IN the decade since governments and private agencies began thinking about ways to deal with AIDS, the focus has been on the health of individuals. Over the next decade, steps will include the economic health of families and societies, which has been undermined by the continuing spread of the pandemic.
``The economic implications of AIDS have been underappreciated, but now it's accepted that AIDS is having effects beyond the health sector,'' says Paurvi Bhatt, a senior program officer at CARE, the international relief agency. ``That's forcing development agencies to go beyond prevention to deal with the economic disruption AIDS is causing to families.''
``AIDS is taking such a high toll that we no longer define success [in development] as an increase in harvests but rather how well we keep people's living conditions from deteriorating,'' adds Marshall Burke, director of CARE's agriculture and natural resources program.
In a report issued this week, the World Bank says AIDS can have a direct effect on economic development by plunging self-sufficient families into destitution. In developing nations, where 80 percent of AIDS cases occur, the cost of treating the disease is on average 150 percent of an AIDS patient's annual income. Worldwide, more than 17 million people now have the HIV virus, according to the Bank. By the end of the decade, the Bank says, 2 million people will succumb to the disease each year, mostly in Asia and sub-Saharan Africa.
A report to be published next year by CARE says AIDS retards economic development in other, sometimes less direct ways. For one thing, it takes its highest toll on the most productive members of society. In countries that rely on labor-intensive agriculture, that means less food.
Food shortages can be aggravated if survivors of AIDS victims are forced to sell family land or other assets, if the amount of land under cultivation has to be reduced, or if cash crops have to be replaced by subsistence crops requiring less labor but providing less nutrition.
AIDS also undercuts the productivity of women, who now head up to 40 percent of households in some African countries and whose potential economic contribution is increasingly recognized as essential to retrieving developing nations from poverty. Faced with caring for AIDS patients, women spend less time in the field and in gathering water and firewood. These jobs are then often delegated to children, frequently kept out of school for the tasks.
Experts say economic development is achieved most efficiently within the traditional family structure. At a minimum, the AIDS pandemic has made families less self-sufficient. At worst, it has decimated traditional families altogether.
Anecdotal evidence suggests that public education programs have had some success in moderating sexual behavior. But development agencies are looking at new ways to supplement prevention measures with programs to help the families of AIDS victims.
Among the options: promoting low-labor intensive cropping techniques or micro-enterprises that can be run from the home. In the 10 worst-affected African countries, the Bank calculates, AIDS slows the growth of annual per capita income by 0.06 percent. With such incomes averaging less than $400, the loss is significant. ``A little over half of 1 percent can have a major impact and seriously constrain the ability to develop,'' says David de Ferranti, director of the Bank's population, health and nutrition department. ``You can see the possibility of democracy crumbling away,'' he says. The spread of AIDS, meanwhile, has made disproportionate claims on cash-starved health care systems in poor nations.
The political effect of AIDS is dramatically illustrated in Malawi. The African nation recently threw off a restrictive regime and launched a democracy. But nascent democratic reforms are now threatened by the simultaneous afflictions of AIDS and a prolonged drought.