HIV/AIDS and economic growth: Evidence from West Africa

Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is one of the leading causes of morbidity and mortality in West Africa. Prevalence among the most productive age group in West and Central Africa stood at 1.5%, 3.4.0%, 2.5%, and 2.1% in 1990, 2000, 2010, and 2015 respectively. This study examined the effect of HIV/AIDS on economic growth in West Africa with focus on 11 countries. The augmented Solow model, rooted in the neoclassical growth theory, was used, which was operationalized using dynamic panel data modeling approach. Incidence, prevalence, number of people living with HIV/AIDS (PLWHA), and AIDS‐related deaths were used to measure HIV/AIDS. Estimations using system GMM returned statistically significant results while those of first difference and difference GMM were not. From the outcome of system GMM analysis, a percentage increase in incidence, prevalence, PLWHA, and AIDS deaths correspondingly reduced growth significantly through their effects on life expectancy by 0.15%, 0.02%, 0.004%, and 0.03%. Acquired immune deficiency syndrome deaths and PLWHA lowered economic growth through enrolment but not significantly. The import of the findings is that HIV/AIDS threatens growth through life expectancy in West Africa. Therefore, its spread in the subregion should be effectively contained while proper treatment should be provided for all infected persons.     

Demographic impact of AIDS in a low-fertility urban African setting: projection for Addis Ababa,Ethiopia

The study estimated the potential demographic impact of acquired immunodeficiency syndrome (AIDS) in a low-fertility urban setting in sub-Saharan Africa. The prevalence of human immunodeficiency virus (HIV) projected using a deterministic mathematical model was put into the AIDS Impact Model (AIM) of the SPECTRUM Policy Modelling System to estimate the potential demographic impact ofAIDS in Addis Ababa, Ethiopia. Demographic indicators from 1984 (the start of the HIV epidemic in Ethiopia) to 2024, including and excluding the HIV epidemic, were compared. Addis Ababa is experiencing a demographic transition in which the total fertility rate has declined from 3.8 to below replacement level over the last 20 years. The prevalence of HIV is predicted to stabilize at 10% in adults, resulting in a total number of people living with HIV at 200,000 and a cumulative number of deaths due to AIDS at 50,000. About 60% of adult deaths can be attributable to AIDS by 2000. The epidemic is predicted to reduce life expectancy by 10 and 17 years in 2000 and 2024 respectively, and to turn to negative, the rate of natural increase after 2009. Accordingly, the rate of natural increase will be -0.18%, -0.35%, and -0.71% per annum by 2009, 2014, and 2024 respectively. Population growth is expected to continue with or without HIV, as a result of high net in-migration, although data for migration are scanty. In a low-fertility urban society of Africa, this study shows the potential for the HIV/AIDS epidemic to turn the rate of natural increase to negative.     

It's about TIME: engendering AIDS in Africa

This paper analyses how TIME magazine represents sub-Saharan African women in its coverage of HIV/AIDS. As rates of infection escalate across the continent, researchers are increasingly emphasising the need to understand the socioeconomic and cultural contexts that make women particularly vulnerable to infection. Yet popular media representations of AIDS continue to rely on older colonial imageries of Africa as the feminised, diseased 'dark continent'. This article identifies three major themes in TIME's representation of sub-Saharan African women and HIV/AIDS: the metaphor of Africa as a woman in crisis, the construction of women as the means of transmission, and the engendered nature of the debate about the impact of international development policies. It is argued that the reliance on familiar cultural narratives often obscures the epidemiological, economic and cultural realities within which sub-Saharan women live. Not merely a consequence of unprotected sex, AIDS in sub-Saharan Africa is also the result of global economics and politics, reflecting the inequities between the West and Africa, male and female, white and black. The paper concludes with a call for further research on the role of representations of HIV/AIDS and its actual routes of transmission.     

