Distr.: LIMITED E/ECA/PHSD/SDU/95/1 October, 1995
Original: ENGLISH
ECONOMIC COMMISSION FOR AFRICA
Senior Policy Seminar
on the Social Impact of
HIV/AIDS in Households and Families in AfricaAddis Ababa, Ethiopia
2 - 4th October, 1995
DEMOGRAPHIC AND SOCIO-ECONOMIC CONSEQUENCES OF HIV/AIDS IN SUB-SAHARAN AFRICA
Population Division ECA Presenter: Mr. Banda
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DEMOGRAPHIC AND SOCIO-
CONSEQUENCES OF HIV/AIDS IN SUB-SAHARAN
(Paper presented at the seminar on HIV/AIDS held at EGA Headquarters, October 1995
by Mr. K.A. Banda, Population Division) This paper was finalized without formal editing
DEMOGRAPHIC AND SOCIO-ECONOMIC CONSEQUENCES OF HIV/AIDS IN AFRICA
CONTENTS EXECUTIVE SUMMARY
I. INTRODUCTION AND BACKGROUND
II. DIMENSIONS OF HIV/AIDS IN SUB-SAHARAN AFRICA 2.1 Global dimension
2.2. Sub-Saharan Africa regions
III. DEMOGRAPHIC AND SOCIO-ECONOMIC IMPACT 3.1 Demographic impact
3.1.1. Population size and growth 3.1.2. Mortality and HIV/AIDS 3.1.3. Fertility and HIV/AIDS 3.2 Socio-economic impact of HIV/AIDS 3.3 Achievements
IV. CONCLUSION
APPENDIX A. TABLES (1-7)
B. FIGURES 1A-1E Linear graphs on population size 2A-2E Linear graphs crude death rates 3A-3E Linear graphs Life expectancy at birth
3
EXECUTIVE SUMMARY
1. Human Immunodeficiency Virus (HIV) that causes Acquired Immunodeficiency Syndrome or commonly known as HIV/AIDS or simply AIDS is a pandemic that is everywhere, in almost all communities, or countries. Its distribution, concentration, extent, magnitude and impact vary significantly among different population groups. In countries, particularly of subSahara Africa, it has acted like a fierce force of fire spreading into rural and urban areas, alike. It has exerted greater public concern to governments and their protagonists included. Fragile economies, high poverty levels, scarce resources, food insecurity, socio-cultural and sexual traditions and customs together with inadequate and compromised health infrastructure, emergencies due mainly to civil wars and displacement of population, other epidemic diseases such as measles, cholera, etc. and lack of political will, coordinated approaches involving all agencies and sectors and information, education and communication; aggravate HIV/AIDS in Africa.
2. Cumulative cases of HIV/AIDS up to 30 June 1995 worldwide suggested a 35 per cent for Africa with about 12 per cent of worid population. The implication is also that for SubSaharan Africa, being the hardest hit region with projected, AIDS cases of 11 million out of the 30-40 million worldwide by the year 2000. Presently more than 2.5 million HIV infected Africans have already died of AIDS. Botswana, Congo, Malawi. Namibia, Uganda, Zambia and Zimbabwe are among the hardest hit countries of Sub Saharan Africa.
3. The impact of HIV/AIDS is that it hits the rich and poor, the educated and uneducated, urban and rural residents, alike. It affects mostly young people of under age 26 years with new infections about equally distributed among males and females. The expected death toll by the year 2000 for Africa is about 7 million most of whom will be in Eastern and Central Africa, where there are about one third of women in some cities and towns are seropositive against HIV/AIDS. Furthermore nearly four - fifths of hospital beds in wards is occupied by infected HIV patients such as in Central Africa. The overall impact of the pandemic cuts across all sectors of life of the peopie inclusive of the demographic phenomena, the social structures and norms of behaviour, the economic functions and complex processes of development.
4. By the year 2000 when the epidemic will most likely reach its peak, mortality levels will have increased by about 10 to 15 per cent above levels without HIV/AIDS environment. This will have the effect of lowering further the life expectancy at birth to less than 50 years. This clearly indicates that most countries in the region will not attain set targets contained in the "Health For Ail by the year 2000"
ideals as well as the declaration agreed at the second African population conference of 1992, but will most likely be postponed till the year 2010 or 2020 i.e. an overall delay of 20 years.
5. Fragile African economies and traditional family structures will equally be affected. For example, economic growth will slacken because industries that are labour intensive such as mining and agriculture will loose most labour force to AIDS deaths. The increased levels of morbidity and mortality due to HIV- related causes will affect already overstretched health infrastructure. Large proportion of young adult parents succumbing to AIDS will leave behind an equally large group of orphans with little economic support for themselves and grandparents.
6. The pandemic, while having caused havoc on both demographic and socio-economic conditions
of the people, the international community has responded in various ways to finding a solution to combat
the pandemic. The fact that this gathering is taking place at the moment is a positive approach to sharing
knowledge and experience to fight against the disease. While many fora have been organized across the4
continent, there was no such coordinated approach to enable the ECA to position itself in the leadership role and status, hence this seminar will propose intervention actions to alter the course of the disease.
I. INTRODUCTION AND BACKGROUND
7. Human Immunodeficiency Virus (HIV) that causes/Acquired Immunodeficiency Syndrome commonly known as HIV/AIDS or simply AIDS is a pandemic that is everywhere among communities, professional groups or countries. Its distribution, concentration, extent, magnitude and impact vary significantly among different population groups, communities and nations. In countries, particularly of subSahara Africa, it has acted like a tierce force of fire. It has spared no country and exerted greater concern to governments and their protagonists included.
8. The great public concern the pandemic has caused has been recognized by all governments worldwide and those in Africa, in particular. The deep concern has been expressed because of the great danger the pandemic causes to humanity at ail its levels, including its demographic processes and socio- economic development endeavour. In view of these concerns, recommendations and programmes of
"Action Plans" to prevent or slow down the spread of the pandemic have been debated and passed at different fora. These include the WHO Global Programme on AIDS (GPA); the "six Point Agenda Declaration on the AIDS Epidemic in Africa" which was passed in 1992 in Dakar. Senegal and the Tunis Declaration on AIDS also passed in Tunisia, which was later reiterated by the Conference of African Ministers of Health Meeting held in Cairo 1995; the "Intensified Country Action Plans (ICAPS)" for population and AIDS prevention programmes of the Global Coalition for Africa (GCA) and the National AIDS control programmes (NACP), etc. have been institutionalized in nearly all African countries-.
This seminar for senior policy expects should contribute to efforts to intervene to change tHe course and
direction of the disease.
9. The disease affects of all population groups, the educated, professional experts and all categories of socio-economic status first appeared as a strange disease during the late seventies and early 1980s in Africa. The first cases were diagonised in Zaire, Uganda. Zambia and so on by the first half of 1980s' decade. Thereafter, it has become common knowledge in the fabric of Africa societies. In some communities the sefoprevalence rates exceed 10 percent and in most atfected as much as 20 percent of adult population having been infected. Fragile economies, high poverty levels, scarce resources, food insecurity, socio-cuitural and sexual traditions and customs together with inadequate and compromised health infrastructure, emergencies, other epidemic diseases such as measles, cholera, etc. and lack of political will, coordinated approaches involving all agencies and sectors and information, education and communication aggravate HIV/AIDS in Africa-.
