ASSESSMENT OF THE SOCIO-ECONOMIC CAUSES AND CONSEQUENCES OF HIV/ AIDS

Objectives, Outputs and Processes


Increasing numbers of countries have undertaken or are proposing to undertake studies of the socioeconomic issues relating to the HIV epidemic. In some cases these studies are planned as part of the preparations relating to Strategic Planning for HIV and AIDS, and in other cases are seen as one of the important outputs of the Plan. The main objectives of such Studies are as follows: -

Advocacy: to increase understanding of the multiple ways in which the HIV epidemic affects human development as an essential input in the mobilisation of government and civil society in the national response to HIV and AIDS.

Economic and Social Analysis of the HIV epidemic: to present data/ information and analysis relevant for the design and implementation of a broad based multisectoral response to the HIV epidemic.

Given these as the two main objectives of such Studies the key outputs that can be expected are: -

· an increased understanding of the threat that the epidemic has for the sustained development of the country, both as a mechanism for raising awareness and as a means of increasing commitment to broad-based action, and,

· a clear specification of the practical activities that are feasible in the country, and which are needed if the socioeconomic aspects of the epidemic are to be addressed in a timely and effective manner.

The precise focus of such Studies needs to reflect the policy and programme needs of the country taking into consideration both the objectives and outputs identified above. Thus if the important issue that requires analysis is the impact of the epidemic on households then this should become the focus of the Study, and resources will not be misused in more general analysis and in less useful ways.

The processes followed in undertaking a Study must ensure that potential users of the data and information are involved throughout so as to ensure that it reflects policy and programme priorities. Furthermore, processes need to ensure national ownership, involve all important stakeholders in the design and implementation of the Study, and strengthen national research and other policy, programme and institutional capacity.

Below, we set out precisely what this entails.


Stage 1. Situation Analysis

Studies must involve an analysis and description of the socioeconomic conditions in the country as an essential step in identifying those factors which affect the susceptibility of the population to the HIV epidemic. Consideration will need to be given to the following: -

· identification of those behavioural and other factors which affect HIV transmission and the capacity to cope with a range of socioeconomic impacts of the epidemic

· the presentation and analysis of socio-economic data and information which increases understanding of the situation in the country at national and other levels, and which have policy and programme relevance both for understanding the conditions in which the epidemic is thriving and as a base for a broader-based policy and programme response.

Thus poverty is often seen as a factor which leads to behaviours which expose socially and economically excluded groups to risk of HIV infection, and which then reduces the capacity of such households to cope with the effects of HIV/AIDS [which are social, economic and psycho-social in their nature]. Exploring these relationships is crucial for ensuring that HIV and AIDS are integrated in poverty programmes.

An important output of will be a better founded understanding of the socioeconomic vulnerability of the population and of the country1s institutions, through a deeper understanding of the structure of the society and the economy. Thus the situation analysis will, for example:

· identify and explore the ways in which conditions of poverty and social exclusion, gender relationships, employment [especially of young persons], labour migration etc. affect the transmission of HIV, and thus have direct relevance for policies for HIV prevention, care and the mitigation of the socioeconomic impact of the epidemic,

in order to:

· strengthen understanding of the socio-economic factors which underlie the epidemic and which determine household, sectoral and national capacity to respond to the epidemic, as a foundation for a broader-based and more effective inter-sectoral national response.

It is also important to undertake an analysis of the existing epidemiological data on HIV and AIDS, so as to establish: -

· from the data/information what are the trends in HIV in the population, its spatial distribution, and its distribution by gender and age,

· the important relationships between epidemiological information and other data relating to education, occupation, rural/urban and other charactersistics of the population should be presented and analysed.

· a discussion of the present sources of data on HIV and on AIDS; the reliability of existing data and its coverage, and identification of any deficiencies with data for establishing more effective policies and programmes within the country.

· analysis of data/information that is set in the context of the HIV situation in the region and sub-region so that the epidemic can be seen within an appropriate context for a regional/sub-regional response ? including identifying relevant socioeconomic factors [such as labour migration and other factors affecting the movement of people].

This review of HIV surveillance and other data should generate a better understanding of trends in the epidemic in the country; a clearer perception of the factors that seem to be important in HIV transmission [including those which are social, cultural and economic in nature]; analysis of those factors which affect coping capacity in affected populations at household and sectoral level; provide a firm base for recommendations in the Study for improvements of the HIV surveillance data and system, and identify behavioural and other socio-economic data important for policy and programme development.


Stage 2. Assessing Socioeconomic Conditions

Identifying Causes and Estimating Impacts


This section of the Study needs to build on the Situation Analysis and other data/information drawn from regional and global sources. It should NOT simply address issues of actual and expected socioeconomic impact but also analyse those conditions which determine vulnerability and susceptability in the different sectors under discussion.

It is also important that each of the following sub-sections lead to practical recommendations of value to those developing the national response to the epidemic.

The Study may focus its analysis and description in respect of each or all of the 3 levels depending on policy and programme priorities as noted above.


A. Households

These are the primary socioeconomic unit in all societies with critical functions of an economic, social and cultural nature. They are important as productive units, especially in respect of farming and food production but also in the formal and informal productive sectors. They have crucial social and reproductive functions in terms of children and their socialisation [economic support, transference of productive skills and social patterning]. At the early stages of the HIV epidemic the effects are usually first felt and are observable at household level ? although many factors may intervene to hide these effects due to the shame, stigma and discrimination often associated with HIV and AIDS.

