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Africa: HIV/AIDS Update
Africa: HIV/AIDS Update
Date distributed (ymd): 000705
Document reposted by APIC
+++++++++++++++++++++Document Profile+++++++++++++++++++++
Region: Continent-Wide
Issue Areas: +economy/development+
Summary Contents:
This posting contains two documents a press release and a fact
sheet -- from UNAIDS (http://www.unaids.org) released on the eve of
the XIIIth International AIDS Conference in Durban, South Africa,
July 9-14 (http://www.aids2000.com). Speaking to the press, UNAIDS
director Dr. Peter Piot said that global investment for AIDS
prevention and care amounted to only $300 million this year, as
compared to an estimated need for $2 billion a year in sub-Saharan
Africa for prevention alone. According to Piot, quoted in a new
Washington Post series of feature articles beginning today, "If
this would have happened in the Balkans, or in Eastern Europe, or
in Mexico, with white people, the reaction would have been
different".
The African Development Forum 2000, organized by the Economic
Commission on Africa (ECA), will focus on "AIDS: the greatest
leadership challenge," and will take place in Addis Ababa from 22-
26 October, 2000. The ECA has launched a pre-conference on-line
discussion. To join, send a message to join-adf2000-
l@lyris.bellanet.org For more information on ADF 2000, see the ECA
web site (http://www.un.org/depts/eca/adf2000).
In a related posting also sent out today, documents related to
African demands for accessibility of drugs for HIV/AIDS and other
diseases.
+++++++++++++++++end profile++++++++++++++++++++++++++++++
UNAIDS (http://www.unaids.org)
Press Release
Geneva, 27 June 2000
NEW UN REPORT ESTIMATES OVER ONE-THIRD OF TODAY'S 15-YEAR-OLDS WILL
DIE OF AIDS IN WORST-AFFECTED COUNTRIES
* HIV/AIDS is causing dramatic shifts in demographics, with
long-ranging social consequences for hardest-hit nations
* Massive increase in resources needed to reduce the epidemic's
spread and impact
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
programmes manage to halve the HIV risk.
- In countries such as South Africa and Zimbabwe, where a fifth or
a quarter of the adult population is infected, AIDS is set to claim
the lives of around half of all 15-year-olds.
- In Botswana, where about one in three adults are already
HIV-infected -- the highest prevalence rate in the world -- no
fewer than two-thirds of today's 15-year-old boys will die
prematurely of AIDS.
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 Programme on HIV/AIDS (UNAIDS), and
released today in advance of the XIIIth International AIDS
Conference being held in Durban, South Africa, from 9 to 14 July.
Speaking at the release of the report in Geneva, 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."
Long-term demographic impacts threaten social stability
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.
- So far, a total of 13.2 million children under 15 have lost their
mother or both parents to AIDS since the epidemic began.
- The epidemic is undermining basic learning in certain parts of
Africa: diminishing funds for school fees, forcing young people
into the workforce earlier, and claiming the lives of teachers well
before retirement age. In Cote d'Ivoire, 7 out of 10 teacher deaths
are due to HIV. In 1998, Zambia lost 1300 teachers in the first ten
months of the year - equivalent to two-thirds of the new teachers
trained each year.
- Agriculture, which in many developing countries provides a living
for as much as four-fifths of the population, is suffering serious
disruption. In West Africa, for example, reduced cultivation of
cash crops and food products is reported.
- Business is already seeing the impact of AIDS on their bottom
line. On an agricultural estate in Kenya, new AIDS cases and health
spending showed a massive ten-fold increase over a recent 8-year
period.
- Increased demand for health care for HIV-related illness is
taxing overstretched health services. In countries from Thailand to
Burundi, HIV-positive patients are occupying 40-70% of the beds in
big city hospitals. At the same time, the health sector is
increasingly losing its own human resources to AIDS. One study in
Zambia found a 13-fold increase in deaths in hospital staff,
largely due to HIV, over a ten-year period.
"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 HIVAIDS 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."