V ECA, Socio-Economic and Demographic consequences of HIV/AIDS in ECA member States.
E/ECA/PSD.S/21, Addis Ababa, 1994.
2j OAU/5CAMH, Addressing the HIV/AIDS Epidemic in Africa. Achievements and challenges. Paper presented at the OAU Conference of African Ministers of Health Fifth Ordinary Session, 24-29 April, 1995 Cairo, Egypt.
10. The dimension of HIV/AIDS worldwide appears to hard hit Africa according to the most recent reports compiled by the World Health Organization (WHO). Cumulative cases of HIV/AIDS upto 30 June 1995 suggested a 35 percent tor Africa with about 12 percent of world population2'. The implication is also that for SubSaharan Africa, being the hardest hit region is projected to have 11 million of the 30-40 million worldwide AIDS cases by the year 2000, Presently more than 2.5 million infected Africans have already died of AIDS. Botswana, Congo, Malawi, Namibia, Uganda, Zambia and Zimbabwe are among the hardest hit countries of Sub-Saharan Africa.
11. The impact of HIV/AIDS is that it hits the rich and poor, the educated and uneducated, urban and rural residents, alike. It affects mostly young people of under age 26 years with new infections about equally distributed among males and females. The expected death toll by the year 2000 is about 7 million of whom most will be in Eastern and Central Africa, where about one third of women in some cities and towns are seropositive with HIV/AIDS. Furthermore nearly four- fifths of hospital beds in wards is
occupied by infected HIV patients such as in Central Africa-'. The overall impact of the pandemic cuts
across all sectors of life of the people inclusive of the demographic phenomena, the social structures and norms of behaviour, the economic functions and complex processes of development.12. This paper focuses on the analysis of unfolding situation of HIV/AIDS as reported by various countries in the sub-Saharan Africa, excluding the North Africa region for lack of adequate data and seemingly reduced gravity of the pandemic among those countries. The main objective of this paper is therefore, to attempt undertake an assessment of the impact the pandemic poses to the demographic and socio-economic conditions of Africans. Part two presents the dimension, as.it unfolds, of the HIV/AIDS pandemic from country reports complied by WHO. The impact of pandemic in relation to demographic and socio-economic consequences in sub-Saharan Africa is in part three, with conclusion following it.
Data used in this paper are from reports of cases compiled by WHO/AFRO in Brazzaville and published estimates and projections of the United Nations released before and after the pandemic. Both data sets, the WHO reports and UN estimates have been analyzed without assessing data quality.
II. DIMENSIONS OF HIV/AIDS IN SUB-SAHARAN AFRICA
13. The first diagonisedeases of HIV in sub-Sahara Africa are not known for certain, but such cases are presumed to have occurred during 1970s with first deaths recorded in early 1980 decade in-some Africa countries like in Zambia. AIDS was first recognized in 1982 in Zambia as an atypical, aggressive
type of Kaposi's sarcoma in young adults-'. Therefore, since AIDS has incubation period it is most likely
that the HIV must have strike in the 1970s.U WHO, "AIDS Cases .reported to WHO by country/Area based on Reports Received through 30 June 1995". AFRO Brazzaville.
V OAU, op.cit. Cairo, 1995.
V Subhash Hira, ci ai Designing Appropriate Intervention Strategies for HIV/AIDS in Southern Africa.
a paper in Population and Environment, A Journal of Interdisciplinary Studies, Volume 14, Number 3,
January 1993. I .
14. Ever since, the disease has acquired many pseudonyms like "slimmer", "stow or death sentence",
"incurable", "killer", "exterminator"."the drainer","the robber, "family disease (\ etc. Basically these nicknames express the social concerns of the people about the disease since it has affected the pleasurable activity of sexuaiity. AIDS is considered a robber because it deprives individuals of social expectations and wealth6/.
15. Regarding its dimension, HIV/AIDS in sub-Sahara Africa has a sex ratio of almost 1:1 in the entire population suggesting that its transmission is of basically heterosexual more than through blood transfusion or mother to newborn transmission. Its transmission is also on very fertile ground where prevalence is high of sexually transmitted diseases like herpes, gonorrhoea and syphilis. In the general population, the majority of cases are in working age groups and childbearing age groups with men dominant in 30-34 years and women 15-49. The mean age for women being 27 and 32 for men,respectivelyz/.
2.1 Global dimension
16. Transmission of the diseases outside Africa is largely not heterosexual, but much more through sharing of drug needles, homosexuality, and blood transfusion particularly during early 1970s when less was known about its existence and transmission among people.
17. According to latest reports of the spread of the disease, by 1995 there should have been an estimated 19.5 million or more affected by the HIV in less than 20 years since the virus was first identified. This figure was 7 million higher than a few years earlier in 1992. It is expected that in the year 2000 about 30-40 million adults of whom 13 million will be women and four million of them will have died2'. While reports complied by WHO indicate that cumulative cases upto 30 June 1995 worldwide were 1,169,811. Of these 45.6 per cent or 581,129 were reported cases from the Americas, Africa had reported 35.7 per cent or 418,051 with Europe having 12.1 per cent or 141,275 cases.
18. Although these data are seriously affected by compliance to reporting systems designed by WHO and its member states, one issue is clear that the HIV/AIDS is of greatest concern to all. There is no country, as Jonathan Mann and his colleagues have asserted, in the world already affected by AIDS can claim that the spread of HIV has stopped. HIV is spreading, perhaps quite rapidly, to new communities like rural areas of countries in subSaharan Africa. The HIV/AIDS has demonstrated its ability to cut
l! Christine Obbo, HIV Transmission: Men are the Solution, a paper in Population and Environment, a Journal of interdisciplinary studies volume 14, number 3, January 1993, Human Sciences Press, Inc. New York 1993.
V Christine Obbo, on.cit. 1993
V OAU, Addressing the HIV/AIDS epidemic in Africa: Achievements and challenges. CAMH/6 (V),Cairo, Egypt 1995
Jonathan Mann, et al, AIDS in the World, a Global report. Harvard University Press, Cambridge, Massachusetts, and London, England 1992
across all social, cultural, economic and political categories and sectors. All mainline population groups are affected-.
2.2 Suh-Saharan Africa
19. The countries of Sub-Saharan Africa have, not at all, been spared by the HIV/AIDS pandemic.
As a matter of fact, this is the region that has been most affected and some countries that are hardest hit are in this region. The region is hardest hit with a current cumulative total of 11 million infected adults.
Already 2.5 million adults have died of AIDS, over one million infected children were born-.by late 1994 and that inf:areas were the AIDS is more mature as in Eastern Africa there are 79 per cent of new infections among females and 74 % for males occur under age of 26 years-. Table 1 presents distribution of reported cases tor countries in sub-Saharan Africa.
20. Table 1 contains reported cases between 1978 and 1992, those tor 1993, 1994, upto June 1995 and all cases between 1978 and 1995. There is also information about the prevalence rate of number of reported cases per 100,000 population, and percentage distribution of cumulated cases out of the total reported infections for the whole region. It is expected that these data, since they rely on reports of governments to WHO/AFRO, have omission rates that should be high for many reasons, including political, financial resources like from tourism, foreign investment ventures, etc. For these reasons, it is therefore imperative that these data represent the barest minimum of the dimension of the problem of the pandemic.
