SOCIO-ECONOMIC CAUSES AND CONSEQUENCES OF THE HIV EPIDEMIC IN

SOUTHERN AFRICA:

A CASE STUDY OF NAMIBIA part 3

Parts: 1 2 3

                Many more women than men are infected with HIV and many more young women than young

                men. In part, this reflects the inequalities that women continue to endure in Namibia - in all

                aspects of economic and social life. Their health status is worse than for men; and they have

                much lower labour force participation rates than men. As the NHIES concluded, "About 40% of

                Namibian private households are headed by females. The private consumption level in female

                headed households is about half the consumption level in male headed households." While there

                has undoubtedly been progress in girls access to education and in improvements in the legal

                position of women (at least on paper but less so in implementation) there is still a long distance

                to travel in Namibia. As the UNDP HDR for Namibia concluded in 1996, "In many

                communities...attitudes to women are at best outdated and at worst abominable, as evidenced

                by the high rate of rape and violent crimes against women." In a world of HIV and of AIDS the

                lives of women have to be changed or there can be no progress in addressing the fundamental

                factors which are driving the epidemic in Namibia.

                Agriculture continues to be the base for most of the country's population and there is a clear

                duality in this sector with high productivity and incomes for commercial farmers and low

                productivity and basic subsistence for the mass of traditional farmers. Since the traditional

                farming sector is where most of the poor are concentrated, it follows that efforts need to be

                intensified to raise productivity and incomes. This is crucial if rural to urban migration is to be

                slowed. Similarly, there is a need to re-examine industrial development strategies so as to

                minimise the mobility of labour within Namibia. It is well known that Tourism can be a factor in

                HIV transmission, and while no one would suggest that development not take place in this

                sector, there is nevertheless a need to ensure that structures and programmes are in place to

                minimise the possibilities of HIV transmission. In the aggregate all areas of development

                strategy should be assessed so as to address the ways in which planned developments have

                adverse effects on the growth of HIV in the population.

           Namibia is a fractured society. How could it be otherwise given its recent history of colonialism and war

           of independence? It is divided on ethnic grounds, on the basis of income and wealth, on social class,

           and on gender. But the HIV epidemic requires that society perceive the risks to its continuation and its

           prosperity posed by the epidemic. As such, the whole of civil society - not just Government and one or

           two large private employers - have to understand that all are threatened in one way or the other by the

           epidemic. The challenge for Namibia is how under conditions of social and economic differentiation to

           build a partnership of all Namibians. There are no blueprints for how to do this but an attempt must be

           made, nevertheless. The changes in social policy of recent years with a better distribution and higher

           levels of expenditure on health and education are a start. But the depth of the social deprivation and

           inequalities - especially those that are gender based - are what is driving HIV transmission in Namibia.

           Unless there is a more intensive attack on many aspects of the things that make up the lives of the

           poor, including access to employment and better social services, there will be little that can be

           achieved in reining back the HIV epidemic.

           Epidemiological Situation in Southern Africa

           As noted above sub-Saharan Africa has some 70% of the global total of 30 million people living with

           HIV, with Southern Africa the worst affected region on the continent. Adult HIV infection rates of

           20-25% are seen in countries with the highest prevalence, with urban rates in some cities double the

           average for the total adult population. In 1997 it was estimated that 2.4 million South Africans were

           living with HIV - an increase of more than a third compared with 1996. In Botswana the proportion of the

           adult population living with HIV has doubled over the past five years (to an estimated 25% in 1997). In

           Francistown the second largest city in Botswana the rate of HIV for pregnant women is now almost

           50% (1997). In Zimbabwe the adult rate of HIV infection in 1996 was 20% - one in five of all adults in the

           population. With 32% of pregnant women testing HIV positive in Harare in 1995, and a staggering 59%

           in Beit Bridge (1996). Throughout the region HIV prevalence continues to increase with rates in cities

           increasingly being mirrored by those in rural areas.

           The majority of new infections are in young people - those between the ages of 15 and 24 (sometimes

           younger). Thus in Zambia in one recent study over 12% of the 15-16 year olds seen at an ANC were

           HIV positive. In South Africa the % of pregnant 15-19 year olds infected with HIV rose to 13% in 1996

           from about half that level two years earlier. In Botswana the HIV rate for the same age group stood at

           28% in 1997. Infection rates in girls and young women are significantly higher than they are for boys

           and young men of the same age - thus in Malawi it is reported that HIV infection rates of young women

           are 5 to 6 times higher than for young men in the age range 15-20. The explanation of these differential

           rates of infection are complex, partly physiological and partly socio-economic. Whatever the causes

           the differentials both create gender biased socio-economic consequences, and at the same time call

           for programme responses which specifically address the problems of young men and young women.

