The impact of HIV/AIDS on human development in African countries
© Boutayeb; licensee BioMed Central Ltd. 2009
Published: 18 November 2009
In the present paper, we consider the impact of HIV/AIDS on human development in African countries, showing that, beyond health issues, this disease should and must be seen as a global development concern, affecting all components of human development. Consequently, we stress the necessity of multidisciplinary approaches that model, estimate and predict the real impact of HIV/AIDS on human development of African countries in order to optimise the strategies proposed by national countries, international institutions and their partners.
In our search strategy, we relied on secondary information, mainly through National Human Development Reports of some African countries and regular publications released by the United Nations (UN), United Nations Development Programme (UNDP), World Health Organization (WHO) and the World Bank. We restricted ourselves to reports dealing explicitly with the impact of HIV/AIDS on human development in African countries.
Results and discussion
HIV/AIDS is affecting the global human development of African countries through its devastating impact on health and demographic indicators such as life expectancy at birth, healthcare assistance, age and sex distribution, economic indicators like income, work force, and economic growth, education and knowledge acquisition and other indicators like governance, gender inequality and human rights.
On the basis of the national reports reviewed, it appears clearly that HIV/AIDS is no longer a crisis only for the healthcare sector, but presents a challenge to all sectors. Consequently, HIV/AIDS is a development question and should be viewed as such. The disease is impeding development by imposing a steady decline in the key indicators of human development and hence reversing the social and economic gains that African countries are striving to attain. Being at the same time a cause and consequence of poverty and underdevelopment, it constitutes a challenge to human security and human development by diminishing the chances of alleviating poverty and hunger, achieving universal primary education, promoting gender equality, reducing child and maternal mortality, and ensuring environmental sustainability.
Human Development Index 2006 
8. United States
111. South Africa
172. Central African Rep
174. Burkina Faso
176. Sierra Leone
HD rank evolution of ten African countries 
HD Rank 1990
HD Rank 2000
HD Rank 2006
In the present paper, we consider the impact of HIV/AIDS on human development in African countries, showing that, beyond health issues, this disease should and must be seen as a global development concern, affecting education and knowledge acquisition, income and social status, productivity and economic growth, and other direct and indirect components of human development such as gender equality and human rights. Consequently, we stress the necessity of multidisciplinary approaches that model, estimate and predict the real impact of HIV/AIDS on human development of African countries in order to optimise the strategies proposed by national countries, international institutions and their partners.
Methods (search strategy)
In our search strategy, we relied on secondary information mainly through National Human Development Reports of some African countries and regular publications released by the United Nations (UN), United Nations Development Programme (UNDP), World Health Organization (WHO) and the World Bank. For national reports, we restricted ourselves to the eight National Human Development Reports which dealt explicitly with the impact of HIV/AIDS globally on human development, or partially on its components during the last years.
Results and discussion
Major infectious diseases
Main causes of mortality due to infectious diseases, 2001(in million) 
Deaths per year (millions)
HIV/AIDS: the indomitable disease
Impact of HIV/AIDS on human development in selected African countries
Zambia: life expectancy and HI with and without AIDS 
Mozambique: comparison of regional and national HIV prevalence rates 
Kenya: adult HIV prevalence by province and sex (%) (2004) 
Under the title "reversing HIV/AIDS in Malawi", the Malawi HDR 2005 devoted a chapter to the impact of HIV and AIDS on households welfare, orphaned children, the extended family, educational and health sectors, agricultural production, business and public service delivery. The chapter concludes that HIV and AIDS have the potential to reverse those gains made in human development in the last few years .
According to the Benin HDR 2005, HIV/AIDS is at the same time a cause and consequence of poverty and underdevelopment . According to this report, the impact of the disease on human capacities and institutions is the most apparent. It has repercussions for the economy, health systems, education and food security at national, regional and family levels.
Benin: HIV prevalence and life expectancy and education indices in different regions 
Life expectancy idex
Zimbabwe: overall, HDI has declined by 12%, from 0.507 to 0.444 between 1995 and 2000 
(Life expectancy index)
(Adult literacy index)
20% or more
10% to 20%
5% to 10%
Côte d'Ivoire 9.6%
Centr Afric Rep 12.9%
South Africa 21.3%
Sierra Leone 6.7%
Burkina Faso 6.4%
HIV/AIDS and human development in the most affected countries
Life expectancy at birth(years)
Number of deaths(millions)
Infant mortality rate(per 1 000)
Child mortality rate(per 1 000)
The Millennium Project 
Millennium Development Goals
UN Millennium Project task forces
1. Reduce extreme poverty and hunger by half relative to 1990
1. Poverty and economic development
2. Achieve universal primary education
3. Promote gender equality & empowerment of women
3. Education and gender equality
4. Reduce child mortality by two-thirds relative to 1990
4. Child and maternal health
5. Improve maternal health, including reducing maternal mortality by three-quarters relative to 1990
5. HIV/AIDS, malaria, tuberculosis, and access to essential medicines
6. Prevent spread of HIV/AIDS, malaria, and other diseases
6. Environmental sustainability
7. Ensure environment sustainability
7. Water and sanitation
8. Develop a global partnership for development
8. Improving the lives of slum dwellers
10. Science, technology, and innovation
However, beyond the international agreement on principles, at the 7-year juncture, most African countries, have made little (if any) headway in preventing and controlling the HIV/AIDS epidemics in particular, nor in reducing the rates of extreme poverty and making progress in the MDGs targeted for 2015 in general [23, 24]. Meanwhile, it is sad to notice that in 1999, the governments of sub-Saharan Africa dedicated US$7 billion to military spending, whereas diverting just 10% of this would have raised US$700 million, more than enough to support the HIV/AIDS vaccine research program .