Impact of HIV/AIDS on African children

In Central and East Africa, pediatric human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are becoming increasing threats to child health due to the predominance of heterosexual transmission of HIV, high HIV infection rates in women of reproductive age and high birth rates. This paper examines the potential impact of HIV/AIDS on orphanhood and under-five mortality in 10 Central and East African countries. The author estimates that, in the 10 countries studied, HIV/AIDS in children under age five will cause between one-quarter and half a million child deaths annually by the year 2000. Whereas the United Nations estimate (without AIDS) and target for the under-five mortality rate in this 10-country region by the year 2000 are 132 and 78, respectively, HIV/AIDS will cause the under-five mortality rate to rise to between 159 and 189. Increasing HIV/AIDS-related adult mortality is creating a large and growing number of children under age 15 whose mothers have died of HIV/AIDS. During the 1990s, HIV/AIDS will kill a total of between 1.5 and 2.9 million women of reproductive age in this region, producing between 3.1 and 5.5 million AIDS orphans--which means that between 6 and 11% of the population under age 15 will be orphaned. National and international government and nongovernment service providers in Central and East Africa need to recognize this potential impact of HIV/AIDS on children, expand AIDS-prevention efforts, and develop policies and programs to address children's HIV/AIDS-related needs.     

Seroprevalence of the human cytomegalovirus among blood donors and AIDS patients in Bamako

Our aim was to study the prevalence of the human cytomegalovirus (HCMV) among blood donors and AIDS patients and to examine a clinical correlation between AIDS and HCMV seroprevalence in Bamako (Mali, West Africa). We have used Elisa kits for detecting HIV and HCMV specific antibodies. The HCMV seroprevalence was 89% among AIDS patients, 71% among HIV-infected blood donors and 58% among HIV-uninfected blood donors. The HCMV seroprevalence rate was higher among AIDS patients than among HIV-uninfected blood donors (p=0.0000007) and than among HIV-infected blood donors (p=0.00146). There was no significant difference between the HCMV seroprevalence among HIV-infected blood donors and among HIV-uninfected blood donors (p=0.0547). There was no relationship between HCMV seroprevalence and sex or age among AIDS patients and blood donors. There was a significant difference on pneumonia among HCMV-infected AIDS patients and among HCMV-uninfected AIDS patients (40% versus 0%; p=0.005). Buccal and phaiyngal candidosis, dermatosis, Kaposi's sarcoma and nervous system diseases had the same frequency among HCMV-infected and HCMV-uninfected AIDS patients.     

The World Health Organization (WHO)

Abstract

Nigeria has the largest number of HIV/AIDS cases in West Africa, with 3.3 million people estimated to be living with the disease. The country remains a fragile democratic state and has allocated insufficient resources to combat the spread of HIV/AIDS among its citizens. The preponderance of President's Emergency Plan for AIDS Relief (PEPFAR) dollars, expert knowledge, conservative ideology and activities has shaped the direction of HIV/AIDS sexual-transmission prevention programmes in Nigeria. PEPFAR channels significant resources through Nigerian faith-based organisations (FBOs), and considers these organisations integral for HIV prevention strategies. In many instances, HIV/AIDS prevention programmes managed by FBOs reflect their ideologies of morality and sexuality. There is a convergence of religious ideology concerning morality and HIV infectivity between American and Nigerian conservatives; this produces a fertile ground for the influence and expansion of the conservative activities of PEPFAR in Nigeria. The paper highlights this nexus and draws attention to the biopolitical underpinning of PEPFAR in shaping Nigeria's HIV prevention programmes. The paper further notes both positive and negative effects of PEPFAR activities and attempts by the Obama administration to redirect PEPFAR to a more holistic approach in order to optimise outcomes.     

河南省艾滋病高发区不同人群艾滋病相关知识态度行为调查

目的 了解艾滋病高发地区HIV感染者/AIDS患者和一般健康人群对艾滋病传播途径的知晓情况、对艾滋病的态度以及采取的防治措施情况.方法 采用自制的问卷对河南省4个项目县10个乡/镇居民进行调查,利用Epi Data 3.0软件建立数据库,SAS 9.13软件进行资料分析.结果 河南省艾滋病高发区居民艾滋病相关知识的总体知晓率为79.00％,其中HIV/AIDS组知晓率为81.62％,一般健康人群知晓率为76.47％,差异有统计学意义( P＜0.001);HIV/AIDS组和一般健康人群组对亲戚朋友HIV/AIDS态度上的差异有统计学意义(P=0.038,P=0.019);在日常性行为中HIV/AIDS组中39.59％的人坚持每次都使用安全套,而一般健康人群组中仅占11.08％.结论 河南省艾滋病高发区居民艾滋病相关知识的知晓率较高,病例组均高于一般健康人群组;安全套的使用率较低,艾滋病的性传播危险性较大,需要加强艾滋病健康教育和安全性行为干预.     