21. From the table it can be deduced therefore that the extent of the problem varies significantly from one country to the other. Taking the percentage distribution of reported cases, it is indicative that for the initial period between 1978 and 1992 countries such as United Republic of Tanzania, Uganda, Kenya.
Malawi were the hardest hit with 10 per cent or more cases of HIV/AIDS. By 1995 when reporting was expected to be better than before, these counties were joined by Zimbabwe, Zambia, Zaire, Cote d'lvoire, Ethiopia, and most probably Ghana and Rwanda. The slight reduction in proportion of cumulated cases between 1978-92 and upto 1995 is likely to be due to maturing of the pandemic, lacking in reporting new cases or changing behaviour of the people against the pandemic.
22. Another index to explain the dimension of the disease among countries is the prevalence rate per 100.000 population. Talcing the rate for 1993 data in table 1 pick Zambia, Zimbabwe. Botswana, Congo, Malawi, Kenya, Togo and perhaps Cote d'lvoire as countries with very high risk rates of 30 or more per 100,000. It is important to note that the extent of the dimension is concealed by misreporting tendency of such statistical data.
23. In recent reports of estimates of the dimension of the pandemic in African countries with the highest prevalence rate of infection or were about 1 per cent of total population is at risk, the Population Division in New York has estimated that 7.8 million adults and 1,5 million children under the age of five
V Jonathan Mann, et al, op.cit, 1992 Christine Obbo, op.cit, 1993
107 OAU, on.cit, 1995
years had been infected with the HIV by 1995. Many of these people will die of AIDS and especially for women they will also die of other causes like obstetric complication, malaria, cholera, etc. because the prevailing environment is that of high mortality populations of Africa-.
24. The dimension of AIDS infections in Africa is almost equal for both men and women because
its transmission is generally heterosexual than elsewhere. Table 2 presents a breakdown of reported cases
by sex or gender among countries in Africa.25. Reports of countries to AFRO presented in table 2 indicate that there were more males than females infected with HIV in 1994 in the subregion. Countries with very large proportion of infected
male, ie. perhaps with better reporting were Uganda (14.6 %),followed by Kenya (11.5 %), Tanzania(10.7 %), Zimbabwe (10.5 %), Malawi (10.3 %) and Zambia (10.0) of total reported male cases of the pandemic. Similarly, largest proportion among women is in slightly different countries and these were Tanzania (13.3 %) followed by Kenya (11.8 %), Uganda (11.7), Zimbabwe (11.0 %)and Malawi (10.5
%). Even though ranking positions of countries were different for males and females, these countries
were certainly among hardest hit in the SubSaharan Africa.26. The data in table 2 further suggested, that there were more males than females infected with HIV, if reporting was not biased to either sex. Overall, the sex ratio of infections among males to females were to indicate the dimension of gravity of the pandemic, therefore, a ratio of 134.5 of males for every 100 infected females for Africa indicates that there were about one-third more males than females. In a majority of countries in table 2. more males than females were infected with HIV. Niger (392.4) had the largest number of infected males per 100 females in that country followed by Namibia, Burkina Faso, Cote d'lvoire, Benin, Nigeria, Zambia and Uganda. The others are Gambia, Ethiopia, Gabon, Cameroon,
Togo and Malawi. In a paper by Christine Obbo writing on Uganda, apparently singles out men as majorculprits tor the spread, while in Zambia, as Subhash and others, travel abroad by mostly Zambian male folk, and their wealth as a symbol of socio-economic status, were more affected than females, with the HIV-. What are the consequences of the pandemic on population and development of Africa ? To
answer this question, the section that follows throws some light.III. DEMOGRAPHIC AND SOCIO-ECONOMIC IMPACT
27. HIV/AIDS pandemic is not just another disease, it has caused great public concern, it above all, has major consequences that go far beyond the health and weilbeing of the individual. In high mortality countries such as those in sub-Saharan Africa, morbidity and mortality levels have increased because the health of the people is already debilitating from numerous other parasitic and infectious diseases that are associated with poverty, but preventable. On the other hand HIV/AIDS hits all categories of population both rich and poor, educated and uneducated, urban and rural residents, health personnel and labourers or unskilled workers. The traditional cultural believers, moderates, conservatives, etc. no category and no country has been spared by the pandemic.
IV UN, World Population Prospects:The 1994 Revision, (Forthcoming)
1;/ Virginia Abernethy (Editor), Population and Environment, A Journal of Interdisciplinary Studies, Volume 14, number 3, January 1993, Human Sciences Press, Inc, New York, 1993
^
28. HIV/AIDS is a unique pandemic. Unlike malaria, measles or polio which are some of the diseases for the poor. AIDS affects particularly young and middle aged adults, families, households, couples,and that its demographic and socio-economic impacts multiply from infected individual to the group, and the country. In this presentation, we have confined to descriptive and quantitative analysis of its demographic and socio-economic consequences of the pandemic because of lack of adequate data.
3.1 Demographic impact of HIV/AIDS
29. Recently research on developing mathematical modelling has contributed to adoption of three
major models namely (1) the Epi model which is an epidemiological model developed by the WHO,(2) the Abacus which was created by the United Nations, and (3) iwgAIDS model of the United States Department of State's Interagency Working Group-. The development of these and other modelsdefend largely on various assumptions about the pandemic and its perceived nature course of development. However, these efforts have the potential to help health policymakers to better understand the dynamics of the epidemic in order to be able to forecast the burden of the illness in the future, and to evaluate potential interventions to alter the course of the pandemic; and its likely impact on the demographic and socio-economic development, as well as at the individual, household or community level. Furthermore, whichever model is used the results enable other researchers and development planners, etc. to understand the potential impact HIV/AIDS has on demographic processes, health,
education, manpower and labour force and other socio-economic sectors. -30. Results of modelling used in this paper to analyze the impact of HIV/AIDS are estimates and projections published by the United Nations in its series of the world population prospects of 1988, which do not take into account assumptions about the pandemic and those of 1992 revision when the pandemic entered into the assumptions. For 1992 estimates and projections were based on the use of the Epi and Abacus model. Although these data are the most reliable, it is important to interpret with caution the demographic impact of HIV/AIDS because there are limitations about baseline data used in the model and other implicit HIV-related assumptions when projecting such populations, and that little is known about future developments in medicine and behavioral changes, all these assumptions may affect future trends
of populations under HIV/AIDS.
31. The demographic impact HIV/AIDS in this paper has assessed the population size as a result of the spread of HIV/AIDS and its demographic processes of fertility and above all, on mortality. The
impact on population size is considered, first.l2J UN and WHO, The AIDS epidemic and its demographic consequences. ST/ESA/SER.A/119, New
York, 1991
UN, World Population Prospects. The 1992 revision. New York 1993
Peter O. Way and Karen Stanecki, How Bad Will It B? Modelling the AIDS epidemic in East Africa, in Population and Environment, A Journal of Interdisciplinary Studies, volume 14, Number 3, January 1993, Human Sciences Press, Inc. New York 1993.
IV Michael A. Stoto, Models of the Demographic Effects ofAIDS, in DEMOGRAPHIC CHANGE IN
SUB-SAHARAN AFRICA, by (Editors) Karen Foote, Kenneth Hill and Linda Martin, NATIONAL ACADEMY PRESS,Washington D.C., 1993
3.1.1 Population size and HIV/AIDS
32. Nowadays, serious newspapers and magazines often report about the impending number of people, but mostly workers, who would succumb to AIDS*.
