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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

    


The Economic Impact of
HIV/AIDS on South Africa and its Implications for Governance

http://www.jointcenter.org/

 

A BIBLIOGRAPHIC REVIEW

 

–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
Compiled by the Centre for AIDS Development, Research and Evaluation (Cadre)
on behalf of USAID through the Joint Center for Political and Economic Studies.
November 2000.

The Economic Impact
of HIV/AIDS on South Africa
and its Implications for Governance

Compiled by

The Centre for AIDS Development, Research
and Evaluation (Cadre) on behalf of USAID through the
Joint Center for Political and Economic Studies.
© USAID
November 2000

Written by

Warren Parker, Ulrike Kistner, Stephen Gelb, Kevin Kelly and Michael O’Donovan


Acknowledgements

The authors acknowledge the assistance provided by Diane Stuart,
who undertook administrative support and proofreading, Annalie van Niekerk who contributed to sections of the bibliography, David Neves, who conducted the initial literature search, and Nathan and Associates who conducted a supplementary search using resources at UNISA. We also acknowledge the important contribution of various researchers and key informants working in this field who gave of their time at short notice to contribute insights into this
area of research.

Note

This document represents a companion document to a Literature Review of the titles listed. Abstracts are a combination of author developed abstracts, where these have been available, and original abstracts by the authors of this Bibliographic Review. This data is available in Acrobat format and in Microsoft Excel (excluding abstracts). It is intended that this document be updated on a regular basis. Listed authors are welcome to forward abstracts where there are none, or to suggest alternative abstracts. Suggestions for inclusion of more recent research or omissions are also welcome. The Literature Review, Bibliographic Review and spreadsheet are also available on www.cadre.org.za (from December 2000)

Contact information

The Centre for AIDS Development, Research and Evaluation (Cadre) is a South African
non-profit organisation with offices in Johannesburg and Grahamstown, South Africa.
Comments on or additions to this report can be sent to Warren Parker at mediaids@icon.co.za.

Contents

Section One: The Macroeconomic Impact

Section Two: The Demographic Impact

Section Three: The Impact on Sectors

Section Four (A): The Impact on Firms and Workplaces

Section Four (B): The Impact on Households and Communities

Section Five: The Response of Government, Donors and
              Public/Private Interventions.

Section Six (A) The Response of Firms and Workplaces

Section Six (B): The Response of NGOs, CBOs and Communities

Section Seven: The Economics of Interventions

Section Eight: Behavioural and social response

SECTION ONE

The Macroeconomic Impact

Abt and Associatees, South Africa (2000)

The impending catastrophe: A resource book on the emerging HIV/AIDS epidemic in South Africa

Lovelife, Henry J Kaiser Family Foundation, South Africa

Acott, D (2000)

The economic impact of AIDS in South Africa: a critique of the demographic methods used in the ING-Barings report of April 2000, and their implications

Mimeo

The AIDS epidemic has already affected many sub-Saharan African countries, and is expected to have profound effects in South Africa over the next 20 years. By striking sexually active individuals, AIDS kills individuals during their most productive years. This impact feeds into the economy in numerous ways, including: A smaller labour force; A less productive labour force; Lower savings rates; Lower aggregate demand; Shifting expenditure towards health care. ING Barings uses the ASSA600 model with a national calibration to generate demographic forecasts for the total population, as well as for four race groups. This information is merged with data from the 1996 South African census to obtain forecasts of AIDS in 16 sectors and 3 skill levels. Little information is available on these forecasts. However, a simple weighted average closely approximates these rates. When this weighted average is used with data accurately calibrated to individual race groups, two changes become apparent: The long-term rate of HIV+ infection in all sectors is 3 to 5 percent of the population higher than projected by ING Barings. The distribution of HIV+ infection across skill levels shifts towards highly skilled workers. ING use current HIV+ infection and wage distribution over skill levels to determine an index of sectors to HIV/AIDS. This is discredited because it takes no account of the future rates, is based on rankings not actual values, assumes a uniform distribution of HIV+ infection across skills levels, and ignores input supply and output demand changes. The author believes that INGs projections are too optimistic. They will, however, become more pessimistic when including increased AIDS levels in the correctly calibrated model.

AIDSCAP (1996)

AIDS in Kenya: Socioeconomic Impact and Policy implications

Family Health International (FHI) and AIDSCAP, Washington

Ainsworth, M. and Over, M. (1994)

The economic impact of AIDS in Africa

In: AIDS in Africa, Essex, M., et al, New York, Raven Press

Ainsworth, M. and Over, M. (1994)

AIDS and African development

World Bank Research Observer, 9 (2)

Alaban, A. and Guinness, L. (2000)

Socio-economic impacts of HIV/AIDS in Africa

UNAIDS, ADF 2000 (Powerpoint presentation)

Armstrong, J.

Socioeconomic implications of AIDS in developing countries

Finance and development, Dec:14-7

Arndt, C. and Lewis, J.D. (2000)

The macro implications of HIV/AIDS in South Africa: A preliminary assessment

The World Bank, presented to IAEN Conference, July 2000

In this paper, we report on the preliminary results from an analysis of the macro impact of HIV/AIDS in South Africa. We have constructed an economy-wide simulation model that embodies the important structural features of the South African economy, into which we have added major impact channels of the HIV/AIDS epidemic. Using available demographic estimates for the impact of the epidemic (on labour supply, death rates, and HIV prevalence) along with assumptions about behavioural and policy responses (household and government spending on health, slower productivity growth), we use the model to generate and compare two scenarios: a hypothetical ‘no-AIDS’ scenario in which the economy continues to perform as it has over the last several years, and an ‘AIDS’ scenario in which the key AIDS-related factors affect economic performance. Focusing on the differential between the “no-AIDS” and “AIDS” scenarios, we find that the impact of the epidemic could be substantial. Over the 1997-2010 simulation period, GDP growth rates in the two scenarios diverge steadily, reaching a maximum differential of 2.6% points. The result is a GDP level in 2010 that is 17% lower in the ‘AIDS’ scenario; an alternative measure of ‘non-health, non-food absorption’ is 21% lower by 2010. While some of this decline is due to the lower population associated with the ‘AIDS’ scenario, per capita GDP does drop by around 7%. In fact, our simulations suggest that, despite the fact that AIDS impacts the high-unemployment unskilled labour category more than others, the net effect of higher AIDS-related mortality and slower growth is to leave the unemployment rate largely unchanged. We also use the model to ‘decompose’ the overall decline in growth performance into the contribution of the various channels. Given our current assumptions, the largest share (nearly half) of the deterioration in growth is attributable to the shift in government current spending towards health expenses (which increases the budget deficit and reduces total investment), while an additional third stems from slower growth in total factor productivity (TFP). The decomposition illustrates the importance of considering the slow moving nature and hence long duration of the epidemic. If the epidemic imposes a drag on the rate of accumulation of knowledge (reduced TFP growth) or the rate of accumulation of capital (through a switch from savings to current expenditure), these effects become amplified over time. Over the course of a decade, the implications for macroeconomic performance are substantial. Looking forward, our analysis suggests several avenues for further investigation. First, the parameters used in specifying the various AIDS effects are based on fairly limited empirical evidence, and it will be important where feasible to supplement these with additional data. For example, we have limited the impact of AIDS on household expenditure patterns to an assumed increase in health service spending, but there may well be other shifts that will occur and that could be incorporated, based on survey results. Second, there are important dynamic effects that are not yet included in the model: for example, lower private and government spending on education (because of higher AIDS spending) will slow down skills accumulation and change labor force growth rates. Finally, consideration must be given to how to capture the impact of alternative ‘intervention’ strategies – for example, at present there is no feedback between possible government policies to slow the spread of AIDS, and the demographic (and subsequent economic) trajectory of the epidemic.

