Journal of Population Economics

, Volume 28, Issue 4, pp 1097–1135 | Cite as

Demographic consequences of HIV

  • Martin Karlsson
  • Stefan PichlerEmail author
Original Paper


In this study, we estimate the effect of the HIV epidemic on demographic outcomes in three countries in Sub-Saharan Africa. We apply the synthetic control group method and estimate the consequences for life expectancy, mortality, and birth rates. According to standard measures of fit, the method seems to perform well for all countries and outcomes. Our results show a large effect on life expectancy and mortality in two countries, and a small and insignificant effect on birth rates. The impact of the pandemic is very heterogeneous. In Mozambique, the impact of HIV on life expectancy and mortality appears to have been surprisingly small. This heterogeneity is not due to AIDS causing fewer deaths in Mozambique than in the two other countries. Instead, the net effect of HIV in Mozambique appears to be diminished by reduced mortality for other causes—in particular child mortality, respiratory infections, and injuries.


HIV AIDS Mortality Life expectancy Fertility Synthetic control groups 

JEL Classification

I15 J11 O15. 



We would like to thank Emily Oster for making HIV prevalence data available. Moreover, we thank Annika Lindskog for excellent comments and Christian Brückner for research assistance. Finally, we thank two anonymous referees for their help and guidance. We take responsibility for all remaining errors in and shortcomings of the article.


