Like the impacts on public services at the local level, the main impacts of HIV/AIDS will be in health and education. As well as the number of services available falling, the quality of these services will be affected too.

Health services

As more people become ill as a result of HIV/AIDS, more medical staff and more drugs will be needed. HIV/AIDS mainly affects young adults, and this means that many medical staff may themselves be ill.

As the economy is affected by HIV/AIDS, there may not be enough money available to pay medical staff, to pay for drugs and to train people to take over when medical staff die or become too sick to work.

The public health service will be affected most seriously, and may become unable to cope with the number of people who need help. Private health care may be available for a few people, but only those who can afford it.

The majority of sick and dying people will be cared for informally, by relatives and friends within the household. This often has a great social cost as children may be unable to attend school or go to work as they are needed to look after sick relatives.

Education

In the local impacts on public services section, we discussed how the number of people attending school will fall due to pressures to take over work that adults would normally do.

As with medical services, there are also impacts on education because of the number of teachers who become ill because of HIV/AIDS. Again, because HIV/AIDS tends to affect young adults, the majority of teachers are in the age range which is highly vulnerable to the infection.

This can have a devastating affect on the amount and quality of education which is available. For example, between 1997 and 2001, in two districts in Malawi, it was estimated that 1 out of every 7 primary school teachers died and 1 out of every 15 secondary school teachers died.

We cannot be certain that these teachers died because of HIV/AIDS, but because they were young, we can assume that their deaths were due to the disease.

It is not just the loss of teachers because they die which is important for learning. It is likely that the teachers would have been away from school due to illness for a long time before they died.

If there are fewer teachers and a smaller proportion of school-age children attending school, the chances of finding trained, educated people to replace the teachers and doctors who die are much lower. In addition to this, training people to be teachers or medical professionals is expensive and, as we have seen, HIV/AIDS means that there is much less money available for training and education generally.

Primary school, Uganda.
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