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HIV/AIDS and Socio-Economy
By
Thiyam Bharat
There is no doubt about the significant impact HIV/AIDS has had on the economies of nations. The economic repercussions of the HIV epidemic at macro level are already being felt in the public and private sectors of the sub-Saharan countries. The epidemic has cost millions and millions of dollars to individuals and their families, to business and to the State. The cause and consequences of the epidemic are closely associated with other challenges to development including poverty, unemployment, civil unrest, indebtedness and rural-urban movements. For example, HIV related illness and death creates new poverty, deepens existing poverty and increases family and national indebtedness. The HIV/AIDS epidemic in developing countries has drawn the attention of epidemiologists, demographers and health economists. The pandemic poses a big challenge that goes beyond the sphere of public health and the emerging perplexity of the epidemic has made it a subject matter that touches all aspects of human life.
The epidemic of HIV/AIDS is assuming significant proportion in the State. The distinct feature of HIV/AIDS epidemic in the State is that more than 70 per cent of the HIV positives are through sharing of needles and syringes among IDUs while in other State more than 70 per cent are through sexual transmission. Manipur has about 0.2 per cent of India's population but contributes about 8 per cent of all HIV cases reported in India. The first HIV positive case in the State was repotted in February 1990 from blood samples collected in October 1989 among a group Injecting Drug Users (IDUs) who were in central Jail. Age, gender and geographic setting are also important variables in the incidence of HIV and AIDS in the State.
The article here made an attempt to assess the impact of HIV/AIDS on the socio-economic development of Manipur against the background of a simple economic theoretical analysis. It does not mean that the theoretical analysis will be practicable to the State of Manipur. Nevertheless, given the growing number of HIV/AIDS infected people, the theory may be partially pertinent to the State within the next few decades. The effect of HIV/AIDS is generally associated with rising morbidity and rising mortality rates for particular age groups. The rise in morbidity will have two important effects, viz.., labor productivity and the positive health care expenditure. The negative labor productivity effect will arise because sick or worried workers are less productive than happy, healthy workers. Even the productivity of those who do not have AIDS may be negatively altered as infection rates and illness among friends, families and co-workers rise. The positive health care expenditure effect refers to increased expenditures by household and the health care system to assist AIDS patients and their families in managing with deteriorating health.
As costs of health care increase due to AIDS, there will be a negative domestic saving effect barring the case where the increase in medical spending is paid for by reducing other current expenditures. The fall in domestic saving will indicate a fall in capital formation, which in turn will lead to a potentially large adverse effect on per capita income over the long term. In addition to the direct dissaving by households that experience greater income variability in the presence of AIDS. Higher medical expenditures will reduced not only saving but also other current expenditures. Funeral costs can be very large in traditional societies, where workers must stop working and travel great distances to pay their last respects. Families with the AIDS illness may attempt to increase saving in anticipation of having to pay large funeral expenses in the not-to-distant future. And anecdotal evidence suggests that reduced spending on education may be an important consequence of increasing health care expenditures. The demand for education may also be reduced as children are forced to leave school earlier to support ill parents. The potential for adverse growth effects from AIDS will be heightened to the extent that investment in human capital is reduced.
It is quite immature to assess the impact of the rising prevalence of HIV/AIDS on the socio-economy of the State at the moment. Nevertheless, the problems associated with the increasing number of HIV/AIDS cases in the State cannot be ignored in the near future. Since most of the infected with HIV/AIDS are younger people. It would be relevant here to define the working age of population. The working age of population for each country is generally calculated as the total population minus ages 0-14 and ages 65 and over (International Labor Organization, ILO). The labor force is calculated as the sum of the economically active population for each age group between 15 and 64. Economically active person also includes all persons who contribute to the supply of labor for the production of goods and services, i.e., all persons in employment (employees, own-account workers, salaried employees, wage earners, unpaid family workers, members of the armed forces), as well as all the unemployed both those worth previous job experience and those seeking work for the first time. (Growth and Poverty in Rural India, Martin Ravallion & Gaurav Datt. WRD, 1995).
