Friday, August 29, 2008

Impacts of HIV/AIDS on Economic Development

In 2000, the United Nations created a list of 8 Millennium Development Goals to help promote economic growth and development among developing countries. One of these goals is to combat HIV/AIDS by stopping and reversing its spread and providing universal access to drugs for those infected. While this is definitely a worthwhile goal, why is it included among a list of targets to support growth? Well it turns out, that the impact of HIV/AIDS on the economy can be substantial.

The first immediate effect of HIV is a drop in household productivity as the working members of the household succumb to the disease. One study by UNAIDS estimated that household production could drop anywhere between 30%-60% due to an AIDS death in the family. Another study from the Ivory Coast examined what implications this could have on other aspects of the families’ lives. It was estimated that “families with a member sick from AIDS cut spending on their children's education in half and reduced food consumption by about 40 percent as they struggled to cover health expenditures that soared to four times their usual level.” Unfortunately this leads to a vicious cycle as these countries are often already experiencing higher malnutrition rates and lower education levels.

Individual companies will be affected by high levels of HIV as well. Not only will the actual amount of workers decline due to more AIDS deaths, but their quality of work will also decline due to ill-health and increased absenteeism. Companies will incur direct costs in order to hire and train new workers. Additionally, due to an inexperienced work force, productivity will decrease and the potential for accidents will increase. Finally, as AIDS deaths increase in number, employees will experience a loss of morale and labor cohesion.

These losses in household and company productivity have important implications for the national economy. One important indicator for development is domestic savings and investment. Households that are able to save money are better able to start their own business or finance their education in the future. Additionally, companies that invest in new plants or equipment can grow at a faster rate. However, with high levels of HIV, households are forced to spend more money on healthcare and companies have less to invest due to higher costs and lower productivity. As a result, the country experiences a much lower rate of growth.

Government expenditures will also be affected by HIV. Tax revenues will drop as companies and households are earning less money. At the same time, the government will be increasing health expenditures to help those affected by AIDS. With less revenues being generated and a higher percentage being spent on healthcare, government programs to promote infrastructure and growth will diminish in quantity and quality.

Economists have developed models that predict the growth domestic product (GDP) both with and without HIV/AIDS. Most of these models indicate a rather small drop, on the order of 0.5% to 1% per year. While this may seem small, when this drop is compounded over many years, the impacts can be substantial. One study estimated that due to HIV’s extensive impact on the economy, expenditures on HIV prevention would be 17 times more effective at promoting development than similar expenditures on capital investment. As a result, slowing the spread of HIV and treating those with AIDS will be an integral part of any development plan.

This is Ben Young, thanks for listening.

Friday, August 22, 2008

HIV/AIDS: The role of abstinence only programs

Welcome to this installment of The AIDS Pandemic, a podcast hosted by Dr. David Wessner from the Department of Biology at Davidson College. I’m Amy Jendrek.

In fiscal year 2005, President Bush requested $270 million to fund abstinence-only education programs in the U.S. While Congress did not appropriate the full amount requested, they did allocate $167 million to support these programs. There are three principal programs that use federal funds to support abstinence-only education.

The first of these is SPRANS, Special Programs of Regional and National Significance, which has a sub-program devoted to Community-Based Abstinence Education. In 2001, its first year of funding, 33 SPRANS recipients received $20 million in grants. By 2004, the program had over 100 grantees and a budget of $75 million.

The second program is Section 510 of the 1996 Welfare Reform Act, which provided $250 million over five years for programs with “the exclusive purpose” of promoting abstinence. The law has since been extended in June 2004, providing $50 million per year.

The third program, the Adolescent Family Life Act (AFLA) was originally passed in 1981 to promote “prudent approaches” and self-discipline to adults. In 2004, it provided $13 million for abstinence-only education programs, and the same amount was again appropriated in 2005.

In 2004, California Representative Henry A. Waxman led an investigation of abstinence-only education programs funded by the federal government. The investigation, titled “The Content of Federally Funded Abstinence-Only Education Programs,” found that 80% of curricula used by two-thirds of SPRANS grantees contained false, misleading, or distorted information about reproductive health.

