(Fwd) WWN: Worldwatch Issue Alert #10 Africa, HIV, population

[J. Halász Judit]

NEWS FROM THE WORLDWATCH INSTITUTE

>>From the Office of the Chairman
Worldwatch Issue Alert 2000 - 10
For Immediate Release
October 31, 2000

HIV EPIDEMIC RESTRUCTURING AFRICA'S POPULATION
A missing generation - a population of orphans - a shortage of
women

Lester R. Brown

The HIV epidemic raging across Africa is a tragedy of epic
proportions, one that
is altering the region's demographic future. It is reducing life
expectancy,
raising mortality, lowering fertility, creating an excess of men over
women, and
leaving millions of orphans in its wake.
    This year began with 24 million Africans infected with the virus.
In the
absence of a medical miracle, nearly all will die before 2010. Each day, 6,000
Africans die from AIDS. Each day, an additional 11,000 are infected.
    The epidemic has proceeded much faster in some countries than in others. In
Botswana, 36 percent of the adult population is HIV-positive. In Zimbabwe and
Swaziland, the infection rate is 25 percent. Lesotho is at 24 percent. In
Namibia, South Africa, and Zambia, the figure is 20 percent. In none of these
countries has the spread of the virus been checked.
    Life expectancy, a sentinel indicator of economic progress, is falling
precipitously. In Zimbabwe, without AIDS, life expectancy in 2010 would be 70
years, but with AIDS, it is expected to fall below 35 years. Botswana's life
expectancy is projected to fall from 66 years to 33 years by 2010. For South
Africa, it will fall from 68 years to 48 years. And for Zambia, from 60 to 30
years. These life expectancies are more akin to those of the Middle Ages than of
the modern age.
    The demography of this epidemic is not well understood simply because, in
contrast to most infectious diseases, which take their heaviest toll among the
elderly and the very young, this virus takes its greatest toll among young
adults. The effect on mortality is most easily understood. In the absence of a
low-cost cure, infection leads to death. The time from infection until death for
adults in Africa is estimated at 7 to 10 years.
    This means that Botswana can expect to lose the 36 percent of its adult
population that is HIV-positive within this decade, plus the additional numbers
who will be infected within the next year or two. The HIV toll, plus normal
deaths among adults, means that close to half of the adults in Botswana today
will be dead by 2010. Other countries with high infection rates, such as South
Africa, Swaziland, and Zimbabwe, will likely lose nearly a third of their adults
by 2010.
    Adults are not the only ones dying from AIDS. In Africa, infants of mothers
who are HIV-positive have a 30 to 60 percent chance of being born with the
virus. Their life expectancy is typically less than 2 years. Many more infants
acquire the virus through breastfeeding. Few of them will reach school age.
    Thus far, attention has focused on the effect of rising mortality on future
population trends, but the virus also reduces fertility. Research is limited,
but early evidence indicates that from the time of infection onward, fertility
among infected women slowly declines. By the time symptoms of AIDS appear, women
are 70 percent less likely to be pregnant than those who are not infected.
    Females are infected at an earlier age than males because they have sexual
relations with older men who are more likely to be HIV-positive. Female
infection rates are also higher than those of males. Among 15- to 19-year-olds,
five times as many females are infected as males. Because they are infected so
early in life, many women will die before completing their reproductive years,
further reducing births.
    A demographically detailed study in Kisumu, Kenya, found that 8 percent of
15-year-old girls are HIV-positive. For 16-year-olds, the figure is 18 percent;
and by age 19, it is 33 percent. Among the 19-year-olds, the average age of
infection was roughly 17 years. With a life expectancy of perhaps nine years
after infection, the average woman in this group will die at age 26, long before
her child-bearing years are over.
    Much work remains to be done in analyzing the effects of the HIV epidemic on
fertility, but we do know that with other social traumas, such as famine, the
effect of fertility decline on population size can equal the effect of rising
mortality. For example, in the 1959-61 famine in China, some 30 million Chinese
starved to death, but the actual reduction in China's population as a result of
the famine was closer to 60 million.
    The reasons are well understood. In a famished population, the level of
sexual activity declines, many women stop ovulating, and even the women who do
conceive often abort spontaneously. In a prolonged famine, the fall in births
can contribute as much to the population decline as the rise in mortality. How
much the HIV epidemic will eventually reduce fertility no one knows.
    One thing is known: The wholesale death of young adults in Africa is
creating millions of orphans. By 2010, Africa is expected to have 40 million
orphans. Although Africa's extended family system is highly resilient and
capable of caring for children left alone when parents die, it will be staggered
by this challenge. There is a real possibility that millions of orphans will
become street children, trying to survive by whatever means they can.
    Africa is also facing a gender imbalance, a unique shortage of women. After
wars, countries often face a severe shortage of males, as Russia did after World
War II. This epidemic, however, is claiming more females than males in Africa,
promising a future where men will outnumber women 11 to 9. This will leave many
males either destined to bachelorhood or forced to migrate to countries outside
the region in search of a wife.
    The demographic effects of the HIV epidemic on Africa will be visible for
generations to come. Until recently, the official projections at the United
Nations indicated continuing population growth in all countries in Africa. Now
this may be changing as the United Nations acknowledges that populations could
decline in some countries. If the new U.N. biennial update of world population
numbers and projections, due out before the end of this year, includes the full
effect of the epidemic on fertility as well as on mortality, it will likely show
future population declines for many African countries, including Botswana,
Zimbabwe, South Africa, and Zambia.
    There are many unknowns in the effects of the HIV epidemic on the
demographic equation. Will health care systems, overwhelmed by AIDS victims, be
able to meet the need for basic health care? How will the loss of so many adults
in rural communities affect food security? What will be the effect on fertility
of women surrounded by death? What will be the social effects of the missing
generation of young adults unable to rear their children or to care for their
parents?
    Even though the HIV epidemic may claim more lives in Africa than World War
II claimed worldwide, the epidemic is simply not being given the priority it
deserves either within the countries most affected or within the international
community. The challenge is to reduce the number of new infections as rapidly as
possible. Nothing should deter societies from this goal.
    One of the earliest countries hit by the epidemic, Uganda, has become a
model for other countries as the infected share of its adult population has
dropped from 14 percent in the early 1990s to 8 percent in 2000, a dramatic
achievement. In Zambia, which has mobilized the health, education, agricultural,
and industrial sectors, plus church groups, in the effort to curb the spread of
the virus, the infected share of young females in some cities has dropped by
nearly half since 1993. Zambia may soon turn the HIV tide. If all African
countries can do what Uganda has done and what Zambia appears to be
doing--namely, reduce the number of new infections below that of AIDS
deaths--they may set the stage for ending this history-altering epidemic.

- end -

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that analyzes global environmental and development issues.
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