           The epidemiological situation in Namibia reflects that common to other countries in the Region. Data on

           HIV for pregnant women attending ANCs suggest an average rate for the country as a whole of 15.4%

           in 1996 - this is a tripling of the level of HIV nationwide in the 4 years since 1992. HIV prevalence for

           women ranges from just over 3% to more than 24% in the different districts; is higher in urban than in

           rural areas (17.6% and 10.9% respectively), and reaches its peak in the age range 20-34. While AIDS

           deaths are widely under-reported it is still the case that it is now the leading cause of death for all age

           groups in Namibia. For AIDS to have become the leading cause of death by 1996 it follows that the

           present estimates of HIV prevalence must be serious under-estimates of the actual situation in the

           country. It is thus much more probable that HIV rates are closer to those in neighboring countries such

           as Botswana and Zimbabwe.

           Chart I is a summary representation of seroprevalence for pregnant women in Southern Africa C it is the

           best proxy available for measuring adult HIV infection. The visual picture is bleak: the realities of the

           lives of people even bleaker. The epidemic is without a doubt the greatest threat to sustained

           development facing the Region.

           Demographic Effects of HIV and AIDS

           No specific studies have been undertaken in Namibia into the demographic effects of HIV and AIDS and

           it is thus necessary to present data which relates to other high prevalence countries in sub-Saharan

           Africa. These have obvious relevance for Namibia given that HIV prevalence rates here are similar to

           other countries in the region and that demographic structures are also sufficiently similar as to make

           comparisons possible. The US Census Bureau has recently published its estimates of the

           demographic effects of HIV and AIDS on Africa and these are the most up to date and consistent

           estimates and projections currently available. In what follows the Census Bureau's estimates and

           projections are presented in the form of a commentary for the main aggregates under discussion,

           together with Charts to illustrate their projections which compare states with and without AIDS for the

           Southern Africa region. The following key outcomes are presented below:

                - crude death rates

                - infant mortality rates

                - child mortality rates

                - population growth rates

                - life expectancy

           1. The most immediate effect of the HIV epidemic is to increase the crude death rate for the

           populations affected. These will be higher where HIV prevalence is higher, which in sub-Saharan Africa

           is in the Eastern and Southern regions where the epidemic is most mature. Within these regions HIV is

           highest generally everywhere in urban settings and so also will be observable and predicted mortality.

           Chart 1 presents data on crude death rates for Southern Africa for the year 2010. Since crude death

           rates are generally lower in this region that elsewhere in sub-Saharan Africa so the increases will be

           relatively greater. By the year 2010 the crude death rate is projected to be 6 times higher in Zimbabwe,

           4 time higher in Botswana and 3 time greater in Zambia than it would have been in the absence of AIDS

           (Chart 2).

           2. Infant mortality rates are already rising sharply in countries with mature epidemics. Children borne to

           mothers who are HIV positive have a 30-60% chance of becoming positive themselves. In 1996 infant

           mortality rates in Zambia and Zimbabwe are estimated as being already 25% higher than they would

           have been in the absence of AIDS. In Southern Africa projections for 2010 are that deaths due to AIDS

           will more than double infant mortality rates in Botswana and Zimbabwe, and be more than 40% higher

           in Malawi (where rates are currently higher than elsewhere in the Region) and 60% higher in Zambia

           (Chart 3).

           3. It is estimated that two-thirds of AIDS-deaths will occur in children aged 1-4 years. These rates will

           increase since many children who are positive survive past their first birthday. Child mortality rates are

           already higher today than they would have been without AIDS in some high prevalence countries. Thus

           child mortality rates are estimated as being 75% higher in Botswana in 1996. By the year 2010 child

           mortality rates are expected to be twice as high in Botswana, 4 times greater in Zimbabwe and about

           twice as high in Zambia and Malawi (Chart 4).