Targeted interventions required against genital ulcers in African countries worst affected by HIV infection.

It remains unclear why there is such marked variation in the severity of the human immunodeficiency virus (HIV) epidemic between African countries. The prevalence of HIV infection has reached high levels in many parts of southern Africa but in most countries of West Africa the levels are much lower. Although there is good evidence that sexually transmitted infections (STIs) and genital ulcers in particular facilitate heterosexual transmission of HIV, there is little comparative STI data from the African countries worst affected by HIV infection. A MEDLINE search covering the period 1966 to August 2000 using the keywords "sexually transmitted diseases", "genital ulcers" and "Africa" was performed to identify factors that might be relevant to the spread of HIV infection in countries with the highest prevalences of the virus. In the countries worst affected by HIV infection, the proportions of men and women with STI who had genital ulcers lay in the ranges 45-68% and 13-68%, respectively. The proportions were much lower in countries of West Africa than in those of southern Africa. The African countries worst affected by HIV infection should adopt a more specialized approach to STI control than hitherto and specifically target the high incidence of genital ulceration. Locally, technical STI committees should draw up country-specific guidelines taking into account the prevalence of the various causes of genital ulceration. In these countries, national AIDS control programmes and donor agencies should develop a specific focus for decreasing the incidence of genital ulcer disease.     

工厂外来女工艾滋病干预模式研究

目的 了解珠江三角洲工厂外来女工艾滋病相关知识、态度、信念、行为(KABP)，探索适合该人群的有效的艾滋病干预模式。方法 采用匿名问卷法对外来女工进行基线调查后开展针对该人群的艾滋病综合干预措施，并对干预结果进行评价。结果 工厂外来女工艾滋病知晓程度非常低，缺乏自我保护意识和能力，生殖健康状况较差，是艾滋病的脆弱人群。干预后，其对艾滋病传播途径和预防方法的知晓率显著提高，安全性行为率增高，安全套使用率增高。结论 干预模式取得明显效果，可在该类人群中推广。     

Effects of Response to 2014–2015 Ebola Outbreak on Deaths from Malaria,HIV/AIDS,and Tuberculosis,West Africa

Response to the 2014–2015 Ebola outbreak in West Africa overwhelmed the healthcare systems of Guinea, Liberia, and Sierra Leone, reducing access to health services for diagnosis and treatment for the major diseases that are endemic to the region: malaria, HIV/AIDS, and tuberculosis. To estimate the repercussions of the Ebola outbreak on the populations at risk for these diseases, we developed computational models for disease transmission and infection progression. We estimated that a 50% reduction in access to healthcare services during the Ebola outbreak exacerbated malaria, HIV/AIDS, and tuberculosis mortality rates by additional death counts of 6,269 (2,564–12,407) in Guinea; 1,535 (522–2,8780) in Liberia; and 2,819 (844–4,844) in Sierra Leone. The 2014–2015 Ebola outbreak was catastrophic in these countries, and its indirect impact of increasing the mortality rates of other diseases was also substantial.     

A comparison of HIV/AIDS-related stigma in four countries: Negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS

HIV/AIDS-related stigma and discrimination have a substantial impact on people living with HIV/AIDS (PLHA). The objectives of this study were: (1) to determine the associations of two constructs of HIV/AIDS-related stigma and discrimination (negative attitudes towards PLHA and perceived acts of discrimination towards PLHA) with previous history of HIV testing, knowledge of antiretroviral therapies (ARVs) and communication regarding HIV/AIDS and (2) to compare these two constructs across the five research sites with respect to differing levels of HIV prevalence and ARV coverage, using data presented from the baseline survey of U.S. National Institute of Mental Health (NIMH) Project Accept, a four-country HIV prevention trial in Sub-Saharan Africa (Tanzania, Zimbabwe and South Africa) and northern Thailand. A household probability sample of 14,203 participants completed a survey including a scale measuring HIV/AIDS-related stigma and discrimination. Logistic regression models determined the associations between negative attitudes and perceived discrimination with individual history of HIV testing, knowledge of ARVs and communication regarding HIV/AIDS. Spearman's correlation coefficients determined the relationships between negative attitudes and perceived discrimination and HIV prevalence and ARV coverage at the site-level. Negative attitudes were related to never having tested for HIV, lacking knowledge of ARVs, and never having discussed HIV/AIDS. More negative attitudes were found in sites with the lowest HIV prevalence (i.e., Tanzania and Thailand) and more perceived discrimination against PLHA was found in sites with the lowest ARV coverage (i.e., Tanzania and Zimbabwe). Programs that promote widespread HIV testing and discussion of HIV/AIDS, as well as education regarding and universal access to ARVs, may reduce HIV/AIDS-related stigma and discrimination.     

