Nyheder om Sydafrika (Juli 2006)

Provision Of Antiretroviral Treatment Will Reduce Economic Impact Of Aids

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Bureau For Economic Research (Stellenbosch)

PRESS RELEASE July 14, 2006
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The implementation of a large-scale antiretroviral treatment (ART) programme will not only extend the lives of HIV+ South Africans, but will also significantly reduce the adverse economic consequences of the HIV and AIDS epidemic.

This is according to an in-depth study of the macro-economic impact of HIV and AIDS in South Africa under alternative treatment scenarios. The research has been conducted by the Bureau for Economic Research (BER). The study was commissioned by the Joint Economics, AIDS and Poverty Programme (JEAPP) with funding from the Department for International Development (DFID) and the United States Agency for International Development (USAID).

The study aims to quantify the macro-economic effects of HIV and AIDS in South Africa, with specific focus on the costs and benefits of HIV prevention and treatment interventions, as well as the impact of HIV and AIDS on the different sectors of the economy. The BER's annual macro-econometric forecasting model has been adapted and employed to model the impact of HIV and AIDS on the South African economy, and incorporates the latest available information on the demographic impact of the epidemic.

The analysis was conducted with the aid of three model-based scenarios including:
- a No-AIDS scenario;
- AIDS with prevention programmes but no ART programme; and
- AIDS with prevention programmes and the roll-out of a large scale ART programme with a take-up rate of 50% by 2008.

Demographic projections produced by the ASSA2002 model show that the introduction of ART (with 50% uptake) could reduce the number of AIDS deaths by around 100 000 per year between 2008 and 2010. However, since ART is ultimately not a cure for the disease, this "saving" could narrow to 35,000 per year by 2020.

The economic impact channels of the epidemic modelled in the analysis include the implications of slower growth in the population and labour force on the production and expenditure sides of the economy; direct costs to companies that provide employee benefits such as medical aid and death benefits; indirect costs related to increased absenteeism, lost experience and skills, higher recruitment and training costs and lower labour productivity; the impact of HIV and AIDS on the demand for health care and welfare spending by government, and the economic effects of an increase in the number of funerals.

The simulation results from the different scenarios indicate that the HIV and AIDS epidemic will have a negative impact on overall economic growth in South Africa.

In the absence of ART, the rate of GDP growth could fall from a projected average of 4.4% over the period 2000-2020 to 4.0% per year due to the HIV and AIDS epidemic. BER's simulation results suggest that the South African economy will be 8.8% smaller by the year 2020 than it would have been without HIV and AIDS.

In contrast, the level of per capita GDP is projected to be about 8.0% higher (in real terms) by 2020, as the adverse impact of the epidemic on the size of the population will outweigh the negative impact on real GDP.

These projections are notably less alarming compared to the 2003 study by Bell, Devarajan and Gersbach from the World Bank. According to their study, assuming full employment and that no remedial action is taken by society, the impact on economic growth in South Africa would be devastating.

However, according to Prof. Ben Smit, the Director of the BER, the assumption of full employment is not realistic for the South African economy, which is characterized by high unemployment levels.
- Given that HIV/AIDS is more concentrated among the semi- and unskilled sections of the labour force in South Africa and the fact that these workers can be replaced comparatively easily from the large pool of unemployed workers in these skill categories, the economic impact of HIV and AIDS could be less pronounced than suggested by studies that assume full employment, said Smit.

Furthermore, according to Smit, previous studies on the economic impact of HIV and AIDS around the globe have often ignored the fact that expenditure on health care products and services (by government and the private sector) also contribute towards a country's gross GDP, resulting in overly pessimistic projections of the impact of HIV and AIDS on overall economic growth in South Africa.

In November 2003, the South African Cabinet approved the Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for South Africa - the largest and most ambitious project of its kind in the world, which included the roll-out of a large scale ART programme to patients with low CD4 counts.

Although a number of company studies have concluded that the benefits of providing ART outweigh the cost of treatment, particularly for large firms, previous studies on the macroeconomic impact of HIV and AIDS in South Africa did not consider the economic implications of a large scale ART programme. The results of the BER study suggest that the provision of ART with a 50% uptake could reduce the impact of HIV and AIDS on economic growth by, on average, 17% between 2000 and 2020, or from a projected impact of -0.46 percentage points to -0.38 percentage points.

Their results also show that, on a macroeconomic level, the benefits of providing ART (in terms of economic growth "saved") far outweigh the costs. According to Smit,
- The positive GDP impact follows primarily from the impact of the ART programme on the size and the health of the total population and the labour force – a larger and healthier labour force relative to the AIDS no-ART scenario implies higher labour productivity, lower HIV and AIDS related indirect costs and higher potential output, which translates into lower pressure on capacity utilization and hence, lower inflation and interest rates.

Relatively lower interest rates, in turn, stimulate consumer spending and fixed investment, while population sensitive variables like residential investment also benefit from therelatively higher population.