           4. Projecting the overall effects on population growth is difficult in part because it depends on fertility

           decisions which are themselves partly the outcome of the effects of AIDS, and on decisions made in

           the knowledge of the effects of AIDS. Almost all past projections have supported the proposition that in

           spite of AIDS most countries will continue to experience positive population growth. Nevertheless the

           Census Bureau estimates suggest that 2 countries in sub-Saharan Africa will experience negative

           population growth by the year 2010 - in Botswana the rate is estimated to be minus 0.4 %(compared to

           a without AIDS rate of 1.9%), in Zimbabwe minus 0.5% (compared to 1.8%), and in Zambia 1.2%

           (compared to 3.1%), and in Malawi 0.1% (compared to 2.2%), see Chart 5.

           5. The most striking demographic effects are on life expectancy (Chart 6). Without AIDS all countries

           in the region would have been expected to have increased life expectancy as has been the case in

           recent decades more or less everywhere in sub-Saharan Africa. The effects of AIDS will be to increase

           mortality for children and young adults where mortality would otherwise have been low (and falling). The

           result is that AIDS will have the greatest impact on life expectancy, which other things being equal is

           one of the most important ways in which improvements in the standard of living are achieved and

           measured. It is indeed one of the three important elements in the UNDP HDI because of its value in

           summarising the benefits to individuals (societies) of sustainable human development.

           The estimates suggest that life expectancy has already been reduced from 64.1 years in Zimbabwe to

           41.9. But the situation in Zimbabwe is projected to deteriorate even further; without AIDS life

           expectancy in 2010 would have been an estimated 70 years but with AIDS it falls to less than 35 years.

           A disastrous decline and the worst projected for any country in sub-Saharan Africa. All of the countries

           in the Southern Africa Region are projected to suffer major declines in life expectancy caused by AIDS

           by the year 2010 -- for Botswana from 66.3 to 33.4; for Malawi from 56.8 to 29.5; for South Africa from

           67.9 to 47.8, and for Zambia from 60.1 to 30.3 years.

           Estimating the Impact of HIV and AIDS on Human Development

           It is now generally accepted that the HIV epidemic has multiple and complex effects on sustainable

           human development. These impacts have their origins in the effects of HIV and AIDS on the growth in

           the labour force and on the productivity of labour and capital. It also has effects on demographic factors

           in ways which have been identified above, with the probability that labour losses due to HIV and AIDS

           will erode the human resource base of the country. It is also the case that the HIV epidemic will distort

           the uses of national income and through changing its composition over time will reduce the growth rate

           of potential economic growth.

           This effect will come through two channels. Firstly, a diversion of savings into less productive uses

           (primarily into health and related expenditures by households and governments) so that fewer resources

           are available for investment which is the main instrument for achieving economic growth. With less

           productive investment there will be slower growth in GDP, and, very importantly less growth in

           employment. For countries which already have severe employment problems and with large projected

           numbers of youths entering the labour force in the coming years, such as Namibia, the loss of

           employment opportunities is indeed a major problem.

           The second main channel whereby economic growth may be reduced is through what might be

           described as "system failure". this could take many forms and have many causes. The most likely

           effect on the economic system's capacity to function will occur through the losses of human resources

           which are projected on account of HIV and AIDS. Both the economic and social systems depend on

           the expectation that individuals and institutions (both public and private) function more or less normally.

           Thus the expectation is that the legal system functions - that cases are prepared and heard in a timely

           fashion. But there is evidence that this can no longer be assumed to be the case for all sorts of

           reasons to do with the effects of HIV and AIDS (witnesses are sick and do not turn up, lawyers and

           court officials similarly). The examples could be multiplied but the point is fairly obvious that HIV and

           AIDS will have effects which reduce the capacity of systems to function and thus will reduce the overall

           efficiency of the country. These are effects which will compound over time, and are far from easy to

           address through policy and programme interventions. This is not to suggest that nothing can be done to

           reduce system losses in efficiency, because there are things that can be done, and indeed it should be

           part of the plans of both the private and public sectors to develop appropriate programme responses in

           advance of the problems becoming too severe.

           An interesting attempt to capture some of the effects of the HIV epidemic has been attempted by

           researchers from Columbia University. This is, as with most estimates, only a partial measurement of

           what is a dynamic process with many contributing elements. As we have seen above, the epidemic will

           have catastrophic effects on life expectancy in sub-Saharan Africa - including Namibia. Life expectancy

           is one of the three elements in the UNDP Human Development Index with an approximate weight in the

           index of one-third (for an explanation of the index and its construction for Namibia, see the Namibia

           Human Development Report, UNDP, 1996). As was also noted earlier, the life expectancy indicator can

           be seen as a summarising variable which measures standard of living achievements for the population

           as a whole. It follows that charting the effects of changes in life expectancy caused by HIV and AIDS is

           very important for aggregate measures of human development such as the HDI.

