Facing up to AIDS: The Socio-Economic Impact in Southern Africa

338 Pages·1996·29.213 MB·English

by  Sholto Cross, Alan Whiteside (eds.)

FACING UP TO AIDS
Also by Alan Whiteside
INDUSTRIAUZATION AND INVESTMENT INCENTIVES IN
SOUTHERN AFRICA (editor)
*TOWARDS A POST-APARTHEID FUTURE (editor with Gavin
Maasdorp)
*From the same publishers
Facing up to AIDS
The Socio-Economic Impact
in Southern Africa
Edited by
Sholto Cross
Director, Urban and Rural Development
Independent Development Trust
Cape Town
and
Alan Whiteside
Associate Professor
Economic Research Unit
University of Natal
Selection and editorial matter© Sholto Cross and Alan Whiteside 1993, 1996
Chapters 1-14 © Macmillan Press Ltd 1993, 1996
Softcover reprint ofthe hardcover 1st edition 1996 978-0-333-66989-1
All rights reserved. No reproduction, copy or transmission of
this pubHeation may be made without written permission.
No paragraph of this pubHeation may be reproduced, copied or
transmilled save with written permission or in accordance with
the provisions of the Copyright, Designs and Patents Act 1988,
or under the terms of any licence permitting limited copying
issued by the Copyright Licensing Agency, 90 Tottenham Court
Road, London WIP 9HE.
Any person who does any unauthorised act in relation to this
publication may be liable to crimina! prosecution and civil
claims for darnages.
First edition 1993
Reprinled (with new Preface) 1996
Published by
MACMILLAN PRESS LTD
Houndmills, Basingstoke, Hampshire RG21 6XS
and London
Companies and representatives
throughout the world
ISBN 978-0-333-66990-7 ISBN 978-1-349-24930-5 (eBook)
DOI 10.1007/978-1-349-24930-5
A catalogue record for this book is available
from the British Library.
First published in the Uniled Statesof America 1993 by
Scholarly and Reference Division,
ST. MARTIN'S PRESS, INC.,
175 Fifth Avenue,
New York, N.Y. 10010
ISBN 978-0-312-09106-4
Library of Congress Cataloging-in-Publication Data
Facing up to AIDS : the socio-economie impact in Southern Africa I
edited by Sholto Cross and Alan Whiteside.
p. cm.
Includes index.
ISBN 978-0-312-09106-4
I. AIDS (Disease)-Africa, Southern-Social aspects. 2. AIDS
(Disease)-Africa, Soulhem-Economie aspects. I. Cross, Sholto.
11. Whiteside, Alan.
RA644.A25F33 1993
362.1 '9698'9200968-dc20 92-2489
CIP
Contents
Preface to the First Edition vii
Preface to the 1996 Reprint ix
Acknowledgements X
Notes on the Contributors xi
Part I Setting the Scene
1 Introduction
Alan Whiteside 3
2 The Global Pandemic of AIDS
David FitzSimons 13
3 Current Research on the Economic Impact of
HIV/AIDS: A Review of the International and
South African Literature
Jonathan Broomberg 34
Part II Modelling the AIDS Impact in South Africa
4 South African Trends and Projections of
HIV Infection
Hilary Southall 61
5 The Demographic Impact of AIDS on the South
African Population
Peter Doyle 87
6 Modelling the Demographic Impact of AIDS:
Potential Effects on the Black Population in
South Africa
Gwenda Brophy 113
Part III Economic Assessments for South Africa
7 A Socio-Economic Analysis of the Long-Run Effects
of AIDS in South Africa
Sholto Cross 137
8 The Economic Impact of the AIDS epidemic in
South Africa
Jonathan Broomberg, Malcolm Steinberg, Patrick
Masobe and Graeme Behr 158
v
vi Contents
9 Some Reflections on a Human Capital Approach to
the Analysis of the Impact of AIDS on the South
African Economy
George Trotter 191
Part IV The African Experience
10 The Impact of AIDS on Industry in Zimbabwe
Alan Whiteside 217
11 The Medical Costs of AIDS in Zimbabwe
Richard Hore 241
12 Simple Methods for Monitoring the Socio-Economic
Impact of AIDS: Lessons from Sub-Saharan Africa
Tony Barnett and Piers Blaikie 261
Part V Facing up to AIDS in South Africa
13 Lessons from Tropical Africa for Addressing the
HIV/AIDS Epidemic in South Africa
Alan Fleming 295
14 Facing up to AIDS
Sholto Cross 318
Index 321
Preface to the First Edition
South Africa, as befits the most powerful economy on the African
continent, has a large investigatory literature on its history and so
ciety. Much of this, as with the current concerns directed at that land,
has its focus on politics. Yet while the political events which are
unfolding as a new era is born will continue to dominate the debate,
this is a widely diverse country - a crucible for social change - where
many worlds meet. Insights into these changes which are captured
through analysis may continue to have a general impact on the way in
