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enora@worldbank.org WASHINGTON, DC, February 27, 2009 ─ HIV and AIDS can pose a serious economic and social development risk to countries in South Asia unless prevention programs, targeting vulnerable groups at high risk of infection, are scaled up, says a World Bank report released today. The report, titled “HIV and AIDS in South Asia: An Economic Development Risk,” argues that, even if the overall prevalence rate is low (up to 0.5 percent), there is high and rising HIV prevalence among vulnerable groups at high risk for HIV infection, including sex workers and their clients, and injecting drug users and their partners. Without increasing prevention interventions among those at highest risk, these concentrated epidemics can further escalate. Overall, the number of people living with HIV and AIDS in South Asia is about 2.6 million, of whom the lion’s share is in India. AIDS accounts for 1.5 percent of all deaths in South Asia and about 2 percent of all deaths in India. These numbers of deaths are comparable to the numbers from diabetes, tuberculosis, and measles. The report finds the impacts of HIV and AIDS in South Asia on the aggregate level of economic activity to be small. For India, the effect on GDP (0.16 percent) corresponds to a one-off loss of about 1.5 weeks of GDP growth. However, the direct welfare costs of increased mortality and lower life expectancy are more substantial, accounting for 3 percent to 4 percent of GDP in India and Nepal, respectively “Even in the low HIV prevalence countries of South Asia, there cannot be any room for complacency,” said Mariam Claeson, World Bank HIV and AIDS Coordinator for South Asia. “While the impact of HIV and AIDS on economic growth is small in South Asia, the welfare cost on households is by no means negligible. HIV and AIDS also have an enormous disproportionate impact on vulnerable and often marginalized people at highest risk of infection, and on poor households with less access to information, preventive services and treatment.” The economic impact on individual households affected by the disease is substantial, the report says. In a household study on India, 36 percent of people living with HIV and AIDS who were able to retain their employment nevertheless reported an income loss, which averaged about 9 percent. Among those who lost their employment (about 9 percent), the income loss was severe, at about 66 percent. Many of the adverse development impacts of HIV and AIDS arise from its uneven impact on different population groups. Access to prevention and treatment, for example, is strongly linked to socioeconomic factors such as gender, education, and wealth. And, people’s ability to cope with the financial effects of HIV and AIDS differs strongly. For example, the report finds that HIV and AIDS have a disproportionate economic impact on HIV-positive widows who face the double burden of living with HIV and AIDS and the low socioeconomic status of women. “This analysis shows that failure to contain the epidemic at low levels may have serious economic consequences,” said Sadiq Ahmed, World Bank's Acting Chief Economist for the South Asia Region. Access to antiretroviral treatment (ART) is low in South Asian countries, even compared to countries in other regions with much higher infections rates. The report says the fiscal cost of treatment could be very high if South Asian countries fail to contain the epidemic. Access to effective treatment is vitally important to mitigate the health and economic impacts of HIV and AIDS, the report says. At the same time, the medical costs of treatment can put a substantial proportion of the population living with HIV and AIDS at risk of poverty, especially in a region where most health services are paid for out of pocket. This underscores the crucial role of effective prevention. With the exception of Sri Lanka, three-quarters or more of health expenditures in South Asia are financed privately and little are covered by third-party payers like insurance agencies. With the limited ability of many households to pay catastrophic health expenses associated with HIV and AIDS, and the negative externalities associated with poor adherence, the report argues for a large and critical role for the public sector in the provision of ART. # # # To read the report, visit http://go.worldbank.org/YHRC95J2J0 For more about the World Bank’s work in HIV and AIDS in South Asia, visit
http://www.worldbank.org/saraids |
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