HIV infection rates continue to increase in many countries
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.
- Determined HIV prevention programmes in several countries in Asia
and Latin America have, for now, stemmed what threatened to be a
massive rise in heterosexual infection rates. However, unsafe sex
between men and women is contributing to a growing epidemic in some
populous states of India where more than 2% of 15-49-year-olds are
infected. Heterosexual transmission also dominates in the
Caribbean, where the Bahamas and Haiti have adult HIV prevalence
rates higher than anywhere in the world outside Africa.
- HIV is becoming more firmly entrenched among injecting drug users
and men who have sex with men. Globally, injecting drug users
continue to be exposed to the virus, and in many places at least
one in three is infected. Over the past two years, the relative
increase in the proportion of adults living with HIV has been steep
in the Baltic states, but the number of infections is far higher
and still growing in the Russian Federation and in Ukraine, where
around 1 adult in 100 is now infected nationwide. Among men who
have sex with men, the prevalence of HIV is 15-20% in many places
and there is no sign that the rate of new infections is slowing
down.
- AIDS deaths have declined drastically in high-income countries
and parts of Latin America thanks to expensive therapy with
antiretroviral drugs. However, there is good evidence that --
as a result of complacency and other factors -- risky sexual
behaviour is on the rise. In San Francisco, the proportion of gay
men reporting multiple partners and unprotected anal sex rose
between 1994 and 1998, in parallel with a steep rise in rectal
gonorrhoea after years of falling trends.
Signs of hope, but response needs urgent and massive expansion
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.
- As a result of AIDS education and information campaigns, there is
an encouraging increase -- though by no means sufficient -- in the
number of young people using the full range of prevention
approaches, from delaying their sexual debut to having fewer casual
partners and engaging in protected sex.
- Developing countries and donor agencies are increasingly looking
on AIDS-related care as a good investment having direct benefits
for people with HIV/AIDS and indirect spin-offs for AIDS prevention
in the wider community. Collaborative ventures of various kinds are
opening the door to better access to care and support. In Latin
America and the Caribbean, for example, a multicountry survey on
the prices being paid for HIV-related drugs and commodities brought
major price differences to light and led to reductions through
negotiations with pharmaceutical companies.
- Inspired by Thailand's successful campaign, Cambodia launched a
pilot programme in Sihanoukville promoting "100% condom use" in
commercial sex. In just two years, 65-75% of male clients
(military, police and motorbike taxi drivers) were reporting that
they always used condoms with commercial partners -- up from less
than 55% -- while similar high rates were reported by brothel-based
sex workers.
- Experience from Malawi and Uganda shows that micro-credit schemes
can work very successfully even in communities with high HIV
prevalence. These schemes, which grant small loans to individuals
who want to start up a small business and who seem likely to be
able to repay, could play a greater role in alleviating poverty and
mitigating the economic impact of AIDS.
- Condom use for first intercourse has become impressively high in
Brazil, where the government has taken an active lead in HIV
prevention, care and protection of the rights of people affected by
AIDS. In 1986 less than 5% of young men reported using a condom the
first time they had sex. The figure in 1999 was close to 50% -- and
among men with higher education, it was over 70%.
- In Zambia, new surveillance data from the capital Lusaka show
that the proportion of pregnant girls aged 15-19 infected with HIV
dropped by almost half over the past six years. This holds out hope
that Zambia might follow the course charted by Uganda, where a
decline in infection rates in young urban women heralded the
turnaround in the epidemic. Uganda's nationwide rate of adult HIV
prevalence has now fallen to just over 8% from a peak of close to
14% in the early 1990s.
"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."
Fact Sheet: HIV/AIDS IN AFRICA
UNAIDS (http://www.unaids.org)
While some gains were made in prevention and care in a number of
countries, there were 4 million new HIV infections in sub-Saharan
Africa during 1999. In Africa, AIDS now kills ten times more people
a year than war.
There are now 16 countries in Africa in which more than one-tenth
of the adult population (aged 15-49) is infected with HIV.