33. In the general population, the HIV/AIDS pandemic will lead to increased mortality rates and consequently reduce the size of population of countries, according to results of modelling for AIDS population. In some communities in Uganda, for instance whole villages have evaporated or wiped out like in Rakai district. However, results of our analysis are based on comparing projections prepared before the pandemic, such as those the United Nations published in 1989 do not have HIV-related assumptions and data published by the United Nations in 1993 having the HIV-related assumptions of models of Epi and Abacus-. There is another advantage to rely on these two sets of data by the United Nations because they are standardized and therefore, facilitates reliability of our results of assessment of impact of HIV/AIDS on population size and growth, etc. in the countries of sub-Saharan Africa during the period of the pandemic, beginning 1980 and beyond, to about the year 2020.
34. Estimates of population size based on projections of the 1988 worid population prospects and those of the 1992 revision of the world population prospects were studied. It is expected that any differences will be due to the impact of HIV/AIDS overtime. However, the pandemic has undefined period of incubation, lack of possible cure within foreseeable future and succumb to morbidity and mortality due to other HIV-related illnesses. Table 3 presents population sizes of selected countries in sub- Saharan regions for the two sets with No AIDS (NA) and With AIDS (WA) assumptions.
35. Data in table 3 indicate large differences between these sets of data. The estimates that do not base their assumption on existence of HIV/AIDS pandemic, identified in this table as NA are the expected demographic trends of population since the end of the second world war (WWII) and the column identified as WA represents population estimates in the environment of AIDS beginning in 1980 to 2020.
It is considered that the effect of AIDS in Africa must have commenced in 1970s or early 1980s and that it is not possible to project such population beyond the year 2020 based on scant information available so far,
36. The estimates of WA are generally less in size compared to those in the NA column tor nearly ail countries and sub-regions over the period between 1980 and the year 2020. Since we have postulated that any differences between NA and WA are due to deaths of victims of HIV/AIDS, we can notice that the margin increases during subsequent decades, with a peak occurring in the year 2000 or 2010 when most infected persons will have died of AIDS in the region as a whole.
UN, op.cit. New York 1989 UN, on.cit. New York 1993.
Notes;
* A big mining firm in South Africa for example, was reported recently, by British Broadcasting Corporation (BBC) radio relay that GENCO was burying 30 or more victims of AIDS every month and that the mining company had already a quarter of its 100,000 work force seropositive prevalence rate.
10
37. For the Africa region as a whole it is therefore,- to be expected that while two million Africans would have died of AIDS in 1980. this must have risen to six million in 1990 and for the future there will be 16 million by the year 2000 and double that in ten years later before coming down to 20 million in the year 2020. A similar trend is expected for the most,affected regions of Eastern, Southern and Western Africa. It appears that in the next century AIDS deaths will be larger in Western than Eastern Africa perhaps for the fact that most victims will have died in the latter part before the year 2000, if reporting quality is not biased. Data for the Central sub-region do not provide a clear indication of the impact of the pandemic and should not suggest the contrary because HIV/AIDS has inflicted damage almost in every country in the continent and the world as a whole. These observations are further illustrated in Figures 1A to IE where WA lines are tower than for NA values.
38. Among the most affected countries, data in table 3 suggest that comparatively more people have had to die of AIDS in Kenya, Namibia, Swaziland and Zambia. For instance, in Kenya the population should be 87 % in the year 2000 and thereafter remaining at 82 % of the expected population in a demographic environment without AIDS. In Namibia, which seems to be the hardest hit will have about 73 % of its expected population in the decades of the next century. The sad fact for that country is when about one third of the population will die of AIDS poses greatest public concern. For Zambia the WA is less than NA, for example it is 95 % in 1990, falling further in year 2000 to about 86 % and 80 % in 2010, respectively suggesting that about20 per cent of population will have died of AIDS. Obviously, these reduced sizes of Population will have serious implications pertaining to various social sectors like education, labour force, etc; and overall economic development since the victims of AIDS will be
expected to be young adults in productive ages.
3.1.2 Mortality and HIV/AIDS
39. Of the three components of population dynamics, the one that is expected to have the greatest
impact is mortality. Many countries and their governments in Africa consider reduction in levels of morbidity and mortality as important factor in enhancing development of their countries. Apart from the demographic fact that mortality is influenced by age structure of population, it becomes a double tragedy that HIV/AIDS is also selective with regard to age. AIDS affects mostly young adults in productive and
childbearing ages. It is therefore expected that living in an HIV/AIDS environment will most certainlylead to heightened levels of mortality hence higher estimates of CDR or IMR and reduced life span. Table
4 presents estimates of CDR under assumptions of NA and WA.CO Crude birth rare, CDR
40. Data in table 4 indicate, as expected, estimates of CDR are progressively higher in environment of HIV/AIDS than otherwise.- In Eastern Africa where many countries have suffered greatly from the disease the estimates are 15 per cent higher and they are generally twice as much as for the region as a whole. For the Western subregion the difference between them is moderate, but positive. In all subregions the peak occurs by the year 2000 when the AIDS pandemic will reach its worst impact on mortality of affected persons. Linear graphs in Figures 2A to 2E illustrates clearly the gap between the NA and WA.
The gap is larger for Eastern than Western or Southern. The bulge tends to appear at bout the year 2000 in all subregions except Southern and western.
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41. Among the hardest hit countries that have tremendous differences in CDR with HIV/AIDS are Uganda with the largest difference of 43 per cent at peak year 2000 followed by Cote d'lvoire with largest difference of 31 per cent at its peak in the year 2000, Rwanda and Zambia. Malawi is another country also apparently devastated by AIDS related mortality in a country which already has significantly high mortality in an environment without HIV/AIDS.
(ii) Infant mortality rate, MR
42. The indicator of infant mortality rate does not appear to better illustrate the impact of the HIV/AIDS pandemic. Probably this could be the result of transmission which is likely to be only from effected mother to foetus before birth or thereafter from breast feed. It is therefore expected that the impact will not be significant as regards mortality among infants, but perhaps young children because of the period of incubation of 2 to 3 years among children. Table 5 presents estimates of IMR under the environment of HIV/AIDS and AIDS free.
43. Eastern and Western subregions appear to show slight impact of AIDS on mortality of infants, while the Southern subregion indicates the contrary. However, among countries presented in the table, Congo has quite large impact of infant mortality as a result of AIDS, followed by Zambia, Uganda and
Botswana. For Swaziland. Namibia and Zimbabwe as well as the whole Southern Africa sub-region infant mortality rates appear not to be strongly affected by the HIV/AIDS. More research is needed to ascertain this apparently unusual demographic impact of AIDS among infants in some countries in the sub-region.Since HIV/AIDS has an incubation period, it is possible that infected infants easily survive first year of life, but may die in childhood before fifth birthday. Estimates of child mortality q5 were not available to
index impact of pandemic on child mortality.(Hi) life expectancy at birth, e0
44. In order to understand better the impact of the pandemic on demographic processes in the most affected countries of the sub-Saharan Africa, we analyzed estimates of life expectancy at birth. These are presented in table 6, and in linear graphs of Figures 3A to 3E.