The report looked at 13 abstinence-only sexual education curricula, and found errors in scientific information presented by 11 of them. Many contained errors regarding HIV prevention and the effectiveness of condoms.

According to the CDC, “Latex condoms, when used consistently and correctly, are highly effective in preventing the transmission of HIV.” According to the Waxman report, multiple abstinence-only curricula use a 1993 study by Dr. Susan Weller which found that condoms reduce risk by 69%, using an analysis which both the FDA and the CDC found erroneous. One abstinence-only curriculum, “I’m in charge of the FACTS” claims that “The actual ability of condoms to prevent the transmission of HIV/AIDS, even if the product is intact, is not definitively known.”

These curricula fail to mention the multiple studies showing the effectiveness of condoms against transmission of HIV, as well as the rigorous standards the FDA holds for testing contraceptives.

Another area in which the Waxman report found many errors was in curricula’s analysis of HIV risk behaviors. Data on exposure risks is presented in a confusing and exaggerated manner. Data from CDC chart titled “HIV infection cases in adolescents and adults under age 25, by sex and exposure category,” is presented by FACTS as “Percent HIV Infection.” This means that, where the CDC chart showed that nearly 50% of male teens living with HIV reportedly acquired it through homosexual contact, the curriculum’s chart shows that 50% of homosexual male teens are HIV+. In a similar fashion, it implies that 41% of heterosexual female teens are also HIV+. After the Waxman Report, a caption was added to include the original title of the chart.

Many curricula use a one in ten infection ratio for HIV-risk activities, ignoring the fact that even with a high estimate, one in 300 people in the US are infected with HIV.

WAIT (Why Am I Tempted?) Training, a program used by 19 SPRANS grantees, places sweat, tears, and saliva in the “At Risk” category for HIV transmission. Since the Waxman report came out, WAIT Training has changed its curriculum to put sweat in the “No Risk” category, but maintains that there is risk of contracting HIV through tears and saliva, as the disease can be isolated from them, despite the CDC’s assertion that there is no risk of transmission from these fluids.

In some cases, even discussion of HIV and AIDS are not allowed under abstinence-only guidelines. The Franklin County, NC, school board had three chapters cut out of a ninth grade textbook because they did not adhere to state laws mandating abstinence-only programs. The chapters covered marriage and partnering, contraception, and HIV. In Orlando, Florida, a high school teacher was suspended when he chose to show a student-made video about HIV prevention. In Illinois and New York, AIDS-prevention presentations by an AIDS task force and the CDC were cut from programming because they were not “consistent with an abstinence-only message.”

Other errors are more simple. In what is probably a typo, but one that should have been caught, Tree of Life Preventative Health Maintenance, Inc., a grantee in Arkansas, tells teens on its website that “AIDS is the result of HPV.” One student handbook, from the FACTS curriculum, defines AIDS as “Acquired Immune Disease.”

Currently, only 12 states have not accepted federal abstinence-only money. That does not necessarily mean that all these states provide a comprehensive sex education, or that those states that have accepted money teach a strictly abstinence-only curriculum. However, 35% of school districts with a sex education policy require abstinence to be covered and either do not allow discussion of contraceptives or allow discussion only of their failure rates.

According to Planned Parenthood, “most reputable sexuality education organizations in the U.S., as well as some prominent health organizations, including the American Medical Association, has denounced abstinence-only sexuality programs.” In 1997, the National Institutes of Health concluded that “Abstinence-only programs cannot be justified in the face of effective programs and given the fact that we face an international emergency in the AIDS epidemic.”

I’m Amy Jendrek. Thanks for listening.

