Indian economy is not immune to AIDS

[Guest guest]

The economy is not immune to AIDS

This pandemic should be tackled as a larger developmental issue, says

Seetha Published : October 6, 2003

In what should set the alarm bells ringing, a survey commissioned by

the Delhi government has estimated the number of people vulnerable to

HIV/AIDS in the nation's capital at 12 lakh, a little over 8 per cent

of its population. This should shatter any smugness over the low

levels of HIV/AIDS in Delhi.

Right now, Delhi is a low prevalence state, with only 0.25 per cent

of pregnant women surveyed in four antenatal clinics (an indication

of HIV infection among the general population) and 3.23 per cent of

the people surveyed in four sexually transmitted diseases clinics

testing positive in 2002.

At the national level, the prevalence rate may be only 0.8 per cent

of total population, but this translates into huge numbers — between

3.82 million and 4.58 million as of 2002, according to National AIDS

Control Organisation (NACO).

This, worryingly, is a 15 per cent increase over 2001 when the number

of HIV infections ranged between 3.31 million and 3.97 million.

So, if there is any complacency on the HIV/AIDS front, it is time to

jettison it now. Otherwise, the economy will have to bear a huge

cost, as the United Nations Development Programme's (UNDP's) Regional

Human Development Report, 2003: HIV/AIDS and Development in South

Asia and a World Bank research paper The Long-run Economic Costs of

AIDS show.

Not taking preventive action in the early stages of the pandemic,

before the prevalence rate touches the critical 1 per cent mark, the

reports say, would have a debilitating impact on economic and human

development.

The UNDP report quotes various studies that have shown that the

pandemic would have reduced the worldwide annual growth rate of real

GDP per capita by nearly 0.06 percentage points below what it would

have been in the absence of AIDS between 1980 and 1998.

In sub-Saharan Africa — with an 8.8 per cent prevalence rate — the

reduction in annual growth rate is estimated to be 0.15 percentage

points.

The impact in south Asia was found to be negligible but that was

because of the extremely low prevalence in the region between 1980

and 1998.

The World Bank paper (a study of the impact on South Africa's

economy) argues that most current estimates of the economic cost of

HIV/AIDS are modest since they are based only on reduction in GDP

growth.

These studies assume that while the increase in HIV/AIDS deaths may

lead to a fall in savings and investments, it also reduces the

pressure of population on land and capital, thereby raising the

productivity of labour. This, ultimately, dampens the impact on

growth.

The report focuses, instead, on the loss of human capital. AIDS can

severely retard economic growth by destroying human capital in three

ways:

AIDS primarily affects people in their productive years.

The death of parents affects the transmission of knowledge and

ability across generations. Besides, the loss of income due to

disability and early death reduces the resources available for

educating children and this, in turn, translates into low

productivity of future adults.

These adults will be less able to invest in the education of their

children.

The inevitable slowing down of the economy will mean poorer

exchequers. Reduced resources for public expenditures and increased

spending on medical treatment of HIV-positive people will, both

reports point out, crowd out spending on education and health, two

crucial inputs for human capital.

The report cites studies that show that the ratio of treatment costs

to per capita income (not including the cost of anti-retroviral

drugs) in India was 2.2.

Besides, the bank's paper warns, the government may have to shoulder

the burden of caring for those affected by HIV as traditional social

norms of caring will not be able to cope with the scale of the

epidemic.

The epidemic can also push up costs of worker replacement,

absenteeism, insurance expenses and health care expenditures for the

private sector.

Firms could take up to 24 weeks to replace a deceased professional

and some multinational companies in South Africa are reported to hire

three workers for each skilled position to ensure that replacements

are on hand when trained workers die.

In addition, HIV/AIDS could also shrink the customer base since it

mostly affects those in the working age group.

India's health planners, to be fair, are not exactly impervious to

the magnitude of the HIV/AIDS epidemic in the country and have

responded fairly quickly.

The National AIDS Control Programme (NACP) was launched in 1987, a

year after the first case was detected in Tamil Nadu in 1986. NACO

was set up in 1992 and state AIDS Control Societies have also been

formed.

The National AIDS Prevention and Control Policy talks about

mainstreaming HIV/AIDS control policy within the overall health

policy framework.

Universal screening of donated blood for HIV is mandatory and state

governments are experimenting with innovative measures, like the

Manipur government's Needle and Syringe Exchange programme, covering

injecting drug users.

The government's efforts are being supplemented by the NGOs as well,

especially in the field of education and counselling.

But responses focussing only on the medical and behavioural aspects

of HIV/AIDS and on vulnerable groups, the UNDP's report argues, will

not be effective in checking the epidemic's spread.

HIV/AIDS, it asserts, is a larger developmental issue and draws

attention to the two-way relationship between low economic and human

development and HIV/AIDS.

The epidemic, the report says, is influenced by — and, in turn, has

an impact on — poverty, poor social and economic infrastructure, low

human development and social systems.

" HIV/AIDS arises from developmental failures and can exacerbate those

shortcomings, if not addressed in a holistic manner, " the report

says.

Poverty, for example, limits spending on health and nutrition as well

as education. Lack of education will naturally mean lack of awareness

about HIV.

It also means fewer choices in the job market and lesser bargaining

power to negotiate working conditions. Sex workers, therefore, cannot

insist on use of condoms and migrant labourers have to live and work

in unhealthy conditions.

Lack of employment opportunities drive women into the sex trade and

are factors in increasing migration within the country or across

national borders. Long periods of separation from their families

often lead migrant workers to indulge in high risk sexual behaviour

or drug use.

Gender discrimination is a major factor in the increase in HIV/AIDS

among women, an indication of its spread in the general population.

Women have limited access to reproductive health services and are

unable to insist on safer sex options.

Persecution of sexual minorities, drug users and sex workers make

them reluctant to avail of health programmes targeted at them. HIV

then becomes socially invisible, complicating the task of checking

it.

The report's central argument — that prevention strategies must

necessarily deal also with issues relating to the management of the

economy in a manner that increases scope for employment and better

livelihoods — seems to be based on sound reason. Economic development

is a necessary condition for all-round development.

But the vexed problem of unequal access to resources cannot be wished

away for that will again increase the vulnerability of certain

groups. Clearly, a deft balancing act is required to win the battle

against HIV/AIDS

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