HIV/AIDS and Education - UNESCO · 3 Number of people living with HIV/AIDS in sub-Saharan Africa,...
Transcript of HIV/AIDS and Education - UNESCO · 3 Number of people living with HIV/AIDS in sub-Saharan Africa,...
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HIV/AIDS and Education
IAEN Current Issues in the Economics of
HIV/AIDS by
Alan WhitesideDirector, Health Economics and
HIV/AIDS Research DivisionUniversity of Natal
Thanks to
• USAID• UNAIDS• DFID• Peter Badcock-Walters
• Tom Cobbley
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Outline of Presentation
• The scale of the epidemic• Describe the dynamics• Demographics• A case study
HIV prevalence in adults in sub-Saharan Africa, end 2001
20 – 39%10 – 20%5 – 10%1 – 5%0 – 1%
No data unavailableoutside region
2001
Source: UNAIDS, 2002.
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Number of people living with HIV/AIDS in sub-Saharan Africa, 1980-2001
0
5
10
15
20
25
30
1980 1983 1986 1989 1992 1995 1998 2001
Mill
ion
s
Source: UNAIDS, 2002
National trends in HIV prevalence
0
5
10
15
20
25
30
35
40
45
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
% H
IV p
osi
tive Botswana
Namibia
South Africa
Swaziland
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Outline of Presentation
• The scale of the epidemic
•Describe the dynamics• Demographics• A case study
Epidemic Curves, HIV
27Aug01 - Report I: Epidem’gy & Lit. p. 27
T1 T2 Time
Numbers
A1
A2
HIV prevalence
A
B
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Epidemic Curves, HIV and AIDS
27Aug01 -Report I: Epidem’gy & Lit. p. 27
T1 T2 Time
Numbers
A1
A2
HIV prevalence
AIDS - cumulative
B1
A
B
Epidemic Curves, HIV, AIDS & Impact
27Aug01 -Report I: Epidem’gy & Lit. p. 27
T1 T 2 Time
Numbers
A1
A2
HIV prevalence
B 1
A
B
AIDS- cumulative
Impact
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0
10
20
30
40
50
60
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
Mill
ion
s
To
tal
po
pu
lati
on
0
1
2
3
4
5
6
7
8
9
Mill
ion
s
Nu
mb
ers
HIV
, A
IDS
sic
k an
d H
IV d
eath
s
Totalpopulation
Total HIV
TotalnumberAIDS sick
CumulativeHIVdeaths
Numbers infected, sick and dead, ASSA2000
A model of futureAIDS and non-AIDS Deaths
0
200000
400000
600000
800000
1000000
1200000
1995 2000 2005 2010 2015
year
num
ber
of d
eath
s
Other deaths AIDS Deaths
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All orphans and orphans due to AIDS by HIV prevalence, Uganda, by year
1985 1990 1995 2000 2005 2010 Year0
0.5 million
1 million
1.5 million
2 million
Total Number
0
6%
12%
HIV Prevalence
Total OrphansAIDS OrphansHIV Prevalence
Outline of Presentation
• The scale of the epidemic• Describe the dynamics
•Demographics• What we know• What we are doing - the MTT
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NYHQ HIV/AIDS Unit 1-May-03
Estimated increase in adult death rates relative to the 1985 rates
Women
0.000
0.500
1.000
1.500
2.000
2.500
3.000
3.500
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
A g e
Rat
io
1994
1996
1997/8
1998/99
1999/2000
Declining life expectancy
Changes in life expectancy in selected African countries with high and low HIV prevalence: 1950-2005
Source: UNAIDS, 2002. Report on the global HIV/AIDS epidemic
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Projected population structure with and without the AIDS epidemic, Botswana, 2020
80757065605550454035302520151050
020406080100120140 0 20 40 60 80 100 120 140
Males Females
Deficits due to AIDS
Projected population structure in 2020
Population (thousands)
Ag
e in
yea
rs
Source: US Census Bureau, World Population Profile 2000
Under Five Mortality 2000 and 2010
2000 2010
50
100
150
Botswana
02000 2010
50
100
150
Cote d’Ivoire
02000 2010
50
100
150
South Africa
0
With AIDS With AIDS With AIDS
Without AIDS
Without AIDS Without AIDS
Rate per 1000 live births
29
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0
500000
1000000
1500000
2000000
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
AIDS orphans in South Africa
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By 2010, orphans will account for 15-25% of all children in 12 countries in SSA
0 5 10 15 20 25
Lesotho
Swaziland
Botswana
Zimbabwe
Mozambique
Zambia
Namibia
Malawi
Rwanda
South Africa
Burundi
Central African Republic Non-AIDS
AIDS
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Outline of Presentation
• The scale of the epidemic• Describe the dynamics• Demographics• A case study
HIV/AIDS Impact on Education
• The primary impact of HIV/AIDS is to explode the scale of existing systemic and management problems in education;
– Labour attrition, recruitment & training
– Access, enrolment & gender equity
– Increase orphaning & drop out rates
– Reduce household/school fee income
– Learner transition, graduation rates & quality
• AIDS makes dysfunctional systems worse.