  1. Abadie A, Diamond A, Hainmueller J (2010) Synthetic control methods for comparative case studies: Estimating the effect of California’s tobacco control program. J Am Stat Assoc 105(490):493–505CrossRefGoogle Scholar
  2. Abadie A, Gardeazabal J (2003) The economic costs of conflict: a case study of the Basque Country. The Am Econ Rev 93(1):113–132CrossRefGoogle Scholar
  3. Arrehag L, De Vylder S, Durevall D, Sjöblom M (2006) The impact of HIV/AIDS on livelihoods, poverty and the economy of Malawi Sida Studies no 18Google Scholar
  4. Becker G, Murphy K, Tamura R (1990) Economic growth, human capital and population growth. J Political Econ 98(5):S12–S137CrossRefGoogle Scholar
  5. Bell C, Devarajan S, Gersbach H (2006) The long-run economic costs of AIDS: a model with an application to South Africa. The World Bank Econ Rev 20(1):55CrossRefGoogle Scholar
  6. Bloemen S (2012) In a major policy shift, mothers in South Africa are encouraged to exclusively breastfeed instead of using formula. Unicef NewslineGoogle Scholar
  7. Bloom D, Mahal A (1997) Does the AIDS epidemic threaten economic growth J Econ 77(1):105–124CrossRefGoogle Scholar
  8. Bloom D, Sachs J, Collier P, Udry C (1998) Geography, demography, and economic growth in Africa. Brook Pap Econ Act 1998(2):207–295CrossRefGoogle Scholar
  9. Bongaarts J, Pelletier F, Gerland P (2010) How many more AIDS deaths. The Lancet 375(9709):103–104CrossRefGoogle Scholar
  10. Booysen F (2006) Out-migration in the context of the HIV/AIDS epidemic: evidence from the Free State province. J Ethn Migr Stud 32(04):603–631CrossRefGoogle Scholar
  11. Chen H (2010) Life expectancy, fertility, and educational investment. J Popul Econ 23(1):37–56CrossRefGoogle Scholar
  12. Coovadia HM, Rollins NC, Bland RM, Little K, Coutsoudis A, Bennish ML, Newell M-L (2007) Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. The Lancet 369(9567):1107–1116CrossRefGoogle Scholar
  13. Cutler D, Deaton A, Lleras-Muney A (2006) The determinants of mortality. The J Econ Perspect 20(3):97–120CrossRefGoogle Scholar
  14. Deaton A (2008) Income, health and wellbeing around the world: evidence from the Gallup World Poll. The J Econ Perspect 22(2):53CrossRefGoogle Scholar
  15. Decosas J, Adrien A (1996) Migration and HIV. AIDS (London England) 11:S77—84Google Scholar
  16. Duijts L, Jaddoe VW, Hofman A, Moll HA (2010) Prolonged and exclusive breastfeeding reduces the risk of infectious diseases in infancy. Pediatrics 126(1):e18–e25CrossRefGoogle Scholar
  17. Durevall D, Lindskog A (2011) Uncovering the impact of the HIV epidemic on fertility in Sub-Saharan Africa: the case of Malawi. J Popul Econ 24(2):629–655CrossRefGoogle Scholar
  18. Ellis M, Muschkin C (1996) Migration of persons with AIDS: search for support from elderly parents. Soc Sci & Med 43(7):1109–1118CrossRefGoogle Scholar
  19. Fabiani M, Nattabi B, Ayella E, Ogwang M, Declich S (2006) Differences in fertility by HIV serostatus and adjusted HIV prevalence data from an antenatal clinic in northern Uganda. Trop Med & Int Health 11(2):182–187CrossRefGoogle Scholar
  20. Fink G, Linnemayr S (2008) HIV education and fertility: long term evidence from Sub-Saharan Africa Working paper. Harvard School of Public HealthGoogle Scholar
  21. Fogel R (2004) The escape from hunger and premature death, 1700–2100: Europe, America, and the Third World. Vol. 38. Cambridge University PressGoogle Scholar
  22. Food and Nutrition Council (2010) Zimbabwe National Nutrition Survey 2010 Ministry of Health and Child WelfareGoogle Scholar
  23. Forouzanfar MH, Foreman KJ, Delossantos AM, Lozano R, Lopez AD, Murray CJ, Naghavi M (2011) Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis. The Lancet 378(9801):1461–1484CrossRefGoogle Scholar
  24. Fortson J (2009) HIV/AIDS and fertility. Am Econ J Appl Econ 1(3):170–194CrossRefGoogle Scholar
  25. Fortson JG (2011) Mortality risk and human capital investment: the impact of HIV/AIDS in Sub-Saharan Africa. The Rev Econ Stat 93(1):1–15CrossRefGoogle Scholar
  26. Frankema E, Jerven M (2014) Writing history backwards or sideways: towards a consensus on African population, 1850–2010. The Econ History Rev 67:907–931CrossRefGoogle Scholar
  27. Fung K, Krewski D, Burnett R, Dominici F (2005) Testing the harvesting hypothesis by time-domain regression analysis. J Toxicol Environ Health Part A 68(13–14):1137–1154CrossRefGoogle Scholar
  28. Gaffeo E (2003) The economics of HIV/AIDS: a survey. Dev Policy Rev 21(1):27–49CrossRefGoogle Scholar
  29. Gregson S, Garnett GP, Nyamukapa CA, Hallett TB, Lewis JJ, Mason PR, Chandiwana SK, Anderson RM (2006) HIV decline associated with behavior change in eastern Zimbabwe. Sci 311(5761):664–666CrossRefGoogle Scholar
  30. Hinrichs P (2012) The effects of affirmative action bans on college enrollment, educational attainment, and the demographic composition of universities. Rev Econ Stat 94(3):712–722CrossRefGoogle Scholar
  31. Iliffe J (2006) A history of the African AIDS epidemic Athens. Ohio University PressGoogle Scholar
  32. Juhn C, Kalemli-Ozcan S, Turan B (2013) HIV and fertility in Africa: first evidence from population based surveys. J Popul Econ 26(3):835–853CrossRefGoogle Scholar
  33. Kalemli-Ozcan S (2012) AIDS, reversal of the demographic transition and economic development: evidence from Africa. J Popul Econ 25(3):871–897CrossRefGoogle Scholar
  34. Karlsson M, Nilsson T, Pichler S (2014) The impact of the 1918 Spanish flu epidemic on economic performance in Sweden: an investigation into the consequences of an extraordinary mortality shock. J Health Econ 36:1–19CrossRefGoogle Scholar