45. The e0 estimates under the environment of HIV/AIDS presented in WA column are generally lower than those in NA-- column which represents estimates of life expectancy in the demographic
environment without AIDS. :
46. For Africa as a whole life expectancy at birth will reduce gradually as a result of AIDS. It will remain below the set target by the year 2000 when it is expected to be 60 according to the recommendations of the HFA. Africa will therefore delay by ten to 20 years before achieving its set target. Among the sub-regions. Eastern will have lost most years of life expectancy and may not easily gain until the year 2020 and*beyond. Graphs in Figures 3A to 3E illustrate these observations better.
47. In countries which are hardest hit. life expectancy will have reduced by about a quarter than without AIDS. For example; in the year 2000 which is the period the pandemic will have had its worst devastation e0 in Uganda will be 26 % lower than if there were no consequences of the disease, followed by Zambia at 24 % lower, Malawi with a reduction of 15 % and Rwanda at 13 % as well as Zimbabwe with 12 % reduction in life expectancy at birth. These results are interesting, particularly for Zimbabwe because other indices do not reveal such a iarge impact due to AIDS. Next, we analyzed the fertility components and impact of AIDS.
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3.1.3 Fertility and HIV/AfPS -
48. Fertility is the other component of population growth likely to be affected by the HIV/AIDS pandemic in several ways. Since mortality due to AIDS affected young adults in reproductive age groups the base population reduces hence the level of fertility in the population would likewise drop. On the other hand, because of the strong relationship between child mortality and fertility couples tend to raise their fertility either as an insurance against expected child deaths or as replacement of dead children. In both cases the desire is linked to value of children especially for support of parents in old age. Data in table 7 presents estimates of crude birth rates for sub-Sahara regions and selected countries.
49. , Even though GBR is sensitive to age structure of population, it has been used here to draw conclusions of the demographic impact of HIV/AIDS in Africa. The GBR is generally lower for conditions of HIV/AIDS in most countries particularly in the year 2000 when the pandemic reaches its
•peak of the impact. In most affected countries such as Swaziland, Botswana, Kenya, Namibia or Zambia the,level of fertility drops by about 5 to 15 per cent because of AIDS. However, in some of these countries like those in Southern Africa, and Kenya have already.started experiencing fertility reduction because of increased use of contraceptives and other methods of family planning.
50. Another observation from these data is that levels of fertility although reducing in all countries overtime, CBR is higher under environment of HIV/AIDS particularly after the pandemic passes through its peak in the year 2000 in most of these countries, perhaps because of the strong relationship between fertility and mortality, etc.,In order to be able to ascertain ourselves about the consequences of HIV/AIDS on fertility, there should be more research focused on this matter covering some of these counties. ;
3.2. Socio-economic impact of HIV/AIDS
51. It is not possible to estimate direct or indirect cost of AIDS for countries in sub-Saharan Africa because of lack of data, but the impact of the pandemic on social and economic development is critical.
Since. AIDS tends to affect young adults, it causes havoc both economically and socially in individual households, communities and the country as a whole. Media reports nowadays give wide coverage to impending catastrophe of economies of many countries". Zambia's Copperbelt, for example is another labour intensive mining industry, as in South Africa, faces labour losses due to AIDS.- Other media reports suggest that where .seropositive prevalence is one per cent of population, it entails a loss of one year in development efforts of countries as attributed to studies undertaken by UNDP.*** ' . ;
lV The Panos Institute, AIDS and the THIRD WORLD, published in association with the Norwegian
Red Cross, London
Notes:
"Recently, the British Broadcasting Corporation reported that a major company, Gencor Mining in South Africa, reported that it was loosing 30 employees every month to AIDS deaths and a
quarter of its work force of 100,000 plus strong, was seropositive with the HIV- related infection. Mostof the work force comprises migrant lahour from neighbouring countries of South Africa, such as Lesotho, Swaziland. Mozambique and Malawi all of which are traditional reservoir of migrant labour to the republic of South Africa.
*" According to the BBC radio reports. 13
52. Since data pose the problem of understanding better the consequences of the pandemic, we are only able to reflect on research being pursued on developing mathematical and epidemiological models as well as conceptual frameworks. Recently a team of researchers at Havard in the United States evolved such a framework which defines the AIDS impact in selected sectors like health, social services, education agriculture, industry and trade. Effort was directed at analyzing impact of pandemic at all levels, notably (1) individual, (2) household. (3) family, (4) community, (5) production unit, and (6) national. The framework is not exhaustive, but it can be used tor exploring the broad consequences of the HIV/AIDS^'.
53. Many developing countries including those in sub-Saharan Africa are characterized by fragile economies, high poverty levels, limited government resources, scarce human capital, food insecurity as well as high seropositive levels of AIDS. The prevalence of AIDS entails additional burden of economies hence presenting serious implications for development process of the hardest hit'countries and its people.
As we discussed earlier about the demographic impact of the pandemic, adultS: in their prime sexual and
productive ages are among most affected. AIDS affects the occupational or the urban elite since it is not
the disease of the poor only. From scanty reports it is apparently clear that in sub-Saharan region, AIDS is spreading rapidly among higher socio-economic classes and it has been found to be a leading cause of death in many cities such as Abidjan, Nairobi, Lusaka, etc-.Mining sector
54. Where empirical data are available, AIDS challenges economic growth through its impact on
services and industrial sectors. The HIV/AIDS morbidity most likely reduces productivity such as in mining, which is a labour intensive sector. The impact on availability of miners and trained staff causes
declines in production. The AIDS illness will lead to accelerating mining companies medical expensesthrough health insurance programmes^2'. Newspaper reports from countries in the sub-region have
already raised this matter, such as in Zimbabwe, South Africa, Zambia and so forth.Agriculture sector
55. Apart from causing reduced productivity in mining, HIV/AIDS has greater impact on the
agriculture sector which is another labour intensive economic mainstay of most countries in Africa. The rural to urban migration streams have already taken away able-bodied adults from rural areas where mostagricultural activity is undertaken. The spread of HIV/AIDS to rural areas is aggravating the shortage
of labour force and will lead to serious reduction in agricultural yields. At a family level, household resources that were meant to be used for purchasing and improving agricultural inputs may be divened to pay for other expenses like medical treatment, funeral costs, and overall reduction in household resources. Reduced agricultural yields because of AIDS will enhance food insecurity and malnutrition with extended families taking on orphans would further spread food resources more thinly.XV Jonathan Mann and others, A Global Report AIDS in the World. Harvard University Press, 1992 X2J Linda A. Valleroy and others, The Consequences of HIV/AIDS in Eastern Africa on Mothers- Children, and Orphans, in population and bnvironment A Journal of Interdisciplinary Studies Vol. 14,No.3, January 1993, Human Sciences Press, Inc..New York.
lV John K. Anarfi, HIV/AIDS IN SUB-SAHARAN AFRICA. ITS DEMOGRAPHIC AND SOCIO- ECONOMIC IMPLICATIONS, in AFRICAN POPULATION PAPER NO.3, African Population and Environment Institute. Kenya, December 1994.
14
ftfel^fe^lipii^Mg^"^?^p!^!^rjlqit^^il;'i|ft5iffiz=sgi^B»rtl!i^n^p£Tl&.&^[ai;H==s±g^^i^^_di&^
Health sector
56. In the health sector itself, the HIV/AIDS has perhaps me greatest impact because the demand of infected people increases rapidly. Expenditure in the health sector will rise as AIDS treatment, with no cure at the moment, causes considerable amounts of current expenditures on health. It has been reported that most medical wards have all beds occupied by AIDS patients in most hospitals in cities and towns in the region. AIDS causes an added burden to improving general health of the people because of growing demand in health personnel like nurses, drugs and hospital beds.