The proportion of population in the working age group (in case of Manipur,15-59) increased from 58 per cent in 1911 to about 55 per cent in 1981 in Manipur and then it further rose to 58 per cent in 1991 (Economic Survey, Manipur,1999-2000). However, the proportion of population marginally fell to 57 per cent in 1992-93 (Sample Registration, Fertility & Mortality Indicators, 1994). High infection rate with HIV among the economically active persons in the State is a real cause of concern. For example, the proportion of HIV positive cases is found to be highest in the age group between 21-30 years. While the age group between 21-30 years contributed 57.14 per cent of the total positives, the age group between 31-40 years contributed about 25 per cent.
There is a possibility that AIDS epidemic, if growing at geometric progression, may reduce the overall size of the population and will shift its composition toward the young. The labor force, in turn, will be composed of younger, less-experienced workers. The shift in age structure can be expected to have important effects on both aggregate supply and aggregate demand. On the supply side, the size of the participation rate of the labor force will be reduced. The smaller working-age population will directly reduce potential output. The loss in output will be aggravated by a fall in labor force productivity as the average age and experience of the labor force declines.
On the demand side, the shift in the size and composition of the population will affect the level and the composition of public expenditures, as well as the economy's overall saving rates. For example, the smaller absolute number of younger people will place lower demands on the educational system. In per capita terms, by contrast, educational expenditures may rise because of the increased proportion of the young in the total population. The resulting effect on the government budget will be exacerbated because more and more of the young will be orphans as the AIDS epidemic worsens, implying higher government costs if not total costs of raising children.
Prevalence of HIV varies noticeably from district to districts in the State. For example, Imphal West and Imphal East accounted for 68.83 per cent while Thoubal, Bishnupur, Churchandpur, Ukhrul, Senapati and Chandel recorded 9.06 per cent, 4.91 per cent, 6.02 per cent, 3.60 per cent, 3.65 per cent and 3.66 per cent respectively. Tamenglong district registered 0.26 per cent which is said to be the lowest in the State. The low level of percentage in Tamenglong has been attributed to low level of HIV testing. UNAIDS/NACO has estimated the number of HIV infection in Manipur to be around 38,000 out of 3.5 million HIV infections in India (December, 1998). Sero-surveillance data from the Epidemiological Analysis of HIV/AIDS in Manipur during the period September, 1986 to May 2002, indicate that as of May 2002, a total of 13,448 HIV positive cases (1831 females) and 1236 AIDS cases (217 deaths as per officially recorded) had been reported out of 85,298 blood sample screened. This provides for a sero-positivity rate of 15.66 per 1000 blood samples screened against all India figure of 26.88 (June, 2000, NACO). The HIV sero-prevalence rate in Manipur among pregnant women increased from 0.8 per cent in 1994 in 1994 to 2.04 per cent in 2001 (August -November) while sero-prevalance rate among IDUs fell from 76 per cent in 1997 to 56.27 per cent in 2001. The sero-prevalance rate among commercial Sex Workers (CMSs) is around 22 per cent in the year 2000. It has also been reported that there are 1063 (CMSS) who carry the dreaded disease.
In Manipur, the transmission of HIV through IDUs has been declined while transmission through sexual route has risen overtime. It shows that the predominant modes of transmission have transformed in the State. Since more and more sex partners of IDUs are infected, there is a new wave of pandemic appeared among women in the State. It has been reported that more than 80 per cent of women acquired HIV infections from their husbands out of the total HIV positive in Manipur. Most of the people infected by the disease in the State belong to younger age and working age group. Therefore, it is true to say that there is a great possibility of multiplier effects of the disease which can penetrate to the general population of the State in the near future. This will make a significant dent on the growth rate of Net State Domestic Product (NSDP) of Manipur within the next few decades. Per Capita income 9PCI) levels are also expected to fall in future.
Therefore, it may be suggested here that a decisive policy action is the need of the hour at this stage to minimize the negative effects of the AIDS epidemic on the socio-economy of Manipur. This needs a multi-sectoral and multi-disciplinary response, with collaboration between partners, Governments and non-Government research institutes, international agencies, community based groups and most importantly, the people directly affected.
(The author is
based in Imphal, Manipur)
(Courtesy: The Sangai Express)
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