UNIVERSITY OF PENNSYLVANIA - AFRICAN STUDIES CENTER
Africa: HIV/AIDS update Date distributed (ymd): 981130 Document reposted by APIC
Region: Continent-Wide Issue Areas: +economy/development+ Summary Contents: This posting contains excerpts from an update from the Joint UN Programme on HIV/AIDS and the World Health Organization, noting that Sub-Saharan African countries are the hardest-hit by the epidemic. The full text of the report (in a pdf file), and additional information, can be found on the UNAIDS web site (http://www.unaids.org/highband/whatsnew.html). See also Aids in Africa (http://www.unaids.org/highband/fact/saepap98.html) and the AIDS background links at the South African internet provider iafrica.com (http://iafrica.com/doconline/hiv_and_aids.htm).
Another posting today provides background on malaria.
UNAIDS AIDS epidemic update December 1998 (excerpts)
ANATOMY OF THE EPIDEMIC
By the end of 1998, according to new estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), the number of people living with HIV (the virus that causes AIDS) will have grown to 33.4 million, 10% more than just one year ago. ...
More than 95% of all HIV-infected people now live in the developing world, which has likewise experienced 95% of all deaths to date from AIDS, largely among young adults who would normally be in their peak productive and reproductive years. ... Whether measured against the yardstick of deteriorating child survival, crumbling life expectancy, overburdened health care systems, increasing orphanhood, or bottom-line losses to business, AIDS has never posed a bigger threat to development.
According to new UNAIDS/WHO estimates, 11 men, women and children around the world were infected per minute during 1998 -- close to 6 million people in all. One-tenth of newly-infected people were under age 15, which brings the number of children now alive with HIV to 1.2 million. Most of them are thought to have acquired their infection from their mother before or at birth, or through breastfeeding.
While mother-to-child transmission can be reduced by providing pregnant HIV-positive women with antiretroviral drugs and alternatives to breastmilk, the ultimate aim must be effective prevention for young women so that they can avoid becoming infected in the first place. Unfortunately, when it comes to HIV infection, women appear to be heading for an unwelcome equality with men. While they accounted for 41% of infected adults worldwide in 1997, women now represent 43% of all people over 15 living with HIV and AIDS. There are no indications that this equalizing trend will reverse.
Altogether, since the start of the epidemic around two decades ago, HIV has infected more than 47 million people. And though it is a slow-acting virus that can take a decade or more to cause severe illness and death, HIV has already cost the lives of nearly 14 million adults and children.
An estimated 2.5 million of these deaths occurred during 1998, more than ever before in a single year.
AIDS and the infectious disease picture
According to recent WHO estimates, malaria causes over 1 million deaths a year. In 1998, AIDS deaths totalled some 2.5 million. Both diseases are among the five top killers worldwide. ...
Tuberculosis, the second biggest infectious killer, is also on the rise, driven in large part by the HIV epidemic. People whose immune defences are weakened by HIV infection become an easy prey for other microbes, including the bacillus that causes tuberculosis. ... Around 30% of all AIDS deaths result directly from tuberculosis. ...
Sub-Saharan Africa is home to 70% of the people who became infected with HIV this year. It is also the region in which four-fifths of all AIDS deaths occurred in 1998.
Africa, the global epicentre, continues to dwarf the rest of the world on the AIDS balance sheet. Since the start of the epidemic, 83% of all AIDS deaths so far have been in the region. Among children under 15, Africa's share of new 1998 infections was 9 out of 10. At least 95% of all AIDS orphans have been African.[UNAIDS defines AIDS orphans as people who lost their mother or both their parents to AIDS when they were under the age of 15.] Yet only a tenth of the world's population lives in Africa south of the Sahara.
The sheer number of Africans affected by the epidemic is overwhelming. Since HIV began spreading, an estimated 34 million people living in sub-Saharan Africa have been infected with the virus. Some 11.5 million of those people have already died, a quarter of them children. In the course of 1998, AIDS will have been responsible for an estimated 2 million African deaths -- 5500 funerals a day. And despite the scale of death, today there are more Africans living with HIV than ever before: 21.5 million adults and a further 1 million children.
While no country in Africa has escaped the virus, some are far more severely affected than others. The bulk of new infections continue to be concentrated in East and especially in Southern Africa.
The southern part of the African continent holds the majority of the world's hard-hit countries. In Botswana, Namibia, Swaziland and Zimbabwe, current estimates show that between 20% and 26% of people aged 15-49 are living with HIV or AIDS. South Africa, which trailed behind some of its neighbours in HIV infection levels at the start of the 1990s, is unfortunately catching up fast: one in seven new infections on the continent this year are believed to be in this one country. ...
