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The threat posed by HIV and AIDS in South Asia

Mariam Claeson's picture

To answer this question we have examined the dynamics of the HIV epidemic, the economic and social impact, and the fiscal burden of HIV and AIDS in South Asia. We published the findings in the book “HIV and AIDS in South Asia: An Economic Development Risk,” launched in New Delhi on February 27. At the launch, we discussed the risks to development with Dr. Rangarajan, MP and Chairman of National Institute for Public Finance and Policy, and Sujatha Rao, Secretary and Director General for the National AIDS Control Organization in India. We conclude in our report that the impact of HIV and AIDS in South Asia on the overall economic activity is likely to remain small, while the direct welfare costs of increased mortality and lower life expectancy is more substantial, accounting for 3 percent to 4 percent of GDP in India and Nepal, respectively. The economic impact on individual households affected by the disease is substantial. In addition to shortfalls in income, which in some cases can be very significant, HIV and AIDS are also associated with an increased demand for health services. Dr Rangarajan commented on several adverse consequences, including neglect of health conditions, indebtedness, the additional burden on women and children’s education. The extreme case, he noted, is that of the AIDS orphans, for whom very little has been done until now in Asia.

Many of the adverse development impacts of HIV and AIDS arise from the uneven effect it has on different groups in society. Knowledge about prevention and access to treatment, for example, are strongly linked to socioeconomic factors such as gender, education, and wealth. We find in particular that HIV and AIDS have a disproportionate economic impact on HIV-positive widows who have to face the double burden of living with HIV and AIDS, and the already low socioeconomic status of women. Access to antiretroviral treatment (ART) is low in South Asian countries, even compared to countries in other regions with much higher infection rates. Sujthata Rao commented on the estimates of people needing treatment, the cost of scaling up treatment and its share of the total health budget. There are about 630,000 people in need of treatment in India -- with 15 percent being treated to date. The high fiscal cost of treatment underscores the crucial role of effective prevention. Debrework Zewdie, Director of the Global AIDS program at the World Bank, alerted us to the increased cost and loss of momentum that even the smallest financial gap might cause as a result of the current financial crisis. With the exception of Sri Lanka, three-quarters or more of health expenditures in South Asia are financed privately and little are covered by third-party payers like insurance agencies. With the limited ability of many households to pay catastrophic health expenses associated with HIV and AIDS, we argue for a large and critical role for the public sector in the provision of treatment. 

Yes, HIV poses a threat to economic and social development in South Asia, unless prevention programs working with high risk groups in South Asian countries are scaled up. Dr Rangarajan noted that the Report of the Independent Commission on AIDS in Asia which he presented to the UN Secretary General Mr.Ban-ki Moon in New York last March, found that for countries with expanding epidemics like the ones in South Asia, one dollar spent on appropriate prevention could save up to 8 dollars in long-term treatment costs. In his view, the design and implementation of national prevention strategies should be accorded the highest priority as far as HIV and AIDS policy is concerned. With this report we provide the economic rationale - in addition to the strong public health and human rights justifications -- for a rapid increase in prevention, treatment and care of HIV and AIDS in settings with concentrated HIV epidemics. Governments and partners must plan now for sustained and uninterrupted financing of effective prevention services such as comprehensive harm reduction, including clean needle exchange and oral substitution therapy, and condom use and treatment.

For more information on the World Bank's fight against HIV and AIDS, please visit the World Bank HIV and AIDS website.


Submitted by N.Lakshmi Narayana on
YES it is possible to minimize "The threat posed by HIV and AIDS in South Asia". In this direction the work done by the WOHO is commendable and we all should congratulate it for the same. Tow aspects were involved in this. They are prevention and Rehabilitation. The mojor focus is on care & support for better rehabilitation. Some of the key areas where focus is required are: # Prevetnion - which is mostly caused by us and the prevention is in our hands only. The dual policy of use condom for SAFE SEX certainly puts the people at X roads with self motivation. Strict ruels should be formulated and monitored with better implementation strategies. I am positive that this works to reduce the impact on long term basis. # Holistice development covering Medical, Social and Economic areas is the need of the hour to put them in the mainstream with better empwoerment oppertunities. As long as they are not independent with better sustainable approaches / strategies, the dependency on the service provideds / fundign agencies / Go and other stakeholders of the sector will be confined to the smaller groups and other needy peoples reach may not be significant. With all the limitation still there is a RAY OF HOPE to look for better and helthy ENVIRONMENT with acceptable issues and barriers. Looking forward for better network and t0o reach the needy with suitable service delivery system suiting to their chanllenges, skills, needs and living environment so as to to empower them to lead an independent living with better sustainabilaity and quality of lfie to the maximum extent possible in the given environment. Hoping for better and an effective discussion on this form....

Submitted by Frasi on
What is clear from every study is that there is an exceptionally severe epidemic of HIV/AIDS in South Africa. This epidemic affects all parts of the population, though women are more likely to be infected than men. Many tens of thousands of people are dying. For South Africa there are tremendous challenges remaining in the fields of HIV education, prevention and care.

Submitted by Sai Paranjpye on
The current global recession, may well be offered as a valid reason for Government reluctance in scaling up HIV prevention programmes among high risk vulnerable groups in the Country. To my mind, this very state of financial depression is ample reason to step up measures which will curb heavy cure-related expenses, in the future. How prevention is always better than cure, is propounded most effectively in Mariam Claeson’s book. Sadly, in India, such is our social hypocracy, that two major groups that play a vital role in the HIV Saga – are just not recognised by our Government. Sex workers and Homosexuals do not have an identity of their own in the social scheme of things. Ironically, they are the very groups that are most vulnerable, and need to be addressed. Stern measures have to be taken and some International pressure applied in order for reticent Governments to rectify this. For my current film ‘Suee’ ( The Needle) which I am making for SARDAM, the Prison Authorities graciously gave me permission to shoot a sequence in the Central Jail, Mumbai. However, they forbade any mention of the Condom Distribution Programme conducted by an NGO, for inmates. This would amount to acknowledging MSM behavior in prisons !

Submitted by Anit on
Dear Mariam, Thanks for the very nice blog post. I have just made a comment as well, hope it is useful. My new strategy is to talk of increasing the efficiency of the expenditure, essentially better planning and monitoring, putting in place the right kinds of programs, and eliminate excesses. The alibi is the financial crunch which is a real problem for a sector such as HIV which had comparatively good funding levels over the last half a decade. I hope I am not being too much of a fiscal conservative, but I seriously do believe that the national and sub-national AIDS programs can be made leaner and more effective. Congratulations again on a great effort in getting the book published. Best wishes, Anit

Submitted by incontinenta on
There is no identifiabale program for needle exchange found on the Internet. If they want to put out millions of, uneeded medical, dollars to care for the people that suffer, because of this ... I guess they can supply a lot of patients for their teaching hospitals!

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