Precise data about the economic impact of STIs are not easily obtained. The biggest body of evidence can be derived from the economic analysis of HIV/ AIDS, bearing in mind that HIV unlike some other STIs cannot be cured. Although therapy today allows people living with HIV/AIDS to lead productive lives for decades after infection, in many of the most affected areas of the world, appropriate therapies are not readily available to all who need them.
People living with HIV die earlier and the economic consequences may be more significant than in the more
developed world. Therefore, experiences from HIV/ AIDS, which is in fact currently causing the biggest
economic burden of all STIs, will especially be focused on. At the same time, HIV/AIDS is closely related with other STIs, as with preexisting STIs – often unrecognized or untreated out of shame or lack of access to treatment – the likeliness of HIV infection increases significantly.
STIs, and AIDS in particular, can have economic implications on different levels, in particular on the macroeconomy and on companies and their workforce. On the macroeconomic level, the impact of an
HIV/AIDS epidemic is difficult to measure. Most models show a moderate decline of the gross domestic
product (GDP).
However, even a GDP decline of only 1–2% per year results in a situation where after 25 years the GDP is about 30% lower than without an epidemic. The impact of the epidemic becomes more visible when looking at the health sector specifically. In some countries, the funds required to sustain complex programs in response to HIV/AIDS may be higher than the amount previously available for the entire public health budget.
In South Africa, for example, when the government first planned to bring 80% of all patients in need into therapy, the estimated cost of 45 billion South African Rand (4.7 billion euros) exceeded the total previous health budget by 20% ([7], p. A2933). Later, while implementing the programs, shortages in funding threatened to interrupt the availability of antiretroviral drugs for patients already on treatment in some provinces.
The global financial crisis has made the shortages in funds for HIV/AIDS and STIs more dramatic as
donor countries downscale funding or refrain from scaling up as needed to achieve universal access to
treatment. HIV/AIDS epidemics may also affect the attractiveness of a country for foreign direct investment.
Higher public expenditure for health and redirected public budgets – away from infrastructure or other businessfriendly policies – as well as reduced demands for certain goods (as household income decreases due to disease or income is reallocated to health related goods and services) may make certain locations look less attractive.
International rating agencies may classify countries strongly affected by HIV/AIDS less favorably. South African companies, for example, have been burdened with a higher risk premium. This however, has not led to any visible decrease in economic investment. A South African study showed that 90% of companies
had not been influenced in their investment decisions by the HIV situation.
Nevertheless, it remains difficult to measure business opportunities lost as companies refrain from new
investments because a country is burdened with an AIDS epidemic, since other factors such as high crime
rates or lack of skilled staff may also come into the equation. At the same time, business confidence into a location may be increased by a proactive government response.
An issue of concern, however, is that new epidemics are currently developing in countries occupying key positions in the international economy such as China or India. The impact of the STI situation and an AIDS epidemic can also be felt on the individual company level. Direct, indirect and systemic costs can be distinguished.
Among the direct costs are increasing expenses for health programs, for social and health insurance, for recruitment and education of replacement staff. Indirect costs may incur through absenteeism or less productivity due to sickness. Systemic costs are the combined negative effects of disease on workplace coherence or strained atmosphere and less motivation in the work environment.
Systemic costs may also be incurred by a general decrease in levels of education and experience as well as the availability of internal tacit knowledge. In general, companies seem to react in a more intuitive than calculated manner to these challenges. A survey of the World Economic Forum (WEF) among more than 10,000 business leaders in 117 countries revealed that only about 9% of companies had carried out a quantitative risk analysis on the impact of HIV/ AIDS on their companies.
However, the survey also revealed growing concern. Close to every second participant (46%) in the survey expected an impact of the epidemic on their operations over the coming 5 years, 17% of which expected a strong impact. The WEF report showed that only when national prevalence of HIV is higher than 20%, that is, when the epidemic becomes more visible, do more companies start to take action.
They may draft policy papers on HIV in the workplace and may introduce programs on prevention, counseling, testing and therapy targeting their workforce. At the same time, companies in Western European countries with low HIV prevalence have hardly been concerned with STIs or HIV/AIDS.
Outside the hardest hit countries, only 6% of the companies surveyed had written AIDS policies. Thanks to Highly Active Antiretroviral Therapy (HAART), people living with HIV/AIDS in those countries are well integrated into working life. A Swiss study showed that 70% of people living with HIV were in paid employment, 68% of which were in full-time.
For Germany, data from the Competence Network for HIV/AIDS provide the most comprehensive evidence. Within this cohort, 48.7% of men and 23.4% of women are working full time, that is, at least 35 h a week. Another 5.2% of men and 14.3% of women worked part-time (15–34 h/week) and 2.9% of men and 4.9% of women worked less than 15 h/week, while 34.7% of men and 48.4% of women were not working at all (the status of 6.5% of men and 7.3% of women was not known) (Competence Network HIV/ AIDS, 2009, personal communication).
As the Swiss study highlights, people living with HIV tend to keep their infection secret from their employer. Employers in turn do not see that HIV is an issue in their workforce, although integration of HIV-patients can be a real win-win situation: Productive participation in the work environment can have positive effects on disease progression.
Patients report that they are more satisfied and integrated into society. This may eventually even decrease health spending and companies may profit from a highly motivated workforce. Increasingly, international forums offer assistance to companies to better handle their AIDS risk and situation. In addition to the Global Business Coalition against HIV/AIDS, TB and Malaria there are several regional and more than 40 national business coalitions supporting the private sector to address HIV-related issues.
According to the needs in an individual country or a region, they offer services such as coordinating the national private sector treatment program (Malawi Business Coalition Against HIV/AIDS), assisting small, medium and micro enterprises in developing HIV workplace programs (the South African Business Coalition on HIV and AIDS), initiating staff capacity building and community outreach to customers or monitoring and evaluating workplace programs (Coalition des Entreprises de Côte d’Ivoire contre le sida).
The UNAIDS Corporate and Private Sector Team, among others, works with business coalitions
around workplace issues. In summary, it can be seen that STIs may have an impact on the macroeconomy and the individual company level, the exact extend of which may be difficult to measure. Given its economic consequences – how does the political level react, which policy frameworks have been put in place to address these issues?
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