AIDS now the Number One Cause of Death in Africa Close to 30 Million Have HIV A t the beginning of the 21st century, (HIV) - Human Immunodeficiency Virus which causes the Acquired Immune Deficiency Syndrome (AIDS) continues to have its greatest impact in the developing world. Although the full demographic impact is not expected to be felt for several more years, and perhaps will not be completely measured at the pandemic's epicenter in Sub- Saharan Africa, the emerging downward trends in life expectancy and population growth, and the breakdowns in support systems are already being seen in some countries. At the extreme in Southern Africa, Botswana, South Africa, and Zimbabwe are thought to be experiencing negative population growth due to AIDS mortality. AIDS is the number four cause of death globally but the number one cause of death in Africa. • If current trends in HIV seroprevalence (the proportion of population infected with HIV) continue into the near future and existing relationships between HIV infection rates and subsequent AIDS mortality continue to hold, the AIDS pandemic will dictate the size, growth, and age-sex structures of entire populations around the world. • The U.S. Census Bureau's modeling and projections work indicates that severe distortions in age-sex structures are likely in severely affected countries. In countries with moderate epidemics, AIDS mortality is expected to have less effect on the population structure. • Life expectancies in HIV/AIDS affected countries are projected to decline, negating gains achieved during the past several decades. By 2010, many countries in southern Africa are expected to see life expectancies falling to near 30 years of age, levels not seen since the beginning of the 20th century. • The most direct impact of AIDS is expected to be an increase in the number of deaths in populations affected. In many Sub- Saharan African countries, crude death rates are projected to be even higher in 2010 than in 2000, even though mortality due to non-AIDS causes will continue to decline. • Infant mortality rates are now higher than they were in 1990 in some Sub-Saharan African countries. In four Sub-Saharan African countries, more infants are likely to die from AIDS in 2010 than from all other causes. • In 26 Sub-Saharan African countries, under-5 mortality rates have increased over what they would have been without AIDS. Based on current trends, under-5 mortality rates in 2010 are expected to be much higher with AIDS than they would have been without AIDS. If programs to prevent mother-to-child transmission are dramatically scaled up, then the course of future child mortality rates can be changed. • By 2010, populations in the majority of Sub-Saharan African countries are projected to increase, despite the high levels of mortality. The exceptions are Botswana, Lesotho, Mozambique, South Africa, Swaziland, and Zimbabwe. The AIDS pandemic in the 21st century continues to have devastating impacts on populations, particularly in the developing world. Since the beginning of the epidemic two decades ago, more than 20 million people have died of AIDS. Twice that many - 40 million-are now living with HIV. Barring some major breakthrough, most of these people are expected to die during the next 10 years or so. In 2001, the Joint United Nations Programme on AIDS (UNAIDS) estimated that 5 million people were newly infected with HIV. Populations in Most Sub-Saharan African Countries Are Projected to Increase, in Spite of the High Levels of Mortality. The Exceptions Are Botswana, Lesotho, Mozambique, South Africa, and Swaziland Although AIDS mortality has resulted in lower growth rates, fertility is still high and population growth is still positive in most countries affected by AIDS. Such is the case for Uganda. However, the population in the most severely affected countries, such as Botswana and South Africa, is projected to decline over time, in that the population, by 2050, is likely to be lower than it was in 1990, even if current AIDS control programs result in lowering future HIV incidence and prevalence At the Beginning of the 21st Century, AIDS Is the Number One Cause of Death in Africa and Is Number Four Globally5 Just 20 years ago when AIDS first appeared, few would have predicted the current state of the pandemic, particularly in Sub-Saharan Africa. That over 30 percent of adults would be living with HIV/AIDS in any country was unthinkable. Yet, this is the current situation in four countries. In seven Sub-Saharan African countries, at least one out of five adults is living with HIV/AIDS and in an additional five Sub-Saharan African countries, one out of ten adults is HIV positive (UNAIDS/WHO, 2002). Many individuals and governments have difficulty grasping the reality of these high prevalence levels, and the resulting AIDS mortality is difficult to comprehend. The magnitude of the current epidemic in HIV infection and the low likelihood of an effective vaccine or even widespread availability of therapeutic medication strongly suggest that many more millions of individuals are likely to die of AIDS over the next decade than have over the past two decades. Many of the southern African countries are only beginning to see the impact of these high levels of HIV prevalence. Thailand, Senegal, and Uganda are notable success stories. In Thailand and Uganda, concerted efforts at all levels of civil society have turned around increasing HIV prevalence rates. In Senegal, programs put into place early in the epidemic have kept HIV prevalence rates low. These successes can be repeated but doing so would take time. Hence, the current burden of disease, death, and orphanhood is likely to be a problem in many countries of Sub-Saharan Africa for the foreseeable future. The AIDS Pandemic in the 21st Century Continues to Have Its Greatest Impact in the Developing World Over 90 percent of people infected with the Human Immunodeficiency Virus (HIV), which causes AIDS, live in the developing world. The Joint United Nations Programme on HIV/AIDS (UNAIDS) expects that this ’proportion will continue to rise in countries where poverty, poor health systems, and limited resources for prevention and care fuel the spread of the virus" (UNAIDS, 1999). Over 70 percent of the global total of HIV-positive people, 28.5 million out of 40 million, live in Sub- Saharan Africa, even though this region contains only 11 percent of the global population. Nine percent of all adults in Sub-Saharan Africa are HIV positive, compared to 0.6 percent of adults in the United States. Since the beginning of the epidemic, over 15 million Africans have died from AIDS; 2.2 million AIDS deaths