Shifting the burden of HIV/AIDS
Date
2002-05
DOI
Authors
Rosen, Sydney
Simon, Jonathon
Version
OA Version
Citation
Abstract
As the economic burden of HIV/AIDS increases in sub-Saharan Africa, the allocation of the burden among levels and sectors of societies is changing. The private sector has greater scope than government, households, or NGOs to avoid the economic burden of AIDS, and a systematic
shifting of the burden away from the private sector is underway. Common practices that shift the
AIDS burden from businesses to households and government include pre-employment screening,
reduced employee benefits, restructured employment contracts, outsourcing of less skilled jobs,
selective retrenchments, and changes in production technologies. In South Africa, more than two
thirds of large employers have reduced health care benefits or required larger contributions by
employees. Most firms have replaced defined benefit retirement funds, which expose the firm to
large annual costs but provide long-term support for families, with defined contribution funds,
which eliminate firm risk but provide little to families of younger workers who die of AIDS.
Contracting out of previously permanent jobs also shields firms from costs while leaving
households and government to care for affected workers and their families. Many of these
changes are responses to globalization and would have occurred in the absence of AIDS, but they
are devastating for employees with HIV/AIDS. This paper argues that the shifting of the
economic burden of AIDS is a predictable response by business to which a thoughtful public
policy response is needed. Countries should make explicit decisions about each sector’s
responsibilities if a socially desirable allocation is to be achieved.
Description
This repository item contains a single issue of the Health and Development Discussion Papers, an informal working paper series that began publishing in 2002 by the Boston University Center for Global Health and Development. It is intended to help the Center and individual authors to disseminate work that is being prepared for journal publication or that is not appropriate for journal publication but might still have value to readers.
License
Copyright 2002 Boston University. Permission to copy without fee all or part of this material is granted provided that: 1. The copies are not made or distributed for direct commercial advantage; 2. the report title, author, document number, and release date appear, and notice is given that copying is by permission of BOSTON UNIVERSITY TRUSTEES. To copy otherwise, or to republish, requires a fee and / or special permission.