X HIV/AIDS Prevention and Care in Resource-Constrained Settings

D EMOGRAPHIC IMPACTIn some countries, such as Botswana andZimbabwe, life expectancy is plummeting while infantand child mortality is increasing. In countries withhigh HIV prevalence levels and low fertility rates,population growth rates have been reduced to nearzero. Other countries with sharply reduced growthrates include Malawi, Namibia, South Africa,Swaziland and Zambia.Life expectancies in many countries in sub-SaharanAfrica have fallen dramatically from the levels theywould have been without AIDS. In Botswana, lifeexpectancy is now 39 years rather than 71 years; inZimbabwe it is 38 years rather than 70 years. In fact,six countries in sub-Saharan Africa (Botswana, Malawi,Mozambique, Rwanda, Zambia and Zimbabwe) havelife expectancies below 40 years. They would have been50 years or greater without AIDS.In some sub-Saharan African countries, AIDSmortality has reversed the declines in infant mortalityin the 1980s and early 1990s, and the rates are nowhigher than they were in 1990. The relative impact ofAIDS on infant mortality will depend on both thelevels of HIV prevalence in the population and theinfant mortality rate from other causes. In 1990 theinfant mortality rate in Zimbabwe was 54, and in2000 it was 62. In Kenya the 1990 rate was 67, andin 2000 it was 69. Without AIDS, these rates wouldhave been 30 in Zimbabwe and 55 in Kenya.Altogether 26 sub-Saharan African countries haveexperienced increases in child mortality rates becauseof AIDS. The impact on child mortality is highest incountries that had significantly reduced child mortalitydue to other causes and where HIV prevalence ishigh. Many HIV-infected children survive their firstbirthdays, only to die before age five. Seventy percentof all deaths among children under age five inZimbabwe, and 45 percent of the same age cohort inSouth Africa, are AIDS-related.The impact of AIDS is most profound onpopulation structures. Recent national census surveysin Kenya and Malawi show significant overall AIDSrelatedmortality that has not been anticipated inF igure 10Growth Rate With and WithoutThe AIDS Epidemic in 2000South AfricaGabonRwandaGhanaZimbabweKenyaLesothoMozambiqueBotswanaCARMalawiCongo (Brazzaville)CameroonNamibiaCôte d’IvoireNigeriaTogoSwazilandTanzaniaZambiaBurkina FasoBeninUgandaEthiopiaCongo (Kinshasa)BurundiGuyanaBahamasBrazilHaitiHondurasBurmaThailandCambodiaWith AIDSWithout AIDS0 1 2 3 4 5PercentSource: U.S. Census Bureau, International Data Base and unpublished tables.HIV/AIDS Prevention and Care in Resource-Constrained Settings XVII