been drastically changed by the HIV/AIDS epidemic. Traditionally, orphans were absorbed by members of the extended family but today this safety net no longer works so well and many children are left to fend for themselves. The South African Government recognises the problem, but views differ on the effectiveness of the programmes for assisting these children. This article looks at what is known and what needs further research. It is known that child-headed households do exist in South Africa and that children living in these households are vulnerable. What is not known is the prevalence of these households and how to deal with the children's psycho-social problems. The article argues that the definition of child-headed households needs to be refined if we are to understand the extent of the problem. This will facilitate assessment of the programmes established for these children.     

HIV/AIDS Knowledge and Behaviour: Have Information Campaigns Reduced HIV Infection? The Case of Kenya*

Abstract: AIDS continues to have a devastating effect on developing countries, particularly in sub‐Saharan Africa. The lack of a proven effective vaccine to stop HIV transmission has led to much of public policy putting an emphasis on information campaigns in order to reduce HIV‐prevalence. In this paper we examine the impact of HIV/AIDS‐knowledge from two sides. First, we examine to what extent the campaigns have been successful at inducing the expected behavioural change with regards to HIV‐related attitudes. Second, we examine the impact of HIV/AIDS knowledge on HIV status. The basic policy issue can be expressed as follows: even if individuals have acquired sufficient and necessary information on the basic facts about AIDS, factors such as innate risk attitudes or cultural background could undermine the effects of the campaigns. Using the Kenya Demographic and Health Survey (2003) we elicit empirical evidence on the relation between declared HIV/AIDS‐knowledge, behavioural attitudes related to HIV/AIDS situations and the relation between knowledge and observed HIV‐status. Overall, our empirical findings suggest that information campaigns have been effective at equipping the adult population in Kenya with the required knowledge to avoid becoming HIV‐positive. However, when HIV‐status is measured objectively we find that the relation between correctly declared attitudes and actual behaviour is only statistically significant for females who have arrived into sexuality late enough to benefit from such campaigns: it is for these females that the impact of the information campaigns has been to statistically reduce the probability of becoming HIV positive, as intended. In the case of males we find that there is no statistical relation between either knowledge or timing of the information campaigns and a positive HIV status. Nevertheless, another important finding refers to the selection bias induced by males who are sampled randomly but decline to take the HIV test. The consequences of this bias are twofold; first, the estimated policy parameters for males should be interpreted with caution, but more importantly, estimating the population level HIV‐prevalence for Kenyan males based on the DHS implies underestimating the true and unknown prevalence rate. Our analysis controls for individual characteristics, selection bias and endogeneity effects, thus allowing us to make inferences for the full population and with regards to policy implementation.     

HIV/Aids and land: case studies from Kenya,Lesotho and South Africa

Recent research conducted in Lesotho, Kenya and South Africa has revealed that HIV/Aids will seriously impact on a range of land issues as a direct result of very high infection rates in these countries. HIV/Aids will affect different forms of land use, the functioning of land administration systems, land rights of women and orphans as well as the poor generally, and inheritance practices and norms. The epidemic not only affects the productivity of the infected, but also diverts the labour of the household and extended family away from other productive and reproductive activities as they take care of the sick. Affected households fall below the social and economic threshold of vulnerability and ‘survivability’, leaving the survivors – mainly the young and elderly – with limited resources to quickly regain a sustainable livelihood. This indicates the importance of effective land administration systems and of land rights as HIV/Aids impacts on the terms and conditions on which households and individuals hold, use and transact land. This has a particular resonance for women and children's rights, which, in the context of rural power relations that are themselves coming under increasing pressure from the epidemic, are especially vulnerable to being usurped. Thus, the impact of HIV/Aids on land raises complex and sensitive issues for land policies and programmes, particularly if they are intended to underpin rural development and sustainable livelihoods.     

