The Socioeconomic Dimensions of HIV/AIDS in Africa

The Socioeconomic Dimensions of HIV/AIDS in Africa: Challenges, Opportunities, and Misconceptions

edited by DAVID E. SAHN
Copyright Date: 2010
Edition: 1
Published by: Cornell University Press
Pages: 360
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  • Book Info
    The Socioeconomic Dimensions of HIV/AIDS in Africa
    Book Description:

    Since the 1980s HIV/AIDS has occupied a singular position because of the rapidly emergent threat and devastation the disease has caused, particularly in sub-Saharan Africa. New infections continue to create a formidable challenge to households, communities, and health systems: last year alone, 2.7 million new infections occurred globally. Sub-Saharan Africa remains the epicenter of the suffering, with around two-thirds of infected individuals worldwide found there, and a disproportionate number of deaths and new infections.

    For years there have been widespread and concerted efforts to prevent the spread of HIV/AIDS, identify a cure, and understand and mitigate the deleterious social and economic ramifications of the disease. Despite these efforts, and some apparent successes, there is still a long way to go in terms of altering behaviors in order to realize the objective of dramatic reductions in the spread of HIV/AIDS in Africa. The authors in this volume examine the HIV/AIDS crisis in Africa, which persists despite major strides in averting deaths due to antiretroviral therapy. They tell an important story of the distinct nature of the disease and its socioeconomic implications.

    eISBN: 978-0-8014-6232-0
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. List of Figures
    (pp. vii-x)
  4. List of Tables
    (pp. xi-xii)
    (pp. xiii-xiv)
    Patrick J. Stover

    This is the second volume of the Africa Series, a collaborative initiative involving leading scholars from around the globe that addresses some of the most intractable societal challenges that impede efforts to reduce poverty and sustain development on the African continent. The primary goal of the series is to generate new insights and knowledge that will inform the establishment of policies that facilitate progress towards achieving the Millennium Development Goals for sub-Saharan Africa, and to provide a platform for sharing best practices in the unique African context. The project brings together two academic institutions, the United Nations University and Cornell...

    (pp. xv-xvi)
  7. List of Abbreviations
    (pp. xvii-xx)
    (pp. 1-11)

    Since HIV/AIDS came into the public spotlight in the 1980s, it has occupied a singular position because of the rapidly emergent threat and devastation the disease has caused, particularly in sub-Saharan Africa. The grim statistics are readily available and speak for themselves: the latest estimates, for 2008, suggest that 33.4 million people presently are infected, and their numbers continue to grow, beyond the 2 million people who died of the disease in the previous year. New infections continue to create a formidable challenge to households, communities, and health systems: last year alone, 2.7 million new infections occurred globally. Sub-Saharan Africa...

  9. CHAPTER 1 HIV/AIDS, Economic Growth, Inequality
    (pp. 12-41)
    Markus Haacker

    The evolving HIV epidemic can be considered as the most significant adverse health development in modern history. In many countries, it has reversed gains in life expectancy and related health indicators that had been achieved over many decades. However, the impacts of HIV/AIDS on key macroeconomic indicators, such as economic growth and income per capita, have been modest so far. This chapter reviews the available evidence on the macroeconomic impacts, discussing the interactions between the economic impact of HIV/AIDS and the structure of the economy. In particular, we will argue that a high degree of inequality mitigates the impacts of...

  10. CHAPTER 2 Governing a World with HIV and AIDS: An Unfinished Success Story
    (pp. 42-56)
    Alex de Waal

    Contributing to a debate on why Africa’s HIV/AIDS epidemic had not (yet) led to political crisis, Peter Baldwin pointedly asked, “Why would one expect it to do so in the first place?” (Baldwin 2007) His specific point was that illness “. . . has never been the source of political action.” His wider point was that the HIV/AIDS pandemic is being successfully managed, so that it does not pose a political threat. It was a rebuttal to alarming predictions made just a few years before that the HIV/AIDS pandemic spelled political crisis for weak states in hard-hit regions of the...

  11. CHAPTER 3 Microeconomic Perspectives on the Impacts of HIV/AIDS
    (pp. 57-73)
    Kathleen Beegle, Markus Goldstein and Harsha Thirumurthy

    HIV/AIDS impacts individual, families, and communities across numerous dimensions. Beyond the serious consequences on the health and mortality of persons living with AIDS, the disease has implications for socioeconomic and psychosocial outcomes of families. At aggregate (macroeconomic) levels, the disease can affect the course of a country’s economic development and fiscal policy. As financial resources allocated to fight AIDS increase—by seven-fold in the last decade (UNAIDS 2008a)—health spending overall is increasingly dominated by the disease (which van Dalen and Reuser (2008) characterize as an imbalance and a costly shift away from other health services). Much has been written...