           The Box summarises the results of the estimations undertaken by the Columbia researchers of the

           effects of HIV and AIDS on the HDI for a number of countries. As can be seen from the Box the effects

           of HIV as measured by the HDI are very substantial. As was to be expected those countries with

           mature epidemics and high HIV prevalence rates are most affected. In the case of Zambia there is a

           loss of ten years of human development progress, for Tanzania a loss of 8 years, and for Malawi and

           Zimbabwe losses of 3-5 years. It should be noted that these losses relate to the years 1980-1992 when

           the HIV epidemic was exhibiting nothing like the severity it has imposed on countries of Southern Africa

           in recent years. Furthermore, the predicted reductions in life expectancy over the next decade or so (as

           projected above by the US Census Bureau) are far greater than those which occurred during the decade

           1980-1992. It follows that the losses of human development as measured by the Human Development

           Index will be much greater in the coming years than those estimated by the Columbia research team

           for the past decade of the 1980s.

                      The scale of the setback to human development from HIV/AIDS has

                      been confirmed by a recent UNDP study carried out by researchers at

                      Columbia University and the Harvard Institute for International

                      Development. This study concludes that between 1980 and 1992 a

                      sample of 56 countries from all regions of the world lost on average 1.3

                      years of human development progress. And in some countries the

                      setback was particularly severe -- for Zambia, more than ten years,

                      Tanzania eight years, Rwanda seven years and the Central African

                      Republic more than six years. Burundi, Kenya, Malawi, Uganda and

                      Zimbabwe lost between three and five years.

                      The method used compares the actual 1980 and 1992 human

                      development index (HDI) with the estimated 1992 HDI that would have

                      occurred in the absence of AIDS. The impact of HIV/AIDS on the HDI

                      operates mainly through the dramatic reduction of life expectancy. More

                      than 85% of HIV/AIDS deaths worldwide occur among people between

                      20 and 45 years old. The study found only a marginal impact on the

                      other components of the HDI. But because HDI is only a partial

                      measurement of human development, the impact of HIV/AIDS goes far

                      beyond what this study shows.

                      Source: Bloom, Bennet, Mahal and Noor 1996.

           The HDI for selected countries in Southern Africa has been re-estimated to take account of the effects

           of changes in Life Expectancy as calculated by the Census Bureau. These data are given in Chart 7

           which represents the HDI on a With AIDS and Without AIDS basis for 1996 and 2010. These

           calculations need to be treated with caution because of the underlying assumptions made about the

           data over the projected period. As would be expected given the weight of Life Expectancy in the HDI

           there are quite strong changes in the level of the index for individual countries in 1996 when all of the

           countries show a decline in their HDI value. It is difficult to interpret what these changes mean in any

           absolute sense (losses of human development due to AIDS), and it may be simpler to view the data for

           a single year in terms of the changes in relative ranking of these countries - a worsening of their HDI

           performance in all cases.

           It is possible to draw somewhat stronger conclusions from the projected movements of the HDI over the

           period 1996-2010, again bearing in mind the caveats noted above about the assumptions underlying the

           projections. One way to interpret the data is to look at individual countries and compare the Without

           AIDS case in 1996 and 2010, such as Botswana where over this period there would have been an

           increase of the HDI. This can be compared with the With AIDS case where over this period there is a

           decline in the HDI. In other words the improvement in human development that would have occurred in

           the absence of AIDS in Botswana does not materialise. Instead Botswana will witness an actual fall in

           its HDI over the projected period such that human development in 2010 is reduced below what it was in

           the Without and With AIDS cases in 1996. Confirming the expectation that potential human

           development is lost because of the AIDS epidemic. This experience is not confined to Botswana alone

           but is general to other countries in the region with high levels of HIV prevalance.

           It is similarly possible to construct a forward looking HDI for Namibia which takes account of HIV and

           AIDS. The results of doing this are reported below. It needs to be realised that the 2 Scenarios which

           are given are based on estimated data and have unknown errors. They are presented in order to get an

           idea of the effects on human development as measured by the HDI and are NOT projections. Two

           scenarios are developed:

                Scenario 1 is the better case and has used Life Expectancy data for South Africa (US Census

                Bureau Institute estimates) to derive the with and without AIDS information, and has applied a

                negative factor of 0.5% each year to the Income per Capita data. The Educational component of

                the Index is assumed to be unaffected by the epidemic.