Asia-Pacific HIV Impact Research Team

HIV impact assessment tool: The concept and its application

UNDP, Geneva

Balyamujura, H., Jooste, A., van Schalkwyk, H., and Carstens, J. (2000)

Impact of the HIV/AIDS pandemic on the demand for food in South Africa

The demographic impact of HIV/AIDS in South Africa and its provinces conference, Port Elizabeth

The macro economic impact of HIV/AIDS has two dimensions, namely direct and indirect costs. The latter is much more difficult to estimate, whilst its effect is also much more profound. This situation is aggravated by the fact that the portion of the population most affected by HIV/AIDS is the most economically active. The result of this is reduced economic growth and hence pressures on income. This could translate into changes in expenditure patterns that would definitely have an impact on the demand for food. Although the per capita income is expected to increase, it is projected that total expenditure on food will decrease in 2004 and 2009 in the "With HIV/AIDS" scenario. In constant 1995 terms, AIDS will cause a reduction in food expenditure in 2004 from 265,6 million to 258,8 million, while in 2009 the pandemic will result in a 6,52 per cent reduction from 294,5 million to 275,3 million.

Barnett , T. (2000)

Guidelines for preparation and execution of studies of the social and economic impact of HIV/AIDS

13th International AIDS Conference, Durban

Issues: There is often pressure and need to produce socio-economic impact studies when countries reach the stage where the epidemic is visible. Impact studies have a dual purpose. They provide the rationale for both prevention and mitigation The arguments for the studies are: (a) If there is a measurable or predictable impact then people can be convinced of the problem. Showing impact becomes an important tool for advocacy. (b) If the epidemic will have an impact, we need to know its location, scale and form, to begin planning for it. Description: This project developed guidelines on how to carry out impact assessments. The method used was to review all available impact studies including many done by the authors, to establish what they did and did not show in terms of the expectations and how the methodology worked and the level of analysis was decided. Two concepts are put forward for identifying the determinants of the scale and location of the epidemic and its impact. These are susceptibility - which determines where the epidemic will be located in a society and how far and fast it will spread; and vulnerability, which determines the likelihood that AIDS will have adverse consequences. Conclusion: Impact will be (a) detectable but only if the correct instruments are developed and used; (b) located in certain social, economic and spatial groups and areas and some of these may have little political influence or importance and therefore may not attract attention; and (c) felt slowly over a long period. Impact studies have an important role but both those commissioning and those carrying them out must be clear as to what can be done and what is expected.

Barnett, T. and Blaikie, P. (1993)

Simple methods for monitoring the socio-economic impact of AIDS: Lessons from sub-Saharan Africa

In: Cross, S. and Whiteside, A. (eds), Facing up to AIDS: The socio-economic impact in Southern Africa, McMillan, London

Barnett, T. and Whiteside, A. (1996)

HIV/AIDS and Development: Case studies and a conceptual framework

Health Economics and HIV/AIDS Research Division (HEARD), University of Natal, Durban

Barnett, T. and Whiteside, A. (2000)

Guidelines for studies of the social and economic impact of HIV/AIDS

UNAIDS, Geneva, Switzerland

Many countries, particularly those with serious HIV/AIDS epidemics, are increasingly adopting strategic approaches to planning and implementation. Specifically, in planning for HIV/AIDS, they are relying on an anlysis of their particular HIV/AIDS situation and response in order to define future priorities and to set relevant objectives and strategies. Socioeconomic impact studies can be a key element in informing the analysis and in the overall planning process. However, many impact studies have not been aimed at planning, but have merely been an academic exercise of have provided less than solid data for advocacy purposes. The present guidelines are intended to place socioeconomic impact studies in the planning prcess in a systematic way. One of UNAID’s major motivations for publishing this manual is to encourage cuontries to include impact information in their strategic planning process. However, UNAIDS would also encourage specific impact studies in sectors such as education and agriculture, where a strong basis for the development of sector-specific alleviation strategies can be formed.

Barnett, T. and Whiteside, A. (1999)

Guidelines for preparation and execution of studies of the social and economic impact of HIV/AIDS

Health Economics and HIV/AIDS Research Division (HEARD), University of Natal, Durban

Barnett, T., Whiteside, A. and Desmond, C. (2000)

The social and economic impacts of HIV/AIDS in poor countries: A review of studies and lessons

UNAIDS, Geneva

Bechara, M. and Weeks, O. (2000)

AIDS – An economic catastrophe?

Morgan Stanley Dean Witter, London

The epidemic in South Africa is among fastest growing in the world. By 2007, 23% of the adult population may be infected, with annual AIDS deaths forecast to reach 800,000 by 2011. Infection seems to be skewed towards the unskilled. This is unlike in other parts of Africa, and may make the overall economic impact considerably less than feared. Government spending on AIDS remains strikingly low. We do not expect rising healthcare costs to reduce investment and growth significantly.

Botswana Institute for Development Policy Analysis (BIDPA) (2000)

The macroeconomic impacts of HIV/AIDS in Botswana

BIDPA, Botswana

Background: HIV/AIDS is expected to increase poverty and destitution in Botswana. The objective was to quantify the impact of HIV/AIDS on indicators of poverty and income inequality, and to explore the policy implications. Methods: Current HIV prevalence rates by age, sex and location were randomly imposed upon household and individual level data taken from a household income and expenditure survey (HIES) in Botswana. The household income position was then considered after a 10-year period, when those infected with HIV were assumed to have died. Comparative indicators were then calculated. Results: About 50% of households in Botswana have an infected household member. Half of these will lose an income earner within 10 years. In addition, 2% of all households will lose all of their income earners, and become effectively destitute. The analysis predicted an 8% fall in national household level income, and an increase of 5% in the poverty head count. Per-capita income of the poorest 25% of households is projected to fall by 13%, with an increase of 25% in the number of dependents per income earner. The widespread nature of HIV/AIDS in Botswana does however imply that income inequality will not worsen significantly. A comprehensive sensitivity analysis suggested that the results of the analysis are robust to changes in the key assumptions. Conclusions: The results imply that HIV/AIDS will have a significant impact on poverty levels in Botswana, and will cause a large increase in extreme poverty and destitution. The major implication is that the enactment and implementation of poverty alleviation policies will take on a much greater urgency. Particular emphasis will need to be given to employment creation for unskilled workers, orphan care and destitute relief, and to counselling and support services for young people.