Sectorial impact of HIV/AIDS
Impact on health indicators
HIV/AIDS is directly affecting heath and demographic indicators such as mortality rates, life expectancy, and sex and age distributions. By 2000-2005, Zimbabwe, Botswana, Swaziland and Lesotho have lost respectively 35, 28, 28 and 24 years of life expectancy [16, 18–20]. More generally, it is estimated that, in the seven most affected countries in Africa, life expectancy declined by 12.1 years by 1995-2000 and is expected to decline by 29.4 years by 2010-2015. Similarly, the number of deaths, infant mortality rates and child mortality rates were estimated at 2, 10.2 and 28.6 respectively for the first period and expected to reach 6, 13.9 and 43.3 respectively by 2010-2015 . Globally, in 1995-2000, 38 African countries had a mean life expectancy of 47 years, representing 5.7 years of loss attributable to AIDS.
The burden of the disease is not felt only at individual level; it affects households, communities and the whole nation (hospitalisation, healthcare, orphanhood) [12, 15, 17]. More than half of all hospital beds in sub-Saharan Africa are occupied by people with HIV/AIDS and related diseases. Some of the most affected countries have lost more than 15% of their healthcare workforce due to AIDS and, in many other countries, midwives and health workers are living with HIV [11, 14, 16]. It should also be stressed that the HIV/AIDS epidemic worsens the situation of other diseases like cardiovascular diseases, diabetes and tuberculosis. For instance, 80% of tuberculosis patients are HIV positive in countries with high prevalence of HIV [19, 20].
Impact on economic indicators
Contrary to the majority of diseases, HIV/AIDS kills and disables adults in the most productive part of their lives. Consequently, it is affecting business, investment, industry and agricultural sustainability, and ultimately reducing families' income and economic growth. Although at different degrees, all the national reports reviewed stress the negative impact of HIV/AIDS on income at individual, community and national levels [11–18].
These partial and sometimes controversial estimates, combined with the paucity of national data, indicate the necessity of global interdisciplinary studies that can model, estimate and predict the economic impact of HIV/AIDS in Africa.
Impact on education and knowledge acquisition
Impact of orphanhood on school attendance among 10-14 years-olds (%)
West: 9 countries
Eastern: 9 countries
Southern: 10 countries
Ratio double vs. non orphan
On the basis of the national reports reviewed, it appears clearly that HIV/AIDS is no longer a crisis only for the healthcare sector, but presents a challenge to all sectors . Consequently, HIV/AIDS is a development question and should be viewed as such . The disease is impeding development by imposing a steady decline in the key indicators of human development and hence reversing the social and economic gains that African countries are striving to attain [11, 16]. Being at the same time a cause and consequence of poverty and underdevelopment, it constitutes a challenge to human security and human development by diminishing the chances of alleviating poverty and hunger, achieving universal primary education, promoting gender equality, reducing child and maternal mortality and ensuring environmental sustainability [11, 13, 15, 18]. Shortening human life, eroding people's sense of dignity and self-esteem, causing social exclusion, and traumatising and impoverishing individuals, families and whole communities, HIV/AIDS has the potential to reverse those gains made in human development during the past few years [14, 18]. With unpredictable implications for economic and social sectors, it is critical that the relationship between HIV/AIDS and human development be acknowledged at all levels and that the principles of sustainable development be a major focus and priority of the African countries' policies and programmes [12, 16]. The danger and complexity of this disease imposes the necessity of multidisciplinary approaches that model, estimate and predict the real impact of HIV/AIDS on human development of African countries in order to optimise the strategies proposed by individual countries, international institutions and their partners .
Limitations of our search
We are aware of the importance of the topic considered in this paper and the necessity to deal with it seriously and precisely. However, our search relied only on published data by different African countries and international institutions. Consequently, we were limited to data and the numbers available and this may be frustrating not to give a complete panorama of this interesting subject.
This paper is dedicated to African children afflicted by poverty and HIV/AIDS epidemics.
The author is grateful to the Projet de Recherche Global (PGR)
This article has been published as part of BMC Public Health Volume 9 Supplement 1, 2009: The OptAIDS project: towards global halting of HIV/AIDS. The full contents of the supplement are available online at http://www.biomedcentral.com/1471-2458/9?issue=S1.