Friday, August 15, 2008

Opportunistic Infections in Developing Nations: A World Away

In the United States and other developed nations, for many people, AIDS has become a manageable disease. With adequate care and lots of medication, HIV positive individuals can live with relatively few serious complications for a long time. In the US, 71% of HIV-infected individuals have at least started HAART therapy, decreasing deaths per infected individuals per year from 30/100 to 5/100 since the 1980’s. In developed nations, however, HIV positive individuals do not have the luxury of adequate care. In areas like Africa where the burden of disease is highest, HIV positive individuals must face an array of opportunistic infections as their CD4 counts dip lower and lower.

Because these opportunistic infections are generally localized to areas where HAART is not available, it is both hard for us to understand the difficulties in treatment and to determine which infections are endemic to what populations. For example, MAC (for Mycobacterium avium complex) is a common, life-threatening opportunistic infection in Asia causing a significant portion of AIDS-related mortalities. In Africa, however, MAC is rare. In addition, tuberculosis is a particularly life-threatening coinfection that is particularly common in many developing areas, especially Sub-Saharan Africa and Asia. Many opportunistic infections in these nations have developed resistance to the drugs typically used to treat them. Determining which disease populations have resistance to what medications can be exceptionally difficult given how isolated some of these areas are.

The HIV/IDS prevalence is highest in sub-Saharan Africa

The most reputable source for information like this is undoubtedly the World Health Organization. The WHO publishes information on the geography, morbidity, symptoms and treatment of various opportunistic infections for different nations and settings. While it is hard to determine where exactly the WHO gets their sources for information from developing nations, it is clear that they get their information from all parts of the globe. However, it is also hard to pick apart the complicated interactions of HIV and opportunistic infections in a multitude of settings, and even harder when there are additional complicating factors such as malnutrition, social unrest, and a lack of medical infrastructure for reporting treatment schemes. Many times, the WHO provides useful information about the scope of opportunistic infections in developing nations, but they often miss the deeper and more individual issues that a given region may have. If first-line drugs for opportunistic infections are not available in these developing areas (due to oppressively high costs or restrictive storage conditions), the WHO lacks vital information on how to cope.

The availability of antiretrovirals in lowest in sub-Saharan Africa

While it is not the fault of the WHO that there is a dearth of useable information for medical workers in low-resource environments, it is clear that there is a lack of necessary medical care in these nations that perpetuates a cycle of poverty and illness and that millions of HIV-positive individuals are dying as a result of a lack of ARVs. In a situation where prohibitively high costs of necessary drugs prevents individuals from being treated for HIV, we need to focus more on preventative efforts and HIV prophylaxis in the form of vaccines or microbicides. In this sense, the US and other developed nations are providing a massive amount of resources in trying to find a vaccine and developing useful microbicides to prevent HIV infection from happening in the first place. Because of the massive amount of people infected in areas that lack the resources to treat them, the disease needs to be treated when it is least expensive to do so. While it is hard to know what the future holds for those with HIV in developing nations, it is sure that we need to develop better ways of treating opportunistic infections and preventing the development of AIDS from HIV.

For more information on the global context of the AIDS pandemic, please visit:

Friday, August 08, 2008

Themes from the International AIDS Conference

Today marks the end of the 17th International AIDS Conference. 25,000 delegates were in Mexico City this week to discuss the current state of the pandemic. While I was not able to attend this year’s conference, I have been following the proceedings online. What were some of the major themes? The infection rate in the US is higher than previously thought. We need to do a better job reaching out to men who have sex with men. We need to develop an effective microbicide. We need to serve our children more effectively. New media – blogs, podcasts, twitter, mobile phones – may help us get the message out.

Because of AIDS conference, there have been numerous reports about HIV/AIDS this week. Here are a few that I found interesting.

At, Josh Richman tells us that Representative Barbara Lee (D – Oakland) has called for a domestic PEPFAR, stating that we need to spend billions here to fight HIV/AIDS.

At, Tamsin Smith urges us to develop intervention programs specifically designed to empower girls.

Also at, James Boyce makes a strong argument in favor of (RED). He argues that programs like this, termed Creative Capitalism by Bill Gates, work.

I hope you take the time to read this articles. And feel free to comment. I’d love to hear your thoughts.

Until next time, I’m Dave Wessner.