Charlene Smith
In 10 years, the average life expectancy of South Africans may be 40 years, there will be fewer children and many will be in orphanages.
Prison populations will be mostly sick and dying, there will be greater absenteeism in the workplace, and farmers will battle to find enough well people to harvest crops and till the land. Some people will turn to crime to pay for expensive medication.
With the fastest-growing incidence of HIV – the virus that causes Aids – in the world, South Africa may be facing this scenario – a scenario that will dramatically change the face of the nation. Yet neither national nor local government is factoring the economic consequences of Aids or looking at how government should be budgeting and planning for it.
They may be examining its impact on health and welfare – but what about transport, safety and security, education and other areas?
Craig Schwabe, director of the Human Sciences Research Council’s (HSRC) Geographic Information Centre, which undertakes research in spatial information, says, “Late last year, there was a lot of press on the fact that there will be 50 000 Aids orphans – but where? If it is in one area, we need to focus efforts in that area, develop a Reconstruction and Development Programme strategy or special funds.
“Government is not doing enough, fast enough. Nothing will have a more negative impact on the economy of this country than Aids.”
Schwabe believes HIV should be a notifiable disease. His thinking is in line with that of international researchers, who point out that initial resistance to this in the early 1980s was because it was thought that Aids was a homosexual disease and HIV-positive people were being discriminated against.
But one prominent American researcher with links to Atlanta’s Centres for Disease Control and who has been monitoring the disease for the past decade in Zimbawe says, “Now we know that everyone is at risk from HIV. It should be treated like diseases such as measles and be notifiable – it would help us track and work against it better.
“My concern is that the effective allocation of money for people who are infected can only happen if we have a clear understanding of the population that has HIV and that information does not exist. I keep saying government had better do this very quickly otherwise they will be in trouble.”
At present, KwaZulu-Natal is considered the area with the highest incidence of HIV and the Northern Province has one of the lowest statistics – but how accurate are those figures? Aids researchers know that the incidence of HIV in Messina is around 60% and around 77% at Beit Bridge.
Is the incidence of HIV low in the Northern Province because it is – or because clinics and hospitals lack equipment to test for the disease and a lack of academic hospitals in the province means that scant research is being done into the problem?
KwaZulu-Natal MEC for Finance Mike Ellis is presently being lauded for bringing rampant over-expenditure under control, but as part of that he cut health-care by R600-million.
He says, “We have reduced hospital stays, expensive procedures are being eliminated – we are vaccinating children rather than doing heart transplants,” and with Aids, “we are dealing with it on the educational side, encouraging people to modify behaviour”.
But, he admits, “at the end of the day, we are seeing increases in deaths from tuberculosis and malaria in the northern areas [both are opportunistic diseases associated with Aids]”. Better Aids education may simply not be enough in a province where a quarter of the populace are infected.
The Johannesburg hospital reports that 70% of the deaths in its paediatric unit are due to Aids, with pressures on its budget growing by 20% a year.
Last year, the Department of Correctional Services spent more than R54-million sending prisoners for care to private hospitals, and some sources say most of those patients were suffering from Aids-related complications.
However, correctional services representative Russel Mamabalo says they do not know that for certain. He says that at present there are 142 prisoners in private hospitals. Although correctional services does not test prisoners for HIV unless they consent, they have revealed that tests on those who have consented have shown that at present there are 800 prisoners with full-blown Aids, and 1 700 with HIV.
However, Mamabalo said the department was not taking cognisance of the virus and its impact on the prison population when compiling its budget.
Colin Donian of the Financial and Fiscal Commission says that changes to budgeting to take into account the impact of Aids could come into effect when changes take place to the Medium-Term Expenditure Framework in 2001/2002.
“We are beginning to do work on the particular problem of Aids and how it influences general public expenditure and how that affects expenditure to the provinces.
“The current approach looks at a set of health indicators, but we need to evaluate if the data available is credible and try and create some sort of outcomes.
“If we look at the indicators presently used for health, it is our view that there is a strong correleation between HIV-prevalence and factors of ruralness, lack of access to medical aids and poverty.”
Annameyer Wetz, who is involved in Aids research for the HSRC, says it is “very difficult to know the real impact of Aids in the future. Demographers will say maybe a vaccine will be developed tomorrow. What we do know from a new World Health Organisation report is that the majority of new infections occur in the 14- to 25-year-old group. But we have not really examined the economic impact, we are not health economists, the major focus of our work is on prevention.”
l 1 500 people are infected with HIV each day in South Africa. Professor Alan Whiteside of the HIV/Aids Research Unit at the University of Natal says life expectancy at present has dropped from 65,4 years to 55,7 years and in 2010 would be 48 years. However, Aids specialist Dr Neil McKerrow of Greys hospital in KwaZulu-Natal puts life expectancy at between 35 and 40 years by 2010.