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 programs manage to halve the HIV risk.
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 program on HIV/AIDS (UNAIDS), and released in advance of the XIIIth International AIDS Conference being held in Durban, South Africa, from 9 to 14 July.
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."
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.
"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 HIV/AIDS 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."
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.
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.
"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."
June 27, 2000
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