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Foster, Susan Dwight
Languages: English
Types: Doctoral thesis
Zambia has one of the highest HIV \ud seroprevalence \ud rates \ud in \ud the \ud world, estimated \ud in \ud 1995 at 17%. Rural Monze district in the \ud Southern \ud province, the \ud site of the \ud study, \ud has high \ud rates of HIV, estimated at 10-12% in 1991. During the \ud study, the \ud district \ud was \ud affected \ud not \ud only by AIDS but also by the 1991-92 drought \ud and \ud by \ud a \ud bovine \ud epidemic of \ud East Coast \ud Fever. This study documents the impact of \ud HIV \ud and \ud AIDS \ud on the \ud health \ud services and on \ud the district economy, and draws some \ud long term \ud implications for the \ud national economy. \ud At the district hospital, approximately \ud 44% \ud of \ud inpatients \ud and \ud 30% \ud of outpatients were \ud HIV seropositive as were 18% of rural \ud health \ud centre patients. \ud Tuberculosis, \ud other \ud respiratory \ud infections, and diarrhoea accounted for the \ud majority of \ud days in hospital. \ud The \ud HIV \ud epidemic \ud was found to be affecting the hospital staff \ud as well, \ud with mortality at \ud Monze \ud and \ud neighbouring Choma hospitals rising \ud from \ud 2 \ud per \ud 1,000 \ud nurse \ud years \ud in 1980 to \ud 27 in \ud 1991 \ud - a \ud 13-fold increase. Measures to increase supply, \ud reduce \ud losses, \ud and \ud make \ud better \ud use \ud of existing \ud staff are proposed. The household survey found that \ud while \ud patients \ud were \ud better \ud off \ud overall than the \ud district population, there was no appreciable \ud difference in \ud wealth \ud between \ud patients \ud with \ud HIV \ud infection and those without. HIV-positive patients \ud were \ud younger \ud than \ud HIV-negative \ud patients, and had fewer children. The loss \ud of a member with \ud HIV \ud would \ud cause \ud a rise \ud in the \ud average household's dependency ratio of \ud 16-17%. Production \ud was \ud affected \ud by \ud HIV \ud disease, \ud with an average of 94 days' loss of labour (patients \ud plus carers) \ud in the \ud final \ud year of \ud life. \ud Implications for policy include the \ud need to \ud decentralize \ud care of \ud patients \ud with \ud HIV \ud disease to health centres, and to protect and make \ud better \ud use \ud of the \ud health \ud human \ud resources. \ud The impact of HIV/AIDS on rural production, \ud with \ud approximately \ud 1 in 3 \ud district \ud households having a member with AIDS, combined \ud with \ud external \ud factors \ud such as \ud removal \ud of \ud subsidies, changes in marketing processes under structural \ud adjustment, \ud and \ud long term \ud drought, makes it increasingly difficult to \ud eke out a \ud living from farming. \ud Combined \ud with the \ud lure of apparent employment opportunities \ud in \ud urban \ud areas created \ud by deaths \ud due to \ud AIDS, \ud these factors may contribute to increased urbanization, \ud making \ud it \ud difficult for \ud Zambia to \ud replace declining copper revenues with \ud increased \ud yields \ud from \ud agricultural production.
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