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

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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
F igure 11Population of Zimbabwe,With and Without AIDS: 20108075MalesFemalesWith AIDS70Without AIDS656055504540353025201510501000 800 600 400 200 0 200 400 600 800 1000ThousandsSource: U.S. Census Bureau, World Population Profile 2000.current population projection modeling. The mostextreme examples are those countries—such asBotswana, Zimbabwe and South Africa—where therewill be negative population growth within the nextthree to four years. The resulting population pyramidsshow a dramatic restructuring of the population, withdecreasing numbers of children and middle-agedadults and more males than females.O RPHANSBy 2010, at least 44 million children under age 15will have lost one or both parents to all causes in the34 countries most severely affected by HIV/AIDS. Ofthese orphans, 68 percent will have lost their parentsdue to AIDS. This represents a dramatic increase from1990, when AIDS accounted for 16.4 percent ofparental deaths. Orphans are distributed among areasof the world in the same patterns as HIV prevalence,so that countries with the highest infection levels alsotend to have the highest orphan rates. The orphancrisis is most acute in sub-Saharan Africa, where asmany as 35 percent of children under age 15 in at leasteight countries have lost one or both parents. Elevencountries will reach this rate by 2010.XVIII HIV/AIDS Prevention and Care in Resource-Constrained Settings
Page 1 and 2: Edited byPeter R. Lamptey, MD, DrPH
Page 3 and 4: © 2001 Family Health International
Page 5 and 6: SECTION II:Chapter 6PAGE 137Chapter
Page 7 and 8: Chapter 21PAGE 501Chapter 22PAGE 51
Page 9 and 10: I N T R O D U C T I O NPAUL R. DE L
Page 11 and 12: F igure 1Factors That InfluenceThe
Page 13 and 14: F igure 3HIV Seroprevalence for Pre
Page 15 and 16: F igure 5HIV Seroprevalence for Com
Page 17 and 18: F igure 7HIV Seroprevalence for Pre
Page 19: F igure 9Life Expectancy With and W
Page 23 and 24: invest; and feedback further amplif
Page 25 and 26: R EDUCING MOTHER-TO-CHILDTRANSMISSI
Page 27 and 28: F igure 13HIV Seroprevalence in Adu
Page 29 and 30: ACKNOWLEDGEMENTSWe wish to express
Page 32 and 33: SOFIA GRUSKIN, JD, MIAAssistant Pro
Page 34 and 35: THOMAS M. PAINTER, PHDBehavioral Sc
Page 36 and 37: glossary of A C R O N Y M SACTG AID

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