Focus on World Bank report on impact of AIDS

South Africa could face economic collapse within a few generations unless it adopts a more urgent response to its HIV/AIDS epidemic, a new World Bank research report warned on Wednesday. According to the report "The Long-run Economic Costs of AIDS: Theory and an Application to South Africa", most studies on the macroeconomic costs of AIDS had overlooked the long-term damage of the disease. In sub-Saharan Africa, the region hardest-hit by the epidemic, existing estimates range between a modest 0.3 percent and 1.5 percent annual decline in GDP growth. But the costs are likely to be much higher, the report argued. The sharp reduction in economic growth can be attributed to, firstly, HIV/AIDS targeting young adults primarily, destroying the ability to work among the most productive members of society. Secondly, the pandemic has also weakened families, as the quality of child-rearing depends heavily on the parents' human capital. If one or both parents died while their children were still young, the transmission of knowledge and potential productive capacity across the generations would be undermined. As a third contributing factor, the report found that the chance of the children themselves becoming HIV-positive made investing in their education less attractive, even when both parents were uninfected. "This report confirms how important it is for policymakers to act swiftly and effectively to prevent the spread of HIV/AIDS, and to treat those with the disease," the study's co-author, Clive Bell, a visiting World Bank research fellow said in a statement. But in South Africa the standoff between AIDS activists and the department of health over its refusal to implement a treatment policy continues. In late April, AIDS lobby group the Treatment Action Campaign (TAC) suspended its civil disobedience campaign following the group's meeting with Deputy-President Jacob Zuma. It had held protests outside parliament and pharmaceutical companies, and laid charges of culpable homicide against the ministers of health and trade and industry over the government's AIDS policies. Initially there were some positive signs that the government would soon commit to a national treatment plan. A government report investigating the costs of providing the appropriate drugs in the public health sector had been completed and was awaiting approval by cabinet, and the treasury had put aside contingency money for treatment in the 2003/04 budget, clearing the way for a change in policy. Activists and health workers were hopeful that, what TAC described as the "long, painful and unnecessary period of unjustifiable delays" in the country's controversial HIV/AIDS treatment access programme, would soon come to an end. Last week, after months of frustration, TAC leaked the key findings of the joint report by the ministries of health and finance. It estimated that 1.7 million lives could be saved by 2010 if antiretroviral (ARV) drugs were given to everyone needing them. Up to 1.8 million more children would be orphaned by 2010 if ARVs were not provided. This number would be reduced by 860,000 if there was 100 percent drug coverage, and by 350,000 if there was 50 percent coverage, the leaked report found. The total cost of providing the drugs to everybody needing them would be between US $1 billion and $1.09 billion by 2005. These calculations are based on drug regimens costing $720 per patient per year if the cheapest generics available internationally were used. A second set of drugs, prescribed when drug-resistant strains of HIV develop, would cost $1,201 a year. The report has still not been submitted to the cabinet for approval. Chief government spokesman Joel Netshitenzhe accused TAC of trying to grab attention before a cabinet meeting on the issue by releasing the findings. "There is no need for theatrics in dealing with the matter of HIV and AIDS," Netshitenzhe said in a statement. Legitimate concerns, however, could be behind the delays in implementing a national treatment plan. "While we know it is affordable now, what about the long-term costs? Most research shows the epidemic has not peaked yet - what will treatment cost in 2 or 3 years' time?" asked Professor Timothy Quinlan, research director of the Health Economics and AIDS Research Division at the University of Natal. The government must know they had to provide the drugs, but had just not set up the system to do this efficiently, Quinlan pointed out. "You don't get the sense of urgency within the cabinet, but you will certainly find it among professional staff and lower levels," he told PlusNews. The delays in accepting a Global Fund grant awarded last year to the KwaZulu-Natal province was an example of a lack of urgency "at the top" Quinlan said. In April 2002, Minister of Health Manto Tshabalala-Msimang blocked the $72-million grant awarded to the province, saying KwaZulu-Natal should not have approached the fund directly. Global Fund executive director Richard Feachem visited the country earlier this year, expecting to sign an agreement that would allow the grant money to be released, but last-minute hitches prevented the signing. A government statement issued at the time said: "A senior representative of the Fund will be visiting South Africa in the course of May and the agreements will, without fail, be signed during this visit. Programme implementation will begin by the end of May 2003." No documents have been signed to date. The World Bank report recommended that keeping people living with HIV/AIDS alive and well, by providing treatment and care, was vital to a country's long-term economic future. "This is nothing new, we've known this all along," Quinlan said. But AIDS activists and HIV-positive people in South Africa say they are still waiting for the government to act.