Suchergebnisse

The number of people on highly active antiretroviral therapy (HAART) in South Africa has risen from ,2000 in October 2003, to almost 200,000 by the end of 2005. Yet South Africa's performance in terms of HAART coverage is poor both in comparison with other countries and the targets set by the government's own Operational Plan. The public-sector HAART ''rollout'' has been uneven across South Africa's nine provinces and the role of external assistance from NGOs and funding agencies such as the Global Fund and PEPFAR has been substantial. The National Treasury seems to have allocated sufficient funding to the Department of Health for a larger HAART rollout, but the Health Minister has not mobilized it accordingly. Failure to invest sufficiently in human resources— especially nurses—is likely to constrain the growth of HAART coverage.

Despite the recent international effort to expand access to highly active antiretroviral therapy (HAART) in developing countries, its coverage still varies significantly from country to country and is strongly correlated with per capita income. However, regional and political variables are also important. Cross-country regressions indicate that, controlling for political and economic characteristics and the scale of the HIV epidemic, Latin American and African countries have better coverage than predicted. Whereas the level of HIV prevalence was a significantly (negative) factor when accounting for HAART coverage in June 2004, this effect had disappeared by December 2004. The improvement appears to have benefited democratic countries in particular.

The number of disability grant recipients in South Africa is rising sharply, largely because of the AIDS pandemic. Now that the government is 'rolling out' antiretroviral treatment, many people living with AIDS stand to lose their grants as a result of restored health. Given South Africa's high unemployment rates and lack of adequate welfare provision for the unemployed, those who do not find work will suffer a significant decline in income. They thus face a stark choice: to go on antiretroviral treatment and lose their disability grant, or avoid treatment and keep the grant for the rest of their (shorter) lives. Some may opt to start treatment, and then when the disability grant expires, discontinue their medication in order to become eligible once more for the disability grant. Such behaviour will foster drug resistance, thereby undermining the antiretroviral treatment rollout and exacerbating the AIDS pandemic. This is a direct consequence of a welfare system that does not provide support for the unemployed and that places poor people in a situation of having to choose between health and income. Replacing the disability grant with a basic income grant would help address the problem.

Addressing Aids and unemployment is one of the greatest challenges facing South Africa at present. Health and welfare interventions will be costly and are likely to meet with resistance from taxpayers. Expanding employment (which will help alleviate poverty and expand the pool of taxpayers) is thus necessary. An inclusive social accord could help, but only if organised labour is prepared to make concessions, as was the case in the new social accords in Australia, Ireland and the Netherlands. (Dev South Afr/DÜI)

Relatively few people have access to antiretroviral treatment in South Africa. The government justifies this on grounds of affordability.Nicoli Nattrass argues that the government's view insulates AIDS policy from social discussion and efforts to fund large-scale intervention. Nattrass addresses South Africa's contentious AIDS policy from both an economic and ethical perspective, presenting: • a history of AIDS policy in South Africa • an expert analysis of the macroeconomic impact of AIDS • a delineation of the relationship between AIDS and poverty and the challenges it poses for development, inequality and social solidarity • an investigation into how a programme preventing mother-to-child transmission would be less expensive than having to treat children with AIDS-related illnesses • an exploration of the relationship between AIDS treatment and risky sexual behaviour • an economic and social case for expanded AIDS prevention and treatment intervention. This relevant and accessible work is a valuable resource for readers with an interest in AIDS policy and the social and economic implications of the pandemic.

According to South Africa's leading demographic model, the provision of highly active antiretroviral therapy (HAART) for people living with AIDS will have positive spin-offs in terms of limiting the spread of HIV/AIDS. The ASSA2000 Interventions Model (an offshoot of the ASSA2000 demographic model of South Africa) predicts that over a million new HIV infections could be averted in the first twelve years if a HAART treatment programme was added to a set of AIDS prevention interventions. In other words, not only is HAART assumed to prolong the lives of AIDS patients, but it is also assumed to save lives by preventing a significant number of new HIV infections. See Johnson and Dorrington (2002) for a discussion of the modelling assumptions and supporting evidence. This link between AIDS treatment and AIDS prevention occurs for two reasons: firstly, HAART lowers the viral loads of AIDS patients, thereby making them less infectious. Secondly, the model assumes that voluntary counselling and testing (VCT) is an integral part of a HAART programme, and that VCT is effective in encouraging people to practice safer sex. This modelled link between AIDS treatment and prevention is, however, contentious. According to a recent Joint Health and Treasury Task Team government report (on the economic of providing HAART in South Africa), there is 'no compelling evidence that antiretrovirals would reduce numbers of new infections' (2003: 18). This is a strange comment, given that the ASSA2000 Interventions model (which, as noted above, assumes the opposite) was used by the task team in their modelling work. Nevertheless, seeing as there is wide-spread concern about the nature of the link between HAART and fewer HIV infections, the matter requires serious consideration.

In his 'State of the Nation' address in February, President Mbeki (2002) argued that macroeconomic stability had been achieved, the structure of the economy had changed for the better, and that the basis for sustainable growth and poverty alleviation had been laid. In several important respects, the State President is correct. After increasing sharply in the mid-1990s, the budget deficit and total national government debt has fallen as a percentage of gross domestic product (GDP) since 1996,1 South Africa's export performance and balance of payments situation has improved, and inflation has dropped sharply.2 These trends are in what Finance Minister Trevor Manuel frequently refers to as South Africa's 'sound economic fundamentals'. Echoing Manuel, Mbeki concluded that 'barring the exchange rate' (which at the time had depreciated in real terms by about one-third since 1994), 'all critical economic indicators have improved' (2002: 11).

There are two major economic and social security challenges facing South Africa: addressing large-scale unemployment and the AIDS pandemic. As of 2003, an estimated 14% of all South Africans were HIV-positive, with over a thousand people dying each day of AIDS. According to the government household and labour-force surveys conducted from the mid-1990s onwards, about a third of the labour force is without work (Nattrass, 2000a). This amounts to about 4.7 million people and it is, without question, a socio-economic crisis of major proportions. The life-chances and living-standards of entire households are compromised when working-age adults cannot find employment (Seekings, 2003b). Households burdened by AIDS are in an especially difficult position (Desmond et al 2000, Steinberg et al 2002a, 2002b; Booysen, 2002; Booysen et al, 2002). Addressing AIDS and unemployment poses major challenges for social solidarity in South Africa. Over the past decade, the labour-market and industrial-policy environment has benefited relatively high-productivity firms and sectors (Nattrass, 2001). Business thus had strong incentives to reduce dependence on unskilled labour, and once the price of highly active antiretroviral therapy (HAART) started to fall from 2001 onwards, to supply it, either directly or indirectly through medical aids, to their increasingly skilled workforce (Nattrass, 2003). Those without jobs had neither access to earned income nor life-prolonging medication.

The rapid spread of HIV/AIDS in Southern Africa is both a cause and a consequence of poverty. But while there is a clear link between AIDS and economic insecurity, there is no evidence of a connection between AIDS and security understood in the policing/state security sense of the term. Orphans are a human tragedy but not a direct security threat. AIDS does not appear to be high on the list of political priorities for most Southern Africans. Governments are thus likely to continue to respond to the epidemic unevenly and with limited resources.

This evening's lecture is about the economics of AIDS policy in South Africa. But, as one of my colleagues in the Politics Department wryly observed, a lecture on the government's AIDS policy would be 'rather short'. So, I will also be using the topic to touch on the role of the economist in society and on good and bad uses of economics per se.