Aids in Kenya: The social and economic impacts of AIDS
One of the worst impacts of AIDS deaths to young adults is an increase in the number of orphans. We define an AIDS orphan as a child under the age of 15 who has lost the mother to AIDS. With this definition, the number of AIDS orphans would increase to 580,000 by 2000 and to almost 1 million by 2005.
These children may lack the proper care and supervision they need at this critical period of their lives. There will be a tremendous strain on social systems to cope with such a large number of orphans.
- At the family level this increases burden and stress for the extended family which has the traditional mandate to care for these orphans. Many grandparents are left to care for young children. Some families are headed by children as young as 10 - 12 year old.
- At the community and national level there is an increased burden on society to provide services for these children, including orphanages, health care and school fees. Many children go without adequate health care and schooling , increasing the burden on society in future years. There is an increase in the number of street children, particularly in urban areas.
Population Size and Growth
AIDS will have a large impact on population size. However, it will not cause population growth to stop or become negative. The following projection illustrates this point. The projection assumes that the total fertility rate (the average number of births per woman during her lifetime) continues to decline, from about 5.4 during 1990-93 to 4.2 by 2000 and 3.5 by 2010. It also assumes that mortality from all causes other than AIDS continues to decline so that life expectancy would increase from about 57 years today to 67 by 2010 if there were no AIDS deaths.
With no AIDS, the population would increase from about 27.2 million in 1995 to 32 million by 2000 and 37 million by 2005 the population would be growing at 2.5 percent per year.
With AIDS causing increased deaths,the total population of Kenya would be 1.3 million smaller by 2000 and 2.9 million smaller by 2005. Thus, the combined impact of AIDS deaths and fewer births because of a smaller reproductive age population would result in almost 3 million fewer people by 2005. However, by 2005 the population would still be growing at 1.7 percent per year.
AIDS will have a significant impact on population size, but the population will still grow by over 30 percent by 2005. The growth rate of the population will be less because of AIDS, but it will still be 1.7 percent per year. Changes in the total fertility rate will have much more impact on the population growth rate than will AIDS deaths.
Costs of Health Care
AIDS is an expensive disease that will require a considerable amount of resources from the health system. A 1992 study [Forsythe] estimated that the cost of hospital care for AIDS patients averaged about Ksh 27,200 during the course of their illness. If this expenditure rate remains constant then the total hospital costs for AIDS care, expressed in 1992 Ksh, would increase to about Ksh 3,800 million by 2000 and to Ksh 5,400 million by 2005. This could amount to as much as half of public expenditures for health care. Clearly, this would place a tremendous burden on the public health care system to provide adequate care for AIDS patients and still try to meet all the health needs of the population
The demand on health services caused by AIDS can also be illustrated by looking at hospital beds. Not all people with AIDS seek hospital care. But, for those that do, the average length of stay is considerably longer than for most other diseases, perhaps as long as 60 days of total hospital stay. In 1992, as much as 15 percent of all hospital beds in the country were occupied by AIDS patients. As the epidemic grows, so will the hospital bed requirements. By 2000 about half of all hospital beds would be required for AIDS patients. This would leave an insufficient number of beds for all other causes. Therefore, AIDS must be controlled or it will seriously affect the provision of health services to all.
AIDS also affects child survival. About 30-40 percent of babies born to infected mothers will also be infected with HIV. Most of these babies will develop AIDS and die within two years. Few will survive past the age of five.
AIDS could soon become the major cause of child death, worse than other major causes such as measles and malaria. For example, the annual number of child deaths due to measles and malaria is expected to range between 5,000 and 10,000 through the year 2005 [UNICEF, 1992]. The annual number of deaths due to AIDS could reach 40,000 to 50,000 over the same time period.
The increasing number of child deaths due to AIDS threatens to reverse many of the recent gains of child survival programmes.
- The infant mortality rate is the number of inference who die during the first year of life per 1000 live births. It is currently around 72. Without AIDS the infant mortality rate might be expected to decline to 40-50 by 2005. However with AIDS, it would decline to only about 55-60.
- The child mortality rate is the number of children who die before reaching their fifth birthday per 1000 live births. It is currently around 115. Without AIDS it might be expected to decline to around 70 by 2005. However, with AIDS it is likely to remain constant or rise slightly to 120-125.
