Geography Reference
In-Depth Information
Figure: 39.2
Bar chart
showing typical
distribution of AIDS cases
by age cohort and gender
for an east or southern
African country.
are likely to have less good health and diet than
the rich and lower resistance to infection, and to
live more risky lives. Thus, in general, poorer
countries have higher rates of infection than do
rich countries; poorer people within poor
countries have higher rates of infection than do
the better off; and finally, in some cases it is true to
say that poorer people in rich countries have
higher rates than do wealthier people (Table 39.2).
This has three significant implications: (1) the
idea that this is a disease of the third world is only
true inasmuch as it is a disease associated with
poverty; (2) as the livelihoods of poor people often
involve spatial mobility, high levels of uncertainty
and non-formal contracts and conditions of work,
so they are often exposed to high rates of sexual
partner change (and may even undertake sex work
as part of a survival strategy, sometimes under
duress); (3) women, whose rates of infection in
generalised heterosexual epidemics such as those
in sub-Saharan Africa may sometimes exceed
those of men, are at particular risk because of the
unequal nature of gender relations in most
societies and cultures. It is such factors that have
led the World Bank to conclude that:
These findings suggest that rapid and fairly
distributed economic growth will do much to
slow the AIDS epidemic…after controlling for
the percentage of the population that is
Muslim…two measures related to gender
inequality are associated with higher HIV
infection rates.
(World Bank 1997: pp. 28-9)
PRESENT AND PROSPECTIVE SOCIAL
AND ECONOMIC IMPACT OF THE
EPIDEMIC
In considering this question, it is important to
distinguish between the impact in poor and rich
countries and in poor and rich communities in
each of these. It is also necessary to distinguish
between impact as measured by economists using
conventional measures of economic output,
growth and well-being, and other measures and
other approaches to these questions.
Rich countries have smaller epidemics than do
poor countries and are more able to deal with the
consequences in terms of both the costs of medical
care and the longer term economic and social
costs associated with excess illness and death. The
first of these statements is supported by Table 39.1,
which shows the global and regional distribution
of AIDS cases.
It is also important to be aware that economic
measures of the decline attributable to increased
illness and death associated with an epidemic
such as HIV/AIDS are problematic. These
For the average developing country a $2000
increase in per capita income is associated with
a reduction of about 4 percentage points in the
HIV infection rate of urban adults. Reducing
the index of inequality from 0.5 to 0.4, the
difference in inequality between… Honduras
and Malawi is associated with a reduction in
the infection rate by about 3 percentage points.