Bloom David E. and Mahal Ajay S. D. (1997)

Does the AIDS epidemic threaten economic growth?

Journal of Econometrics (77)1 pp. 105-124

Bloom David E. and Mahal Ajay S. D. (1995)

Does the AIDS epidemic threaten economic growth?

National Bureau of Economic Research (NBER), Cambridge, Massacheussets

Bloom, D. and Lyons, J. (eds) (1992)

The economic impact of AIDS in Asia

United Nations Development Programme (UNDP), Dehli

Bloom, D.E. and Godwin, P. (eds) (1997)

The economics of HIV and AIDS: The case of south and south east Asia

Oxford University Press

Bollinger, L. and Stover, J. (1999)

The economic impact of AIDS

The Futures Group International, Washington, DC

Bollinger, L. and Stover, J. (1999)

The economic impact of AIDS in South Africa

The Futures Group International, Washington, DC

Broomberg, J. (1993)

Current research on the economic impact of HIV/AIDS: A review of the international and South African literature

In: Cross, S. and Whiteside, A. (eds), Facing up to AIDS: The socio-economic impact in Southern Africa, McMillan, London

Broomberg, J., Steinberg, M., Masobe, P. and Behr, G. (1991)

The economic Impact of the AIDS epidemic in South Africa

In: Centre for Health Policy, Aids in South Africa, The Demographic and Economic Implications, University of Witwatersrand, Johannesburg

Broomberg, J., M. Steinberg, P Masobe & G Behr (1993)

The economic Impact of the AIDS epidemic in South Africa

In: Cross, S. and Whiteside, A. (eds), Facing up to AIDS: The socio-economic impact in Southern Africa, McMillan, London

Broomberg, J., Soderlund N. and Mills, A. (1996)

Economic analysis at the global level: a resource requirement model for HIV prevention in developing countries

Health Policy, Oct;38(1):45-65

Bureau for Econonomic Research (BER) (2000)

HIV/AIDS and the South African economy

Bureau for Economic Research (BER), Stellenbosch

Butler, M., Gomez, E., Perez, Bollinger, E. and Colvin, C. (2000)

The socioeconomic impact of HIV/AIDS in the Dominican Republic, 1991-2005

13th International AIDS Conference, Durban

The purpose of this report is to summarise the process undergone to estimate both the past and future trends of HIV/AIDS in the Dominican Republic, and to evaluate the socioeconomic impact of these trends. The size of the epidemic is described by the number of people infected with HIV and the number of AIDS cases. The socioeconomic impact is measured by the impact on various demographic measures, such as total fertility rate, infant mortality rate, and life expectancy, and some economic variables, including the impact on the health sector and the Ministry of Health budget. There is a significant difference between an initial set of projections of the HIV/AIDS epidemic, estimated in 1996, and the projections presented here. The initial projections indicated that HIV prevalence in the adult population would reach 4.6% by the year 2000. The projections here estimate that, instead, overall HIV prevalence in the adult population will be 2.34 percent by the year 2000, and will reach 2.44% by 2005. The difference between these two sets of projections may be due to a number of different factors. First, there are now more and better data from surveillance sites. Three of the sites have seven or more years of data, and a fourth site now has five years of data. Increases in the amount of data available for analysis allow for more accurate predictions. Second, our understanding of the current level of the maturity of the epidemic may have changed because of these new data. The projections presented here indicate that the epidemic is at a more mature stage than the earlier projections had indicated, implying that the maximum infection rate will be lower than anticipated before. Third, the spread of the epidemic may have slowed down due to prevention efforts. Although it is difficult to assign causality to the prevention efforts directly, there are a number of examples of successful efforts.

Chevallier, E. and Floury, D. (1996)

The socioeconomic impact of AIDS in sub-Saharan Africa

AIDS 1996;10, Suppl A:S205-11

Cohen, D. (1999)

The economic impact of the HIV Epidemic

United Nations Development Programme (UNDP), Issues paper No 2

Cross, S. (1993)

A socio-economic analysis of the long-run effects of AIDS in South Africa

In: Cross, S. and Whiteside, A. (eds) Facing up to AIDS: The socio-economic impact in Southern Africa, Macmillan, South Africa

Cross, S. and Whiteside, A. (eds) (1993)

Facing up to AIDS: The socio-economic impact in Southern Africa

Macmillan, South Africa

Cross, S. and Whiteside, A. (eds) (1996)

Facing up to AIDS: The socio-economic impact in Southern Africa

Palgrave, England

Cuddington, J.T. and Hancock, J.D. (1994)

Assessing the impact of AIDS on the growth path of the Malawian economy

Journal of Development Economics, 43 (2):363-368

Cuddington, J.T. (1993)

Further results on the macroeconomic effects of AIDS: The dualistic labour-surplus economy

World Bank Economic Review 7 (3)

Cuddington, J.T. (1993)

Modelling the macroeconomic effects of AIDS with an application to Tanzania

World Bank Economic Review 7 (2):173-89

Denolf, D. (2000)

Structural obstacles for economic development in developing countries

13th International AIDS Conference, Durban

Economies of developing countries are often characterised with major macroeconomic problems limiting sustainable development. In periods of economic crisis national resources allocated for health are substantially reduced with dramatic consequences for the population. The AIDS crisis thrives on poverty, together with poor education and health. Direct obstacles which impede economic growth include national monetary policy inducing hyperinflation; excessive price regulation through state intervention; preponderance of informal sector; lack of foreign investments; poorly implemented trade legislation. Underlying obstacles which are more difficult to access: level of technical competence; conflict between personal benefits and benefits for the society; poor administrative capacities; inadequate accountability; unequal distribution of administrative and economical power; weak civil society. Internal and external obstacles in Democratic Republic of Congo are leading to a weak economy which prejudices budget allocation for health expenditures. To achieve a sustainable economic growth, the structural and political obstacles impeding development should be addressed . Introduction of progressive and feasible structural adjustment programs emphasising on social improvements are urgently needed. Economic growth with equitable redistribution of the wealth is of utmost importance to reverse the course of dramatic AIDS epidemic in the developing countries.