  35. Lagarde E (2007) Road traffic injury is an escalating burden in Africa and deserves proportionate research efforts. PLoS Med 4(6):170CrossRefGoogle Scholar
  36. Lurie MN (2006) The epidemiology of migration and HIV/AIDS in South Africa. J Ethn Migr Stud 32(4):649–666CrossRefGoogle Scholar
  37. Manning P (2010) African Population Projections, 1850–1960. Ohio University PressGoogle Scholar
  38. McNeill W (2010) Plagues and peoples Random House Digital IncGoogle Scholar
  39. Mesnard A, Seabright P (2009) Escaping epidemics through migration? Quarantine measures under incomplete information about infection risk. J Public Econ 93(7):931–938CrossRefGoogle Scholar
  40. Miotti PG, Taha TE, Kumwenda NI, Broadhead R, Mtimavalye LA, Van der Hoeven L, Chiphangwi JD, Liomba G, Biggar RJ (1999) HIV transmission through breastfeeding: a study in Malawi. The J Am Med Assoc (JAMA) 282(8):744–749CrossRefGoogle Scholar
  41. Montalvo J (2011) Voting after the bombings: a natural experiment on the effect of terrorist attacks on democratic elections. Rev Econ Stat 93(4):1146–1154CrossRefGoogle Scholar
  42. Newell M-L, Coovadia H, Cortina-Borja M, Rollins N, Gaillard P, Dabis F (2004) Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis. The Lancet 364(9441):1236–1243CrossRefGoogle Scholar
  43. Ng M, Freeman M, Fleming T et al (2014) Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. The J Am Med Assoc (JAMA) 311(2):183–192CrossRefGoogle Scholar
  44. OECD (2005) Trends in International Migration Annual Report 2004 Paris OECDGoogle Scholar
  45. Oster E (2012) Routes of infection: exports and HIV incidence in Sub-Saharan Africa. J Eu Econ Assoc 10(5):1025–1058CrossRefGoogle Scholar
  46. Division Population (2012) World mortality report 2011 United Nations Department of Economic and Social AffairsGoogle Scholar
  47. Rajaratnam JK, Marcus JR, Flaxman AD, Wang H, Levin-Rector A, Dwyer L, Costa M, Lopez AD, Murray CJ (2010) Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970–2010: a systematic analysis of progress towards millennium development goal 4. The Lancet 375(9730):1988–2008CrossRefGoogle Scholar
  48. Rollins NC, Ndirangu J, Bland RM, Coutsoudis A, Coovadia HM, Newell M-L (2013) Exclusive breastfeeding, diarrhoeal morbidity and all-cause mortality in infants of HIV-infected and HIV uninfected mothers: an intervention cohort study in KwaZulu Natal, South Africa. PloS one 8(12):e81307CrossRefGoogle Scholar
  49. Rosling H (2014) Total population for countries and territories. Gap Minder dataset retrieved from Accessed 18 May 2014.
  50. Shapira G (2013) How subjective beliefs about HIV infection affect life-cycle fertility: evidence from rural Malawi. Policy Research Working Paper 6343 The World Bank Development Research Group Human Development and Public Services TeamGoogle Scholar
  51. Siegel S (1956) The Mann-Whitney U test Nonparametric Statistics for the Behavioral SciencesGoogle Scholar
  52. Soskolne V, Shtarkshall RA (2002) Migration and HIV prevention programmes: linking structural factors, culture, and individual behaviour: an Israeli experience. Soc Sci & Med 55(8):1297–1307CrossRefGoogle Scholar
  53. Statistics South Africa (2013) Mortality and causes of death in South Africa, 2010: Findings from death notification. Statistical release P0309.3, Statistics South AfricaGoogle Scholar
  54. The World Bank (2011) World development indicators The Wold Bank IEC information Center Development data groupGoogle Scholar
  55. UN Population Division (2004) The Impact of AIDS. Economic and social analysis of technology. United NationsGoogle Scholar
  56. UNAIDS (2013) AIDS by the numbersGoogle Scholar
  57. UNDP (2013) Trends in International Migrant Stock: migrants by destination and origin United Nations Department of Economic and Social AffairsGoogle Scholar
  58. Nations United (2013) World Fertility Data 2012 United Nations Department of Economic and Social Affairs Population DivisionGoogle Scholar
  59. Victoria C et al (2000) Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet (British edition) 355(9202):451–455Google Scholar
  60. World Health Organization (2003) Global strategy for infant and young child feedingGoogle Scholar
  61. World Health Organization (2004) The World Health Report 2004 Changing History. World Health OrganizationGoogle Scholar
  62. World Health Organization (2008) HIV transmission through breastfeeding: a review of available evidence: 2007 update World Health Organization GeneveGoogle Scholar
  63. World Health Organization (2009) Global data bank on infant and young child feedingGoogle Scholar
  64. World Health Organization (2010a) Guidelines on HIV and infant feeding 2010: principles and recommendations for infant feeding in the context of HIV and a summary of evidence World Health Organization, Geneva, SwitzerlandGoogle Scholar
  65. World Health Organization (2010b) The state of breastfeeding in 33 countries. World Health OrganizationGoogle Scholar
  66. World Health Organization (2014) The top ten causes of death-fact sheet n310World Health Organization GenevaGoogle Scholar
  67. Young A (2005) The gift of the dying: the tragedy of AIDS and the welfare of future African generations. Quart J Econ 120(2):423–466Google Scholar
  68. Young A (2007) In sorrow to bring forth children: fertility amidst the plague of HIV. J Econ Growth 12(4):283–327CrossRefGoogle Scholar
  69. Zuberi T, Bangha M W (2006) The history and future of African census analysis project Louvain—Censuses New trends, new formulasGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.CINCHUniversity of Duisburg-EssenEssenGermany
  2. 2.ETH Zurich, KOF Swiss Economic InstituteZurichSwitzerland

Personalised recommendations