New UN Report Estimates Over One-Third Of Today's 15-Year-Olds Will Die Of Aids In Worst-Affected Countries
- HIV/AIDS is causing dramatic shifts in demographics, with long-ranging social consequences for hardest-hit nations
- Massive increase in resources needed to reduce the epidemic's spread and impact
The ongoing spread of HIV in the world's hardest-hit regions, particularly in sub-Saharan Africa, is reversing years of declining death rates, causing drastic rises in mortality among young adults and dramatically altering population structures in the most affected regions.
While the epidemic of HIV, the virus that causes AIDS, is stabilizing in many high-income countries, as well as in a handful of developing nations, HIV prevalence rates among 15-49-year-olds have now reached or exceeded 10% in 16 countries, all of them in sub-Saharan Africa.
As high as these rates are, they greatly understate the demographic impact of AIDS. The probability of dying of AIDS is systematically higher than prevalence rates indicate. Conservative new analyses show that this is true even if countries manage to cut the risk of becoming HIV-infected in half over the next fifteen years. For example, where 15% of adults are currently infected, no fewer than a third of today's 15-year-olds will die of AIDS. In countries where adult prevalence rates exceed 15%, the lifetime risk of dying of AIDS is even greater, assuming again that successful prevention programmes manage to halve the HIV risk.
- In countries such as South Africa and Zimbabwe, where a fifth or a quarter of the adult population is infected, AIDS is set to claim the lives of around half of all 15-year-olds.
- In Botswana, where about one in three adults are already HIV-infected -- the highest prevalence rate in the world -- no fewer than two-thirds of today's 15-year-old boys will die prematurely of AIDS.
These findings are contained in a new United Nations report that shows that current trends in HIV infection will increasingly have an impact on rates of infant, child and adult mortality, life expectancy and economic growth in many countries. The latest Report on the global HIV/AIDS epidemic, which includes a country-by-country update on the global epidemic, was prepared by the Joint United Nations Programme on HIV/AIDS (UNAIDS), and released today in advance of the XIIIth International AIDS Conference being held in Durban, South Africa, from 9 to 14 July.
Speaking at the release of the report in Geneva, Peter Piot, Executive Director of UNAIDS, warned: "The AIDS toll in hard-hit countries is altering the economic and social fabric of society. HIV will kill more than one-third of the young adults of countries where it has its firmest hold, yet the global response is still just a fraction of what it could be. We need to respond to this crisis on a massively different scale from what has been done so far."
Long-term demographic impacts threaten social stability
In developing countries, where HIV transmission occurs mainly through unsafe sex between men and women, the majority of infected people acquire HIV by the time they are in their 20s and 30s and, on average, succumb to AIDS around a decade later. The resulting decrease in the productive workforce and proportional increase in citizens in the oldest and youngest age groups -- those most likely to require aid from society -- is becoming a key contributor to social instability.
- So far, a total of 13.2 million children under 15 have lost their mother or both parents to AIDS since the epidemic began.
- The epidemic is undermining basic learning in certain parts of Africa: diminishing funds for school fees, forcing young people into the workforce earlier, and claiming the lives of teachers well before retirement age. In Côte d'Ivoire, 7 out of 10 teacher deaths are due to HIV. In 1998, Zambia lost 1300 teachers in the first ten months of the year -- equivalent to two-thirds of the new teachers trained each year.
- Agriculture, which in many developing countries provides a living for as much as four-fifths of the population, is suffering serious disruption. In West Africa, for example, reduced cultivation of cash crops and food products is reported.
- Business is already seeing the impact of AIDS on their bottom line. On an agricultural estate in Kenya, new AIDS cases and health spending showed a massive ten-fold increase over a recent 8-year period.
- Increased demand for health care for HIV-related illness is taxing overstretched health services. In countries from Thailand to Burundi, HIV-positive patients are occupying 40-70% of the beds in big city hospitals. At the same time, the health sector is increasingly losing its own human resources to AIDS. One study in Zambia found a 13-fold increase in deaths in hospital staff, largely due to HIV, over a ten-year period.
"Because of AIDS, poverty is getting worse just as the need for more resources to curb the spread of HIV and alleviate the epidemic's impact on development is growing. It's time to make the connection between debt relief and epidemic relief," said Dr. Piot. "Developing countries, who carry 95% of the HIVAIDS burden, owe in total around US$ 2 trillion. But Africa is the priority because this is the region with the most HIV infections, the most AIDS deaths, and the vast majority of the world's heavily indebted poor countries.
"African governments are paying out four times more in debt service than they now spend on health and education. If the international community relieves some of their external debt, these countries can reinvest the savings in poverty alleviation and AIDS prevention and care. If not, poverty will just continue to fan the flames of the epidemic."
