Economics

Introduction
Human Immunodeficiency Virus is transmitted from one person to another through exchange of tissue fluids like blood, semen, breast milk, and vaginal secretions. Sexual intercourse has been reported to be the major route of spread of the virus. Other ways in which the disease can be spread include sharing of sharp objects like razor blades or needle for injections, at child birth and also during breast feeding. As the virus replicates in the body cells, it attacks the body immune system therefore lowering the immunity. People having this virus are highly susceptible to illness and infections (Obermeyer, 2006).

Acquired immune deficiency syndrome (AIDS) is a condition which results from advanced state of HIV infection.  For one to come down with Aids, the virus must have replicated so much in the body causing serious loss of white blood cells. White blood cells can also be damaged by cancers or infections which targets the bodys immune system. There is no cure for both AIDS and HIV (Obermeyer, 2006). Anti HIV which is also referred to as antiretroviral medications are used to control the replication of the virus and to slow down the advancement of the condition. The drugs can also be used in combination in which they will be referred to as highly active antiretroviral therapy. Antiretroviral do not cure the condition and those people using them can still spread the infection to others.

Although the data on HIVAids prevalence in the Middle East and other Muslim countries indicate that the prevalence is low, recent reports have indicated that there is rise in the prevalence level. This paper is going to tackle the economic impacts of HIVAids in the Middle East and possible recommendations to help lower the prevalence rate. It will also give some insights on the governments efforts to lower the risk of infection, risk factors and people at risk.

Brief history of the disease
The first cases of AIDS were reported in the United States in 1981 among the gay community which led to its naming as Gay Related Immune Deficiency. Scientists later realized that the disease had been present in the world even before the first cases were reported. The first confirmed case of AIDS was found in Belgian Congo. A Bantu man had died of unknown disease and this led to analysis of his blood sample. By 1982, AIDS cases had been reported by about 14 nations. In the same year, CDC received its first report of AIDS in a person who was diagnosed with hemophilia and also in children born to mothers infected with AIDS (Jenkins, 2003).

Approximately 25 million people around the world have succumbed to Aids related diseases. In the year 2008, 2.7 people contracted new HIV infections, and about 2 million men, women and children died of HIVAids related infections. Currently 33.4 million people around the world are living with the infection. It is worrying that the worlds number of people infected with HIVAids is persistently increasing even with the effective preventive measures put in place.

In Africa, the HIVAids impact has been severely felt in its poorest countries. By the end of 2007, there were about 9 countries in Africa whereby 10 of the adult population aged 15-49 were infected with the disease. The prevalence was high in countries like Botswana and South Africa. Prevalence rates are high in sub Sahara Africa, and in this area women are highly at risk of contracting the disease. The effects of HIVAids are even greater in Asia as compared to Africa. Many Asian countries lack efficient methods for monitoring the spread of HIVAids.

Across the world there has been changing pattern of gender infections. Early cases of HIV in most countries were highly intense in male homosexuals and drug injectors, but with the spread of the disease, there has been continuous change towards heterosexuals and increased infections among females. Currently, more females are dying of HIVAids and even the age patterns are varied.  The prevalence is high among the youths. People aged 15-45 are the high risk groups globally.

HIVAids situation in the Middle East
It is believed that the low prevalence of HIV AIDS in the Middle East region is related to the Islamic religion and its influence on the behavior. The Joint United Nations programs on HIVAids estimates that the total number of people infected with HIV in North Africa, the Middle East, and mostly Muslim countries in Asia to be about 1 million. By the end of 2003, the estimates was that up to0.42 million individuals in Mali, 0.18 million in Indonesia, 0.15 million in Pakistan and 61,000 people in Iran had HIV. These numbers are seriously under reported. This is because the figures were arrived at based on surveillance data, therefore lack of information can be mistaken to mean low infection.
The link between Islamic religions to low prevalence of the disease has been condemned as being ambiguous. World Health Organization estimated that about 83,000 people had contracted new infections in the region in 2002, and about 0.3  of the adult people in the region are currently incubating the disease. Latest evidence shows that the prevalence of sexually transmitted infections is on the rise and the total number of people who are dying from Aids related infections has increased six times compared to the figures found in early 1990s. In the low and middle income countries in the Middle East, HIV AIDS were the major cause of the morbidity in the region. Incidences of HIV AIDS infection in patients suffering from tuberculosis is also rising reaching 4.2 reported in Islamic republic of Iran and 4.8 reported in Oman. There was also rise in the incidences of HIV AIDS among people injecting themselves with drugs in Iran (Abrahams, 2007).