                Scenario 2 is the worse case and has used Life Expectancy data for Botswana as a country

                with similar HIV prevalence and many other characteristics which are similar to Namibia. A

                factor of minus 1.0% per annum has been applied to the Income per Capita component of the

                Index on the grounds that the effects of the epidemic will be more severe in this Scenario than in

                1. The Educational Attainment Index has been assumed to be the same as in Scenario 1.

           Comments

           The behaviour of the HDI for Namibia for both scenarios is given in Chart 8. Scenario 1 is the less

           worse case of the two simulations for essentially two reasons. In the first case life expectancy is

           expected to fall by less in the With AIDS case and income per capita to also decline by less than in

           Scenario 2. These different assumptions with respect to life expectancy are what are largely driving the

           changes in the HDI in the two different Scenarios. In the case of Scenario 1, what the data suggests is

           that human development because of HIV and AIDS will more or less show no improvement over the

           decade, whereas if HIV had not been present in the population there would have been significant

           improvement. In effect, HIV and AIDS causes a loss equivalent to a 7% improvement in the HDI

           compared with 1996.

           Scenario 2 represents a significantly worse case. In part this is due to the much more severe

           worsening in life expectancy which is assumed in the With AIDS case (without AIDS this would have

           improved between 1996 and 2006). There is also an assumed greater impact of HIV on growth in GDP

           per capita compared with Scenario 1. Over the decade in the Without AIDS case there would have been

           significant improvement in the index of the order of 7% compared with 1996. In the With AIDS case

           there is an actual fall in the HDI in the order of 3% compared to 1996. In effect there is a net loss over

           the decade compared to 1996 in the With AIDS case of 10% of the level of the HDI in that year. Or to

           put it another way the HIV epidemic will cause a loss equal to about 5 years of the improvement in the

           HDI due to social and economic development that would otherwise have taken place.

           Both of these Scenarios paint a picture of losses of human development which are severe for a country

           such as Namibia where the HDI already places the country very low down in the UNDP rankings (116

           out of 174 in 1996). It represents for the mass of the population who live in abject poverty yet a further

           deterioration in their living standards. Because the HDI is dealing in aggregates it masks the scale of

           the worsening in human development that will be the outcome of HIV and AIDS in Namibia for most of

           the population. Most of the impact of the decline in life expectancy and of the slower growth in average

           per capita income caused by the epidemic will fall unequally on those who are already the most

           deprived, and least able to cope with the multiple impacts of the epidemic.

           Part 3 : ESTIMATING SECTORAL IMPACTS OF THE EPIDEMIC IN NAMIBIA

           1. Households

           The previous sections have identified the probable effects of the epidemic at the national and at the

           personal level. There can be no doubt that for individuals and their families there will be intense personal

           suffering as families attempt to deal with the personal, social and economic effects of illness and death.

           The expectation has to be that there will be both immediate effects on individuals and their families as

           they try to cope with losses of earnings and additional medical costs. But the effects at the personal

           level will also be longer term since households will attempt to deal with the immediate effects of illness

           through depletion of savings (if there are any) and disposing of other assets (such as land). This will

           mean that in the longer team the sustainability of households either as social units (families where

           children are supported and socialised) and/or as productive units (as in subsistence agriculture) will be

           threatened.

           The evidence from other countries in sub-Saharan Africa is mixed, both in terms of the impact on

           individual and family poverty and on the sustainability of households. What is clear, as in the Kagera

           Region of Tanzania, is that households are only able to survive the effects of HIV on family members

           through drawing down extensive assistance from NGOs and their relatives. It is best to use as a

           working assumption that families affected by the epidemic will need psycho-social support from their

           communities and from NGOs, and others, as well as economic support if they are to cope. This

           assistance will not usually be automatically forthcoming and communities and CBOs/NGOs, as well as

           Government, will have to support institutional and other development so as to cushion the impacts on

           families. Unless this is done there will be intense social and economic distress for those often least

           able to cope (the poorest) together with longer term problems of how to maintain families as social, and

           economic institutions.

           2. Productive Sectors

           a. Subsistence Agriculture

           Households have been treated separately from other productive sectors although it is obviously the

           case that they account for a significant part of the national output, both measured and none-measured.