Education sector
57. Another socio-economic sector affected by AIDS is education. Since investing in people or human resources through improved health, education, and nutrition especially in women is not an end. it is a key to higher productivity and growth over time. Here AIDS poses a serious threat to further development of human capital by potentially reversing recent gains in quality and longevity of life. Families with AIDS illness or death are therefore, less able to invest in their children's education because of other expenditure on medical care and reduced disposable income.
Social sector
58. The impact of the pandemic on society is also felt through its economic arrangement. Women and children are more vulnerable, both as potential AIDS casualties and survivors. The implications are serious because women provide all the care, responsible for food production, agricultural labour and
raising children. These roles of women are not affected by type of family bonds being either matriiineal
or where family union systems tbllow patrilineal-'.59. In nearly all African traditions the extended family system is ideally prevalent widely. In this type the whole family system provides and meets all demands for social security of bereaved familymembers, particularly orphaned children and elderly persons. In the environment of AIDS, its impactisgreatly felt regarding care of orphans. In countries that are hardest hit, it is expected that by the year 2000 almost
6 to. 10. percent of populationunder 15 years ori about 4 million will be; orphaned. Since these wiil be
v children of mainly AIDS victims who will die early in their productive'ages, the burden of care for
■"orphans will certainly fall into: responsibility of elderly grandparents who will have little rne&nsof
^■financial or-physical,support. ■ m..
IV. CONCLUSION
60. The fact that this seminar has taken place under the auspices of ECA is most encouraging because a coordinated approach has keen put in place. The knowledge shared in this paper clearly points to the fact that the pandemic will, in the long run have a considerable impact on demographic processes and equally affect the socio-economic development activities. Even if the African population will keep growing, but this will be at a reduced tempo. Some achievements so tar in mortality reduction appear to be reversed because of increased levels of mortality as well as changes effected in its age pattern,
iohn K. Anarfi, Ibid, 1994
15
especially for children under five and of young adults in reproductive and economicaily active age groups of population.
61. The issue is that the impact has challenged all categories of people in all fields of endeavour. As much as countries have mobilized resources for research in an effort to contain the pandemic or find a cure, policy makers and scientists are now better prepared to fight the pandemic than a decade ago. On site experimentation of some drugs and other behavioral research are supplementing effort to a solution of the problem. Health care systems have also been put on challenge that is likely to lead to their improvement in service delivery.
62. The pandemic has also clearly shown that fragile African economies which are dependent on labour intensive methods, like the mining industry or agriculture will have greatest impact as a result of AIDS-related deaths and loss of productivity due to AIDS illness. It may be possible that there would be economic decline or sluggishness in development.
63. The pandemic, while having caused havoc on both demographic and socio-economic conditions of the people, the international community has responded in various ways to finding a solution to combat the pandemic. The fact that this gathering is taking place at the moment, though belatedly, is a positive approach to sharing knowledge and experience to fight against the disease. While many fora have been organized across the continent, this senior policy seminar was no doubt organized at the right occasion to give ECA a reoriented and coordinated approach in its role to tbster socio-economic development for the Africa region, as a whole.
64. The pandemic has contributed in a way that international community including the United Nations family, focusing towards greater effort in vaccine development and research which encompasses
behavioral changes and epidemiological set-up to prevent and find cure. There are countries hardest hit
where experimentation is underway on certain vaccines, such as in Uganda, Tanzania or Zambia3,21/65. For the future, we should all therefore, consider those affected as vulnerable groups needing attention to avoid stigmatization. There is need for focusing on research on changing sexual behaviour altitudes, while at the same time finding methodologies of data collection and analysis in order to understand better the gravity of the pandemic and its consequences on demographic processes and development programmes among countries of the sub-Saharan Africa. More epidemiological research should be intensified to find the cure for the pandemic.
OAU, oo.cit. Cairo 1995
16
ramei:HSV/A1DS Country Angola Benin BurkinaFaso Botswana Burundi. Cameroon CentralAfricaRep. CapeVerde... Chad Congo EquatorialGuinea Eritrea Ethiopia Gabon Gambia Ghana Guinea-Bissau Guinea Coted'lvoire Kenya Lesotho Liberia Madagascar 1.Mali..
casesreportedtoWHO1 1978-92 cases% 568 465 28861 1078- 67632 2197 37301 65 587 52671 19 369 48841 393 236 103053 288 677 146555 3702913 182 28 5 131i_
.2 .2 .1 .4 ,5 .8 .4 - .2 .9 - .1 8 1 1 8 1 3 4 7 1 - -
cases 135 277 836 870 117 1761 17 1010 1206 24 300 5124 128 38 2371 165 328 4015 11560 297 163 6 -673
ysuh-Saharancoun 993 Rate 1.2 5.3 8.5 61.0 2.0 14.4 4.1 16.5 55.7 5.1 10.1 9.9 4.1 14.4 15.6 4.4 28.3 40.7 15.4 5.8 JL£.
cases 157 114 968 144 1417 10 1268 1300 16 625 5558 204 53 2330 254 543 6566 7347 36 7 ■609-^-.
