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Health Equity in Africa

HIV/AIDS and the KZN economy: Spatial and Sectoral Considerations, Policy Implications and Recommendations – KHIS (KwaZulu-Natal HIV and Surveillance and Impact Study)

HIV/AIDS and the KZN economy: Spatial and Sectoral Considerations, Policy Implications and Recommendations – KHIS (KwaZulu-Natal HIV and Surveillance and Impact Study)


The impacts on the business sector of HIV-related mortality and morbidity include decreased productivity, rising production costs and a higher employee turnover. At the same time, employers have been under growing pressure to respond to the epidemic by providing prevention and treatment services to their employees.

The overall purpose of this project is to determine the impact that HIV is having now and in the future on the business sector in KZN and to make recommendations to mitigate this impact.

Part 1 of the project consists of conducting workplace HIV prevalence and knowledge, attitude and practice (KAP) surveys in four sectors (Manufacturing, Tourism, Agriculture and Transport) of the KZN economy. These surveys provide information on the extent and distribution of HIV amongst the workforce which may be used as a basis for HIV/AIDS-related planning.

This includes informing interventions to address prevention, treatment, care and support, as well as to inform forecasting and budgeting for human resource management and treatment and support needs. The information also provides a baseline against which to monitor and evaluate change over time.

Part 2 of the project is an economic assessment of the impact of HIV and AIDS on the KZN economy and the people in the province. The purpose of this assessment is to inform strategic economic planning within the business community and within the provincial and municipal governments.


  • To determine the prevalence and distribution of HIV and AIDS in four business sectors in KwaZulu-Natal
  • To conduct KAP (Knowledge, Attitude and Practice) surveys in companies within these sectors linked to HIV results
  • To investigate the relationship between HIV infection and selected demographic and KAP variables; to produce a report for the Department of Health and the Durban Chamber Foundation on the results and to make recommendations for interventions and ongoing monitoring and evaluation
  • To provide HIV voluntary counselling and testing services for employees wishing to know their status
  • To establish the economic impact of HIV and AIDS for the four sectors at provincial level and implications for the province.

Methodological Outputs:

For the HIV prevalence study, an anonymous, linked, cross-sectional study design is used. This study design is widely used globally and is recommended by the World Health Organisation (WHO). Companies from the 4 chosen sectors are invited to participate with the proviso that they have to fund half the cost of the study.

Within each participating company, employees are invited to complete questionnaires that obtain demographic information and information on knowledge levels, attitudes and behaviours related to HIV. They are also invited to provide blood droplets from finger-pricks for HIV testing.

All participation is voluntary but measures are taken to maximise participation in order to obtain unbiased and valid results. Voluntary counselling and testing for HIV is offered for free to those employees who wish to know their HIV status. The protocol for the HIV prevalence and KAP study is approved by the Ethics Committee of the University of the Witwatersrand.

The foundation for the economic impact assessment study is the HIV prevalence report and the modelling report that forecasts the HIV prevalence levels for the next ten years. The first step in the process is to develop a population/demographic model to capture the effects of AIDS on employees across different occupations.

An economic model is used to estimate and describe the extent to which certain demographic impacts caused by AIDS are affecting economic growth and poverty reduction in KZN. An innovative feature of the so-called computable general equilibrium (CGE) microsimulation economic model is that it captures the detailed industry structure of South Africa’s economy and the linkages between producers and households in order to estimate the impact of AIDS on both growth and poverty.

A key feature of this approach is that by capturing the main transmission mechanisms through which the effects of AIDS are mediated, we are able to approximate the main impacts on growth, poverty and inequality.