AIDS/HIV: The New Trends

AIDS/HIV is reversing decades of progress in improving the quality of life in developing countries. It has slashed life expectancies and forces choices between health and dozens of other investments vital for development. If AIDS affects 5% of the population, for example, total national spending on health will increase by 40%. (1)

AIDS Is the Number One Killer

Worldwide, 33.4 million people are infected with AIDS/HIV, including 1.2 million children. The incurable disease has claimed 13.9 million lives since the epidemic began, 3.2 million of them children. In 1998, 2.5 million people died of AIDS. (3) Fully 30% of all tuberculosis deaths are due to HIV/AIDS infections, and if those deaths are counted, AIDS in 2020 will be the single largest cause of adult death from infectious diseases. (4)

AIDS Is Spreading Fastest in the Developing World

By 1990, AIDS had already caused more adult deaths than malaria in the developing world. (3) By 2020, it will cause 37% of adult deaths due to infectious disease in those nations. (4)

New infection rates are slowing in most of the industrialized world, but 5.8 million infections still occurred in 1998, 70% of them in sub-Saharan Africa. A total of 22.5 million adults are infected there and 75% of all adult deaths result from AIDS or AIDS-related diseases. (3) The vast majority are age 20-50, the most productive years.

• In Botswana, 25% of all adults are HIV-positive. In Zimbabwe and Namibia the rate is 20%; Zambia 19%; Swaziland 18% and in several other African countries, 10% or more. (5)
• Women, the most important agents of development, are especially vulnerable because of social and economic inequality. In Africa, women under 25 have the fastest-rising infection rate. (1)
• In South and Southeast Asia, 6.7 million people now live with HIV/AIDS, while another 1.2 million became infected in 1998.

AIDS has slashed life expectancies in many developing nations. Average life expectancies increased from 40 years to 64 years by 1990 in most of the developing world. But AIDS has wiped out 2/3 of this advance in Burkina Faso and Cote d'Ivoire. (4)

• Botswana's 1990 life expectancy of 61 years has dropped to 47 years.
• In Zimbabwe, life expectancy was on course to reach 66 years by 2005, but because of AIDS, children born today can expect to live only 41 years. The population is expected to stop growing because of AIDS and by 2015 will be 19% smaller. (6)

AIDS Orphans Are a Growing Tragedy

More than 8 million children have lost one or both parents to AIDS since the epidemic began. In 23 countries studied by UNFPA, the number of these "AIDS orphans" is expected to double by 2000, and to reach 40 million by 2010. AIDS orphans typically suffer from malnutrition and are more likely to stop going to school, to have to support themselves and take on adult responsibilities in the home, and to leave home or lose their homes. Often they become street children. Girls may feel increased pressure to marry. (7) In Uganda, where HIV infection rates have fallen and apparently leveled off, AIDS orphans are estimated to number 1.7 million. (5)

Signs of Hope

Concerted government-led programs involving health education, promoting condom use and discouraging sexual promiscuity have slowed HIV infection rates in some poor nations including Thailand, Uganda and Brazil.

• In Thailand, a vigorous campaign involving brothels raised condom use to over 90%. The number of patients with STDs other than AIDS has dropped dramatically, and the HIV infection rate among army conscripts has dropped from 4% to less than 2%.
• In Nairobi, Kenya, a program that treated STDs of 500 prostitutes raised their condom use to 80% and is estimated to have prevented over 10,000 infections per year among their clients, clients' wives and other partners.
• In Brazil, condom sales rose from 406,000 in 1991 to nearly 27 million in 1996. (4)

Sources: (1) Speech given by Callisto Madavo, Vice President of World Bank's Africa Region, 12th World AIDS Conference, Geneva, June 30, 1998; (2) Judith Achieng, "African entrepreneurs take interest in AIDS prevention," Inter Press Service, July 25, 1998 (Nairobi: July 1998); (3) Joint UN Program on HIV/AIDS and World Health Organization, AIDS Epidemic Update: December 1998 (New York: December 1998), www.unaids.org/highband/document/epidemio/wadr98e.pdf; (4) "Confronting AIDS," World Bank Policy Research Report, (New York: Oxford University Press, October 1997); (5) Joint UN Program on HIV/AIDS and World Health Organization, Report on the Global HIV/AIDS Epidemic, June 1998, www.unaids.org/unaids/document/epidemio/june98/global%5Freport/index.html; (6) UN Department of Economic and Social Affairs, Population Division, World Population Estimates and Projections, 1998 Revision (New York: October 1998); (7) UNFPA, State of the World Population 1998 (New York: 1998).

September 1999