Issues that need to be addressed include the following: -

· an assessment of the factors affecting the capacity of households to survive in the face of the HIV epidemic,

· this assessment will build on data and information available on conditions relating to the susceptibility of households and their capacity to cope with the epidemic [poverty, proportion of female headed households, employment/unemployment conditions, health /education status of household members, housing conditions, etc.],

· the Study should build on what is known about these matters from elsewhere in the region, and globally, but the focus should be on what is being experienced now by households in the country, including access to public services and support from Government, NGOs and others [such as Churches],

· it should detail what are the needs of households for more extensive socio-economic support, drawing attention particularly to the effects on children and what is being done to address their specific needs,

· this section of the Study should clearly identify the problems being faced currently by affected households, the gaps in current policy and programme response, and what is needed in terms of extended social and economic support,

· where gaps exist in terms of current information and data the Study should recommend how these issues should be addressed, and by whom, so that a firm basis for policy is established,

· it is important that the special needs of children and young adults be identified by the Study and recommendations made for dealing with these ? including issues of access to key services such as health and education, housing and nutrition, and employment,

· constraints as well as needs have to be identified including matters relating to institutional capacity in public and private institutions ? taking into account that existing institutional arrangements for care and support will often be unable to cope with the new and expanded challenges and will need to be extensively reformed.


Undertaking studies of the effects of HIV and AIDS on households is extremely sensitive and all activities need to ensure that the researched community is fully involved at all stages in the design and implementation of the Study and in respect of follow-up activities. All activities need to ensure the confidentiality of respondents, and be undertaken in accordance with generally accepted ethical standards for such research.


B. Sectors

The Study should identify the ways in which the epidemic affects the capacity to maintain efficient forms of production and service provision in key economic and social sectors in the country. It is essential that the Study understand the structural foundations of the economy and the fact that its efficient operation depends on the functioning of its separate parts. In other words that the economy consists on an inter-dependent set of activities and has to be analysed and described in ways that recognise that the epidemic has systemic effects due to the losses of human and institutional capacity. An example is the impact of losses of transport capacity and higher costs in the transport sector for the marketability of rural products both in local and external markets.

· it is not the case that all productive sectors are equally affected by the losses of human and institutional capacity brought about by HIV and AIDS,

· it is essential that the Study identify what is currently happening in key sectors in the country, and building on other information in the region and globally to establish a set of qualitative and quantitative projections as to what may happen, and what may need to be done to reduce the actual or potential socio-economic impact.

Amongst the key sectors that will need to be analysed are the following:-

Transport and Communications
Tourism
Commercial Agriculture
Small-holder Agriculture [and related rural institutions and services]
Key economic sectors, such as Mining and Manufacturing
Finance ? Banking, Insurance, Development Banking
Health services ? public and private
Education
Military and other uniformed services [police and prisons]
Other key public and private services such as general public administration, water and the judicial system

The Study should therefore -

· establish what are the reasons for selecting sectors to be identified in terms of their essentiality for the continued functioning of the economy, and in the light of the predicted effects due to HIV and AIDS,

· make it clear why these sectors are vulnerable to losses of human and institutional capacity due to HIV and AIDS,

· identify what the potential effects may be in terms of higher costs and disruption of output,

· identify policy and programme options for mitigating current and future socio-economic impact,

· clearly identify the possible implications for the economy of the continued provision of key public and private services as noted above, together with recommendations as to what needs to be done to protect these services.

Important in this analysis is the identification of the impact of HIV and AIDS on public budgets and on public polices and programmes [including the establishment of effective HIV in the Workplace Programmes and review of training and other policies for public servants ? including review of the Government1s personnel policy framework so as to make this more relevant].

In all cases the Study should make recommendations as to what actions are needed to reduce future HIV infection amongst workers and managers; what needs to be done to mitigate current and expected socio-economic impact, and where responsibility lies for the development and implementation of appropriate policies and programmes.


C. Macroeconomic

Within the limitations of the HIV surveillance and other data available in the country the Study should attempt to set out the main channels through which the economy in the aggregate may be affected by the HIV epidemic. In addition it:

· should review data from other countries in the region who have attempted to estimate the macro impacts, and review other information on global estimates of the macro-economic impact on developing countries

· should summarise the main findings of such studies and the policy implications if any for the country

· should also indicate what data needs to be collected for rapid estimation of the macro impacts, bearing in mind that estimates of macro-economic effects are more useful as tools for advocacy than for the development of effective and practical responses to the epidemic

· should clearly indicate the limitations of existing macro studies of economic impact, and demonstrate if possible how such studies may be used in moving towards a deeper understanding of the HIV epidemic in the country.

Where data and other resources permit estimates of the macro-economic impact then these estimates can be made. Bearing in mind -

· the fact that projections of HIV are extremely unreliable in most countries, such that estimates more than 2 years into the future may have very high errors,

· that human capital approaches to estimating macro-economic effects contain serious analytical and other estimation problems, and

· that econometric estimates of economic impact require data and information not usually available to researchers in developing countries, and depend on often unjustified simplification of conditions in both product and factor markets.

It is important before setting out to make these predictions to realise their limitations, and to understand their role in the development of practical responses to the epidemic in the country.


Summary of Recommendations and Follow-up Processes

There are 2 basic conditions that need to be established and met by any studies that are undertaken. The study outputs must include the following:-

· the identification of, and policy and programnme recommendations relating to, all important socioeconomic aspects of the epidemic; concentrating on those recommendations that are most relevant for the operationalisation of the National Strategic Plan by the National AIDS Programme and other stakeholders.

· the establishment to the extent feasible of a set of recommendations for follow up by Government and others so as to ensure that the Study does indeed lead to a broader based and multisectoral response to the HIV epidemic. It should indicate what are the next steps in the policy process, and where responsibility lies for implementing the Study's main policy recommendations.

The operationalisation of the recommendations and any consequent decisions at national and other levels will be the litmus test of the value-added by the Study, given that the purpose of such studies is to strengthen the national response to HIV and AIDS within policy and programme frameworks which are multisectoral.