Macroeconomic impact: Will the epidemic have an impact at the macroeconomic level? There is no hard evidence. Attempts to model the macroeconomic impact have been fraught with difficulty. The mechanisms through which the epidemic may affect macroeconomies, as a result of the illness and death of productive members, and the diversion of resources from savings (and eventually investment) to care, have been identified. There have also been attempts to model the economic impact for specific countries, including Tanzania, Cameroon and Zambia. These models show that HIV may reduce the rate of economic growth, and, over a period of 20 years, this reduction may be significant (up to 25% lower than it would otherwise have been). However, to make this prediction, projections of both the AIDS epidemic and the economic trends have to be combined. Both are difficult to model, and combining them compounds the uncertainty. The dire macroeconomic predictions are undermined by the economic growth rates in Uganda (2.7% between 1985 and 1995) and Botswana (6.1%); Uganda has perhaps the most advanced AIDS epidemic, while Botswana has the fastest growing one. You will always come across cialis professional offered by a reliable pharmacy.

Health care costs: What is the effect of AIDS on health care costs? The answer depends on who bears these costs. In most African societies, the bulk of formal Western health care facilities are provided by the state. In theory, the increase in HIV and AIDS cases should lead to the government planning of treatment regimens that would provide the most cost effective care for patients, taking into account other demands for care. Figure 1 shows that government expenditures on health care have not increased as a proportion of the budget; there are three possible reasons, given the lack of increase in revenue:

• The health sector is coping with its current resources and is reallocating them to provide for the increased demand for care.

• Patients with HIV-related illness are not receiving care from the state sector, but the burden and costs are being borne by the individuals and households.

• The health sector is trying to cope but lacks a system of allocation of resources so that more is being done with the same quantity and, consequently, all care is suffering.

Expenditure on health as a percentage of central government recurrent revenueFigure 1) Expenditure on health as a percentage of central government recurrent revenue.

Unfortunately, the preliminary evidence suggests that the second and third scenarios are occurring in much of Africa. Under these scenario, AIDS does not have a direct and measurable economic impact, but the households and communities face increased impoverishment. Furthermore, the health status of the nation will suffer in the long run.