which her policies are shaped, and attitudes formed. Specifically, for
issues of demography and health policy, they also have great poten
tial significance for other lands with similar profiles. South Africa's
role and inftuence within the sub-continent is a growing one, and
initiatives taken here have the potential to spread widely within the
region.
The AIDS pandemic now spreading throughout southern Africa is
without parallel in modern times in terms of probable long-run im
pact. The purpose of this collection of studies on the socio-economic
aspects of its impact is to contribute to the process of policy formula
tion. The study of HIV and AIDS has been dominated by medical
epidemiology, and only to a limited extent have studies been pub
lished concerning either economic analysis, or an understanding of
the social context. This may partly reftect the fact that in those countries
with an effective research infrastructure the disease has been largely
confined to specific sub-cultures. South Africa has both a research base
and an expected national problem of major proportions.
This volume is concerned with the social, economic and ultimately
behavioural analysis of the disease where it is no longer confined to
small segments of a national population. The methodology for such
studies is still in its infancy: but southern Africa offers a possible
terrain for the investigation of AIDS which goes beyond the patholo
gical dimension. We believe that the modification of behaviour,
whether at the level of atomistic individuals, peer groups or wider
social entities, is a major form of defence against its spread. This
requires detailed understanding of a spectrum of aspects of AIDS
ranging from the modelling of population dynamics through to re
search on individual sexual behaviour, and both micro- and macro
economic and sociological investigations of its impact.
vii
Vlll Preface to the First Edition
A number of the contributors to this volume specify areas for
further research; programmes of both national and local level activity
are already being planned in South Africa at the time of writing this
preface. If the discussion and analysis presented here can lead to a
further vigorous development in public (and private) health policies,
to preparatory research and planning for preventative strategies, and
to successful intervention to minimise the spread of AIDS and to
sustain those afflicted by the disease and its consequences, then the
book will have served its intended purpose.
Monetary values in the text refer to mid-1991, when the following
exchange rates prevailed: 5 Rand to 1 pound sterling; 2.9 Rand to 1
American dollar; 1.25 (3.7) Zimbabwe dollars to 1 Rand (1 American
dollar).
SHOLTO CROSS
ALAN WHITESIDE
Preface to the 1996 Reprint
It is two years since the first edition of Facing up to AIDS was first
published. Since then, the news of the spread of the epidemic in southern
Africa has been almost uniformly bad. There is also little sign that
governments or the private sector have yet realised what the implications of
this epidemic are.
In South Africa there have been annual sero-surveys of antenatal clinic
attenders since 1990. The increase in HIV prevalence has been rapid: in
1990 the National Seroprevalence was 0.76 per cent, by 1993 it had risen to
4.69 per cent. In the worst affected province - KwaZulu-Natal -the rise
was from 1.61 per cent to 9.62 per cent over the same period.
Botswana has also had good antenatal surveillance and surveys were
carried out in 1992, 1993 and 1994. The prevalence in antenatal clinic
attenders in the second city of Francistown rose from 23.7 per cent in 1992
to 34.2 per cent in 1993 and fell to 29.7 per cent in 1994. The rest of the
country has seen a steady climb toward 30 per cent prevalence.
A similar pattern in prevalence is seen in the other countries for which
data are available; however, in a number of instances, there are simply no
data. The lack of data is particularly marked with regard to AIDS cases. It
seems that they are extremely under-reported throughout the region and all
that can really be said is that they are on the increase.
Finally, there has been little new research into the impact of AIDS. Thus
this book remains as relevant as when it was first published. It is to be
hoped that by the time the reprint is sold out there will be new publications
on both the impact and how to mitigate it.
Sholto Cross and Alan Whiteside