In the six countries of southern Africa, AIDS is expected to claim
the lives of between 8% and 25% of today' practising doctors by the
year 2005.
In seven countries, all in the southern cone of the continent, at
least one adult in five is living with HIV. In countries where 10%
of the adult population has HIV infection, almost 80% of all deaths
in young adults aged 25-45 will be associated with HIV.
Infection rates in young African women are far higher than in young
men. According to studies presented in the report, the average
rates in teenage girls were over five times higher than in teenage
boys. Among young people in their early 20s, the rates were three
times higher in women. In Africa, women’s peak infection rates
occur at earlier ages than men’s. This helps explain why there are
an estimated 12 women living with HIV for every 10 men in this
region.
A recent study estimates that in 1997, public health spending for
AIDS alone already exceeded 2% of gross domestic product (GDP) in
7 of 16 African countries sampled – a staggering figure in nations
where total health spending accounts for 3–5% of GDP.
In Zimbabwe, by 1997 the likelihood of a 15-year-old woman dying
before the end of her reproductive years quadrupled from around 11%
in the early 1980s to over 40% by 1997. More than 2000 Zimbabweans
die of AIDS each week.
In Botswana, a shocking 35.8% of adults are now infected with HIV,
while in South Africa, 19.9% are infected, up from 12.9% just two
years ago. The adult HIV prevalence rate in Botswana has more than
tripled since 1992, when it was an estimated 10%.
With a total of 4.2 million infected people, South Africa has the
largest number of people living with HIV/AIDS in the world, as well
as one of the world's fastest-growing epidemics. Already, 1 in 4
South African women between ages 20 and 29 are infected with the
virus.
More than 1 in 4 adults living in Zambian cities are HIV-positive,
and more than 1 in 7 Zambian adults are infected in the country's
rural areas.
On the other hand, the percentage of pregnant girls aged 15-19
infected with HIV in the capital, Lusaka, has on average dropped by
almost half in the last six years. The percentage of unmarried
women who were sexually active fell from 52% to 35% between 1990
and 1996.
A study in Zambia showed that in one hospital, deaths among health
care workers increased 13-fold over the 10-year period from 1980 to
1990, largely because of HIV.
In West Africa, relatively less affected, prevalence rates in some
countries are creeping up. Côte d’Ivoire is already among the 15
worst-affected countries in the world. In Nigeria, by far the most
populous country in sub-Saharan Africa, over 2.7 million people are
infected with HIV.
By the year 2010, crude death rates in Cameroon will have more than
doubled as a result of HIV/AIDS. An estimated 340,000 people in
Ghana are currently living with HIV.
Infection rates in East Africa, once the highest on the continent,
hover above those in West Africa but have been exceeded by the
rates now being seen in the southern cone.
The prevalence rate among adults in Ethiopia and Kenya has reached
double-digit figures and continues to rise.
Since the epidemic began, AIDS has created some 12.1 million
orphans in Africa, out of a global total of 13.2 million AIDS
orphans. Before AIDS, about 2% of all children in developing
countries were orphans. By 1997, the proportion of children with
one or both parents dead had skyrocketed to 7% in many African
countries.
HIV-positive patients have occupied 39% of the beds in Kenyatta
National Hospital in Nairobi, Kenya, and 70% of the beds in the
Prince Regent Hospital in Bujumbura, Burundi.
Through strong prevention programmes, Uganda has brought its
estimated prevalence rate down to around 8% from a peak of close to
14% in the early 1990s. HIV prevalence among 13-19-year-old girls
has fallen significantly over an eight-year period, while the rate
in teenage boys -- always much lower because boys are less likely
than girls to have partners in the older, more heavily infected age
groups -- has remained roughly stable. The percentage of teenage
girls who had ever used a condom tripled between 1994 and 1997.
This material is being reposted for wider distribution by the
Africa Policy Information Center (APIC). APIC provides
accessible information and analysis in order to promote U.S.
and international policies toward Africa that advance economic,
political and social justice and the full spectrum of human rights.
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