Clinical research, prophylaxis, therapy, and care for HIV disease in Africa.

By the end of the century, citizens of resource-poor countries will constitute 90% of the world's human immunodeficiency virus (HIV)-infected people. Clinical management of such persons in developing countries has been neglected; most AIDS research has concentrated on epidemiology, and donor agencies have generally invested in the prevention of HIV infection. The heavy burden of HIV disease in Africa requires that care for AIDS be addressed, and prevention and care should be seen as interrelated. Prevention and treatment of tuberculosis, the commonest severe infection in persons with AIDS in Africa, illustrate this interrelationship. We outline priorities for applied research on the management of HIV disease in a resource-poor environment, and discuss prophylaxis, therapy for opportunistic diseases, terminal care, and use of antiretroviral therapy. Research should define the standard of care that can realistically be demanded for HIV disease in a resource-poor environment. Research and public health programs for AIDS in developing countries must address AIDS care and attempt to reduce the widening gap between interventions available for HIV-infected persons in different parts of the world.     

艾滋病患者合并巨细胞病毒感染状况研究

目的了解艾滋病患者合并巨细胞病毒感染状况,及其对艾滋病疾病进展的影响。方法以278例在某院住院的艾滋病确诊患者为研究对象,采集外周血,分离血浆,通过人巨细胞病毒核酸定量检测(PCR-荧光法)检测巨细胞病毒DNA。同时检测CD4+T淋巴细胞和血浆病毒载量的水平。结果在278例艾滋病患者中合并巨细胞病毒感染者60例,感染率为21.58%,其中75%的合并巨细胞病毒感染的患者主要存在于CD4+T淋巴细胞低于50/μl的艾滋病感染者中。合并巨细胞病毒感染者的CD4+T淋巴细胞低于HIV单一感染者,而病毒载量则呈相反趋势,两者间差异有统计学意义(P﹤0.01)。结论对艾滋病患者的管理,在监测CD4+T淋巴细胞的同时,应加强监测巨细胞病毒的混合感染,并可结合CD4+T淋巴细胞计数对患者进行预防性服药,降低混合感染造成的死亡。     

Criminalizing HIV transmission using model law: troubling best practice standardizations in the global HIV/AIDS response

A growing body of social science research has focused on the negative public health consequences of criminalizing the sexual transmission of HIV. I examine the criminalization of contagion in West and Central Africa and address a significant research gap: How do legislative environments that enable harmful laws to be applied become created in the first place? With stated aims of promoting human rights and public health objectives, HIV/AIDS-related laws have been created transnationally though the use of an omnibus model law. A group of legislative actors have problematized this United States Agency for International Development (USAID) funded model law, known as the USAID/Action for West African Region model law, or N'Djamena model law. This ‘harmonizing’ text led to the rapid spread of HIV/AIDS laws, including the criminalization of HIV transmission, across at least 15 countries in West and Central Africa between 2005 and 2010. The HIV model law was packaged and ‘sold’ to developing countries through the strategic use of best practice discourse. Best practice replications are enabled though a set of social and technological relations of use including the availability of mobile, standardizing texts. Although best practice standardization has been a key feature of global health institutions work activities in the HIV response over the past two decades, recent replications related to the criminalization of HIV transmission illustrate the potential public health dangers of ‘don’t reinvent the wheel’ thinking. I offer a normative critique of the transnational, text-mediated process that has produced highly problematic laws.     