The other reason for the assumed low prevalence of HIV AIDS in Middle East countries is attributed to lack of proper data. There is no country in this region which carries out systemic surveillance of groups at risk of infection.  As a result of this, UNAIDS estimates the total number of people infected with HIV AIDS in the Middle East and North African countries to range from 200,000 to 1.4 million. It is also reported that only 5 of the infected people in this region have access to antiretroviral drugs (IRIN, 2010).  

The World bank report of 2003 on HIV AIDS prevalence rate in Middle East revealed that assumption of low rates of infection has led governments to assume the disease is not important therefore reluctance in taking proper action against it. Most governments pressed with other needs like housing, employment, and education and regard HIV AIDS control measures as the last priority in their list of issues to be solved. Other governments assume that their social and cultural conservatism will some how help in turning away HIV AIDS (IRIN, 2010).   In the GCC the low numbers are attributed to the deportation policy the people face if they are found with the HIV virus.

Economic impact of HIVAids in the Middle East
The impact of the epidemic on the economy is measured by looking into these four channels size and composition of labor force, productivity growth, health expenditure, and the saving rates of the economy. There are various types of labor which are considered and they include skilled, unskilled, and unemployed. Other channels like lowered human capital is also considered. Evaluation of all the above factors will give a clear insight on the effects of HIV AIDS in the region. The main routes of spread are through infected needles by injecting drug users, and through having sexual intercourse (Akala  Jenkins, 2005).

The figures got from this region are relatively low as compared to Africa, South, and Southeast Asia, and the Caribbean regions. Low cases cannot be equated to low risk of getting the disease. Insufficient surveillance methods which are common weaknesses in the region can ignore outbreaks in the marginalized social groups. Although the prevalent rate of HIV AIDS is low, this situation can change as it had occurred in Indonesia and Nepal (Chelala, 2009).

In countries which are severely affected by HIVAids pandemic, the heartbreaking and sudden loss of parents and productive citizens affects families, farms, other places of work like schools, health systems, and finally governments. The epidemic affects all aspects of life. Household is the first victim to feel the effect of HIV AIDS. Since it is the family members who provide care to the sick, they suffer financial difficulties. Since the condition takes long, there will be loss of income and also increased cost of caring for the sick which leaves most families unstable financially. Death of parents put children left behind in compromising situation of either supporting themselves or splitting up to go and stay with other relative. This also brings about break in the family unit (Cheemeh, Montoya, Essien,  Ogungbade, 2006).

Healthcare facilities also experiences massive demand as the disease spreads. The epidemic has already brought down health care facilities in the region, since these facilities have been very weak before the epidemic emerged. Expenses are on the rise for treatment of AIDS and AIDS related illnesses. Since the resources are always scarce, massive allocations to AIDS cases can result in ignoring other health related issues since public funds for healthcare will become scarce. Other costs related to health care are then left to households and private sector to look for (Abrahams, 2007).

Business and agriculture also suffer from the impact of HIV AIDS epidemic. Employers get affected through the loss of workers, frequent absenteeism due to illness, the increasing cost of providing health care benefits, and payment of benefits to dead workers. The economic survival of small farms and commercial agriculture is also affected with the loss of workers through death. Studies also indicate that in countries seriously affected by AIDS, the agricultural labor force is likely to reduce by 10 to 26 by 2020. Another study showed that countries with slow agricultural growth are likely to experience increasing food insecurity in the future (UNAIDS, 2009).  In addition to the influence on cumulative economic performance, persons working in some sectors within the economy are likely to be susceptible to HIVAids. People working in sectors that involve mobile and sex segregated labor, like trucking, fishing, and military sectors, healthcare sectors, and tourism sector since it is very sensitive to ill health.