trythroughS< 1994 Rate 1.4 2.1 65.6 2.4 11:3
2.3 ;
20.2 58.4 3.3 10.7 15.3 5.5 13.7 23.5 7.1 44.6 24.8 1.8 0.1»30June199 1995June 35 194 592 15 245 2476 156 13 637
5. Total cases 895 856 3722 3110 7024. 5375 3730 92 3457 7773 74 1539 18042 881 340 15QQ6 707 1548 25236 56573 515 191 18 2SQA
2 1 9 .7 1.7 1.3 9 .8 1.9 .4 4.3 2 3.6 2 .4 6.1 13.6 .1
Date 31/03/95 14/12/94 31/12/93 05/06/95 31/12/94 31/12/94 30/11/92 31/12/94 31/05/95 22/04/95 07/06/95 31/05/95 12/05/95 29/05/95 31/03/95 "3OT2/94 31712/94 04/01/95 31/05/95 25/04/95 31/12/94 31/03/94 31/03/95
Country Malawi Mauritania Mozambique Namibia Nigeria Niger Rwanda Senegal SierraLeone SouthAfrica Swaziland UR.Tanzania Togo Uganda Zaire Zambia Zimbabwe TotalforRegion
1978-92 2695510.0 40 662.2 36221.3 705.2 809.3 94863.5 848.3 88 1891.7 250.1 4242215.7 2142.8 3855214.2 221598.2 71242.6, 187316.9 270667100
1993 4916 10 164 1479 256 453 1220 349 23 1567 163 3327 1330 2641 588 22610 9174 81736
52.8 0.5 1.0 71.8 0.2 5.8 15.2 4.4 0.5 4.2 18.6 10.9 35.1 12.9 1.5 239.3 86.0
1994 raspsRafp 4731 9 534 630 429 100 22 391 219 1284 4927 3384 10647 56929
49.2 0.4 3.1 0.5 5.3 1.2 0.5 1.0 0.7 32.8 23.2 8.3 96.7
1995June 1070 455 22 353 6263
Total 376739.1 59 1815.4 51011.2 1591.4 1691.4 107062.6 1297.3 155 3849.9 413.1 45968H.I 51091.2 4612011.1 261316.3 297347.2 385529.3 415595100
Date 05/06/95 30/09/94 31/05/95 31/12/93 31/05/95 07/03/95 30/06/93 22/11/94' 31/05/95 27/07/94 15/02/94 30/06/94 08/06/95 31/12/94 06/07/94 20/10/93 31/12/94 Source:WHO/AFRO,AIDScasesreportedtoWHO,June,1995
19 Table2:ReportedHIV/AIDS Country Angola Benin BurkinaFaso Botswana Burundi Cameroon CentralAfricaRep. Chad Congo EquatorialGuinea Eritrea Ethiopia Gabon Gamhia Ghana Guinea-Bissau Guinea Coted'lvoire Kenva Lesotho Liberia Mali Malawi Mozambique Namibia
casesbysexin Male cases 370 567 2875 819 4315 2430 1890 1450 2672 6 _ 8694 290 200 4197 217 495 12560 21571 245 102 1302 19450 462 3710 745
African % .2 .3 1.5 .4 2.3 1.3 1.0 .8 1.4 _ _ 4.6 .2 .1 2.2 .1 .3 6.7 11.5 .1 .1 .7 10.3 .2 2.0 4
countriesof Female cases 396 289 1318 1153 3247 1528 1840 891 3949 3 _ 5380 182 120 9512 163 475 6110 16529 234 89 1080 14707 264 1391 403
Will. % .3 .2 .9 .8 2.3 1.1 1.3 .6 2.8 _ _ 3.8 .1 .1 6.8 .1 .3 4.4 11.8 .2 .1 .8 10.5 .3 1.0
VAFRO cases 766 856 4193 2011 7562 3958 3730 2341 6621 9 1193 14074 472 320 13709 380 970 18670 38100 479 191 2382 34157 826 5101 1148
asoiDecember Total %M/F 93.4 196.2 218.1 71.0 132.9 159.0 102.7 162.7 67.7 200 _ 161.6 159.3 166.6 44.1 133.1 104.2 205.6 130.5 104.7 114.6 120.6 132.2 126.9 266.7 1R49
1994. Date* 30/06/94 14/12/94 31/12/93 31/03/94 31/12/93 23/11/94 30/11/92 29/10/94 11/08/94 10/07/94 31/10/94 31/10/94 10/12/94 05/12/94 29/12/94 11/06/93 31/12/93 24/02/94 31/12/93 10/12/93 31/03/93 05/08/94 22/09/94 31/12/93 31/12/93 04/04/94
20 Country Niger Rwanda Senegal SierraLeone SouthAfrica Swaziland UR.Tanzania Togoi Uganda Zaire Zambia Zimbabwe Total
Male 981 5980 _ 59. - 208 20140 2724 27450 _ 18745 19847 188126
.5 3.2 _. _ _ .1 10.7 1.5 14.6 _ 10.0 10.5 100
Female 250 4726 _ 36 ■_ 202 18579 1798 16425 _ 10989 15387 139906
.2 3.4 _ _ _ .1 13.3 1.3 11.7 _ 7.9 11.0 100
Total 1262 10706 1297 95 3849 410 38719 4766 43875 26131 29734 35791 361373
392.4 126.5 163.9 _ 103.0 108.4 151.5 167.1 170.6 129.0 134.5
Date*: 31/12/93 30/08/93 01/06/94 07/07/93 27/07/94 15/02/94 07/01/93 30/12/94 31/12/93 06/07/93 20/10/93 29/11/94 Source:AddressingtheHIV/AIDSepidemicinAfrica:Achievementsandchallenges.CAMH/6(V)Cairo,1995 *DateoflatestreportsenttoAFRO
...21 Table3:Populationsize(millions)ofsub-Saharanregionsandselectedcountries,havingnoA!DS(NA)andwithAIDS(WA)assumptions. Country/subregion AFRICA Eastern Central Southern Western Botswana' Congo Coted'lvoire Kenya Malawi Namibia Rwanda Swaziland Togo Uganda Zambia Zimbabwe
NA 481 144 52"-." 32 144 0.9 1.5 8.3 16.4 6.1 1.4 5.2 0.6 .2.6 13.1 5.7 7.1
1980 WA 479 145 52 33 141 0.9 1.6 8.1 16.6 6.1 1.0 5.1 0.5 2.6 13.1 5.7 7.1
NA 648 195 70 41 200 1.3 2.0 12.6 25.1 8.4 1.9 7.2 0.8 3.5 18.4 8.5 9.7
1990 WA 642 194 70 43 193 1.2 2.2 11.9 23.5 9.5 1.4 7.0 0.7 3.5 17.5 8.1 9.9
NA 872 269 94 51 277 1.8 2.6 18.5 37.6 11.7 2.6 10.1 1.1 4.7 26.2 12.2 13.1
2000 WA 856 264 95 54 262 1.6 2.9 17.0 32.8 12.6 1.9 9.7 0.9 4.8 23.4 10.6 13.1
2010 NAWA 1148 366 125 62 374 2.4 3.5 26.5 53.5 16.0 3.5 13.6 1.5 6.4 36.9 17.2 17.0
1116 350 127 67 350 2.1 3.8 23.6 44.3 16.4 2.6 13.3 1.2 6.4 30.6 13.8 16.8
2020 NA 1441 471 162 73 477 3.0 4.5 35.4 69.6 20.6 4.5 16.6 2.0 8.5 49.2 22.7 20.9
WA 1421 457 167 79 455 2.6 50 32.6 57.3 21.8 3.3 18.0 1.5 8.3 40.5 18.4 20.9 Source:UN,WorldPopulationProspects,the1988Revision.NewYork1989 UN,WorldPopulationProspects,the1992Revision.NewYork1993
and
22 Table4:CrudedeathratesforthepopulationprojectionwithNoAIDS(NA)andwithAIDS(WA)assumptionsforsub-Saharanregion andselectedcountries. Subregion/Country AFRICA Eastern Central Southernt Western Botswana Congo Coted'lvoire Kenya Malawi Namibia Rwanda Swaziland Uganda Zambia Zimbabwe
1980 NA 16.4 18.3 17.8 11.4 18.4 14.3 15.4 15.6 13.6 21.4 13.7 18.8 14.1 16.8 14.9 11.7
WA 16.4 18.3 17.7 11.4 17.9 14.2 15.8 15.7 13.2 22.3 13.6 18.8 13.9 17.9 15.1 11.7
