The health delivery systems in the basin and the SADC region have been failing to cope with the rising number of AIDS patients, and thus many have to be cared for by their families and friends. In some cases, even where health care is available, low incomes and poverty force families to look after their sick relatives at home because they cannot afford hospital costs. Much as home-based care is recommended, it should be complimented with professional hospital care.

A critical issue is that the drugs, which are imported, are expensive for the majority. Others include the rising number of children orphaned by the disease, the loss of human capital, and the impact on the basin’s natural resources.

Orphans
SADC, in its recent declaration on HIV and AIDS seeks to strengthen family and community-based care as well as support to orphans and other vulnerable children. The heads of state who met in Lesotho in July 2003 noted that there are a number of best practices in the implementation of HIV and AIDS programmes. The best practices include interventions to prevent mother-to-child transmission, voluntary testing as well as anti-retroviral therapy to the infected parents and their children, and establishment and implementation of workplace HIV and AIDS prevention and management programmes. Most countries in the basin are making interventions aimed at reducing the burden on children, particularly those left behind by parents who succumb to AIDS.

Human capital
The prevalence of HIV and AIDS among people in southern Africa between the ages of 18 and 40 is estimated to be about 12 percent. The pressures this places on national budgets in allocations on health, education and social welfare can lead to a slowdown in economic growth. Realising the need for businesses to join forces in developing workplace programmes and policies, a number of private sector organistions have initiated programmes aimed at education and awarenessraising as well as prevention and coping with HIV and AIDS. There have been initiatives by the transport, banking, mining, tourism and other sectors to foster community spirit among employees, with some companies introducing flexi-time to allow employees to meet caring obligations of their relatives. There has been introduction of non-discriminatory policies, training and media campaigns by the private sector in most of the basin countries.

Impact on natural resources
In view of the current trends and prevalence of HIV and AIDS, it is quite challenging to predict the natural resources management regimes for the future.

A study by Hastings Chikoko on the uncertainty of natural resources management says the impact of HIV and AIDS is two-pronged – loss of human capacity and changes in the use of land and natural resources. The key impacts on natural resource management include:

• overuse of natural resources including medicinal plants, timber, and wildlife;
• changes in land use as agricultural practices change with falling capacity for heavy labour;
• changes in access to resources and land especially where widows and orphans cannot inherit land;
• loss of traditional knowledge of sustainable land and resource management practices;
• loss of human capacity for natural resources management in government, non-governmental organisations, academic institutions, communities, donor organisations, and private sector;
• increased vulnerability of Community Based Natural Resources Management (CBNRM) programmes as communities lose leadership and capacity, and HIV and AIDS issues take priority; and
• diversion of conservation funds for HIV and AIDS related costs.