HIV and Tuberculosis
Efforts over the past 20 years to control tuberculosis had been showing some success. However, recently the number of TB cases has been rising rapidly. This is due to the spread of HIV infection. HIV infection weakens the immune system of otherwise healthy adults. Many, perhaps half, of all adults in Kenya carry a latent TB infection which is suppressed by a healthy immune system. When that immune system is weakened by HIV, it can no longer control the TB infection and overt TB can develop.
In the absence of HIV, the number of new TB infections would be limited to about 0.2 percent of the population [Harries, 1990]. This would result in 30,000 to 50,000 new TB cases each year.
With AIDs, a number of new cases will develop. If we assume that among people with both HIV and latent TB infections, 8 percent develop TB each year, then the additional number of TB cases due to HIV infection would be about 100,000 by 2005. Even this is likely to be an under-estimate since these new cases may transmit the disease to others.
The impact of HIV infection on tuberculosis is a serious problem because TB is infectious through casual contact. It threatens to vastly increase the risk of tuberculosis for the entire population. Also, drug-resistant strains of TB are appearing, making it much more difficult and expensive to treat tuberculosis. The control of TB is very expensive and puts considerable strain on health budget.
The Economic Impacts of AIDS
AIDS will impact the economic development of Kenya in a number of ways. The loss of young adults in their most productive years of life will certainly affect overall economic output. The magnitude of the effect could be large or small depending on several factors. If AIDS is more prevalent among the economic elite, the best-educated people with the highest-paying jobs, then the impact could be much larger than the absolute number of AIDS deaths would indicate. It is also important to consider how the private costs of AIDS will be paid. These costs include expenditure for medical care, drugs, funeral expenses, etc. If most of these extra expenditures are financed out of savings then the reduction in investment could lead to a significant reduction in economic growth. A World Bank study [Over, 1992] on the economic impacts of AIDS in Africa concluded that the macroeconomic impacts of AIDS could be significant if these two factors are taken into account.
An analysis conducted by the Long Range Planning Division of The Office of the Vice President and Ministry of Planning indicates that the costs of AIDS could be a major burden to the economy in Kenya. This study projected that the cost of caring for AIDs patients by the year 2000 could be equal to the entire 19993/94 recurrent budget of the Ministry of Health. This analysis also projects that the total direct and indirect costs of AIDS could increase from 2-4 percent of GDP in 1991 to 15 percent by 2000. [Ministry of Planning, 19993].
The economic impacts are likely to be larger in some sectors than others. Certainly, health care and insurance are likely to be significantly affected. The military will also be severely affected. Infection rates tend to be quite high among military personnel since many are young, sexually active men who are away from their families for long periods of time. Other sectors that require a mobile work force may also be adversely affected, including transportation, extension services and banking.
The impacts on agriculture are likely to vary by agricultural systems. In rainy areas, where a variety of crops are planted throughout the year, families can cope relatively well with the loss of few laborers. They may reduce the area cultivated and cut back on the number of crops planted, but may still be able to produce an adequate amount of food. In dry areas, where farming depends on one or two crops that must be planted and harvested at specific times of the year, the impacts are likely to be more severe. In these areas the loss of a few workers at the crucial periods of planting and harvesting can significantly reduce the size of the harvest. The loss of labour force because of AIDS could make it difficult for families to feed themselves.
When someone in a family becomes sick with AIDS, it is usually the woman who cares for the sick person. Young girls may have to stay from school to help the mother with the other children. The family may exhaust its savings to pay for drugs and funeral expenses. In some cases they are even forced to sell land. The result is that families become poorer, children's education may suffer and standard of living of the entire family declines [Okeyo, 1992].
A loss of agricultural labour is likely to cause farmers to switch to less labour-intensive crops. In many cases this may mean switching from export crops to food crops. Thus, AIDS could affect the production of cash crops as well as food crops.
A more detailed examination of the economic impact of AIDS in Kenya is provided in An Assessment of the Economic Impact of AIDS in Kenya [Forsythe, 1992] and Socioeconomic Impact and Policy Implications of AIDS in Kenya [Forsythe, 1996].