THE RELATIONSHIP BETWEEN LABOUR MARKET DYNAMICS AND HIV/AIDS PREVALENCE IN SOUTH AFRICA ‐ A LITERATURE REVIEW1

The aim of this literature review is to analyse the contribution of current research and literature to an understanding of the relationship between labour market dynamics and HIV/AIDS prevalence in South Africa. It highlights and assesses the extent to which those factors that are regarded as determinants of HIV susceptibility, AIDS vulnerability and prevalence, interact with differentiation in the labour market. The conclusion is that current research studies do not sufficiently consider a more nuanced relationship between complex labour market dynamics and socio‐economic risk factors driving HIV/AIDS susceptibility and vulnerability.     

THE IMPACT OF HIGHLY ACTIVE ANTIRETROVIRAL TREATMENT (HAART) ON EMPLOYMENT IN KHAYELITSHA

This paper examines the impact of highly active antiretroviral treatment (HAART) on labour force participation of people living with HIV/AIDS in Khayelitsha, South Africa. Cox Proportional Hazard Models with stratum effects for three medical clinics, and Accelerated Failure Time Models with individual specific unobserved shared effects (frailty), are estimated for transitions from inactivity to unemployment, and transitions from unemployment into employment, using a longitudinal data set. The findings of this study indicate that HAART leads to greater activity in the labour market, but there was not a strong effect on re-entry into employment.     

HIV/AIDS in the transport sector of southern Africa: Operational challenges,research gaps and policy recommendations

The transport sector is an integral element of southern Africa's economic development. The impact of HIV/AIDS on the region is therefore a major cause for concern. Using a method of triangulation, we used the findings of a comprehensive literature review, a stakeholder questionnaire and a United Nations regional workshop to take stock of the existing evidence linking HIV/AIDS to the transport sector. This paper outlines the strategies used to address HIV/AIDS by a range of stakeholders in the road, maritime, aviation and railway transport sectors. It highlights regional, national, and intervention-specific good practice examples in the field, suggesting key research gaps and putting forward policy recommendations for the region. As a result, national action plans will hopefully be able to benefit from this knowledge-sharing, enhanced regional cooperation and implementation of more effective responses to the epidemic in this critical sector.     

THE BURDEN OF HIV/AIDS IN THE PUBLIC HEALTHCARE SYSTEM

Given current lack of routine data, assessing the burden of HIV/AIDS on the public healthcare system is complex. This research aimed to collect a wide range of data that could be used to estimate this burden and the costs of meeting it. Data collection was undertaken by research doctors who were employed in a wide spectrum of facilities to compile information on patients' HIV-status, retrospective utilisation of services and unit costs of care. Key results indicated that the percentage of expenditure on HIV-related care was 26% across all facilities. HIV-positive patients had higher utilisation of services compared to other patient groups; the annual cost per patient was estimated to be R4,813 (2007/08 prices). Results should be interpreted in the light of the underlying population need and context-specific access barriers.     

HIV/AIDS and child malnutrition in eastern and southern Africa

HIV/AIDS and child malnutrition are pervasive in eastern and southern Africa. This paper employs cross‐country panel data on 20 countries from 1991 to 2017 to explore the macro‐level relationship between HIV/AIDS and child malnutrition. Using instrumental variables (IV) regression, we find that HIV/AIDS is a robust predictor of long‐term and chronic malnutrition. Conditional on various controls, the results demonstrate a positive empirical association between HIV/AIDS and stunting. Moreover, increased access to improved water, female education, and food availability are critical for reducing stunting. These findings underscore the need for an integrated national policy on nutrition and HIV/AIDS and intersectoral collaboration between government agencies responsible for managing nutrition and HIV/AIDS programs.     

Scaling up support for children in HIV-affected families by involving early childhood development workers: community views from KwaZulu-Natal,South Africa

The United Nations Programme on HIV/AIDS estimates that South Africa has 1.2 million orphans as a result of AIDS. This study investigated the views of communities in KwaZulu-Natal on the potential use of early childhood development (ECD) practitioners for helping children in vulnerable households. It reports on in-depth interviews and focus group discussions with community members and service providers in six different areas of KwaZulu-Natal. Despite the increase in the numbers of deaths, people in affected areas have yet to accept that HIV is the cause. Stigma, denial, myths and witchcraft beliefs were evident, particularly in the rural areas. There was general agreement by the respondents that ECD practitioners with additional training specific to HIV/AIDS could assist families if cost difficulties were overcome. As community members with basic training in childcare they could enhance community responses by linking with community health workers and other service providers to assist children and households in need.     

