The electoral system in a democracy is the crucial institutional device 
through which opinions among the electorate are translated into seats and power in legislatures.
While much analytical attention has been spent on exploring how electoral systems differ in their construction and in terms of what democratic principles they entrench, little if any attention has been given to how sensitive they are to the effects of an epidemic such as HIV/AIDS (ibid.: 28).
The report suggests that the Westminster electoral model, or First-Past-the Post (FPTP), is more vulnerable to HIV/AIDS than the Proportional Representation (PR) system. The effects are felt in the process of replacing Members of Parliament who succumb to the disease (ibid.: 15). The FPTP has serious cost implications for sustainability; this system is particularly vulnerable as in most cases by-elections must be held in order to replace any members who die.
Preliminary evidence of by-elections generated by increased deaths and the cost of holding them is provided from three Southern African countries to underline this fact. While South Africa uses the PR method at national level, it does operate a hybrid system (FPTP and PR) at local level and might yet endure the effects of the disease.
Conversely, a pilot study by IDASA undertaken in 2003 in Zambia – which uses the FPTP electoral method – indicates that between 1964 and 1984 (the 20-year period before the advent of HIV/AIDS) a total of 46 by-elections were held, and 14 of those were a result of death by illness and accidents combined.
While over an 18-year period (from 1985, the year the first case of AIDS was documented in Zambia, to February 2003) 102 by-elections were held and 59 of those were due to death by disease. The majority of the 59 by-elections, a total of 39, were held between 1992 and February 2003, which coincidentally are the years in which the HIV/AIDS pandemic peaked in Zambia While there may be no specific information on the nature of the illnesses that led to the deaths of representatives, trend analyses can be indicative of the influence of the pandemic.” (ibid.: 15f).
The report notes that disease in general, and especially HIV/AIDS, will contribute to power shifts in countries operating the FPTP electoral model. The effect of illness, combined with vacancies generated by expulsions, resignations or floor crossing by members, has compelled Zimbabwe to hold 13 (+1) by-elections since the 2000 legislative polls.
Eight of the by-elections arose because parliamentary representatives had died prematurely of “illness”. The sum effect is that the opposition parties have lost the majority of the by-elections, partly perhaps due to their inability to perpetually compete with a well-resourced ruling party.” (ibid.: 16)
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