           This is most obviously true in the case of subsistence agriculture from which some 50% of Namibians

           derive their support. Most of the poorest in the country are concentrated in this sector, where the

           capacity to withstand the effects of the epidemic on production is least developed. What is evident from

           other countries' experience is that adjustment to losses of productive labour through the illness and

           death of family members is possible but also difficult. Thus there is evidence that surviving children,

           who may have lost both parents to HIV-related illnesses, often have problems in retaining family land

           and other assets (such as housing and animals). There is a clear need to strengthen the rights of

           survivors - which will often include widows as well as children - if families are to continue to produce

           food and marketable outputs. These matters cannot and should not be left to individuals to cope with,

           and there is a clear and identifiable role here for the Ministry of Agriculture and for social sector

           ministries, as well as NGOs, if the sectoral effects of the epidemic on this very large number of

           Namibians is to be minimised. Government, and others, have to begin now to plan for the

           consequences so as to develop the structures and the programmes for what is going to become the

           largest single problem flowing from the epidemic. While this sector may account for only some 3% of

           GDP it is, nevertheless, the primary support for half of the population.

           b. Commercial Agriculture

           About 4000 farmers employing some 36000 workers account for some 9% of GDP. This sector is thus

           an important contributor to national output and a major source of employment. It follows that what will

           happen to HIV infection in this sector is of great importance. But the sector (unlike mining) is

           characterised by many independent producers (farmers) which will make it difficult to create a common

           interest in responding to HIV and AIDS. The same factor of physical isolation as well as productive

           independence makes it difficult for the workers to respond (even if other conditions made this possible -

           such as labour unionisation). But this important sector, like all other sectors in Namibia, will be

           significantly affected by illness and death of workers - both skilled, supervisory, and unskilled.

           The evidence from other countries in sub-Saharan Africa is that the effects of the HIV epidemic are

           already being felt on commercial farmers, e.g., in Kenya and Zimbabwe. These effects cannot now be

           avoided for HIV infection is already high in the adult population throughout Namibia. The epidemic will

           impose significant costs for producers in terms of lower labour productivity and higher costs generally -

           some of these will be direct and some indirect (as the epidemic effects the suppliers of other services

           such as mechanical repair and transport) and as the epidemic effects the general performance of the

           economic system. While some of the costs are now unavoidable there are things that the sector can

           do as a sector through appropriate organisation. In part, the objectives should be to minimise the

           effects of HIV and AIDS through planning for the consequences of existing infection in the work force,

           and also to undertake those activities which can reduce future HIV infection. It has to be assumed, for

           example, that many skilled and supervisory workers will be infected and that these workers will not be

           at all easy to replace, even if this is possible in the case of unskilled workers.

           Whatever the actual situation facing individual farmers, there is a joint interest as a group in doing

           whatever can be done to minimise the effects on the commercial farming sector. An obvious first step

           would be to communicate with commercial farmers in Zimbabwe in order to observe and learn from their

           activities. There is also an obligation on this sector to help their workers and their families cope with the

           consequences of illness and death. These are obligations which should not be just shrugged-off by

           farmers, nor should Government permit this to happen. More generally the farming community has a

           social responsibility to take a leadership position in the national response to the epidemic and for this

           to be possible their organisations need to both formulate a strategy for action and become active.

           c. Mining

           This sector accounts for about 12% of GDP and for some 3.5% of employment. As such it is not only a

           major contributor to national output but it also accounts for no less that 50% of total merchandise

           exports. It has, therefore, a critical role in the economy - a role which is currently irreplaceable both in

           terms of foreign exchange earnings but also as a source of financial revenue for the financing of

           Government. As with other sectors it will have to deal with HIV infection amongst its labour - at both

           managerial, skilled and unskilled levels. Since it is a "modern" sector it will incur all the usual direct

           costs associated with the epidemic - absenteeism, health costs for employees and sometimes for

           dependents, retraining costs and additional recruitment costs, etc. But since labour costs account for

           such a small proportion of total costs, it is unlikely that these additional costs will have dramatic effects

           on what are profitable activities. But effects the epidemic will have - in addition to the direct costs listed

           above - largely through the effects of managerial and supervisory labour losses. These losses of human

           capacity will not be easy to replace even if it is the case that more unskilled labour losses can be

           absorbed more easily through new recruitment.

