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HOME: STATE OF WORLD POPULATION 2002: HIV/AIDS and Poverty
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HIV/AIDS and Poverty

Overview
Devastating Impacts
Priorities for Action

Overview

HIV/AIDS is the deadliest and fastest spreading of the diseases of sex and reproduction. It poses a greater threat to development prospects in poor countries than any other disease. The impact is hardest among the poor, who have no economic cushion and the weakest social support of any group.

Twenty years after the first clinical evidence of AIDS, it has become the most devastating disease yet faced by humanity, striking, on average, 14,000 men, women and children daily, the leading cause of death in sub-Saharan Africa and the world's fourth biggest killer.

The disease spreads through infected blood products and drug abuse, but overwhelmingly by sexual contact, predominantly between men and women. Women are more vulnerable to infection for physiological and social reasons, and sex workers are far more likely than the population at large to be infected. But the sexual behaviour of men is largely responsible for spreading the disease.

More than 60 million people have been infected with HIV, and AIDS has already killed more than 20 million people, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS) and WHO (1). In sub-Saharan Africa alone, 3.5 million were newly infected in 2001.

An estimated 40 million people are living with the virus, over 28 million in Africa and almost 95 per cent in developing countries. It is spreading most rapidly now in Eastern Europe and Central Asia, where most new infections are among injecting drug users (2). India may have more than 4 million infected. Its prevalence in China is unknown, but it may be far more than the official estimate of about a million. Some estimates are as high as 6 million, with a possible 10 million by the end of the decade (3).

HIV can also be passed in utero from infected mothers to their children. About a third of infected mothers pass the disease to their children in this way.

UNAIDS and WHO now estimate that more than 4 million children under the age of 15 have been infected with HIV. Over 90 per cent were infants born to HIV-positive mothers and acquired the virus before or during birth or through breastfeeding.

These infections have resulted in an unprecedented increase in infant mortality, because HIV infection progresses quickly to AIDS in children and many of these children have died. Of the 580,000 children under the age of 15 who died of AIDS in 2001, 500,000-nearly nine out of ten-were African (4).

Half of new HIV infections are among young people aged 15-24, many of whom have no information or prevention services and are still ignorant about the epidemic and how to protect themselves. In studies of sexually active 15-19 year-olds in seven African countries, at least 40 per cent did not believe that they were at risk. In one country the figure was 87 per cent. At least 30 per cent of young people in 22 countries surveyed recently by UNICEF had never heard of AIDS; in 17 countries surveyed, over half of adolescents could not name a single method of protecting themselves against HIV. In all surveys, young women know less than young men, though young women are more vulnerable to infection (5).

In developing countries HIV/AIDS is destroying lives and livelihoods alike, wiping out decades of progress. Even in the industrial countries most infections are among the poor. No developed country has an AIDS epidemic even approaching those of the poor world (6).

"Economic and social changes … have created an enabling environment that places tens of millions of people at risk of HIV infection." (7) Initiatives that only "seek to change behaviour are insufficient to stem the epidemic. Determinants of the epidemic go far beyond individual volition." We will not stop the pandemic by treating it only as a disease. HIV/AIDS accompanies poverty, is spread by poverty and produces poverty in its turn.

The relationship between poverty and HIV transmission is not simple. If it were, South Africa might not have Africa's largest epidemic, for South Africa is rich by African standards. Botswana is also relatively rich, yet this country has the highest levels of infection in the world. While most people with HIV/AIDS are poor, many others are infected.

Poverty's companions encourage the infection: undernourishment; lack of clean water, sanitation and hygienic living conditions; generally low levels of health, compromised immune systems, high incidence of other infections, including genital infections, and exposure to diseases such as tuberculosis and malaria; inadequate public health services; illiteracy and ignorance; pressures encouraging high-risk behaviour, from labour migration to alcohol abuse and gender violence; an inadequate leadership response to either HIV/AIDS or the problems of the poor; and finally, lack of confidence or hope for the future (8).

Individuals, households and communities living with HIV/AIDS find that lost earnings, lost crops and missing treatment make them weaker, make their poverty deeper and push the vulnerable into poverty. The cycle intensifies.

Inequality sharpens the impact of poverty, and a mixture of poverty and inequality may be driving the epidemic. A South African truck driver is not well paid compared to the executives who run his company, but he is rich in comparison to the people in the rural areas he drives through. For the woman at a truck stop, a man with 50 rand ($10) is wealthy; her desperate need for money to feed her family may buy him unprotected sex, although she knows the risks.

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