Department of Finance, South Africa (2000)

Budget Review 2000

Department of Finance, Pretoria, South Africa

Department of Finance, South Africa (2000)

National Expenditure Survey

Department of Finance, Pretoria, South Africa

Doehring, R.O. (1991)

The socio-economic impact of the AIDS epidemic

Degree: Graduate School of Business Administration, University of the Witwatersrand

Doyle, P.R. (1991)

AIDS in South Africa: The demographic and economic implications

The Centre for Health Policy, University of Witwatersrand

Du Plessis, P.G. (1991)

The potential influence of AIDS on the South African investment milieu

Degree: Department of Business Management, University of Stellenbosch

Godwin, P. (1998)

The looming epidemic: The impact of HIV and AIDS in India

Mosaic Press, New Dehli

Hamoudi, A. (2000)

AIDS and the economists in Durban: Laying a foundation

AIDS Analysis Africa, 11(2)

ING Barings (2000)

Economic impacts of AIDS in South Africa: A dark cloud on the horizon

ING Barings, Johannesburg

This report uses the WEFA time-series based macroeconomic model, which is a widely-used commercial forecasting model. Demographic input data is based on the ASSA600 model, which in turn originated from the ‘Doyle model’ used by Broomberg et al. The key results are that the growth rate of GDP declines by 0.2–0.3% up to 2005, and thereafter by 0.3-0.4% (Figure 1). Since population growth declines by more than this – 1.33% - up to 2005, per capita income will actually be higher until 2005, as compared with a ‘no AIDS’ situation, if the model’s projections are accurate. After 2005, the decline in population growth averages 0.12% p.a., which is less than the decline in the growth rate of GDP, so per capita income will be lower than without the epidemic. Notwithstanding the ‘dark cloud’ image in the title, the ING Barings study gives some support to the ‘cautiously optimistic’ view discussed above; indeed, the study makes explicit that it is presenting a ‘non-alarmist’ scenario.

Jones, C. (1996)

Does structural adjustment cause AIDS: One more look at the link between adjustment, growth and poverty

In: Ainsworth, M., Fransen, L. and Over, M., Confronting AIDS: Public Priorities in a Global Epidemic, European Commission, 1998

Kambou, G., Devarajan, S. and Over, M. (1992)

The economic impact of AIDS in an African country: Simulations with a computable general equilibirum model of Cameroon

Journal of African Economies, 1 (1)

Kinghorn, A. and Steinberg, M. (1998)

HIV/AIDS in South Africa: The impacts and Priorities

Department of Health, South Africa

Kongsin, S., Lerttchayantee, S., Jiamton, S. and Watts, C. (2000)

Socio-economic determinants of HIV/AIDS in Thailand

13th International AIDS Conference, Durban

Since AIDS infects mainly adults at their prime working age, which can have a profound social and economic impact on the welfare of surviving members in low socio-economic households. Empirical information on the socio-economic impact of HIV/AIDS on households and communities in Thailand is scarce of variable quality, where the majority of cases under the re-emerging worldwide epidemic occur. Knowledge about these factors is required to assess the economic impact of the disease at the societal level. The high level of poverty among young age group of PLWHA was similar to that observed in the general population. The distribution of socio-economic variables in the study group did not differ significantly from that found in the general population. HIV/AIDS equally affects members of all socio-economic groups in Thailand. While the prevalence of poverty is higher in the study group, poverty is not a risk factor for the occurrence of the disease. Also, the higher disease risk among the young age group of PLWHA is not determined by poverty.

Loewenson, R. and Kerkoven, R. (1996)

The socio-economic impact of AIDS: Issues and options in Zimbabwe

SafAIDS and TARSC, Harare

Loewenson, R. and Whiteside, A. (1997)

Social and economic issues of HIV/AIDS in southern Africa: A review of current research

SafAIDS, Harare

Mills, A. et al (1993)

The costs of HIV/AIDS prevention strategies in developing countries

World Health Organisation, Global Programme on AIDS, Geneva

National Treasury, South Africa (2000)

Intergovernmental fiscal review

National Treasury, Pretoria, South Africa

National Treasury, South Africa (2000)

Medium term budget policy statement

National Treasury, Pretoria, South Africa

Nicholls, S. et al (2000)

Modelling the macroeconomic impact of HIV/AIDS in the English-speaking Carribean: The case of Trinidad, Tobago and Jamaica

IAEN Conference, July 2000

Over, M. (1992)

The Macroeconomic Impact of AIDS in Sub-Saharan Africa

World Bank, New York

The earliest conjectures regarding the impact of the AIDS epidemic in severely affected countries presumed that the disease would cause substantial declines in such conventional measures of macroeconomic performance as the growth of GNP per capita. This paper written in 1992, together with other papers that are cited in Chapter 1 of ‘Confronting AIDS,’ were the first to provide detailed calculations of the probable magnitude of these impacts. Now that some countries have in fact attained the 21% adult prevalence rate that was hypothesised in this paper, its projections are particularly relevant. Whether they are accurate is more difficult to determine. However, the continued macroeconomic growth of such severely affected countries as Uganda and Botswana, despite serious AIDS epidemics, seems to support the predictions of this paper that the impact of the epidemic on per capita GNP growth will be small. The possibility remains that profound, cumulative "disruption effects" of the epidemic not modeled in these papers will manifest themselves in the coming years.

Raditapole, D.K. (1995)

The economics of HIV transmission

In: HIV and AIDS: the global inter-connection, edited by Elizabeth Reid. West Hartford, Connecticut, Kumarian Press, 55-62

Squire, L (1998)

Confronting AIDS

Finance and Development, March

Taylor, V. (1998)

HIV/AIDS and human development, South Africa.

In: United Nations Development Report, Human development report, United Nations Development Programme (UNDP), Geneva

Trotter, G. (1993)

Some reflections on a human capital approach to the analysis of the impact of AIDS on the South African economy

In: Cross, S. and Whiteside, A. (eds), Facing up to AIDS: The socio-economic impact in Southern Africa, McMillan, London

Wehrwein, P. (2000)

The economic impact of AIDS in Africa

Harvard AIDS Review, Fall 1999/Winter 2000

Whiteford, A. (1999)

Implications of the AIDS epidemic for the South African labour market

WEFA Monthly Outlook, March

Whiteside, A. (1996)

Economic impact in selected countries and the sectoral impact

In: Mann, J. and Tarantola, D.J.M. (eds), AIDS in the world II: global dimensions, social roots, and responses, Oxford University Press, New York

Whiteside, A.

Economic effects of AIDS: Socio-economic causes and consequences

University of Natal (ERU), Durban

Whiteside, A. and Sunter, C. (2000)

AIDS: The challenge for South Africa

Human and Rousseau, Tafelberg, South Africa

This book acruges that there are many interventions that can be carried out in response to HIV/AIDS. It covers the origin of HIV/AIDS, the current situation in the world and in Africa, the South African impact, and demographic and social consequences in South Africa. The authors recommend a grassroots approach on a wide front.