Apart from its examination of the macroeconomic impact of a large scale ART programme, the BER study also contributes to available research with a supply and demand side HIV/AIDS risk analysis for the different economic sectors in South Africa. This analysis is based on ASSA2003 provincial estimates, produced under the auspices of the Actuarial Society of South Africa (ASSA).

The BER's results suggest that whilst the magnitude of the impact on overall economic growth does not appear to be alarming, the macroeconomic projections may conceal more negative impacts on certain sectors of the economy.
The analysis shows that the general government, water & electricity, mining, metals & machinery and electrical machinery sectors are relatively seriously exposed to both supply side risk (i.e. high HIV prevalence and relatively high skills intensity) and demand side risk (stemming from the impact of HIV and AIDS on intermediate and final demand and exports).
In contrast, sectors with low overall risk include community, social and personal services, clothing and textiles, agriculture and construction.

In conclusion, the results from the BER's macroeconomic impact analysis indicate that HIV and AIDS will undoubtedly have a negative impact on economic growth in South Africa. However, the provision of ART will ameliorate this impact and it is important to note that the country is not faced with a doomsday scenario. The economic impact of the epidemic will manifest gradually - the brunt of the impact of the epidemic will most likely only be felt during the period 2010 - 2020 and even then, GDP growth will remain positive. The level of GDP will be significantly higher than it is now, while the size of the population could be similar to the current level. This implies that real per capita income will continue to improve over the next 15 years. However, it should be noted that the simulation results presented herein make no reference to the human suffering caused by the disease.

Anti-Aids message may be lost on youth

Durban, South Africa 14 June 2006

The anti-Aids ABC message - abstain, be faithful and use condoms - has left many of the continent's youth confused, an Aids conference in Durban heard.

In a survey of 1 766 pupils conducted in the Valley of a Thousand Hills near Durban, only one schoolgirl said abstinence is "not having sex until one is married".

Being faithful is also an area of concern. Only two pupils in the survey made any reference to one's partner when asked what "being faithful" meant.

The survey - conducted by the Valley Trust, the Child Development Research Unit and funded by the United States President's Emergency Plan for Aids Relief (Pepfar) - was conducted to find out how schoolchildren between the ages of 11 and 15 understood the ABC message.

Tobey Nelson - of an organisation called Horizons, who presented the survey's findings - said the survey showed that abstinence, being faithful and consistent condom usage are behavioural patterns that are not thought to be common or feasible.

Virginity testing is cited as a deterrent to sex. But delegates also heard from a Kenyan aid worker how teenaged girls in Kenya's coastal area indulged in anal sex after being encouraged to protect their virginity.

The Valley of a Thousand Hills survey found that peer pressure, coercion and rape are barriers to abstinence for girls.

"If a girl abstains and boys know that, they then want to rape that girl because they know that she does not have Aids. The bad thing is that they want to kill that girl after [the] rape," one schoolgirl was quoted as having said during the survey.

Peer pressure was also described as a barrier to being faithful.

"When you tell them [peers] that you don't have a girlfriend or you only have one girlfriend, they would just laugh at you saying that you are stupid," said one schoolboy.

Conference delegates were repeatedly told that messages about abstinence, being faithful and using condoms have to be clear and non-contradictory, and have to take cultural practices into account.

But not all the signs are negative. The two-year "Zip Up" campaign in Nigeria has increased abstinence and is believed to have raised the age at which Nigerians have their first sexual encounter from 16,8 years to 17,6 years.

Zip Up is a mass-media campaign run by the Society for Family Health in conjunction with some of Nigeria's leading faith-based organisations.

Delegates heard how a "cool slogan" on billboards and the country's airwaves helped the youth of Nigeria identify with abstinence.

"We were aware from our research that the word 'abstinence' was not well understood, so we needed something brand new," said the campaign organisers.

The conference, attended by 1 100 delegates and hosted by Pepfar, ends on Thursday. US President George Bush announced the five-year, $15-billion plan in 2003. - Sapa

South Africa: HIV Medicine (ARV) FIGURES INCORRECT: HEALTH DEPT

JOHANNESBURG 17 November 2006 Sapa

Incorrect antiretroviral treatment (ART) figures were released
this week, but South Africa still has the fastest growing programme
in the world, the Department of Health said on Friday.

Figures released on Monday said 235,378 children and adults were on the anti-Aids drugs at the end of September, but the correct figure was 213,828, said departmental spokesman Sibani Mngadi.

The wrong figure resulted after the number of children on ART (21,550l) was added to the total figure.

The number of patients receiving treatment in September had increased by 35,193 since June.

"This represents an average of more than 11,000 patients being put on treatment every month, making the South African programme the fastest growing ART programme in the world," Mngadi said.

The number of ART facilities had grown to 273 from 251 in the same period.

The number of patients on treatment were:

- Eastern Cape 24,920;

- Free State 6950;

- Gauteng 55,580;

- KwaZulu-Natal 59,404;

- Limpopo 11,660;

- Mpumalanga 7989;

- Northern Cape 21,579;

- North West 4476; and

- Western Cape 21,270.