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Education MIS: The Need
• Need for EMIS to:
– providing system input, performance & output data moreregularly and efficiently
– capturing/monitoring key indicators of HIV/ AIDS impact regularly and efficiently
• Their key feature should be the capacity to capture
monthly time-series data.
HIV/AIDS Data Requirements
• Labour: Establishment and temporary & permanent loss by reason, age, gender, type and school (To inform recruitment & training, loss of contact time/quality – can link to payroll)
• Enrolment: Temporary & permanent loss by reason, age, gender, grade and school (To inform access, gender equity, orphaning & pregnancy rates)
• Transition & graduation rates: Ex-EMIS (To project output & tertiary supply)
• Orphaning: Incidence by month (trends)
• Fees: Loss through school exemptions
• Geographic variation: Analysis by school.
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The Response
• A decentralised District Education Management and
Monitoring Information System (DEMMIS)* has been
developed to test viability of monthly data capture;
• The pilot system has been designed to capture key
indicators of HIV/AIDS impact on a monthly basis, to
guide response at the school, circuit and district levels;
The System
• The DEMMIS system captures monthly statistics on
teachers, learners, support staff and school governing
bodies;
• Provides time-series data on enrolment, absenteeism, attrition, contact time, drop-out, pregnancy, orphaning and fees – all by gender and grade;
• Copy to school, one to the Circuit and District;
• Indicators of HIV/AIDS impact can be quickly and easily derived from these;
• Linked to a District Managers Resource Kit with FactSheets and Management Response Checklist………
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The Pilot
• Pilot districts in the KwaZulu Natal Province,
South Africa’s worst affected, were selected on
the basis of their demographic mix;
• Pilot initiated in 95 schools in the Dannhauser
District, in February 2001;
• This illustrative sample, over 10 months, involved
32 schools: 20 Primary, 6 Secondary, 5 Combined
and 1 Pre-Primary;
The Geography
• KwaZulu Natal is South Africa’s most populous
province at around 8 million;
• It has a school enrolment of almost 2,7 million,
taught by about 75 000 teachers in almost 3 000
schools;
• It is also the worst affected by HIV/AIDS with an
antenatal HIV prevalence rate of over 36% in 2002;
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Change in enrolment figures
12700
12800
12900
13000
13100
13200
13300
Feb-01
Mar-01
Apr-01
May-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Nov-01
+42
-21
-35
-29
-103
-13
-43
-33
-32
Annualized 2.6% decline
Absenteeism rates days lost as % of available time
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
Feb-01
Mar-01
Apr-01
May-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Nov-01
LearnersEducators
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Loss of contact time - educators
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
Feb-01 Mar-01 Apr-01 May-01 Jun-01 Jul-01 Aug-01 Sep-01 Oct-01 Nov-01
Absent
Leave taken
Annualized 8.4% loss of time
Learners that left the system –cummulatively
517
29
0
100
200
300
400
500
600
Feb-01
Mar-01
Apr-01
May-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Nov-01
13 177 learners in Feb 3.9% cumulative loss 5% annualized loss
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1
16
0
5
10
15
20
Feb-01
Mar-01
Apr-01
May-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Cumulative Loss of Educators
371 educators in Feb 4.3% cumulative loss 5% annualized loss
Teacher Attrition in KZN:A Case Study
Normal Attrition:
In 1999 6.79% of educators left the system according to payroll data analysis -
• Estimated that 0.69% left because of AIDS
• Around 6.1% could be considered ‘normal’ attrition
HIV/AIDS Attrition:
• Only the beginning: AIDS deaths are increasing sharply and will reach close to 5% a year by 2010
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Conclusions
• The total number of educators needed will
decrease
• The training requirement will, however,
increase as educators leave the system
faster than the decline in the need.