World Bank (1997)

Confronting AIDS: Public priorities in a global epidemic

Oxford University Press, New York

Zungu, N.G. (2000)

Economics and globalisation: developing countries slow economic take-off and the uneven process of globalisation and HIV/AIDS epidemic

13th International AIDS Conference, Durban

The failure of the economies in Less Developed Countries (LCDs) to take off and the uneven process of globalisation contribute to the alarming spread of HIV/AIDS epidemic. It also trivialises the research projects that have been undertaken to teach poverty-stricken communities about the epidemic. It is the same situation that, in the long run, is staggering the economies of the less developed countries (LDCs). When the LDCs economies take off due to the extractive process of globalisation, it means there is little to spare for HIV/AIDS programmes. Lack of funding for HIV/AIDS programmes necessarily means higher infection rates and death instances that translate to further deterioration of the already limping economies of the LCDs.

SECTION TWO

The Demographic Impact

Boerma, J.T. et al (1998)

Mortality impact of the AIDS epidemic: evidence from community studies in less developed countries

AIDS, 12

This review focuses on the evidence of mortality impact among adults and children in community studies. The majority of these studies are located in Africa, particularly eastern Africa, where the AIDS epidemic is conjectured to be older than in other less developed countries. Community studies show a two- to threefold increase in total adult mortality with an even larger increase in mortality among young adults in communities with adult HIV prevalence levels below 10%. Mortality amongst HIV-infected adults ranges from 5 to 11% per year, and more than half of all adult deaths can be attributed to HIV. HIV-infected women die at an earlier age than men and thereby lose significantly more productive years of life. Follow-up studies of incident cases are few, but population-based data indicate that the median survival time is substantially longer than originally thought on the basis of mortality amongst HIV-infected commercial sex workers. Tuberculosis incidence is on the increase, but evidence of additional impact on mortality is hitherto limited. Infant and early child mortality among children of HIV-infected mothers is two to five times higher than among children of HIV-negative mothers in follow-up studies of maternity-based and community samples. The large increase in adult mortality and moderate increase in child mortality lead to dramatic falls in life expectancy. For instance, in a rural area of Uganda, which has an HIV prevalence of 8%, life expectancy has dropped from just under 60 years to 42.5 years.

Bos, E. and Bulatao, R.A. (1992)

The demographic impact of AIDS in sub-Saharan Africa

International Journal of Forecasting (8) 3:367-384

Bourne, D. (2000)

Demographic implications for development in Southern Africa as a result of the AIDS epidemic – a graphical review

Urban Health and Development Bulletin, 3 (2)

Bourne, D., Dorrington, R., and Loubser, R. (2000)

Rapid AIDS mortality surveillance in South Africa

Joint Population Conference: The demographic impact of HIV/AIDS in South Africa and its provinces, Port Elizabeth

Mortality patterns in South Africa are changing rapidly, with an increase in the overall number of deaths and a shift in the age structure with increased mortality among younger adults. Part of the increase can be ascribed to better reporting of deaths but the shift in age structure can be explained in terms of additional deaths due to AIDS. Official mortality statistics for South Africa currently appear four to five years after the event. By using anonymous data from the Population Register of the Department of Home Affairs it is possible to monitor mortality three to six months after the registration of death. A rapid surveillance system was piloted by comparing mortality data from the Population Register for a 12-month period in 1997/98 with the projected number of deaths from the ASSA600 model. The ASSA600 model currently reproduces the general trend of the observed mortality and the level of mortality in total, although it currently appears to overestimate female mortality and underestimates male mortality. Improvements to the model and potential sources of bias in the mortality data set are being investigated.

Bourne, D., Dorrington, R., Laubscher, R. and Bradshaw, D. (2000)

Rapid AIDS mortality surveillance in South Africa

Joint Population Conference: The demographic impact of HIV/AIDS in South Africa and its provinces, Port Elizabeth

This paper presents the results of the ASSA600 demographic model developed by the AIDS Committee of the Actuarial Society of South Africa. The model assumes that there are four populations at risk with respect to AIDS and further assumes an average of ten years between infection and death for adults and two years for infants. The model has been calibrated to meet the population estimate of 42.2 million in 1996 and the results of the national antenatal survey. No behavioural changes are accounted for. The model displays the increasing numbers of deaths attributable to AIDS and to the changing age profile of the population.

Brophy, G. (1993)

Modelling the demographic impact of AIDS: Potential effects on the black population in South Africa

In: Cross, S. and Whiteside, A. (eds) Facing up to AIDS: The socioeconomic impact in Southern Africa, Macmillan, London

Cameron, W., Garnett, G., Bartley, L.M., and Anderson, R.M. (2000)

Shared community benefits of good medical health care for HIV: Mathematical modelling of the potential impact of treatment on the spread of HIV infection

13th International AIDS Conference, Durban

This paper sets out to model mathematically the epidemiological and economic impact of health care including anti-HIV treatment on the public health of HIV, in comparison and in combination with accepted public health interventions. A deterministic, compartmental model of HIV transmission in a sexual activity-stratified heterosexual population was developed. This included HIV disease progression and transmissibility, related to allocation patterns of medical treatment and acquired drug resistance. The modelled population incidence of HIV and AIDS could be reduced through the use of anti-HIV treatment. A net public health benefit is possible when treatment is appropriately targeted early in an HIV epidemic in a context of a highly focused initial source of infection. Conservative assumptions about the potential alterations in parameter values suggest that HIV treatment could be more effective than other interventions. There are many barriers to the effective treatment of HIV infection in resource poor settings. This is particularly true in populations for which targeted therapy would have the most beneficial impact on HIV epidemiology. Our model results indicate that resources allocated to targeted health care as a means of preventing the spread of HIV may confer both net public health and economic benefits.

Cohen, D. (1999)

Socioeconomic causes and consequences of the HIV epidemic in southern Africa: A case study of Namibia

United Nations Development Programme (UNDP), Geneva

Colvin, M. (1998)

Draft protocol: 1998 annual antenatal HIV and syphilis seroprevalence survey

MRC, Durban

Colvin, M., Gouws, E., Kleinschmidt, I., and Dlamini, M. (2000)

The prevalence of HIV in a South African working population

13th International Conference on AIDS, Durban

Estimates of the prevalence of HIV in South Africa are almost exclusively based on data from the annual survey of public-sector antenatal clinics. There is very little HIV prevalence data on men and non-black women. This study aimed to determine the prevalence of HIV and associated risk factors among a nationally based working population comprising all race groups and both sexes.

Colvin, M. and Mullick, S,

Draft outline of a national STD/HIV/AIDS survellance strategy

MRC, Durban

Department of Health, South Africa (1999)

National HIV sero-prevalence survey of women attending public antenatal clinics in South Africa

Department of Health, South Africa

This report explains, broadly, the method used by the Department of Health, in collating the national ANC prevalence rate data. It also summarises the results for the year 1999 by age and province. The report indicates some of the limitations of the data by presenting the design adjusted confidence intervals and expressly states that the results do not adequately represent the non-African population.