- UNPD: The Human Development Indices. United Nations Development Programme. Human development report office. 2004Google Scholar
- UNDP: Human Development reports. accessed 4/12/2008, [http://hdr.undp.org/]
- Boutayeb A, Serghini M: Heath indicators and human development in the Arab region. International Journal of Health Geographics. 2006, 5: 61-10.1186/1476-072X-5-61.PubMed CentralView ArticlePubMedGoogle Scholar
- Boutayeb A: Social Inequalities and health Equity in Morocco. International Journal for Equity in Health. 2006, 5: 1-10.1186/1475-9276-5-1.PubMed CentralView ArticlePubMedGoogle Scholar
- The World Health: Global defence against the infectious diseases threat. Geneva, World Health Organization, WHO/CDS/2003.15.Google Scholar
- The World Heralth: Reducing Risk: Promoting Health Life. 2002, Geneva, World Health Organization, Annual Report, accessed 4/12/2008, [http://www.who.int/whr/2002/en/]Google Scholar
- The World Health: Today's challenge. 2003, Geneva, World Health Organization, Annual Report, accessed 4/12/2008, [http://www.who.int/whr/2003/en]Google Scholar
- The World Health: Make every mother and child count. 2005, Geneva, World Health Organization, Annual Report, accessed 4/12/2008, [http://www.who.int/whr/2005/en/]Google Scholar
- Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS, Bellagio Child Survival Study Group: How many child deaths can we prevent this year?. Lancet. 2003, 362: 159-164. 10.1016/S0140-6736(03)13870-6.View ArticleGoogle Scholar
- The World Health: Changing history. 2004, Geneva, World Health Organization, Annual Report, accessed 4/12/2008, [http://www.who.int/whr/2004/en/]Google Scholar
- Zambia Human Development Report 2007: Enhancing household capacity to respond to HIV and AIDS. 2007, United Nations Development ProgrammeGoogle Scholar
- Mozambique Human Development Report 2007: Challenges and opportunities: the response to HIV/AIDS. 2007, United Nations Development ProgrammeGoogle Scholar
- Kenya Human Development Report 2006: Human security and human development: a deliberate choice. 2006, United Nations Development ProgrammeGoogle Scholar
- Malawi Human Development Report 2005: Reversing HIV/AIDS in Malawi. 2005, United Nations Development ProgrammeGoogle Scholar
- Rapport sur le Développement Humain au Bénin: " VIH/AIDS" et Développement Humain 2005. 2005, United Nations Development ProgrammeGoogle Scholar
- Zimbabwe Human Development Report 2003: Redirecting our responses to HIV and AIDS. 2003, United Nations Development ProgrammeGoogle Scholar
- South Africa Human Development Report 2003: The challenge of Sustainable Development in South Africa: Unlocking People's Creativity. 2003, United Nations Development Programme, accessed 4/12/2008, [http://hdr.undp.org/en/reports/nationalreports/africa/southafrica/south_africa_2003_en.pdf]Google Scholar
- Botswana Human Development Report 2000: Towards an AIDS-Free generation. 2005, United Nations Development ProgrammeGoogle Scholar
- United Nations: The impact of AIDS. 2004, Geneva, United Nations Department of Economic and Social Affairs/Population Division, World Population ProspectsGoogle Scholar
- UNAIDS: HIV/AIDS estimates. accessed 4/12/2008, [http://data.unaids.org]
- Macroeconomics and Health: Investing in Health for Economic Development. 2001, World Health Organization GenevaGoogle Scholar
- Sachs JD, McArthur JW: The Millennium Project: a plan for meeting the Millennium Development Goals. Lancet. 2005, 365: 347-353.View ArticlePubMedGoogle Scholar
- UNDP: HIV/AIDS and human Development Thematic Guidance Note. 2005, United Nations Development Programme NHR Occasional Paper 4Google Scholar
- Quinn TC: AIDS in Africa: a retrospective. Bulletin of the World Health Organization. 2001, 79: 1156-1158.PubMed CentralPubMedGoogle Scholar
- Mashelkar RA: Nation Building through Science and Technology: A Developing World Perspective. 10th Zuckerman Lecture. Innovation Strategy Today. 2005, 1: 16-32.Google Scholar
- The World Bank: Sustainable development in a dynamic world. 2003, The World Bank, Washington, D.C., Development ReportGoogle Scholar
- UNAIDS: The impact of AIDS on people and societies. accessed 4/12/2008, [http://data.unaids.org/pub/GlobalReport/2006/2006_GR_CH04_en.pdf]
- UNESCO: Education for All in Least Developed Countries. accessed 4/12/2008, [http://unesdoc.unesco.org/images/0014/001472/147259M.pdf]
- UNICEF: The state of the world's children 2006. 2005, The United Nations Children's FundGoogle Scholar
- Boutayeb A: The double burden of communicable and non communicable diseases in developing countries. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2006, 99: 191-199. 10.1016/j.trstmh.2005.07.021.View ArticleGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.