occurred there in 2001. Southern and eastern Africa have been the most severely affected regions. According to the latest UNAIDS/WHO figures, seven countries have an estimated adult (ages 15-49) HIV prevalence of 20 percent or greater: Botswana, Lesotho, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe (UNAIDS/WHO, 2002). In these countries, all in southern Africa, at least one adult in five is living with HIV. An additional five countries, Cameroon, Central African Republic, Kenya, Malawi, and Mozambique, have adult HIV prevalence levels higher than 10 percent The HIV/AIDS epidemics in southern Africa started later but they have been explosive, such as in Botswana, where HIV prevalence among pregnant women in Francistown increased from 7 percent in 1991 to 44 percent in 2000. The two success stories in Sub-Saharan Africa continue to be Uganda and Senegal. HIV prevalence among pregnant women in Uganda continues to decline in most sentinel surveillance sites. In Kampala, HIV prevalence declined from its peak of 30 percent in 1993 to 11 percent in 2000. In Dakar, AIDS control programs have managed to keep HIV prevalence at very low levels. At the Beginning of the 21st Century, the Population Growth Rate in Botswana Is Now Negative Due to AIDS Mortality Other countries with sharply reduced growth rates include several additional African countries: Lesotho, Malawi, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe. The negative population growth seen in Trinidad and Tobago in 2002 reflects the impact of outmi- gration and AIDS mortality. The underlying non-AIDS growth rate for Trinidad and Tobago is nearly -0.6 percent. In Asia, AIDS mortality has slightly lowered population growth rates in Burma, Cambodia, and Thailand. By the Year 2010, Five Countries Are Projected to Show Negative Population Growth Because of AIDS Mortality The growth rate for Botswana is projected to be suppressed and by 2010 it will be -2 percent. In South Africa it is projected to be -1.4 percent and in Swaziland -0.4 percent. This negative population growth is due to the high levels of HIV prevalence in these countries and relatively low fertility. Previously, most HIV/AIDS experts never expected HIV prevalence rates to reach such high levels for any country. By the end of 2001, adult HIV prevalence had reached an estimated 39 percent in Botswana, 20 percent in South Africa, and 33 percent in Swaziland (UNAIDS/WHO, 2002). By 2010, Zimbabwe and Namibia are projected to experience a growth rate of close to zero. Without AIDS, these countries would have had a growth rate of 2 percent or greater. In Latin America and the Caribbean, the Bahamas and Guyana are projected to see the greatest relative impact, with growth rates reduced from 1 percent to 0.5 percent. Trinidad and Tobago‘s already negative population growth, due to out-migration, is projected to decline further due to AIDS mortality. In Asia, growth rates are projected to be slightly lower in Burma, Thailand, and Cambodia due to HIV/AIDS. Infant Mortality In Five Countries of Sub-Saharan Africa, More Infants Are Likely to Die From AIDS in 2010 Than From All Other Causes In Botswana, Swaziland, and Zimbabwe, twice as many infants are likely to die from AIDS in 2010 as from all other causes; in South Africa and Namibia, more infants are likely to die from AIDS than from all other causes. In 46 of the 51 countries examined, overall infant mortality rates are projected to decline between 2002 and 2010. However, in 43 of these 46 countries, infant mortality due to AIDS is projected to increase over the same period, offsetting the greater drop that would otherwise have been achieved. Moreover, in the five countries with projected overall increases, the entire change can be attributed to increases in AIDS mortality among infants. Without the effect of AIDS, infant mortality would have been projected to decline in these countries. Populations in Most Sub-Saharan African Countries Are Projected to Increase, in Spite of the High Levels of Mortality. The Exceptions are Botswana, Lesotho, Mozambique, South Africa, and Swaziland Although AIDS mortality has resulted in lower growth rates, fertility is still high and population growth is still positive in most countries affected by AIDS. Such is the case for Uganda. However, the population in the most severely affected countries, such as Botswana and South Africa, is projected to decline over time, in that the population, by 2050, is likely to be lower than it was in 1990, even if current AIDS control programs result in lowering future HIV incidence and prevalence. AIDS Is the Number One Cause of Death in Africa and Is Number Four Globally Just 20 years ago when AIDS first appeared, few would have predicted the current state of the pandemic, particularly in Sub-Saharan Africa. That over 30 percent of adults would be living with HIV/AIDS in any country was unthinkable. Yet, this is the current situation in four countries. In seven Sub-Saharan African countries, at least one out of five adults is living with HIV/AIDS and in an additional five Sub-Saharan African countries, one out of ten adults is HIV positive (UNAIDS/WHO, 2002). Many individuals and governments have difficulty grasping the reality of these high prevalence levels, and the resulting AIDS mortality is difficult to comprehend. The magnitude of the current epidemic in HIV infection and the low likelihood of an effective vaccine or even widespread availability of therapeutic medication strongly suggest that many more millions of individuals are likely to die of AIDS over the next decade than have over the past two decades. Many of the southern African countries are only beginning to see the impact of these high levels of HIV prevalence. Thailand, Senegal, and Uganda are notable success stories. In Thailand and Uganda, concerted efforts at all levels of civil society have turned around increasing HIV prevalence rates. In Senegal, programs put into place early in the epidemic have kept HIV prevalence rates low. These successes can be repeated but doing so would take time. Hence, the current burden of disease, death, and orphanhood is likely to be a problem in many countries of Sub-Saharan Africa for the foreseeable future. With no cure for AIDs and the difficulties of getting related medicines to much of Africa, tens of millions will die painful, tragic deaths. This article was prepared by the United Nations and the US Census Bureau using information obtained from the latest African population figures (year 2000). using information obtained from the latest African population figures (year 2000).

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