           Again there are possibilities of learning about what to do to prevent new infections in the labour force

           and how to minimise the costs for the enterprises in this industry. There is a clear gap between firms

           such as Namdeb which have instituted prevention activities and that of other firms in the industry. This

           gap needs to be closed as also are industry practices which recruit single sex (male) labour. This

           pattern of recruitment has been a major element in HIV transmission in Southern Africa and needs to

           be ended as a matter of urgency. This splitting of families through single sex recruitment has not only

           led to male HIV infection but has been part of the process whereby HIV is passed to wives and

           spouses in the rural areas. It is thus part of the mechanism for increasing rural HIV infection rates.

           Government should act to prohibit such practices if the industry is unable or unwilling to do so in its

           own interest. It would be useful for the industry and the National AIDS programme to look at what has

           been accomplished in Botswana (by DEBSWANA) and to see what can be done for the labour force in

           terms of recruitment practices and in health/welfare provision for the families of workers.

           d. Financial Sector

           This sector performs essential services which are integral to the smooth operation of the economy. It

           accounts for only a small proportion of GDP and for only small numbers of workers. But these

           indicators in no way measure the central importance that banks, other financial intermediaries such as

           insurance, brokers, etc., play in economic life. It is instructive that some of the larger enterprises

           operating in Namibia have instituted HIV prevention programmes and again it is essential that all of the

           major institutions establish similar activities for their staff.

           It is also important that Government concern itself with some of the business activities of these firms.

           Elsewhere in Africa (and in other parts of the world) these financial enterprises have introduced policies

           which, while they serve the interests of their shareholders, are definitely NOT in the interest of clients -

           nor of society as a whole. There is a clear conflict here between private business interests and those of

           society. For reasons, which are perfectly plausible for the companies, they have introduced restrictions

           of life insurance cover (often denying benefits to those who die from AIDS), restrictions on health cover,

           and restrictions on access to mortgage finance for housing. The industry should not be allowed such

           freedom in respect of activities which are so central to the lives of many Namibians. They make it

           possible for the industry to impose conditions in respect of financial contracts which are inimical to an

           effective national response to the epidemic. As such, it is essential that Government look at existing

           practices by FI in conjunction with industry representatives; look at the changing patterns of industry

           regulation in other countries who have had to face similar practices, and then establish new regulatory

           structures and controls. This should be done preferably through agreement, but if this proves

           impossible, then through the use of the law.

           e. Fishing

           The fishing industry is a growing sector of the economy. At independence, this sector produced 1.5%

           of GDP; by 1996 it had increased its share to 4%. The sector provides a large amount of employment,

           and is expected to surpass the mining sector in the number of jobs provided by the year 2000.

           The boom in the fishing industry has been one of the major factors in the migration of job seekers to

           Walvis Bay and Luderitz, the two principal sites of the fishing industry. The HIV epidemic can affect this

           development in a number of ways. Firstly, the industry acts as a focal point for the transmission of HIV

           by drawing job seekers and workers from various parts of the country. When infected with HIV workers

           spread infection to their home areas during their frequent visits. Secondly, as has been the case in the

           mining sector throughout Southern Africa, schemes for housing workers contribute to conditions in

           which infection can spread rapidly. Many workers live in either large dormitory compounds or in

           severely-cramped single quarters, where a room built for one person now accommodates twenty or

           more. Coupled with their isolation from families and communities, conditions in these areas increase

           the possibilities for the spread of HIV and other STDs among workers. Finally, the fishing industry

           requires large numbers of trained workers both on fishing boats and in processing. As HIV/AIDS leads

           to losses of human resources, the industry will be forced to spend more on training, pensions and

           medical aid and other costs.

           f. Government

           The Government accounts for about 30% of GDP and for about the same proportion of formal sector

           employment in Namibia. As such, it is by far the largest sector in the economy, and it is also a major

           user of highly trained and professional/managerial workers. Government in all economies provides

           services which are essential to the smooth running of the rest of the society and economy. It is

           inconceivable that Namibia could achieve its development objectives without an effective and efficient

           public sector. Whether one is looking at public administration pure and simple, or public services (such

           as legal and judicial) or economic services (such as communications and water). These are all

           essential services and the extent that they are there and provided efficiently has implications for the

           functioning of the whole system.

