HIV / AIDS IN AFRICA UPDATE - 2001

The epidemic of young people

Young people are disproportionately affected by HIV and AIDS particularly females.  About half of new HIV infections are in people aged 15–24, at the time when most people are starting their sexual lives. New infections are increasingly concentrated in the younger age groups, as HIV rates increase in the general population. Young women for a variety of reasons are particularly vulnerable, due to biological, social and economic disadvantages. Most new infections are in females aged 15-19 years and the peak occurs 5-10 years earlier than in young men. Factors that may contribute to this imbalance are an earlier age of first sex for young women, and the fact that these young women tend to have sex with older men, who are more likely to be infected.

Factors influencing the spread of the epidemic

The HIV/AIDS epidemic has developed very differently in different parts of the world, and among different populations. It is not yet understood why HIV infection may take hold in some places while rates in neighbouring countries remain stable over many years. There is research is under way to explain the differences between epidemics in various countries. Various factors – demographic, behavioral, economic, biological are thought to have contributed to the rapid spread of HIV/AIDS. Some specific factors that may play a role are patterns of sexual networking, levels of condom use with different partners, incidence of other sexually transmitted diseases, population mobility and societal make-up.

Economics

Proximity to trade routes and highways has been identified as a factor. In the early stages of the epidemic urban populations and rural communities located along the highways are affected rapidly. This scenario was seen in Uganda, a country with one of the older epidemics. For example a study found that 33% of long distance truck drivers using the Trans African highway were infected.

Population mobility

This is another contributory factor. One the most common reasons for people leaving their homes (and often their families) is to seek work. In many African countries there is a generalized shift from rural areas to urban centers as people seek jobs and better wages in the city. Moreover the people most likely to move are young sexually active people.

A good example is South Africa where the thriving mining industries attract workers not just from rural areas of the nation, but also from neighbouring countries where job opportunities are limited and wages are lower.   Loneliness due to the separation of migrant workers from their families and familiar surroundings often lead them spending alot of time in bars. These bars often have associated sex workers who have a high rate of HIV infection. Migrant workers who practice unprotected sex with these prostitutes may get infected, and when they return home, will carry the diseases with them.

Other causes of population movement are due to natural disasters such as floods, famine, or environmental degradation. Population mobility has been associated with an increase in STD infections, including HIV.

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War and displacement

Wars and armed conflicts have been shown to be a contributory factor in the spread of HIV.  War leads to disruption of large populations, in many cases causing displacement of people and creation of refugees. Geographers at Cambridge University, U.K. have suggested that the movements of the Uganda Liberation Army and the Tanzanian forces during the war to remove Idi Amin may have been linked with the spread of HIV in Uganda.

Often during war situations a lot of rapes take place facilitating the spread of AIDS. In addition the breakdown of normal social order and behaviour combined with overcrowding in refugee camps may lead to high risk behaviour.

Behavioral and social factors

Sexual behaviors such as rapid partner change, frequency of sexual intercourse  (outside of stable relationships), starting sexual activity at an early age, high rates of contacts with groups having a high risk are all associated with increased rates of HIV spread. Others are cultural traditions, such as high status being bestowed on a man who has many wives and/or mistresses.

Urban and Rural spread

The gap between rates of HIV in urban areas and rural areas has been narrowing. This has serious implications. Two thirds of Africans live in rural areas, which means that though infection rates are still lower than in urban areas, the absolute numbers of HIV infected persons in rural communities will surpass that of urban populations.

At the same time there has been an increase in urbanization with general migration from rural areas to cities. The changes in societal make-up, increased overcrowding, break down of social barriers due to disruption of social networks has increased the vulnerability of urban populations. This will contribute to the expected increase in rates of HIV infection. For instance, in Uganda a clear correlation between urbanization and HIV/AIDS, particularly in the peri-urban areas has been demonstrated.

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Sexually Transmitted Diseases and the spread of HIV/AIDS

The presence of STD’s has been associated with a marked increase in risk for HIV.  In the first instance, the route of infection is the same as for HIV/AIDS; secondly having an STD implies taking part in unprotected sexual activities, which in and of itself is high risk behaviour, and lastly STD’s have been shown to significantly increase the transmission of the HIV virus (10 to 100 fold in each sexual encounter).

Populations with high levels of STD’s have been shown to have much higher levels of HIV incidence. Not unexpectedly, sex workers and people who use their services are most at risk. A study in Kenya found 80% of the sex workers in one community were infected with HIV.