Department of Health, South Africa (1998)

South Africa demographic and health survey: 1998. A preliminary report

Department of Health South Africa, with Medical Research Council and Macro International

This report presents preliminary findings from the 1998 survey. It provides the results for key maternal and child health indicators including medical care for mothers during pregnancy and at the time of delivery, infant feeding practices, child immunisation coverage and the prevalence and treatment of diarrhoeal disease among children. It also provides information on women’s status, fertility levels, contraceptive knowledge and use and adult health conditions.

Department of Health, South Africa (1998)

Report on confidential enquiries into maternal deaths in South Africa

Department of Health, Pretoria, South Africa

Dorrington, R. (2000)

HIV/AIDS in the Western Cape: Is there still time to do something?

Joint Population Conference: The demographic impact of HIV/AIDS in South Africa and its provinces, Port Elizabeth

The Western Cape has the lowest prevalence of all the provinces with a prevalence of pregnant women attending antenatal clinics of only 7.1% compared to an national average of 21.4% and is roughly five years behind KwaZulu-Natal. Therefore the province has the best opportunity of early intervention to slow down the spread of the infection. However, within the province there is wide variation with zero prevalence in some areas rising to highs of 18 to 19% prevalence in Guguletu and Khayelitsha. The Department of Health has set up a Provincial AIDS Management Team to implement a number of programmes designed to curb the spreading of the epidemic and to provide care and support. Although it would have been much more cost effective to have started earlier, there is still time to do something about the course of the epidemic in the province, and the Provincial AIDS Management team have, on paper, made an excellent start.

Dorrington, R. (2000)

What the ASSA2000 model tells us about the epidemic in the provinces and what it tells us about the national epidemic

Joint Population Conference: The demographic impact of HIV/AIDS in South Africa and its provinces, Port Elizabeth

This model is distinguished by applying a four race model to each province from which national estimates are derived. It represents work-in-progress as the model has not been fully calibrated. It improves on ASSA600 by incorporation of ‘98 and ‘99 ANC summary statistics, ’98 DHS results, improved population estimates, mortality data. Despite little data being available to correctly calibrate the model it provides estimates for the four main race groups. The results incorporate risk group percentages and condom use profiles. It assumes migration will fall from a net in-migration of 190 000 in 1996 to a nil gain over a 30 year period. The model assumes an infant mortality rate of 30% per annum for those born infected and a median term to death of five years for those contracting disease via their mothers’ milk. A contagion matrix incorporates a number of additional influences including: transmission probabilities by risk group sex and number of new partners the probability of the partner belonging to a risk group, number of contacts per new partners, condom usage by year and, condom effectiveness measures. The author indicates the resultant projections ‘flatten out too soon’ but concludes that the aggregated data (ie. for all nine provinces) produces a ‘remarkably good fit to all data except 1998 ANC’. The ultimate plateaus of prevalence rates range from 17% for Western Cape to 43% for KwaZulu-Natal – assuming no changes in behaviour. A national prevalence rate of about 30% is observed.

Dorrington, R. (2000)

The demographic impact of HIV/AIDS in South Africa

Joint Population Conference: The demographic impact of HIV/AIDS in South Africa and its provinces, Port Elizabeth

In this paper Dorrington compares the ASSA600 model to observed HIV rates and the projections made by the US Bureau of the Census, the United Nations and the Metropolitan Doyle models. He finds that international models are more pessimistic than local models regarding mortality etc. Nevertheless even the local models confirm that the epidemic is deeply entrenched and will have a significant impact with around six to ten million (additional) deaths over the next ten years. He also finds that the epidemic has, to date, not been affected by interventions, yet the modification of risky sexual behaviour and treatment of STDs could significantly alter the progression of the disease.

Dorrington, R. (1998)

ASSA600: An AIDS model of the third kind?

Mimeo

This paper provides a brief overview of the method and output of the ASSA600 model. The first appendix summarises the findings of the Nedlac census results task team on the validity of the 1996 census population count. That team concluded that the preliminary estimates provided by Statistics SA significantly underestimated the population count – but was unable to measure that underestimate. The second appendix contains a similar overview of the ASSA500 model. Appendix three explains how the ASSA starting population for 1985 was derived. The fourth, fifth and sixth appendices explain the assumptions used in the model for fertility, mortality and immigration respectively. Appendix seven explains the calibration process used in the model.

Doyle, P. (1993)

The dmographic impact of AIDS on the South African population

In: Cross, S. and Whiteside, A. (eds) Facing up to AIDS: The socioeconomic impact in Southern Africa, Macmillan, London

Groenewald, C (2000)

Northern Cape: The demographic impact of HIV/AIDS

Joint Population Conference: The demographic impact of HIV/AIDS in South Africa and its provinces, Port Elizabeth

Groenewald compares the differences between the low and high impact scenarios for the Northern Cape. These scenarios were developed by Calitz of the Development Bank of South Africa. The author notes that, of the nine provinces, the Northern Cape has the second lowest prevalence of HIV. Nevertheless, despite the increased mortality rate and lower life expectancy (a drop of over ten years to 50.8 years in 2011) the population will still tend to age slightly. The median age in 2011 will rise from 25.9 (low impact scenario) to 26.58 years (high impact scenario).

Health Economics and HIV/AIDS Research Division (HEARD)

The impact of HIV/AIDS in KwaZulu-Natal: lessons for equitable and efficient health reform policy

Unpublished report

Herdt, G. (1997)

Sexual cultures and population movement: implications for AIDS/STDs

In: Gilbert Herdt (ed) Sexual cultures and migration in the era of AIDS: Anthropological and demographic perspectives, Oxford University Press, Oxford, England,pp3-22

ING Barings (1999)

The demographic impact of AIDS on the South African economy

ING Barings, South Africa

This study sets out to determine the demographic changes to the South African population by age, skills level and economic sector brought about by the AIDS epidemic. For the total population, HIV infections are forecast to peak at 16% in 2006. Among the economically active, HIV infections will peak at a higher 22%. It is suggested that mining, government, transport, construction and consumer manufacturing will be the highest impacted. Cost impacts include higher benefit payments, costs of rehiring and retraining, and indirect costs of productivity. A key factor likely to lower potential GDP growth after 2005 is the diversion of funds away from savings to pay for the costs of the illness.

