Impact of HIV/AIDS on Four Sectors in Zambia (Tourism, Agriculture, Health Care, and Judiciary)

Project Description

Three decades into the global HIV/AIDS pandemic, it is clear that the disease has not only clinical impacts, but also takes a significant human and economic toll on society. In Zambia, where adult HIV prevalence is estimated at 16%, mortality among working-aged men rose nearly fourfold between 1985 and 1995 and continued to increase over the rest of the decade. To estimate the extent to which HIV/AIDS affected the productivity and cost of labor in Zambia, the Center for Global Health & Development (CGHD) conducted a series of four sectoral impact assessments on Zambia’s tourism, agriculture, health care, and judicial sectors.


In 2005–2006, the CGHD and the Farming Systems Association of Zambia looked at the impact of HIV/AIDS on Zambia’s tourism industry, as represented by Sun International Zambia, the largest tourism company in Livingstone; small and medium-sized companies in the same city; and the Zambia Wildlife Authority (ZAWA). In the case of Sun International, the study found for each employee who died of AIDS-related causes, the average cost to the company was 3.5 times that employee’s average annual salary, but as early as 2005, many HIV-positive employees were already accessing effective treatment with antiretroviral therapy. For the smaller tourism companies, the loss of a skilled worker was estimated to cost just over one full year’s average annual salary, but there were relatively few AIDS-related deaths, and most managers ranked HIV well below other economic threats to their businesses. Unlike these private companies, ZAWA experienced both high AIDS-related mortality and very high direct and productivity costs, losing roughly 5% of its total service delivery capacity as a result.


While HIV/AIDS is still most prevalent in urban populations, a recent study found that one in ten rural Zambian adults was HIV-positive. There is a growing concern that labor shortages due to illness and death is limiting the output of Zambia’s farmers, impoverishing farming households, and suppressing growth in the agricultural sector. To gauge the degree to which this concern was justified, the CGHD conducted a survey of smallholder cotton farming households in Central Province. Based on the results of the survey, the CGHD estimates that almost half of the working-age adult deaths in these households were caused by HIV/AIDS. Households who had lost a member to premature death planted 11% less cotton and produced 16% less cotton. These crop losses at the household level deepened poverty and threatened the welfare of all family members.

Health Care

High AIDS death rates among doctors, nurses, and clinical workers is one of the major causes of the shortage of health professionals and places a major burden on the health care system in sub-Saharan Africa. In collaboration with Zambia’s Central Board of Health, the CGHD documented an annual death rate of 3.5% for nurses, 2.8% for clinical officers, and 0.4% for doctors at three sites in Zambia’s Lusaka and Kasama districts. In addition, in the year prior to death or retirement, these chronically ill health workers had much higher-than-average rates of absenteeism. The CGHD concluded that the most effective way to address this burden on the health care system would be through the provision of treatment to HIV-positive workers.


In 2006, with the cooperation of the Zambia Court System, the CGHD analyzed four years of personnel records of professionals working in various sectors of the judicial system (the High and Magistrate Courts nationwide, the Ministry of Justice, and police prosecutors in two districts), in order to estimate the impact of HIV/AIDS on the judicial system. The CGHD analysis found that there was a higher source of attrition from the court system due to chronic disease than normal retirement or resignation. The young median age of death suggests that AIDS was largely responsible. It is apparent that HIV/AIDS—in legal professionals, defendants, and key witnesses—is contributing to judicial delays. To respond to the impact HIV/AIDS is having on the judicial system in Zambia, the CGHD recommended that the government should assure the prompt testing and effective treatment of legal professionals.

This Project is one activity of CGHD’s Child and Family Applied Research project (CFAR).

Project Details

Principal Investigator Sydney Rosen, Bruce Larson, Rich Feeley
Collaborators Farming Systems Association of Zambia (FASAZ)
Country(ies) Zambia
Dates of Research 2003–2006