Malawi women and HIV: socio-cultural factors and barriers to prevention

Heterosexually transmitted HIV/AIDS continues to devastate the health and economy of sub-Saharan African countries. In Malawi, 15.4% of 15-49 year olds are infected with HIV and 18-26% of pregnant women are living with HIV. Research has shown that sociocultural factors, especially gender roles and relationships, play a significant role in the transmission of HIV in Africa but little is known about Malawi women's perspective on HIV/AIDS. What do Malawi women say about the impact of HIV/AIDS on their lives, their role in prevention, and the barriers they face in trying to stem the spread of the disease? To answer these questions, three focus groups with Malawi women were conducted and analyzed for themes. The purpose of this paper is to describe one emergent theme captured in the statement, "We are just vessels for our husbands." This theme is explicated through discussions of women's and men's images, women's roles, gender/power relationships, disempowerment, role models and empowerment. Evident in this theme are interrelated messages for those involved in HIV/AIDS prevention. Health education alone is insufficient to stem the tide of HIV in Malawi. A multidisciplinary, systematic approach that includes women's education and economic empowerment as well as modifying legal and social structures that contribute to the spread of HIV/AIDS in Malawi is suggested as necessary additions to HIV and AIDS intervention programs. Only through forging partnerships between health, education, women's development groups, and political and social leaders will we be able to reduce the impact of HIV/AIDS in Malawi.     

Towards an understanding of barriers to condom use in rural Benin using the Health Belief Model: A cross sectional survey

Background  

HIV/AIDS is the most dramatic epidemic of the century that has claimed over two decade more than 3 million deaths. Sub Saharan Africa is heavily affected and accounts for nearly 70% of all cases. Despite awareness campaigns, prevention measures and more recently promotion of anti viral regimens, the prevalence of cases and deaths is still rising and the prevalence of systematic condom use remains low, especially in rural areas. This study identifies barriers to condom use based on the Health Belief Model (HBM) in Benin, West Africa.     

Measuring the impact of HIV/AIDS, heart disease and malignant neoplasms on life expectancy in the USA from 1987 to 2000

OBJECTIVES: Quantifying the impact of a disease on society is an important issue for setting priorities for better allocation of healthcare resources and for evaluating the effectiveness of prevention and control of the disease. STUDY DESIGN: The potential gains in life expectancy due to the elimination of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), heart disease and malignant neoplasms were compared for the US population by age and ethnicity from 1987 to 2000. METHODS: The potential gain in life expectancy after hypothetical elimination of cause-specific deaths is an effective indicator of measuring the impact of a disease on a population. Official age-specific mortality rates, by ethnicity, due to HIV/AIDS, heart disease and malignant neoplasms of the US population from the National Center for Health Statistics were used, and multiple decremental life tables were constructed to find the corresponding potential gains in life expectancy. RESULTS: The potential gains in life expectancy for the US population at birth by complete elimination of HIV/AIDS, heart disease and malignant neoplasms were 0.14, 3.71 and 3.06 years in 1987, respectively. In 1995, the potential gain in life expectancy due to the elimination of HIV/AIDS increased from 0.14 years in 1987 and achieved its highest value (0.41 years), whereas the elimination of heart disease and malignant neoplasms led to potential gains in life expectancy of 3.05 and 3.10 years, respectively. Since 1995, the potential gains in life expectancy at birth by eliminating deaths from HIV/AIDS and heart disease have decreased to 0.13 and 2.67 years, respectively, in 2000. However, the potential gain in life expectancy due to elimination of malignant neoplasms remained relatively stable (3.01 years in 2000). It is well known that HIV/AIDS tends to have a greater impact on people of working age, whereas heart disease and malignant neoplasms have a greater impact on people over 65 years of age. To measure the impact of these diseases on life expectancy in people of working age, a partial multiple decremental life table was constructed and the potential gains in life expectancy were computed by partial or complete elimination of various causes of death during the working years. shows the impact on life expectancy of the US working-age population by eliminating deaths from HIV/AIDS, heart disease and malignant neoplasms by race and sex groups. CONCLUSIONS: Since 1995, there has been a rapid reduction in the burden of HIV/AIDS on the life expectancy for the US population, especially for black males of working age. These results could provide useful information when evaluating public health improvements and allocating resources for future disease control programmes.     