The costs associated with HIVAids in this region can be said to underestimate owing to the fact that there is lack of strict reporting regulation. The impact of HIVAids in human can be equated to infinity since it ranges from the pain which people feel when one dies of AIDS or when found positive and the guilt surrounding personal and intimate relationships to shaken social and political security which affects the government. Even though human costs can not be measured, it is necessary to asses the costs and losses that can be quantified since they are also important and can have a great impact on a countrys economy (Akala  Jenkins, 2005).

Using the latest published estimates of HIV prevalence in Middle East countries, losses in gross domestic product and consumption due to the spread of HIV AIDS can be important in many Middle East countries.  From the data obtained from 9 Middle East countries, calculations from broad range of situations shows that the average growth rate of potential gross domestic product could be lowered by 0.2 to 1.5  per year for the period of 23 years starting from 2002. The predicted losses of possible productivity and utilization during that period could be equated to 35 of the current gross domestic product even with the conservative assumptions. Theses losses result from increasing mortality and morbidity which in turn lowers the labor productivity and capital investment, the labor force is also reduced (Al-Jarady, 2008).

The analysis also indicates that there could be a significant increase in money used in seeking health services. It is also projected that by 2015, annual expenditure in treatment of all AIDS patients shall have risen to 1.2  of current GDP even with strict use of antiretroviral drugs. It is likely to find situations in which HIV AIDS related expenses rises beyond 5  of GDP (Al-Jarady, 2008).

In countries where adequate HIV AIDS control measures have not been put in place, the impact of the disease has been quite devastating. In the worst situations, teachers die at a faster rate than they can acquire training, health workers gets infected frequently leading to canceling and evening crippling of healthcare services, and farmers are left unable to maintain normal agricultural productivity. In most cases, military gets affected as it is common in most countries to an extent that defense functions are severely affected. The major cause of the spread of the disease among military officers is linked to military measures taken as a result of political instability (Cheemeh, Montoya, Essien  Ogungbade, 2006).

Health and development benefits showed in increased life expectancy in third world countries are lost, many children are left without parents, families savings and property are lost, and since there is uncontrolled segregation and stigma associated with the disease, the customary safety nets based on relationship and community support are eliminated. Although both the rich and the poor can get infected, the rich people adapt so easily. Illiteracy in the community raises the prevalence rate of the disease since the people involved cannot get information and essential services, stuck in unsteady survival conditions, or even without authority to change their lifestyle. Women who are unstable economically cannot bargain safety in their intimate relationships. Survival and prevention of HIV among the society is only possible when the governments discuss the issue openly, provide relevant information and services, and collaborate with organizations representing the affected communities (Rosenthal, 2006).

Possible preventive measures
The results on the infection rate of HIV AIDS in the Middle East made the executive director of UNAIDS to plead with the leaders from this region to talk about the AIDS situation in this region. The effects of the disease are still not visible in the region and this makes it impossible to make any progress. Until the stigma associated with the disease is challenged and the people living with HIV AIDS come out openly to participate in community based AIDS response, nothing much will be achieved (Abrahams, 2007).

Although the surveillance report on HIV AIDS in the region is giving fewer figures, they are at risk. Medicines for HIV AIDS have been made available in several countries in the region with some governments providing antiretroviral drugs free of charge or at a reduced price. According to world reports, these drugs are still not found easily in the Middle East which calls for immediate action. The figures show that only about 5 of the people who need these drugs get them. There is also need to mobilize infected people to seek medical attention early enough (Akala  Jenkins, 2005).

Since knowledge on AIDS is still inadequate and stigma and discrimination still exist in this region, there is need for greater visibility and more effort to be put in place to encourage people to discuss AIDS issues openly. In the whole region, governments and non governmental organizations have started good projects so as to eliminate the silence on AIDS matters, disseminate the information, encourage prevention, and provide needed care and treatments for those already sick (Chelala, 2009).

Conclusion
Although the present data indicates low prevalence of the disease in Muslim countries, the truth is that the disease is present and is posing great threat to the economic development. Unless people embrace the efforts to control this disease, suffering will continue. Some of the recommendations to help reduce the prevalence rates include incorporating the HIV Aids education as part of the charity giving, domestic and international anti Aids war be planned and implemented as soon as possible, and finally there is need to reach out for the most vulnerable individuals in the society and stop the continued spread of the disease.