Other areas of the continent are far from immune. One in ten adults or more are HIV-infected in Central African Republic, C"te d'Ivoire, Djibouti and Kenya. In general, however, West Africa is less affected by HIV than Southern or East Africa, and some countries in Central Africa have also seen HIV remain relatively stable. Early and sustained prevention efforts can be credited with these lower rates in some cases_Senegal provides a good example. ...
A HEALTH CRISIS AND BEYOND
Invisible no longer
In countries with mature epidemics_-- Uganda in East Africa, Zambia and Zimbabwe in Southern Africa, for example -- AIDS is leaving highly-visible damage in its wake. Some doctors report that three-quarters of beds on hospital paediatric wards are occupied by children ill from HIV. Millions of adults have died. Most have left behind orphaned children. Many have left surviving partners who are infected and in need of care. Their families struggle to find money to pay for their funerals, and their employers must now train other staff to replace them.
Wiping out the gains of development
Together, the epidemic's visible and less-visible consequences constitute an urgent and massive threat to development.
Life expectancy crumbles
Life expectancy at birth is one of the key measures that policy-makers look at to assess human development. Because of the extra deaths from AIDS in children and young adults, this indicator is giving off alarm signals. According to a just-released report prepared by the United Nations Population Division in collaboration with UNAIDS and WHO, the epidemic will wipe out precious development gains by slashing life expectancy.
The impact on life expectancy is proportional to the severity of the local epidemic. In Botswana, for example, where more than 25% of adults are infected, children born early next decade can expect to live just past their 40 th birthday. Had AIDS not been in the picture, they could have expected to live to the age of 70. Not surprisingly, between 1996 and 1997 Botswana dropped 26 places down the Human Development Index, a ranking of countries that takes into account wealth, literacy and life expectancy.
Taking the nine countries with an adult HIV prevalence of 10% or more (Botswana, Kenya, Malawi, Mozambique, Namibia, Rwanda, South Africa, Zambia and Zimbabwe), calculations show that AIDS will on average cost them 17 years of life expectancy. Instead of rising and reaching 64 years by 2010-2015, a gain which would be expected in the absence of AIDS, life expectancy will regress on average to 47 years.
Deteriorating child survival
The dismal decline in life expectancy is due not only to deaths of adults -- most of them young or in early middle age -- but also to child deaths. HIV is contributing substantially to rising child mortality rates in many areas of sub-Saharan Africa, reversing years of hard-won gains in child survival.
By 2005-2010, for example, 61 of every 1000 infants born in South Africa are expected to die before the age of one year. In the absence of AIDS, infant mortality would have been as low as 38 per 1000. With AIDS in the picture, the infant mortality rate in Namibia is projected to be 72 per 1000; without the epidemic the country could have expected a far lower rate of 45 per 1000.
Children on the brink
Zimbabwe offers a frightening window onto orphanhood, another aspect of the epidemic's development impact. In this nation, where over a quarter of the 5.5 million adults are HIV-infected, AIDS is already pushing hundreds of thousands of children to the brink.
The government estimates that in two years' time 2400 Zimbabweans a week will be dying of AIDS. Most of those deaths will be in adults, and they will be concentrated in the young adult ages when people are building up their families. What is more, they may be disproportionately concentrated among single women whose death would leave a child with no parent at all: one recent study in a farming area showed that single mothers, many of them widowed by AIDS, were twice as likely to be HIV-infected as married women.
As early as 1992, a study in Zimbabwe's third largest city, Mutare, recorded that over 10% of children in the study area were orphaned, and that nearly one household in five had taken in orphans. By 1995, an enumeration in the same area showed that the proportion of children who were orphaned had grown to nearly 15%.
The number of children in need of care is rising just as AIDS is cutting into the number of intact families able to provide such care. Some 45% of those caring for orphans are grandparents; often they have no income of their own, and there is a limit to how many children they can take on without outside help. One orphan-support programme reports helping an 80-year-old grandmother who lives with 12 children in a single room. Another has received a request for help from a widower with 9 dependants who has just inherited another 3 grandchildren to care for. A study of households headed by adolescents and children (some as young as 11) showed that while the overwhelming majority had lost both parents, most did have surviving relatives. However, in 88% of those cases, the relatives reported that they did not want to care for the orphans.