  12. CHAPTER 4 The AIDS Epidemic, Nutrition, Food Security, and Livelihoods: Review of Evidence in Africa
    (pp. 74-109)
    Suneetha Kadiyala and Antony Chapoto

    With a six-fold increase in funding to fight HIV and AIDS this decade, significant advances have been made in combating the intractable AIDS epidemic. Close to three million people received antiretroviral treatment (ART) by the end of 2007—a staggering 10-fold increase in the last six years (UNAIDS 2008a). The annual number of deaths declined from 2.2 million in 2005 to 2.0 million in 2007. At the same time, the multiple drivers, causes, and consequences of the AIDS epidemic have become increasingly evident (Gillespie and Kadiyala 2005a; Chapoto and Jayne 2006; Gillespie et al. 2007). However, significant challenges remain. The...

  13. CHAPTER 5 The Relationship between HIV Infection and Education: An Analysis of Six Sub-Saharan African Countries
    (pp. 110-133)
    Damien de Walque and Rachel Kline

    Sub-Saharan Africa has been disproportionately impacted by the HIV/AIDS epidemic, with two-thirds of all HIV positive people living in the region and 32 percent of both new infections and AIDS-related deaths in the world (UNAIDS 2007a). In the face of this crisis, trying to understand the specific dimensions of the epidemic can help in deciding where to focus resources. In the absence of a vaccine for HIV, there is enormous motivation to find reliable methods of preventing infection. One logical place to look to prevent HIV has been in the realm of education. Recently, there is some evidence that national...

  14. CHAPTER 6 Back to Basics: Gender, Social Norms, and the AIDS Epidemic in Sub-Saharan Africa
    (pp. 134-162)
    Susan Cotts Watkins

    For more than a decade, multilateral and bilateral organizations have provided policy guidance, funds, and technical expertise to support national governments in their response to the AIDS epidemic. The outpouring of humanitarian assistance to sub-Saharan Africa has been particularly intense, and for good reason: it is there that the epidemic has also been most intense. This chapter provides an example of how good will and money may be misdirected when insufficient attention is paid to evidence.

    In what follows, I examine the evidentiary foundation for the international HIV prevention community’s presentation of women as particularly vulnerable to HIV infection, said...

  15. CHAPTER 7 The Fight against AIDS in the Larger Context: The End of “AIDS Exceptionalism”
    (pp. 163-185)
    Roger England

    HIV has been promoted as an exceptional disease, a concept encompassing HIV as a disease of poverty, a developmental catastrophe, and an emergency demanding special measures, including interventions beyond the health sector and beyond leadership by the World Health Organization. This led to the creation of UNAIDS, making HIV the only disease to have its own United Nations organization. Under UNAIDS, the “exceptionality” argument was used to raise international political commitment and large sums of money for HIV from, among others, the World Bank, through its multi-country AIDS program (MAP), the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM),...

  16. CHAPTER 8 Prevention Failure: The Ballooning Entitlement Burden of U.S. Global AIDS Treatment Spending and What to Do About It
    (pp. 186-230)
    Mead Over

    Although it was unknown as recently as the 1980s, AIDS is now the most notorious disease in the world. In the United States, children study the HIV/AIDS epidemic in primary school and learn HIV prevention methods in high school. Among some poor, illiterate populations in the severely affected countries of Africa, more people correctly identify sex as a means of HIV transmission than know that mosquitoes transmit malaria, the ancient scourge that kills almost as many Africans.

    The notoriety of the AIDS epidemic is due to many factors. The fact that it first came to attention as a disease that...

  17. CHAPTER 9 HIV Prevention in Africa: What Has Been Learned?
    (pp. 231-267)
    Peter Glick

    In an era of massive scale-up of antiretroviral therapy (ART) for HIV-positive individuals in Africa, prevention remains at the heart of efforts to turn back the epidemic. Presently, new infections are outpacing the expansion of ART treatment. Even if all who are in need were to be covered, the costs of providing ART will escalate cumulatively, and possibly, prohibitively, if new infections are not reduced (Over 2010). Vaccine trials have so far proved disappointing, and by any measure, an effective vaccine against HIV is many years from being available. Effective prevention is thus indispensible to strategies for dealing with HIV/AIDS...

  18. CHAPTER 10 Treating Ourselves to Trouble? The Impact of HIV Treatment in Africa: Lessons from the Industrial World
    (pp. 268-286)
    Elizabeth Pisani

    As the HIV epidemic approaches its fourth decade, there are many failures and rather fewer successes to reflect on. The greatest failure is surely in the area of prevention. This viral infection, preventable by avoiding the exchange of body fluids between infected and uninfected individuals, has killed an estimated 27 million people since AIDS, the syndrome it causes, was identified in 1981. At the end of 2007, between 30.6 million and 36.1 million people were believed to be living with the virus, which remains incurable (UNAIDS 2008a). Two-thirds of these people lived in sub-Saharan Africa; in several countries in Southern...

    (pp. 287-338)
    (pp. 339-344)