# Presentation: 216415

## The Demographic Impact of HIV/AIDS in 15 Developing Countries

- Laura M. Heaton, Timothy B. Fowler, Brynn G. Epstein, Tammany Mulder, and Peter O. Way
- International Programs Center
- Population Division
- U.S. Census Bureau

## The U.S. Census Bureau presents preliminary results of population estimates and projections for15 focus countries covered under President George W. Bush’s Emergency Plan for AIDS Relief.

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## Fifteen Focus Countries

- Sub-Saharan Africa: Botswana, Côte d’Ivoire, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Zambia
- Latin America/Caribbean: Guyana, Haiti
- Asia:  Vietnam

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## Recent Trends in HIV Prevalence Levels

- According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), variations in the epidemic are evident in the 15 focus countries.
- Rising epidemics
- Stable epidemics
- Declining epidemics

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## Population Estimates and Projections Process

## Two Series: With AIDS versus Without AIDS

**With AIDS **shows what has happened and what is projected to happen in each country because of AIDS mortality and its demographic consequences.
**Without AIDS** shows a hypothetical series of what the Census Bureau’s modeling work indicates would have happened if a country had not been affected by the HIV/AIDS epidemic.  This modeling takes into account not only lower death rates but also associated changes to a country’s age-sex structure and, indirectly, the combined effects of lower mortality and changing population composition on demographic indicators.

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## Population Estimates and Projections Process

- Analyze recently available survey, census, and other relevant data.
- Estimate and project levels of fertility, non-AIDS mortality, and international migration.
- Use the Rural-Urban Projection (RUP) program to obtain hypothetical, without AIDS, projections of all components of 	population change to the year 2050.

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## Estimating HIV Prevalence

- Estimation and Projection Package (EPP) World Health Organization (WHO)/UNAIDS modeling software, an epidemiologically realistic model to estimate adult HIV prevalence.

- We use UNAIDS country-specific adult HIV prevalence estimates from EPP for years from the beginning of the epidemic to 2010.
- EPP produces a national “best fit” curve of adult HIV prevalence using sentinel surveillance data pertaining to pregnant women

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## Example of EPP Model

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## Utilize a new application developed at the U.S. Census Bureau that incorporates the EPP adult HIV prevalence estimates through 2010 to obtain AIDS-related mortality.
The application uses WHO/UNAIDS Epidemiological Reference Group assumptions about age-sex distribution and sex ratio of new infections, mother-to-child transmission rate, and disease progression.

- The application uses WHO/UNAIDS Epidemiological Reference Group assumptions about age-sex distribution and sex ratio of new infections, mother-to-child transmission rate, and disease progression.

**Estimating AIDS Mortality (1)**

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## Assume no anti-retroviral therapy.
Allow for competing risk of death.
Project HIV incidence rates from the 2010 rate, assuming a decline of50 percent by 2050.

- Allow for competing risk of death.
- Project HIV incidence rates from the 2010 rate, assuming a decline of50 percent by 2050.

**Estimating AIDS Mortality (2)**

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## U.S. Census Bureau Population Estimates and Projections for the 15 Focus Countries

A Comparison of 2004 and 2015 Key Indicators, With and Without AIDS

- A Comparison of 2004 and 2015 Key Indicators, With and Without AIDS

## Percent Change in Population Size, With and Without AIDS Mortality:2004 and 2015

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## Trends in Population Size, With and Without AIDS: 1990-2015

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## Percent Change in Growth Rate, With and Without AIDS:  2004 and 2015

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## Infant Mortality RateWith and Without AIDS: 2004

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## Infant Mortality RateWith and Without AIDS: 2015

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## Male Life Expectancy at Birth:  1995-2015

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## Female Life Expectancy at Birth:  1995-2015

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## Age-Specific Central Death Rates, With and Without AIDS, by Sex, Mozambique: 2015

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## Conclusions

## Demographic Impact by 2015

- Botswana and South Africa are projected to have negative population growth by 2015 as HIV/AIDS continues to cause elevated mortality while fertility levels decline.
- Population structures are projected to differ, with some resembling “chimneys.”
- Due to AIDS mortality, life expectancy at birth is projected to be quite different from what would have been expected without AIDS.

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## References

- UNAIDS Reference Group on Estimates, Modeling and Projections. 2002. "Improved methods and assumptions for estimation of the HIV/AIDS epidemic and its impact: Recommendations of the UNAIDS Reference Group on Estimates, Modeling and Projections." AIDS 16:W1-W14.
- UNAIDS/WHO. 2003. The UNAIDS/WHO Estimation and Projection Package Multigroup Version (EPP Multi). Version 1.  Available at: _[http://www.unaids.org/EN/resources/epidemiology/epi_softwaretools.asp](http://www.unaids.org/EN/resources/epidemiology/epi_softwaretools.asp)_.
- U.S. Census Bureau, International Programs Center. 2003.  Rural-Urban Projection (RUP) Program.  Available at: _[http://www.census.gov/ipc/www/rup/](http://www.census.gov/ipc/www/rup/)_**.**

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## Need more information?

- International Programs Center
- Population Division
- U.S. Census Bureau
- Washington, D.C. 20233-8800
- U.S.A.
- FAX: 1-301-457-3034
- E-Mail address: _[ipc-hiv@census.gov](mailto:ipc-hiv@census.gov)_

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