AS THE LEADING CAUSE of illness and death in sub-Saharan Africa, HIV and AIDS have become an added burden on already strained health care systems. The full extent is not yet apparent because of the latent period between infection and illness and death. Data on the effect of AIDS on health care systems are scarce, most studies being small and cross-sectional.

The main impact on adult health services appears to be increased hospital admissions, leading to ward overcrowding and possible exclusion of hiv-negative patients as a result. The increasing incidence of tb that accompanies hiv in southern Africa has also had an effect on hospital and other health care services. Increased mortality is seen in both patients infected with hiv and those who are not.

A disproportionate increase in the numbers of medical paediatric admissions against surgical admissions suggests that paediatric hiv is having an impact on paediatric health care services. Studies have found that hiv-positive children have more contact with health care services than those that are negative and mortality among those infected with hiv is consistently higher than among those who are not.

Treating intercurrent illness appears to be more costly among patients who are hiv positive than among those who are not infected. This was particularly the case for those co-infected with hiv and tb according to a study from Kenya.