Some clinical aspects of HIV infection in Africa

WHO has estimated the cumulative number of AIDS cases in Africa to have grown from 2978 (1986) to 81,019 (1990). The actual numbers are probably much higher due to under reporting, under diagnosis, and delays in notification. Pathogenicity and clinical features of HIV 2, found mainly in west Africa, are similar to those of HIV 1. 2nd generation HIV-ELISA tests can check for both viruses' antigens. These and other ELISA tests can be used to rapidly identify HIV, but clinical criteria alone can usually determine an accurate diagnosis. In developed countries, AZT (zidovudine) shows some promise of stemming the onset of AIDS in asymptomatic patients. Other promising antiretrovirus drugs are being developed, but are all too expensive for Africa. Almost 33% of HIV positive patients in Africa also have tuberculosis (TB) and, up to 1988, around 40% of TB patients tested HIV positive. In Uganda, Zambia, and Malawi the percentages ranged from 50-65% in TB patients. HIV positive TB patients have a substantial higher mortality than HIV negative TB patients. In some areas of Africa, 66% of AIDS patients have chronic, watery diarrhea and weight loss. The most common pathogens include Cryptosporidium and Isopora belli. Cryptosporidium does not respond to treatment, so there is a concern of a hospital based outbreak in AIDS patients. Cytomegalovirus also causes gastrointestinal illness in African AIDS patients as well as pulmonary disease. Toxoplasma and Cryptococcus often attack the central nervous system of AIDS patients. Oral fluconazole can provide some initial relief from cryptococcal meningitis. Bacteremia is also common. Little evidence exists to suggest an important interaction between HIV and traditional tropical diseases. Unlike Western nations, pneumocystosis and Mycobacterium avium intracellular are uncommon in Africa.     

Highly active antiretroviral therapy and tuberculosis control in Africa: synergies and potential

HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) and TB (tuberculosis) are two of the world's major pandemics, the brunt of which falls on sub-Saharan Africa. Efforts aimed at controlling HIV/AIDS have largely focused on prevention, little attention having been paid to care. Work on TB control has concentrated on case detection and treatment. HIV infection has complicated the control of tuberculosis. There is unlikely to be a decline in the number of cases of TB unless additional strategies are developed to control both this disease and HIV simultaneously. Such strategies would include active case-finding in situations where TB transmission is high, the provision of a package of care for HIV-related illness, and the application of highly active antiretroviral therapy. The latter is likely to have the greatest impact, but for this therapy to become more accessible in Africa the drugs would have to be made available through international support and a programme structure would have to be developed for its administration. It could be delivered by means of a structure based on the five-point strategy called DOTS, which has been adopted for TB control. However, it may be unrealistic to give TB control programmes the responsibility for running such a programme. A better approach might be to deliver highly active antiretroviral therapy within a comprehensive HIV/AIDS management strategy complementing the preventive work already being undertaken by AIDS control programmes. TB programmes could contribute towards the development and implementation of this strategy.     

Revealing the full extent of households' experiences of HIV and AIDS in rural South Africa

Households experience HIV and AIDS in a complex and changing set of environments. These include health and welfare treatment and support services, HIV-related stigma and discrimination, and individual and household social and economic circumstances. This paper documents the experiences of 12 households directly affected by HIV and AIDS in rural KwaZulu Natal, South Africa, between 2002 and 2004. The households were observed during repeated visits over a period of more than a year by ethnographically trained researchers. Field notes were analysed using thematic content analysis to identify themes and sub-themes. This paper focuses on three dimensions of household experience of HIV and AIDS that have received little attention in HIV and AIDS impact studies. First, that experience of HIV and AIDS is cumulative. In an area where population surveys report HIV prevalence rates of over 20% in adults, many households face multiple episodes of HIV-related illness and AIDS deaths. We describe how these challenges affect perceptions and responses within and outside households. Second, while over 50% of all adult deaths are due to AIDS, households continue to face other causes of illness and death. We show how these other causes compound the impact of AIDS, particularly where the deceased was the main income earner and/or primary carer for young children. Third, HIV-related illness and AIDS deaths of household members are only part of the households' cumulative experience of HIV and AIDS. Illness and death of non-household members, for example, former partners who are parents of children within the households or relatives who provide financial support, also impact negatively on households. We also discuss how measuring multiple episodes of illness and deaths can be recorded in household surveys in order to improve quantitative assessments of the impact of HIV and AIDS.