FREE ESSAY ON AIDS IN AFRICA

AIDS IN AFRICA

As recently as 1990, there were some regions of the world that had remained relatively
unscathed by AIDS. Today, however, there is not a single country around the world which
has wholly escaped the AIDS epidemic. As the epidemic has matured, some of the developed
nations which were hard hit by the epidemic in the 1980s such as the United States have
reported a slowing in the rate of new infections and a stabilization among existing cases
with lower mortality rates and an extension of post-diagnosis lifespan. However, despite
the changing face of the global AIDS pandemic, one factor remains unchanged: no region of
the world bears a higher AIDS-related burden than sub-Saharan Africa. This paper examines
the demographic effects of AIDS in Africa, focusing on the hardest-hit countries of
sub-Saharan Africa and considers the present and future impact of the AIDS epidemic on
major demographic measures such as fertility, mortality, life expectancy, gender, age,
and family structure. 
Although the sub-Saharan region accounts for just 10% of the world's population, 67%
(22.5 million) of the 33.4 million people living with HIV/AIDS in 1998 were residents of
one of the 34 countries of sub-Saharan Africa, and of all AIDS deaths since the epidemic
started, 83% have occurred in sub-Saharan Africa (Gilks, 1999, p. 180). Among children
under age 15 living with HIV/AIDS, 90% live in sub-Saharan Africa as do 95% of all AIDS
orphans. In several of the 34 sub-Saharan nations, 1 out of every 4 adults is
HIV-positive (UNAIDS, 1998, p. 1). Taxing low-income countries with health care systems
inadequate to handle the burden of non-AIDS related illnesses, AIDS has devastated many
of the sub-Saharan African economies. The impact of AIDS on the region is such that it is
now affecting demographics - changing mortality and fertility rates, reducing lifespan,
and ultimately affecting population growth.
Although Africa is the region of the world hardest hit by AIDS, and although no country
has entirely escaped the virus, prevalence rates vary dramatically between regions,
countries, and even within countries. In general, the southern region is the most
affected, with Botswana, Namibia, Swaziland and Zimbabwe showing the highest rates, while
West Africa has been less affected. In almost all countries, the HIV/AIDS prevalence rate
is significantly higher in urban areas than in rural areas. Within the general
population, the highest prevalence rates are found among the sexually active adult (15 to
49 years old) population. Women tend to get infected at earlier ages than males for a
variety of biological and sociocultural reasons.
In recent years an intensive government-sponsored HIV prevention campaign focusing on use
of condoms and changes in sexual behavior has produced impressive results. Researchers
however, have yet to satisfactorily explain the broad variation in HIV seroprevalence
between Western and Eastern sub-Saharan Africa. As Gilks (1999) observes, "in some of the
countries of Western Africa such as Senegal, low levels of HIV prevalence in adults have
been maintained for about a decade, despite many circumstances highly conducive to
appreciable and sustained transmission" (p. 181). In some Western African nations, early
and sustained prevention programs may be responsible for the differences, although other
reports indicate that comparatively low transmission rates prevail in most of the Western
countries regardless of programs designed to encourage safer sex (UNAIDS, 1998, p. 2).
Reports also show that differences in the rate of HIV spread between East and West Africa
cannot be explained by differences in sexual behavior alone. 
AIDS researchers typically make a distinction between concentrated and generalized
transmission patterns of the virus. In a concentrated transmission pattern, infection
tends to be concentrated within "vulnerable groups" such as homosexual men, prostitutes,
and IV drug users. In the generalized pattern, infection is diffused broadly through the
population, typically by means of heterosexual transmission. In sub-Saharan Africa, where
heterosexual transmission predominates, the pattern is that of generalized transmission.
Compared to the U.S. little HIV transmission in Africa is related to IV drug use or
unprotected homosexual sex. In addition to heterosexual transmission, transmission via
transfusion and through contaminated medical equipment is not uncommon in sub-Saharan
Africa. Africans infected with HIV die much sooner after diagnosis than HIV-infected
persons in other parts of the world. Studies in industrialized countries that were
conducted prior to the introduction of treatment with multiple antiretroviral drugs,
found that the survival time following the diagnosis of AIDS ranged from 9 to 26 months.
However, in Africa the survival time of patients with AIDS ranged from 5 to 9 months
(Unaids, 1998, p.2). A number of factors have been cited to explain the shorter survival
times in African which include lower access to health care, poorer quality of health care
services, poorer levels of baseline health and nutrition, and greater exposure to
pathogens likely to result in opportunistic infection and early death (UNAIDS, 1998;
UNAIDS, 1999; Gilks, 1999). 
Mortality & Life Expectancy. There is now compelling evidence drawn from two decades of
AIDS epidemic data in central and east Africa that the AIDS epidemic has had a dramatic
and negative impact upon mortality rates and life expectancy in this region. The most
substantial increases in the mortality rate have occurred among adults aged 20 to 40 in
the southern and eastern regions of sub-Saharan Africa, with more modest mortality rate
increases shown for children within this region. The probability that a male adult in
Zimbabwe would die between the ages of 15 and 60 jumped from 0.181 in 1979 to 0.325 in
1992, while the probability that a female adult would die between these ages during this
time period jumped from 0.248 to 0.419 (Timaeus, 1998, p. S21). The increased mortality
rates have had a substantial impact on life expectancies in the affected regions. A study
in rural Uganda found that life expectancy dropped from just under 60 years to 42.5 years
during the past two decades (Boerma, Nunn & Whitworth, 1998). In late 1998, the UN
Population Division released figures suggesting that AIDS has taken an average of seven
years off the average life expectancy at birth of a baby born in any of the 29 most
affected African countries. On average, in the absence of AIDS, life expectancy for these
29 countries would have averaged 54 years; now, however, the average has dropped to 47
years. 