Kalipeni, E. (2000)

Africa: a comparative and vulnerability perspective

Social Science and Medicine, 50 (7-8):965-83

Using a vulnerability and comparative perspective, this paper examines the status of health in southern Africa highlighting the disease complex and some of the factors for the deteriorating health conditions. It is argued that aggregate social and health care indicators for the region such as life expectancy and infant mortality rates often mask regional variations and intra-country inequalities. Furthermore, the optimistic projections of a decade ago about dramatic increases in life expectancy and declines in infant mortality rates seem to have been completely out of line given the current and anticipated devastating effects of the HIV/AIDS pandemic in southern Africa. The central argument is that countries experiencing political and/or economic instability have been more vulnerable to the spread of diseases such as HIV/AIDS and the collapse of their health care systems. Similarly, vulnerable social groups such as commercial sex workers and women have been hit hardest by the deteriorating health care conditions and the spread of HIV/AIDS. The paper offers a detailed discussion of several interrelated themes which, through the lens of vulnerability theory, examine the deteriorating health care conditions, disease and mortality, the HIV/AIDS situation and the role of structural adjustment in the provision of health care. The paper concludes by noting that the key to a more equitable and healthy future seems to lie squarely with increased levels of gender empowerment.

Kamuzora, C.L. (2000)

The demographic impact of HIV/AIDS in Africa

Joint Population Conference: The demographic impact of HIV/AIDS in South Africa and its provinces, Port Elizabeth

Contrary to most of the recent works this article is typified by an ‘optimism’ regarding the demographic impact of AIDS. The author concludes an examination of UN projections and its impact of age profiles is a ‘bitter sweet scenario’. The author finds that populations of Africa will continue to grow and remain young due to the momentum in the young age structures, from past and current high fertility, offering relief to fears of being wiped out. This is justified by the disease being epidemical (only) on ‘smaller locations’. The conclusions are probably due to the authors reliance on curiously dated UN projections from the late ’80s and early ’90s. This allows the author to accept, as a working hypothesis, that fertility rates would not be affected if ‘HIV prevalence is small, eg. maximum of 15% so far observed’. By relying on this information neither South Africa nor Botswana is identified as being part of the epidemic. Similarly, the epidemic is typified by the author as a largely urban phenomenon.

Kelly, K. (2000)

Communicating for Action: A contextual evaluation of youth response to HIV/AIDS

Beyond Awareness Campaign, Department of Health, South Africa

This paper presents the findings of a study of youth attitudes, perceptions and knowledge at six sentinel sites in South Africa. The sites are diverse and range from rural sites in the Eastern Cape to a tertiary institution in the Northern Province. The study concludes that among the youth there is both regular exposure to HIV/AIDS information and a generally high perception of vulnerability. It also points to the accessibility of condoms and their fairly widespread (albeit inconsistent) use. It however points to an underplaying by the media of other preventative measures including ‘being faithful’ and abstinence. The report suggests that discontinuation of sexual activity is an option that is least strongly supported by the media but may be an attractive option for a ‘surprisingly high proportion of youth’.

Kongsin, S. and Watts, C. (2000)

Conducting a household survey on economic impact of chronic HIV/AIDS morbidity in rural Thailand: Methodological issues

International AIDS Economics Network (IAEN) Conference, Durban

This paper concentrates entirely on the practical issues in conducting a household survey in a rural village type setting. The study seeks to identify the impact of communal coping mechanisms on how households deal with AIDS. The paper describes how the study was structured without presenting any findings. The study is in effect one on the impact on households of prolonged morbidity (probably attributable to AIDS). This impact is to be compared to a control group of similar size. The issues raised are with respect to eliciting participation, involving community leaders etc. It will probably be of use in any similar South African study.

Kremer, M. (1996)

Integrating behavioral choice into epidemiological models of AIDS

National Bureau of Economic Research, Working Paper 5428, Cambridge, MA, USA

Increased HIV risk creates incentives for people with low sexual activity to reduce their activity, but may make high-activity people fatalistic, leading them to reduce their activity only slightly, or actually increase it. If high-activity people reduce their activity by a smaller proportion than low-activity people, the composition of the pool of available partners will worsen, creating positive feedbacks, and possibly multiple steady state levels of prevalence. The timing of public health efforts may affect long-run HIV prevalence.

Kustner, H.G., Swanevelder, J.P. and van Middelkoop, A. (1998)

National HIV surveillance in South Africa: 1993-1995

South African Medical Journal, 88 (10):1316-20

Lincoln, D.W. (1998)

Reproductive health, population growth, economic development and environmental change

MRC Reproductive Biology Unit, University of Edinburgh Centre for Reproductive Biology, United Kingdom

World population will increase by 1 000 million, or by 20%, within ten years. Ninety-five per cent of this increase will occur in the south, in areas that are already economically, environmentally and politically fragile. Morbidity and mortality associated with reproduction will be greater in the current decade than in any period in human history. Annually, 40-60 million pregnancies will be terminated and 5-10 million children will die within one year of birth. AIDS-related infections, e.g. tuberculosis, will undermine health care in Africa (and elsewhere) and in some places AIDS-related deaths will decimate the work-force. The growth in population and associated morbidity will inhibit global economic development and spawn new problems. The key issues are migration, the spread of disease, the supply of water and the degradation of land, and fiscal policies with respect to family planning, pharmaceuticals and Third-World debt. Full education, particularly of women, and more effective family planning in the south have the power to unlock the problem. Failure will see the developed countries, with their 800 million population, swamped by the health, economic and environmental problems of the south, with its projected population of 5 400 million people for the year 2000.

Lurie, M. (1999)

Seeing the whole picture

AIDS Action, 6 (44)

The Hlabisa project based in northern KwaZulu-Natal, South Africa, studied the prevalence of HIV and sexually transmitted diseases (STDs) in migrant and non-migrant couples. The study participants were screened for HIV and STDs, counselled, and given health education. The findings show that migrant couples have a much higher HIV discordance and prevalence than non-migrant couples. However, according to the findings, only women were HIV positive, while their migrant partners were HIV negative. Thus, all migrants and their partners were treated for STDs and given health education. Access to health services is crucial, as is creating sustainable rural development programmes that offer local employment.

Lurie, M., Harrison, A., Wilkinson, D. and Abdool Karim, S. (1997)

Circular migration and sexual networking in rural KwaZulu-Natal: implications for the spread of HIV and other sexually transmitted diseases.

Health Transition Review, Supplement 3:17-27

Patterns of migration do not simply arise out of chance. In South Africa, for example, migration patterns are a result of decades of legislation aimed at restricting the movements of the majority of the population and providing a steady flow of cheap black labour to the gold mines and other industries. In the new democratic South Africa, restrictive laws have been lifted, but circular migration remains a way of life for several million black South Africans. This paper examines the social and epidemiological implications of widespread circular migration from the perspective of a rural South African Health District. In particular, we report our findings on the patterns and prevalence of migration into and out of the Hlabisa Health District in rural KwaZulu-Natal, and the patterns of sexual networking of migrants and their rural partners. We conclude by examining the implications of these patterns of migration and sexual networking for the spread of HIV and other STDs.

