Transcript Measuring Wealth

The economic Impact of HIV/AIDS in
Uganda
Fred Matovu, Ph.D
A Workshop on Economic
Epidemiology, Makerere
University 3rd -5th August 2009
Overview: HIV/AIDS in Uganda
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One of the hardest hit countries in SSA
HIV/AIDS cases increased from 2 in 1982 to
2m HIV infections by 2000
HIV prevalence rates reduced from 19%
1990s to 6.4% by 2005 (against 5% target)
Wide regional variations in prevalence rates:
8.5% in Central compared to 2.3% in west
Nile
HIV/AIDS in Uganda cont.
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About 1.4m people living with HIV/AIDS
Of whom 100000 are children below 15
years
Over 800000 have died of AIDS
Over 1.7 m children orphaned by AIDS
Risk of M-T.C.T estimated at 15-25% in 2004
Impact of HIV/AIDS greatest at household
level
Distribution of HIV prevalence
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HIV prevalence is high in urban (10%) than
in rural areas (5.6%)
Prevalence higher amongst working
population
Prevalence increases with education level
Prevalence is higher in wealthier quintiles
Prevalence is higher on women than men
Prevalence rates by Location, 2004/05
14
Prevalence rate
12
10
Women 15-49
8
Men 15-49
6
Total
4
2
0
Urban
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Rural
Prevalence is higher in urban areas and among women
Prevalence rate
HIV prevalence by Education, 2004/05
10
9
8
7
6
5
4
3
2
1
0
Women
Men
Total
No Education
Primary
incomplete
primary
complete
Secondary +
HIV Prevalence by work status
9
Prevalence rate (%)
8
7
6
Women 15-49
5
Men 15-49
4
Total
3
2
1
0
Currently Working
Not working
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Prevalence rate (%)
HIV Prevalence by Occupation
12
10
8
6
4
2
0
Adult HIV Prevalence by age, 2004/05
Age Cohort
Male
Female
15-19
0.03
2.6
20-24
2.4
6.3
25-29
5.9
8.7
30-34
8.1
12.1
35-39
9.2
9.9
40-44
9.3
8.4
45-49
6.9
8.2
50-54
6.9
5.4
55-59
5.1
7.4
HIV Prevalence by Wealth quintiles
12
Prevalence rate (%)
10
8
Women 15-49
6
Men 15-49
Total
4
2
0
Poorest
2nd
3rd
4th
Least Poor
Impact of HIV/AIDS at household level
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Loss of available income as working adults fall ill or
die or stop work to look after children and/or the ill
Additional expenditure on health care and funeral
costs (e.g. ARV cost per year per person -$500)
Depletion of household assets to finance the health
care
Lower productivity - reduced availability of food.
Decrease in school enrolment as children are forced
to dedicate time to farm labour and/or care-giving
Impact of HIV/AIDS at household level
Distorts family structure and gender roles
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–
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Increase in female-head, child-headed and
grand parents-headed households
Depletes the asset base households
leading to inadequate resources for
production - affecting household income
and nutrition.
Increases dependency ratio - of children
orphaned by AIDS
Healthcare costs to total household
consumption for HIV and no-HIV
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HIV-related costs increase health care costs from
about 10% to 45% of household consumption
Impact at firm level
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Increased morbidity and death of skilled staff,
Reduced staff performance and increased
medical bills
Depletes productive workforce leading to
loss of knowledge and skills and slow
adoption of technologies.
Loss of productive labor force
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8.4% of labour force lost by 2025
Impact at macro-level
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Impacts on macroeconomic variables: GDP
,average income ,savings and investment,
employment and wages
Loss in GDP growth (over 1% points)
Increase incidence and depth of poverty
–
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1% point increase in household poverty overall
Reduction in savings and investment ratio
Macroeconomic Impact cont..
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Decline in life expectancy
–
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Reduction in labor-force
–
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55 years in 2010 with high ART compared to 57
years in the NO AIDS scenario
8.4% loss by 2025
Higher spending on health care – crowding
out fiscal space for other sectors
Expenditure on HIV/AIDS programmes
as %age of GDP
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HIV/AIDS Expenditure/GDP increased by 2.5%
points between 2003/04 and 2008/09
Impact on macro-economy cont..
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Exchange rate : Donor aid inflows affect
exchange rates – export and investment
competitiveness
inflationary pressures
Challenges
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Inadequate supply of ARVs
Increasing cases of discordant couples
Heavy reliance on donor-funding
A wide range interventions currently exist but
coverage and sustainability issues remain
critical
Summary
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Prevalence rate stagnating at 6.4% and feared to be
increasing
Prevalence vary by socio-demographic
characteristics
Economic and social impact higher at household
level
Serious deficit in coverage of ARVs
Most Interventions are donor-funded:
sustainability??