U.S. Agency for International Development

**Highlights from the XIV International AIDS Conference**

**July 31, 2002**

**"The Demographic Impact of AIDS"**

***Connie Carrino of USAID*** introduced the session by noting that the
demographic impact of AIDS was a very hot topic in Barcelona and is
expected to remain so after Barcelona. The USAID-funded U.S. Census
Bureau paper "The AIDS Pandemic in the 21^st^ Century" was released
during the conference and was the subject of a USAID press conference.
The Census Bureau started in 1994 to look at demographic trends and
indicators such as life expectancy, one of the key indicators for
measuring development progress (which is USAID's first line of work).
The Bureau's first projections in 1994 foresaw terrible trends, but the
international community didn't really believe them. Unfortunately, from
the data we are seeing now, they were right on target, so it is critical
that we understand the impact AIDS is having on individuals, families,
communities, and countries.

***Impacts on Development. Karen Stanecki of the U.S. Census Bureau***,
and author of "The AIDS Pandemic in the 21^st^ Century," began by noting
that the numbers contained in the UNAIDS global HIV/AIDS report,
released in the week leading up to the Barcelona, were again staggering.
The number of people with HIV/AIDS is 40 million; people infected with
HIV in 2001, 5 million; AIDS deaths in 2001, 3 million. These numbers
indicate the epidemic is not slowing down but is continuing to grow.

The pandemic continues to have its greatest impact in the developing
world. Over 90 percent of people infected with HIV and AIDS live in
developing countries. An estimated 70 percent of the global total of
HIV-positive people lives in sub-Saharan Africa, which represents only
11 percent of the global population. Southern and Eastern Africa are the
most severely affected regions. Seven countries -- Botswana, Lesotho,
Namibia, South Africa, Swaziland, Zambia, and Zimbabwe -- have an
estimated adult HIV prevalence greater than 20 percent.

AIDS mortality is resulting in falling ***life expectancy***, a key
indicator of developmental progress in developing countries. In
Botswana, nearly 40 years of life expectancy have been lost due to AIDS.
Without AIDS, life expectancy in Botswana would have been 72 years; it
is now estimated to be 33.9. In the sub-Saharan African countries of
Angola, Lesotho, Malawi, Mozambique, Rwanda, and Zambia, life
expectancies are also below 40 years. By 2010 -- less than 10 years from
now -- many countries in Southern Africa will see life expectancies fall
to near 30 years, levels that have not been seen since the end of the
19th century. In Botswana, life expectancy will fall to 27 by 2010. It
will fall to 33 in Swaziland and 34 in Namibia and Zambia.

***Population growth*** is already negative in Botswana. Several other
countries in Southern Africa have sharply reduced growth rates,
including Lesotho, Malawi, Namibia, South Africa, Swaziland, and
Zimbabwe. By 2010, Botswana, Lesotho, Mozambique, South Africa, and
Swaziland will be experiencing negative population growth because of
AIDS mortality. HIV/AIDS is having an impact on population growth in the
Caribbean region also. Although most of Trinidad and Tobago's population
loss is due to out-migration, HIV/AIDS is contributing to increased
negative growth.

***Infant mortality*** is another key indicator for progress and
development in many countries. In some sub-Saharan African countries,
infant mortality rates are now higher than they were in 1990. AIDS
mortality has reversed the declines in infant mortality rates that
occurred in the 1980s and early '90s. With AIDS, infant mortality in
Swaziland and Zimbabwe is nearly twice as high as it would have been
without AIDS. The impact has been most dramatic in countries where
infant morality rates had significantly declined and where HIV
prevalence is high, such as Botswana, Swaziland, and Zimbabwe. By 2010,
more infants will die from AIDS than from any other cause in the poorer
countries of sub-Saharan Africa. In Botswana and Zimbabwe, twice as many
infants will die from AIDS than from all other causes. More infants will
also die from AIDS than from all other causes in South Africa and
Namibia.

In 37 sub-Saharan African countries, ***child mortality*** has increased
over what it would have been without AIDS. AIDS deaths among children
under 5 years of age are resulting in higher child mortality rates.
Again, the impact is highest in those countries that had significantly
reduced child mortality from other causes but have high HIV prevalence
rates. In the absence of prevention of mother-to-child HIV transmission,
child mortality rates in 2010 will continue to be significantly higher
with AIDS than it would have been without AIDS. In Botswana, 80 percent
of the deaths among children under 5 will be due to AIDS. More than 120
babies per 1,000 born will die before their first birthday, about 100 of
them from AIDS.

At the beginning of the 21st century, AIDS is the number one cause of
death in Africa and the fourth largest cause globally. Emerging only 20
years ago, few would have predicted the current state of the epidemic,
particularly in sub-Saharan Africa. An epidemic in which more than 30
percent of adults in any country would be living with HIV/AIDS was
unthinkable. Yet this is the current situation in four countries. In
seven sub-Saharan African countries, at least one out of every five
adults is living with HIV/AIDS, and in an additional six countries, one
out of 10 adults is living with HIV.

There have been success stories -- Thailand, Senegal, Cambodia, Uganda,
Zambia -- and these successes can be repeated. However, the current
burden of disease, death, and orphanhood will be a significant problem
in many sub-Saharan countries for the foreseeable future.

***Questions and Comments.*** A question following the presentation
addressed the shape of the population pyramid that will result from
these trends by 2010. There will dramatic changes in population
structure. Many deaths in the adult age group will create a
"chimney-type" pyramid, with a lot of missing adults in the middle
years, compared with the traditional pyramid.