Fertility. A number of studies have now documented that HIV infection significantly
reduces the fertility levels of HIV+ women in the sub-Saharan African countries. Studies
on fertility changes in 20 sub-Saharan African countries found a 25% to 40% decline in
fertility among HIV+ women versus their HIV-negative counterparts in the same country.
Researchers note that HIV decreases fertility among HIV+ women as a consequence of both
biological (impact on fecundity) and behavioral factors. On the biological level, there
is an increase (among HIV+ women) in menstrual disorders, miscarriages, other STDs, and
partner mortality - all of which negatively impact fertility. On the behavioral level,
HIV+ status may prompt increased divorce and separation, increased use of condoms and/or
other barrier contraceptives, and reduced sexual frequency (Zaba & Gregson, 1998;
Gregson, et al., 1999). Biological and behavioral factors among HIV+ men may also impact
the fertility rates. In general, researchers have noted that biological factors,
including reduced sperm count and reduced frequency of sexual activity related to
physical illness, have been more important than behavioral factors (condom use, etc.)
when examining males' contributions to the declining fertility rates (Zaba & Gregson,
1998).
Orphanhood & Early Childhood Mortality. The data on child mortality and AIDS are more
confusing. There is no doubt that AIDS has had a devastating impact on children in
Africa. The majority of the world's estimated 1.1 million HIV+ children live in the
hard-hit sub-Saharan African nations (Boyle, 1998, p. 1). Most children become infected
in utero through maternal-to-fetus transmission or soon after birth through
breast-feeding. The risk of breastfeeding-related HIV transmission is very high -
estimated at 29% to 34% if primary HIV infection of the mother occurs during lactation
(Boyle, 1998, p. 1). By the end of the year 2000, some 13 million children will have been
orphaned by AIDS; 95% of these orphans live in sub-Saharan countries (Altman, 1999b, p.
1). As of 1997 11% of all children in Uganda, 9% of children in Zambia and 7% of children
in Zimbabwe were AIDS-related orphans, having lost both parents to AIDS (Altman, 1999b,
p. 2). At this point, most analysts view orphanhood as a more serious problem in
sub-Saharan Africa than increases in child mortality. Children who are the victims of
double orphanhood often place an impossible financial and social burden on elderly
grandparents and are at high risk for labor exploitation and/or recruitment into gangs
and militias. 
Gender Effects: The Case of Women. In the developed nations of the world, women
constitute about 20% of all HIV-positive adults (Altman, 1999a, p. 4). This gender
imbalance is primarily related to the concentrated pattern of transmission 
where the greatest number of cases are among male homosexuals and IV drug users. However,
in sub-Saharan Africa, the gender pattern is much different. Researchers have long
observed a fairly even gender distribution among African AIDS cases which is attributed
to the generalized pattern of heterosexual transmission. Recently released official data
has revealed that 12.2 million or 55% of the 22.3 million HIV+ adults in sub-Saharan
Africa are female (Altman, 1999a, p. 1). The African HIV gender disparity is particularly
dramatic at the younger ages. In many sub-Saharan African countries, the incidence of HIV
infection among girls between the ages of 15 and 19 years old is six to eight times that
of their male counterparts (Reuters Health, 1999a, p. 1). A number of social and cultural
factors are responsible for this discrepancy, including the high rates of rape in many
African countries, the low age of sexual initiation among females, and the age disparity
between young women and their first male sexual partners who alot of times are
middle-aged men seeking virgins as sexual partners to ward off AIDS.
Population-Wide Effects. Over time, higher-than-expected mortality rates and
lower-than-expected fertility rates will have an impact on population growth. To date,
hard data on the population-wide impact of AIDS have been limited. Preliminary data from
some of the hardest-hit countries suggest that AIDS has already begun to effect
population growth rates. A 1998 UN report found that the high AIDS-related mortality rate
in Zimbabwe had depressed population growth during the late 1980s and early 1990s.
Between 1980 and 1985, Zimbabwe's population grew at 3.3% per year. By 1998, the annual
growth rate had dropped to 1.4% and was projected to fall to less than 1% beginning in
2000 (Ibrahim, 1998, p. 1).
In conclusion the AIDS epidemic is devastating African society. Historically, few
epidemics have resulted in such widespread, devastating demographic effects. Thus far,
the AIDS epidemic in sub-Saharan Africa has decreased fertility rates, increased
mortality rates, shortened average life expectancy, increased the rate of orphanhood, and
disrupted family structure. It is now poised to decimate population growth rates and
alter the gender ratio. The epidemic may well change the social and economic fabric of
sub-Saharan Africa in ways that are not yet understood or anticipated. An International
Labor Office report released in October of 1999 warned that "HIV/AIDS has now become the
single most important obstacle to social and economic progress in many countries in
Africa" and noted that the epidemic in the region has shifted from being primarily a
health problem to being "a development problem with potentially ominous consequences"
(Reuters Health, 1999b, p. 1). Preliminary studies suggest that the economic consequences
of the AIDS epidemic will be no less devastating than the demographic consequences.
Direct economic consequences include the costs of medical care and social programs
related to the epidemic while indirect consequences include factors such as dwindling
labor productivity as the young, economically productive population takes ill and/or
dies. Solving the development problem of the AIDS epidemic in sub-Saharan Africa will
require not only massive amounts of foreign aid and expertise, but also a massive social
transformation. Through AIDS-prevention programs aimed at increasing condom use, reducing
high-risk sexual behaviors, improving HIV screening, promoting alternatives to
breastfeeding, and reducing social stigma associated with AIDS there can be a positive
and measurable impact on HIV prevalence or else the Aids Epidemic will continue to claim
the lives of millions and millions of Africans.
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