• Total decline by 2008 in demand 4 946
• Total educators leaving by 2008 64 418
• Training requirement 2000-2008 59 472
Number of learners orphanedreported month by month
Month 1 Parent 2 ParentFeb 33 9Mar 7 1Apr 7 0May 11 2Jun 3 0Jul 31 4Aug 17 1Sep 17 2Oct 10 0Nov 7 2Grand Total 143 21
Schools : 32Enrolment: 13177Annualized : 1.5%
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Cumulative rate of orphaning, excluding drop-outs
143
3321
90
20406080
100120140160
Feb-01
Mar-01
Apr-01
May-01
Jun-01
Jul-01 Aug-01
Sep-01
Oct-01
Nov-01
1 Parent
2 Parent
What goes around comes around part 1
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What goes around comes around
Medical interventions for HIV-AIDS
ImmunisationMicrobicidesAnti-
retroviraltreatment
Individual Behaviour
Support
Incapacity & absenteeism inprivate sector &
civil service
cure
s exte
nds
reduces
Viral mutation
redu
ce pre
ven
t
Increaces ?decreases?
prev
ents
Sex industry interventions
Healthy lifestyle
Condom use
increaces
sustains
impr
ove
AIDS education & awareness
caus
es
redu
ces
prod
uctiv
ity
more orphans
Mores & customs (multiple sets of these) Education
Diet &nutrition
affect
Migrant & mobile workers
Stable & settled workers
brings better
Govtpolicies
Funding for health care, infrastructure, sanitation
scarce educators die
challenges
& influences provides skilled people
Re
du
ces
dem
and
sustains
creates vacancies
inhibits
support Drain on
Shareholderexpectations
& values
drive
risk taking &risk avoidance
Role of women
NGOinvolvement
Circumcision
Notions of masculinity
Social cohesion
Spiritual & political authorityReligion challenges
& influences
Beliefs
Above average survivors:chaste & faithful,
long term thinkers,tertiary educated,
non-migrant families,settled LT employees,high income, cohesive
& candid societies, grandparents
Aboveaverage survivors
Above average mortality :unemployed, orphans,soldiers, sex workers,
hazardous occupations, migrants, temps, contract
workers, newly prosperous, young women,
uncircumcised men, & partners of all the above
Population stops
growing, and ages
Businesssector
involvement
Autonomy of HIV in Complex Societies - A systems model of the S’n Africa AIDS epidemic
TreatingSTD’s
HIVEpidemic
(prevalence)
HIV Transmission
LatencyPeriod
(avg8 yrs)
AIDS related Disease & Deaths
(death rate)
Motherto child
treatment
ham
pers
prev
ents
Treatingopportunistic
diseases
Africantraditional
healers
promiscuity
incr
ea
ss
Economicorganisation
Personal responsibility
Self-confidence
Chastity,Fidelity
reduces
Business sector involvement
Migration & mobility
Impr
oves
we
ake
ns
changes
Tension of two worlds
Life force,procreation,
sex urge
Drives
affects
affects uptake of
AIDS testing & counselling
impr
oves
Promote / hamper
increa
ses
Leadershipin society
Bus
ines
s se
ctor
invo
lvem
ent
reduces
Promote / hamper
G i v e s r i s e t o
Global competition &
economy
Weather & climate change
Jobs
Economy
Cost of hiring &
retraining
affe
ctaffe
ct
affect
skilledworkers
die
Who dies & who survives:
(population. Demographics &
particularities)
values, profits, patents, prices, research
Determinesnature of
influ
ence
s
create
provides
prov
ides
prov
ides
promote
s
increases
create
incr
ease
s
perceptionsof risk Hazardous
occupations
crea
te
affects
Housing & land Urbanisation
affect
Safety, crime & war
I n f l u e n c e
Cost toindividuals & households :
medication, care, burial,& orphans
reduces
affects
extends
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Conclusion
• We are only beginning to track the effects of AIDS in education.
• We have not tracked the financial cost
• We have not tracked the development cost
• Human capital • ‘Manpower’ planning