HIV infection rates continue to increase in many countries
In sub-Saharan Africa, where the most severe epidemics are to be found, UNAIDS and the World Health Organization (WHO) estimate that some 24.5 million adults and children are now living with HIV, and that the proportion of 15-49-year-olds infected with the virus is still increasing in most countries. In countries such as Cameroon, Ghana and South Africa -- which now has 4.2 million people living with HIV/AIDS, the highest number in the world -- the adult prevalence rate has shot up by more than half in the past two years.
In all countries of the region, HIV prevalence rates in young women aged 15-24 are higher -- typically two or three times higher -- than those for young men the same age. In the 15-19 age bracket, the sex differential is even wider. Girls who consent or are coerced into early intercourse are especially vulnerable to infection, not only because of their immature genital tract but because they often have older partners, who are more likely to be infected.
On other continents, too, the epidemic has not lost its momentum.
- Determined HIV prevention programmes in several countries in Asia and Latin America have, for now, stemmed what threatened to be a massive rise in heterosexual infection rates. However, unsafe sex between men and women is contributing to a growing epidemic in some populous states of India where more than 2% of 15-49-year-olds are infected. Heterosexual transmission also dominates in the Caribbean, where the Bahamas and Haiti have adult HIV prevalence rates higher than anywhere in the world outside Africa.
- HIV is becoming more firmly entrenched among injecting drug users and men who have sex with men. Globally, injecting drug users continue to be exposed to the virus, and in many places at least one in three is infected. Over the past two years, the relative increase in the proportion of adults living with HIV has been steep in the Baltic states, but the number of infections is far higher and still growing in the Russian Federation and in Ukraine, where around 1 adult in 100 is now infected nationwide. Among men who have sex with men, the prevalence of HIV is 15-20% in many places and there is no sign that the rate of new infections is slowing down.
- AIDS deaths have declined drastically in high-income countries and parts of Latin America thanks to expensive therapy with antiretroviral drugs. However, there is good evidence that -- as a result of complacency and other factors -- risky sexual behaviour is on the rise. In San Francisco, the proportion of gay men reporting multiple partners and unprotected anal sex rose between 1994 and 1998, in parallel with a steep rise in rectal gonorrhoea after years of falling trends.
Signs of hope, but response needs urgent and massive expansion
While the overall picture is a sobering one, the UNAIDS report presents new information showing once again that the world is not helpless against the epidemic. Countries that tackled the epidemic with sound approaches years ago are already reaping the rewards in the form of falling or low and stable HIV rates, greater inclusiveness of people already affected by HIV or AIDS, and diminished suffering. Countries that began to apply those approaches more recently can look forward to similar gains.
- As a result of AIDS education and information campaigns, there is an encouraging increase -- though by no means sufficient -- in the number of young people using the full range of prevention approaches, from delaying their sexual debut to having fewer casual partners and engaging in protected sex.
- Developing countries and donor agencies are increasingly looking on AIDS-related care as a good investment having direct benefits for people with HIV/AIDS and indirect spin-offs for AIDS prevention in the wider community. Collaborative ventures of various kinds are opening the door to better access to care and support. In Latin America and the Caribbean, for example, a multicountry survey on the prices being paid for HIV-related drugs and commodities brought major price differences to light and led to reductions through negotiations with pharmaceutical companies.
- Inspired by Thailand's successful campaign, Cambodia launched a pilot programme in Sihanoukville promoting "100% condom use" in commercial sex. In just two years, 65-75% of male clients (military, police and motorbike taxi drivers) were reporting that they always used condoms with commercial partners -- up from less than 55% -- while similar high rates were reported by brothel-based sex workers.
- Experience from Malawi and Uganda shows that micro-credit schemes can work very successfully even in communities with high HIV prevalence. These schemes, which grant small loans to individuals who want to start up a small business and who seem likely to be able to repay, could play a greater role in alleviating poverty and mitigating the economic impact of AIDS.
- Condom use for first intercourse has become impressively high in Brazil, where the government has taken an active lead in HIV prevention, care and protection of the rights of people affected by AIDS. In 1986 less than 5% of young men reported using a condom the first time they had sex. The figure in 1999 was close to 50% -- and among men with higher education, it was over 70%.
- In Zambia, new surveillance data from the capital Lusaka show that the proportion of pregnant girls aged 15-19 infected with HIV dropped by almost half over the past six years. This holds out hope that Zambia might follow the course charted by Uganda, where a decline in infection rates in young urban women heralded the turnaround in the epidemic. Uganda's nationwide rate of adult HIV prevalence has now fallen to just over 8% from a peak of close to 14% in the early 1990s.
"Achievements like these keep hope alive by proving that the world is not powerless against the epidemic," said Dr. Piot. "But up to now the gains have been scattered, not systematic. We need an all-out effort to turn the tide of the epidemic everywhere, with a massive increase in resources from domestic budgets and international development assistance."