The majority of the STD’s are treatable. Studies have found that the introduction of STD control programs, through early diagnosis, prompt and aggressive treatment have been shown to significantly reduce the STD rate, and in many cases have also been associated with a fall in HIV incidence.

The impact and cost of HIV/AIDS

Economic impact

The onslaught of AIDS is reducing the prospects for economic development in many African economies. Much of the gains of development that had taken place in earlier decades are being wiped out. A recent study estimated that in “1997 public health spending for AIDS alone exceeded 2% of the gross domestic product (GDP) in seven of 16 African countries sampled”. This is a staggering amount, when considered against the fact that total health spending in these nations accounted for 3-5% of GDP.

The majority of those infected with HIV/AIDS are in their productive years. This is leading to a shortage of able bodied adults and is having a profound effect on the composition and size of the labour force, particularly in agriculture and industry. The epidemic is also decimating the limited pool of skilled workers and professionals further exacerbating the adverse effect on economies.

It is hard to quantify exactly what the impact of HIV is on national economies as a whole. Some African companies say that their health bills have doubled and several report that AIDS costs absorb as much as one-fifth of company earnings. In 1998 in Zimbabwe, life insurance premiums went up by four times in just two years because of AIDS deaths.  It is estimated in South Africa by 2010 the GDP will have decreased by almost a fifth compared to what it would have been without AIDS, wiping off US$22 billion from the economy.

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Impact on the Health Care Sector

The demand for palliative care services had increased, as the numbers of people infected with HIV has increased. HIV/AIDS patients because of their immuno-compromised state are prone to opportunistic infections, many of which are life threatening. Recurrent illness forces them to hospital repeatedly and they occupy scarce bed space.

In some hospitals three quarters of beds in paediatric wards are occupied by children ill from HIV. In Uganda patients with HIV/AIDS related illness occupied more than 55% of the beds in 1997.

Reduction in life expectancy

One of the key measures used policy-makers in assessment of human development is Life expectancy at birth. One of the most sinister features of the HIV/AIDS epidemic is the effect it is having on life expectancy in African nations.

The impact on life expectancy is directly proportional to the severity of the local epidemic. In countries with an adult HIV prevalence of over 10% calculations have shown that AIDS will cost on average 17 years of life expectancy. In these countries instead reaching 64 years by 2015 at normal rates, AIDS will decrease life expectancy to 45 years.

Botswana with more than 30% of adults are infected life expectancy fell to just 44 years compared to the 69 years without AIDS In Zimbabwe life expectancy is now 43 years instead of the expected 65 years

Reduction in child survival rates

As the numbers of women infected with HIV have increased, so to have the numbers of children who have the HIV infection. HIV has contributed substantially to rising child mortality rates in many areas of sub-Saharan Africa. Children infected with HIV are immuno-defficient and therefore are more at risk from the lethal conditions of the 6 childhood killer diseases. It is expected that the resultant increase in mortality is going to wipe out the gains made by the Child Survival Revolution.

For example in Uganda AIDS may increase infant mortality by 75% and double under 5 mortality if HIV is not contained. In Namibia infant mortality rates that were projected to be 45 per 1000 by 2015 without the epidemic, is expected to be over 72 per 1000.

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Social consequences

Already millions of adults have died in Africa leaving behind orphaned children. Many have left surviving partners who are infected and in need of care. Their families struggle to find money to pay for their funerals, and their employers must now train other staff to replace them.

HIV/AIDS related morbidity has effects on families and the extended family structure. As the PHA’s become increasingly ill, the burden of caring for them falls on family members. The ability of the PHA to care for their own immediate family is severely affected as productivity falls. This affects family income, household food supply, security etc. The impact on child care is enormous.

The AIDS Orphans

As more and more adults die, an increasing number of children are being left as orphans. Already there are 5.5 million orphans in Africa. Uganda has the highest proportion of AIDS orphans in the world, where over 1.7 million have lost one or both parents to AIDS.

Because the epidemic affects primarily those aged 15-45 years and those aged under 5 years, the epidemic is leading an unusually high number of older children and elderly in the populations. Traditional support systems are failing to cope with the increasing number of orphans. There has been a resultant increase in school dropout rates as well as street children and child headed families. Orphans receive less care and attention. They suffer from poorer health and nutrition when compared to other children.

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