The Impact on the Health Sector

In all affected countries the AIDS epidemic is bringing additional pressure to bear on the health sector. As the epidemic matures, the demand for care for those living with HIV rises, as does the toll of AIDS on health workers. In sub-Saharan Africa, the direct medical costs of AIDS (excluding antiretroviral therapy) have been estimated at about US$30 per year for every person infected, at a time when overall public health spending is less than US$10 per year for most African countries.

The Effect on Hospitals

As the HIV prevalence of a country rises, the strain placed on its hospitals is likely to increase. In sub-Saharan Africa, people with HIV-related diseases occupy more than half of all hospital beds.4 Government-funded research in South Africa has suggested that, on average, HIV-positive patients stay in hospital four times longer than other patients. It is predicted that patients affected by HIV and AIDS will soon account for 60-70% of hospital expenditure in South Africa.5

Hospitals are struggling to cope, especially in poorer African countries where there are often not enough beds available. This shortage results in people being admitted only in the later stages of illness, reducing their chances of recovery. As the epidemic worsens, more complex cases of HIV and AIDS are likely to arise, taking up more hospital time and further reducing the standard of care provided.

Health Care Workers
While AIDS is causing an increased demand for health services, large numbers of healthcare professionals are being directly affected by the epidemic. Botswana, for example, lost 17% of its healthcare workforce due to AIDS between 1999 and 2005. A study in one region of Zambia found that 40% of midwives were HIV-positive.6 Healthcare workers are already scarce in most African countries. Excessive workloads, poor pay and the temptation to migrate to richer countries once trained are factors that have played a role in this shortage.

Although the recent increase in the provision of antiretroviral drugs (ARVS, which significantly delay the progression from HIV to AIDS) has brought hope to many in Africa, it has also put increased strain on healthcare workers. Providing ARVs requires more time and training than is currently available in most countries – for instance, in Tanzania it has been estimated that providing treatment to all those who need it would require the full-time services of almost half the existing health workforce.

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