EXPLORING ATTRITION BIAS: THE CASE OF THE KHAYELITSHA PANEL STUDY (2000-2004)

Attrition bias is a problem for users of panel data. Researchers need to know what socio‐economic factors are associated with attrition, and whether this is of relevance for the kind of analysis they want to conduct. This paper discusses attrition bias in the 2000/2004 Khayelitsha panel study. It shows that women, shack‐dwellers and people living in smaller households are more likely to attrit, but that the impact of these variables on the probability of attrition is relatively small. The implications for labour‐market analysis are then explored using Mincerian earnings functions and a probit regression on whether respondents are wage‐employed or not. The coefficients generated using a restricted sample of non‐attritors do not differ significantly from those generated by the entire sample. This suggests that attrition bias in this particular data set is not a problem for this kind of labour market analysis.     

The challenges facing empirical estimation of household food (in)security in South Africa

This paper sets out to describe current principle theoretical positions in food security research, describe and compare empirical South African food security studies with key international methodologies and pose research challenges for food security research in the country. Scant available food security studies for South Africa seem to indicate that food insecurity and hunger exist and are likely to increase due to increasing food price trends, greater reliance on cash food purchases and spiralling vulnerability as a result of HIV/AIDS morbidity and mortality. Empirical research is urgently needed to determine the coping strategies of households under ‘normal’ conditions, identify vulnerable households, and monitor the impact of various shocks and stresses on household food security.     

Why HIV/AIDS prevention strategies fail in Botswana: considering discourses of sexuality

A phenomenological study that was carried out among five ethnic groups of Botswana revealed the importance of taking into account culturally situated sexual realities when prevention policies for HIV/AIDS are considered and implemented. Furthermore the study threw light on the ineffectiveness of the current national HIV/AIDS prevention strategy of ‘Abstain, Be faithful, or use a Condom’ (ABC), a strategy that has been externally imposed on communities, without sufficiently engaging the behavioural practices and values of the communities themselves. This paper therefore advocates educational strategies for HIV/AIDS prevention that take into consideration localised social relations and value systems. Devising policies that engage with the discourses that are dominant in each ethnic group can make a difference in a country that has been hard-hit by the HIV/AIDS epidemic.     

HEALTH FACILITY CHOICE IN HIV- AND AIDS-AFFECTED HOUSEHOLDS IN TWO SOUTH AFRICAN COMMUNITIES

This paper analysed differences in the choice of health-care facility by ill individuals in human immunodeficiency virus (HIV)- and acquired immune deficiency syndrome (AIDS)-affected households in the Free State province of South Africa. Secondary education, access to medical aid and household income were significant determinants of choice as were severity and type of illness, and type of health care required. Ill persons with HIV- and AIDS-related illnesses are significantly more likely to opt for public health care, although the strength of this preference declines as household income increases. Those with severe and particularly severe HIV- and AIDS-related illness, in turn, are significantly more likely to opt for private health care, especially at higher levels of income. The public health care sector therefore is likely to remain the backbone of health-care provision to those infected with and affected by HIV and AIDS, highlighting the need for equitable access to efficient, quality public health services.     

The effects of female HIV/AIDS status on fertility and child health in Cambodia

Although Cambodia has been on a higher growth track, it still faces a great challenge in public health. Public health is closely related to the standard of living of the people and is indispensable for further economic development. This paper considers a serious public health problem, the HIV/AIDS epidemic in Cambodia. Specifically, it presents two testable hypotheses derived from a simple model and then empirically demonstrates these hypotheses, using data of more than 8000 women from the 2005 Cambodia Demographic and Health Survey (DHS). One hypothesis is the negative effect of female HIV on fertility, and the other is the positive effect of maternal HIV on child health status. Our estimation results are consistent with these hypotheses, implying that women infected with HIV tend to bear fewer children and their children are in better health.