Children themselves are beginning to worry about orphanhood and to recognize the importance of supporting needy children. A majority of children interviewed in one study said that if orphans' needs were not met they would become delinquent. Many said the children would drift into prostitution and onto the streets. They also worried about abuse and exploitation of orphans by relatives. With reason. Reports of sexual abuse of girls have risen rapidly in recent years in Zimbabwe, prompting the establishment of a special clinic at a major Harare hospital and an initiative to promote child-friendly courts. In a single rural district of Zimbabwe one study recorded nearly 400 cases of child sexual abuse, at least a quarter of them girls under the age of 12, and at least 10% of them orphans.
AIDS and business: the bottom line suffers
The onslaught of AIDS is denting the prospects for economic development too. In the hard-hit countries of Africa, the epidemic is decimating a limited pool of skilled workers and managers and eating away at the economy. With many economies in the region in flux, it is hard to determine exactly what the impact of HIV is on national economies as a whole. However, it is clear that businesses are already beginning to suffer.
In Zimbabwe, for instance, life insurance premiums quadrupled in just two years because of AIDS deaths. Some companies say that their health bills have doubled. Several report that AIDS costs absorb as much as one-fifth of company earnings. In Tanzania and Zambia, large companies have reported that AIDS illness and death cost more than their total profits for the year. In Botswana, companies estimate that AIDS-related costs will soar from under 1% of the wage bill now to 5% in six years' time, because of the rapid rise in infection in the last few years.
HIV -- a threat to the world's young people
This year's World AIDS Campaign -- "Young people: Force for change"-- was prompted in part by the epidemic's threat to those under 25 years old. Young people are disproportionately affected by HIV and AIDS. Around half of new HIV infections are in people aged 15-24, the range in which most people start their sexual lives. ...
Research shows that young people adopt safer sexual behaviour provided they have the information, skills and means to do so. In Senegal, 40% of women under 25 and 65% of men used condoms with non-regular partners in 1997, compared with less than 5% for both sexes at the start of the decade.
"HIV/AIDS is among us"
South Africa, which in 1998 accounted for nearly 1 in 10 of the new HIV infections estimated to have occurred worldwide, is the latest country in the ranks of those seeking to break through the shroud of stigma and shine a light on the human disaster of AIDS.
"For too long we have closed our eyes as a nation, hoping the truth was not so real," South African Deputy President Thabo Mbeki told South Africans in October 1998. "For many years, we have allowed the human immunodeficiency virus to spread_ At times we did not know that we were burying people who had died from AIDS. At other times we knew, but chose to remain silent.
"[Now] we face the danger that half of our youth will not reach adulthood. Their education will be wasted," Mbeki said. "The economy will shrink. There will be a large number of sick people whom the healthy will not be able to maintain. Our dreams as a people will be shattered."
Appealing to South Africans to change "the way we live and how we love", Mbeki called for abstinence, fidelity and condom use, and urged a caring, non-discriminatory attitude to those already infected with or affected by HIV. The speech was nationally televised, and the whole nation was urged to stop work to listen to it. Many private companies gave workers a day off. Flags flew at half mast on government buildings and religious leaders, youth, trade unionists, women's organizations and business leaders committed themselves to the President's Partnership Against AIDS.
In some countries, leaders have spoken out loudly, clearly and repeatedly about AIDS, have sought to demystify it, and have encouraged discussion about safe sex everywhere from the classroom to the boardroom. It is in such countries --- of which Uganda is probably the best-known example in the developing world_that most progress has been made not just in putting a brake on new infections but in ensuring the well-being of those people who are already living with the virus.
For more information, please contact Anne Winter, UNAIDS, Geneva, (+41 22) 791.4577, mobile (+41 79) 213.4312, Lisa Jacobs, UNAIDS, Geneva, (+41 22) 791.3387 or Karen O'Malley, UNAIDS, New York, (+1 212) 899.5575. You may also visit the UNAIDS Home Page on the Internet for more information about the programme (http://www.unaids.org).
Note about UNAIDS/WHO estimates
The estimates concerning HIV and AIDS in this document are based on the information available to UNAIDS and WHO at the current time. They are provisional. WHO and UNAIDS, together with experts from national AIDS programmes and research institutions, keep these estimates under constant review with a view to updating them as improved knowledge about the epidemic becomes available and as advances are made in the methods used for deriving estimates.
From: firstname.lastname@example.org Date: Mon, 30 Nov 1998 21:00:46 -0500 Subject: Africa: HIV/AIDS Update
Editor: Ali B. Ali-Dinar
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