MacPhail, C., Campbell, C., Williams, B., and van Dam, J. (2000)

Gender and the relative risk of HIV infection amongst young men and women in a South African township

13th International AIDS Conference, Durban

Data was collected as part of a study of gender and the relative risk of HIV infection in a South African township which is being used to inform an intervention to reduce transmission of HIV. If interventions such as these are to succeed in managing the spread of infection, it is important to understand the patterns of infection and the way in which social, economic and biological factors might combine to make young women particularly vulnerable to infection. By examining relative infectivity amongst young men and young women, and examine the extent to which such differences are associated with four behavioural factors. A random community survey to measure rates of HIV and STDs was conducted in 1998 amongst Carletonville residents aged 13-59 years. Within this sample 600 young people aged between 13 and 25 years were identified. Analysis of variance was conducted on the data. It was found that young women had greater HIV rates than their male peers. At age 20, 43% of females were infected compared to 9% of men. Differences in infection cannot be attributed to age at first sex as the mean ages at first sex were not significantly different. Among young women the risk of infection was found to increase by 25% per partner while for young men this figure was 8% per partner after the third partner. The number of partners reported by men and women differed slightly but were statistically significant. Women were found to have partners older than themselves, and thus have higher HIV rates than their partners. The reverse was true for men. This explains some of the differences in infection rates but is not a full explanation. While some of this difference may be explained by women's higher biological vulnerability to infection, the influence of sexual networks and violence require further exploration.

Makinen, M., Waters, H., and Rauch, M. (1999)

Conventional wisdom and empirical data on inequalities in morbidity, use of services and health expenditures

Partnerships for Health Reform, Abt and Associates, Maryland

The paper summarizes conclusions from eight country-specific studies of inequalities in the allocation of resources in the health sector. The case studies include South Africa and Zambia. The study concludes that conventional wisdom regarding resource allocation and health status may be misleading. For example, ‘there is no consistent pattern that richer households are more likely to use private providers’. They conclude that using conventional wisdom concerning inequalities in the health sector could result in misguided policy decisions.

Martins, J.H. (1996)

Global population growth and structural changes in the RSA population, 1951-2011

Bureau for Market Research, South Africa

The South African population is expected to grow at a rate of 1,7% per annum from 42.1 million in 1996 to 54.1 million in the year 2011. If AIDS deaths continue at the current rate, the population may be three quarters of a million less than the projected 54.1 million. Three concerns about rapid population growth in developing countries are: that rapid population growth reduces the rate of economic growth by reducing investments in human capital; rapid population growth itself has negative externalities for the environment, leading in some scenarios to degradation of natural resources at the local and national level; and rapid population growth has negative ‘pecuniary’ externalities, that is, it reduces the income of some groups (particularly the poor) in comparison with other groups, and therefore exacerbates the problems of poverty and income inequality in developing countries. The effect of the world’s population growth on poverty and the environment, as discussed in the report, should be a lesson to South Africa.

Matebeni, Z. (2000)

Has South Africa turned the corner? Reassessing the recent HIV prevalence rates

Joint Population Conference: The demographic impact of HIV/AIDS in South Africa and its provinces, Port Elizabeth

Matebeni shows that the unweighted ANC surveillance data presented by the Department of Health both overstates the prevalence of HIV and understates the decline in HIV rates for the period 1998 to 1999. Matebeni attributes this difference to departmental mis-weighting by race, province and age group.

Mboweni, G. S. (2000)

The demographic impact of HIV/AIDS on the Northern Province

Joint Population Conference: The demographic impact of HIV/AIDS in South Africa and its provinces, Port Elizabeth

Mboweni reviews the available statistics on HIV/AIDS prevalence in the province. The 1999 prevalence rate (based on ANC attendance) was 11% versus 22.8 % nationally in 1998. Mboweni attributes the ‘high’ prevalence to a number of factors including sexual mores, poverty, internal migration and ignorance.

McKenzie, A. (2000)

The possible impact of HIV/AIDS on fertility decline in South Africa

Joint Population Conference: The demographic impact of HIV/AIDS in South Africa and its provinces, Port Elizabeth

This paper argues that fertility is far more variable than previously believed. The challenge for demographers is to recognise this historical fluctuation. Given the current fertility decline of the last 30 years and the impact of the AIDS pandemic on fertility and CBR, it is likely that the decline will speed up. To some this is the natural process as spelled out in the DTT. But, CDR has increased and part of this fertility decline is not due to factors that played themselves out in the fertility decline in developed countries. Thus, to assume that fertility will continually decline (in line with the DTT) is only one of several scenarios. More likely, with depopulation, fertility (in the medium term) will rise to compensate.

Medical Research Council (1999)

1998/9 annual report: Health impact and transformation report, South Africa

Medical Research Council, 1999

Meidany, F., Horikoshi, Y., Lewis, D., Rhode, J., Kutu, M., Mayana, V., and Ntoto, A. (2000)

Relationship between HIV prevalence and population density: The Eastern Cape experience

Poverty and inequality: The challenges for public health in South Africa Conference, Epidemiological Society of Southern Africa (ESSA), East London

Meidany et al assume that the HIV rate observed at sentinel sites in the Eastern Cape approximates the rate for the magisterial district in which the site is located. They then correlate population density and HIV prevalence. They found that there is a statistically significant correlation between the two variables – as population density increases so does the HIV rate (at a given point in time) HIV rate = 0.09*log (population density) +0.018. The authors reproduce results from the antenatal survey in the Eastern Cape showing the prevalence of the disease by health region, age category and area type.

Nannan, N. (2000)

Estimating childhood mortality in South Africa

Poverty and inequality: The challenges for public health in South Africa Conference, Epidemiological Society of Southern Africa (ESSA), East London

The 1996 Census and the 1998 Demographic and Health Survey are used to definitively estimate levels of childhood mortality from 1983-1996. The national pattern which emerges from both sets of data show the same trend over time. The provinces reveal huge disparities in terms of the levels of infant and under-five mortality. The findings confirm that improvements over time have been achieved, but there is a distinct reversal of this trend around 1992, when these indices begin to increase. These differences and their determinants are explored.

Nannan, N. (2000)

An overview of the demographic impact of the HIV/AIDS epidemic in the Free State

Joint Population Conference: The demographic impact of HIV/AIDS in South Africa and its provinces, Port Elizabeth

A series of overheads, tables and graphs detailing the prevalence and anticipated impact of HIV/AIDS in the Free State at provincial level.

Nannan, N., Timaeus, I.M., Bradshaw, D., Dorrington, R. (2000)

The impact of HIV/AIDS on infant and child mortality in South Africa

Joint Population Conference: The demographic impact of HIV/AIDS in South Africa and its provinces, Port Elizabeth

A generalised HIV epidemic can have a major impact on the trend in all-cause infant and child mortality. This paper investigates recent trends in infant and under-five mortality in South Africa using two new sources of data – the 1996 Census and the 1998 Demographic and Health Survey. The paper concludes that child mortality in South