           But Government is also the largest source of employment in Namibia with obligations to its employees

           and to their families. Not only does Government have an obligation to ensure that it provides the

           services needed by other sectors, it also has an obligation to secure the health of its employees and

           their families. As was noted elsewhere in this Paper, HIV is no respector of class or position and, if

           anything, there are higher rates of infection in higher occupational groups - almost certainly including

           employees in the public sector. In other countries in the region there are already major problems in

           maintaining human resource capacity in the public sector, with high levels of absenteeism and labour

           turnover at all levels of the public services and in public sector industries. The effects are evident in the

           costs that fall on the public sector and on the deterioration in public services associated with morbidity

           and mortality.

           These are not easy matters to rectify but as with everything else it is possible to minimise the

           consequences of the impacts on public services through appropriate planning for what is going to

           happen as a result of existing HIV infection amongst employees. This means establishing

           interdepartmental committees assisted by expertise from outside to monitor what is happening (on

           sickness and absenteeism) and to begin to plan for some of the effects on public services - both at

           central and local levels. It is also necessary to establish for the public service appropriate conditions for

           those infected with HIV to ensure that there is no discrimination at the place of work, and that

           appropriate policies are introduced to maintain people in employment for as long as possible through

           access to health care and social support. Workers can, with appropriate support systems and access

           to health care, remain productive for many years, and it is efficient that they be enabled to do so. It is

           also morally right that they be supported so as to be able to continue to work for as long as possible for

           personal reasons - including supporting their families. At the present time there are very few Ministries

           which have introduced HIV in the Workplace programmes and this is something that they should be

           supported to do, drawing on the considerable experience that now exists in the region about how to

           introduce and manage such programmes.

           This is by no means a complete analysis of the conditions facing the different sectors in Namibia but it

           provides a starting point for planning for the changes required because of the epidemic. Changes in

           policies and in programmes there will have to be. The responsibility lies with Government, but little will

           be accomplished unless there is a partnership between the various concerned parties. There is much

           expertise in Africa now which can be exploited, and there is no need to begin these activities as if there

           was no existing stock of knowledge and capacity in existence.

           CONCLUSIONS

           It is now generally recognised that the HIV epidemic is not only a threat to the nation's health, which it

           is, but also has fundamental consequences for sustainable development. The transmission of HIV is

           not random in the population, who gets infected with the virus and what is the spatial distribution of

           infection is determined by factors which reflect structural social, cultural and economic forces in a

           country. Namibia is no exception to the pattern which is being repeated throughout sub-Saharan Africa.

           Elsewhere in Africa, particularly in the East, Central and Southern regions, the epidemic has cut a

           swathe through the population, causing intense personal suffering for those infected and affected. But

           the effects of the epidemic extend beyond the personal, terrible as these are, and communities and

           nations also have to live and cope with the damaging consequences of the losses of their most able

           and productive members. None of this is inevitable, although countries including Namibia have no

           choice but to try and ameliorate the consequences for the society and economy of past HIV infection.

           Those infected will have to be cared for through public and private provision for them and their families.

           There will inevitably be social costs, including an intensification of the already extensive poverty in

           Namibia, just as there will be economic costs as productive sectors try to grapple with the losses of

           productive labour. But these consequences, while inevitable, can be managed and can be minimised

           through policy and programme responses.

           There are two challenges facing the nation -- not just Government.

           The first is to address through policies and programmes the fundamental factors -- some health related

           and others social (such as gender inequality) and others economic (such as poverty and income and

           asset inequality) -- which have created ideal conditions within which HIV can be transmitted.

           Government has already embarked on actions which begin to address many of these issues but there

           remains much that needs to be done.

           The second is to seek to create a national awareness of the risk that HIV and AIDS poses for the

           nation. This means seeing the epidemic as an ongoing threat to development and as such a factor

           which will constrain all of the futures open to Namibia. It requires no less than a social mobilisation;

           everyone from the poorest Namibian to the richest has a stake in overcoming this threat to human

           development.

           BIOGRAPHICAL NOTE

           Desmond Cohen is an economist with university teaching experience in Africa, Canada, the UK and the

           USA. Formerly he was a Governor and Associate Fellow at the Institute of Development Studies,

           University of Sussex in the United Kingdom and until 1990, he was Dean of the School of Social

           Sciences. He has both research and applied macro-economic policy experience in a number of African

           and Asian countries. Previously he was an adviser to the British Treasury on international financial

           policy. In 1997-98 he was Director of the HIV and Development Programme (UNDP), and currently he is

           Senior Adviser on HIV and Development.

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