An index of existing social and economic injustices, the epidemic is driving a ruthless cycle of impoverishment. People at all income levels are vulnerable to the economic impact of
, but the poor suffer most acutely. One quarter of households in Botswana, where adult
prevalence is over 35%, can expect to lose an income earner within the next 10 years. A rapid increase in the number of very poor and destitute families is anticipated. Per capita household income for the poorest quarter of households is expected to fall by 13%, while every income earner in this category can expect to take on four more dependents as a result of
, the economic hardships of the past two decades have left three-quarters of the continent's people surviving on less than US$2 a day. The epidemic is deepening their plight. Typically, this impoverished majority has limited access to social and health services, especially in countries where public services have been cut back and where privatized services are unaffordable.
In hard-hit areas, households cope by cutting their food consumption and other basic expenditures, and tend to sell assets in order to cover the costs of health care and funerals.
Studies in Rwanda have shown that households with a
patient spend, on average, 20 times more on health care annually than households without an
patient. Only a third of those households can manage to meet these extra costs.
According to a new United Nations Food and Agricultural Organization (FAO) report, seven million farm workers have died from
-related causes since 1985 and 16 million more are expected to die in the next 20 years. Agricultural output -- especially of staple products -- cannot be sustained in such circumstances. The prospect of widespread food shortages and hunger is real. Some 20% of rural families in Burkina Faso are estimated to have reduced their agricultural work or even abandoned their farms because of
. Rural households in Thailand are seeing their agricultural output shrink by half. In 15% of these instances, children are removed from school to take care of ill family members and to regain lost income. Almost everywhere, the extra burdens of care and work are deflected onto women„especially the young and the elderly.
Families often remove girls from school to care for sick relatives or assume other family responsibilities, jeopardizing the girls' education and future prospects. In Swaziland, school enrolment is reported to have fallen by 36% due to
, with girls most affected. Enabling young people -- especially girls -- to attend school and, hopefully, complete their education, is essential. South Africa's and Malawi's universal free primary education systems point the way. Schemes to provide girls with second-chance schooling are another option.
Meanwhile, the epidemic is claiming huge numbers of teachers, doctors, extension workers and other human resources. In some countries, health-care systems are losing up to a quarter of their personnel to the epidemic. In Malawi and Zambia, for example, five-to-six-fold increases in health worker illness and death rates have reduced personnel, increasing stress levels and workload for the remaining employees.
Teachers and students are dying or leaving school, reducing both the quality and efficiency of educational systems. In 1999 alone, an estimated 860 000 children lost their teachers to
in sub-Saharan Africa. In the Central African Republic,
was the cause of 85% of the 300 teacher deaths that occurred in 2000. Already, by the late 1990s, the toll had forced the closure of more than 100 educational establishments in that country. In Guatemala, studies have shown that more than a third of children orphaned by
drop out of school. In Zambia, teacher deaths caused by
are equivalent to about half the total number of new teachers the country manages to train annually.
Replacing skilled professionals is a top priority, especially in low-income countries where governments depend heavily on a small number of policy-makers and managers for public management and core social services. In heavily affected countries, losing such personnel reduces capacity, while raising the costs of recruitment, training, benefits and replacements. A successful response to
requires that essential public services, such as education, health, security, justice and institutions of democratic governance, be maintained. Each sector has to take account of
in its own development plans and introduce measures to sustain public sector functions. Such actions might include fast-track training, as well as the recruitment of key civil servants and the reallocation of budgets towards the most essential services.
Countries that explore innovative ways of maintaining and rebuilding capacity in government will be better equipped to contain the epidemic. Equally valuable are labour and social legislation changes that boost people's rights, more effective and equitable ways of delivering social services, and more extensive programmes that benefit those worst hit by the epidemic (especially women and orphans).