1990 NA 13.4 15.2 14.6 9.0 15.0 9.6 15.7 12.9 9.9 18.3 10.6 15.5 11.0 13.9 15.7 12.7
WA 13.8 16.4 15.3 8.7 15.0 9.3 14.7 14.7 10.3 21.5 10.7 18.2 10.4 21.0 18.0 11.0
2000 NA 10.7 11.9 11.9 7.2 12.0 6.7 12.9 10.3 6.8 14.9 8.0 12.3 8.1 12.9 12.8 10.3
WA 11.4 13.7 13.0 7.0 12.2 6.7 13.7 13.5 7.9 18.6 8.0 16.1 8.1 18.5 16.6 9.8
2010 NA 8.5 9.0 9.5 6.4 9.3 5.1 10.4 7.8 4.9 11.6 6.1 9.3 6.0 10.4 9.9 8.2
WA 8.9 10.0 9.6 6.2 9.7 5.3 9.6 9.4 5.6 13.1 6.2 11.1 6.4 11.9 9.7 6.6
NA 7.0 7.0 7.5 6.3 7.4 4.5 8.3 5.9 4.2 8.9 5.1 7.6 4.9 8.3 7.7 6.4
2020 WA 7.1 7.4 6.8 6.0 7.7 4.8 6.4 6.1 4.4 8.9 5.3 7.5 5.6 7.6 5.6 4.8 Source:UN,WorldPopulationProspects,the1988Revision.NewYork1989and UN,WorldPopulationProspects,the1992Revision.NewYork1993
23 Table5:Estimatesofinfantmortalityrates(SMR)withNoAIDS(NA)andwithAIDS(WA)assumptionsforSub-Saharasiregionsand selectedcountries. Region/Country AFRICA Eastern Central Southern Western Botswana Congo Coted'lvoire Kenya Malawi Namibia Rwanda Swaziland Uganda Zambia Zimbabwe
19 NA 116 125 117 •87 .122 76 81 105 80 163 116 132 129 112
.88
8080 WA 116 127 116 67 121 73 88 106 81 163 91 124 94 112 88 76
NA 97 107 98 67 103 58 .65 87 64 138 97 112 107 94 72 64
1990 WA 95 108 96 55 102 60 82 91 66 142 70 110 73 104 84 59
NA 79 86 81 48 85 41 50 71 47 117 80 94 87 77 56 50
2000 WA 79 90 79 44 85 48 75 77 49 123 51 96 54 88 71 50
NA 63 68 64 35 69 29 37 56 33 99 64 77 68 61 42 37
2010 WA 63 71 61 33 68 35 58 58 33 102 37 74 39 65 47 35
NA 48 52 50 26 54 22 28 42 23 81 50 61 51 47 31 28
2020 WA 48 55 46 23 53 22 40 40 23 81 28 56 29 46 31 23 Source:UN,WorldPopulationProspects,the1988Revision.NewYork1989and UN,WorldPopulationProspects,the1992Revision.NewYork1993
24 Table6:Estimatesof-lifeexpectancyatbirthe0withNoAIDS(NA)andwithAIDS(WA)assumptionsforsub-Saharanregionsand selectedcountries Region/Country AFRICA Eastern .Central Southern ....Western Botswana Congo Coted'lvoire Kenya Malawi Namibia Rwanda Swaziland Uganda Zambia Zimbabwe
NA 49 47 47 .57 47 56 46 50 56 45 53 46 53 49 51 55
1980 WA 49 46 47 .57 47 56 50 50 55 44 53 46 53 47 51 55
NA 53 51 52 62 51 61 50 54 61 49 58 50 58 53 55 60
1990 WA 53 49 51 62 51 61 51 51 58 44 58 46 58 41 44 55
NA 57 56 56 66 55 65 54 58 65 53 63 54 62 57 59 65
2000 WA 56 51 53 66 54 65 51 51 62 45 63 47 63 42 44 57
NA 61 60 60 69 59 69 58 62 69 57 67 58 67 61 63 69
2010 WA 61 58 59 70 59 69 58 58 67 53 67 55 67 52 56 65
NA 65 64 64 72 63 71 62 66 71 61 70 62 70 65 67 71
2020 WA 65 63 65 72 62 72 66 66 71 61 70 62 70 61 66 71 Source:UN.-WorldPopulationProspects,the1988Revision.NewYork1989and UN,WorldPopulationProspects,the1992Revision.NewYork1993
25 Table7:EstimatesofCrudeBirthRateswithNoAIDS(NA)andwithAIDS(WA)assumptionsforsub-Saharanregionsandselected countries. Region/Country AFRICA Eastern Central Southern Western Botswana Congo Coted'ivoire Kenya Malawi Namibia Rwanda Swaziland Uganda Zambia Zimbabwe
NA 45 47 45 34 49 49 44 51 53 53 44 52 47 50 50 42 Source:UN.WorldPooulationPt
1980 WA 45 47 47 36 48 46 43 50 48 56 43 52 44 48 49 42
NA 43 47 44 31 47 44 4344 50 50 51 41 49 45 49 49 39
1990 WA 43 47 46 32 46 38 49 43 54 42 52 37 51 46 40 osnects,the1988Revision.NewYoi
2000 NA 39 43 41 27 43 38 4040 46 43 46 39 43 41 45 44 33 k1989and
WA 38 42 41 28 41 33 45 39 47 37 46 34 45 42 34
NA 32 36 36 23 35 29 36 38 33 38 32 31 33 39 37 27
2010 WA 33 37 37 24 36 27 36 42 32 42 32 42 29 40 38 29
NA 25 27 28 18 26 22 29 29 25 29 25 24 25 29 28 21
2020 WA 28 31 31 19 30 21 31 35 25 34 27 34 24 32 31 22 UN,WorldPopulationProspects,the1992Revision.NewYork1993
&^
Fig. 1A
1500-
1400+
1300+
1200+
1100-
1000+
900-t 800+
700t 600ti
500+
400
Population Size^of Sub-Saharan Regions having no AIDS (NA) and with AIDS (WA)
1980
-7-7
1990 2000 2010 2020
WITH NO AIDS WITH AIDS
.Pig. IB
500-
450+
Popuiation Size of Sub-Saharan Regions
having no AIDS (NA) and with AIDS (WA)- eastern
400+
350+
300- 250-
200+
150+
oo- 1990 2000
2010
tg. ic Population Size of Sub-Saharan Regions
having no AIDS (NA) and with AIDS (WA)- central
180- —
160^ ~4m
140-i -;^- -.
120- 7;p£-
100-i - .--^ -
80- ^— - - -
60H : .^^-:1 „_
40- ■—
1980 1990 2000 2010 2020
: -*- WITH NO AIDS —-r~ WfTH AIDS \
pig. id Population Size of Sub-Saharan Regions
having no AIDS (NA) and with AIDS (WA) - southern
75-
obi
55 t
45-i 4-'
40,
35-i
ar
1980 1990 2000 2010
WITH NO AIDS —*— WITH Aids
Fig. IE
Population Size of Sub-Saharan Rec having no AIDS (NA) and with AiDS
500-
./■
450-
400-
350t
'300-
250t
200-
150-
oo- 1980 1990 2000 2010
WITH NO AIDS WITH AIDS
Pig. 2A
17-
16-
Crude death rates for the population projection with No AIDS and With AIDS
13J—
12t™
10-i--
9-h
7- 1980 1990 2000 2010 2020
20-
NO AIDS WITH AIDS
Crude death rates for the population
projection with No AIDS and With AIDS-EASTERN
12t
10-i-
• )v6-
18-
Crude death rates for the popuiation
projection with No AIDS and With AIDS —CENTRAL
16+
■-H
12+
■4-
-» r\_i
8-r
6- 1980 1990 2000 2010 2020
ZD
12
NO AIDS WITH AIDS
Crude death rates for the population
projection with No AIDS and With AIDS — SOUTHERN
10+
9-
.8-
^^^:es&3ijy^
Tia. ^
20- 18-
16-
Crude death rates for the population projeciion with No AIDS and With AIDS
tr i—
UJ
12
Q -4-
6"
1980 1990 2000 2010
NO AIDS WITH AIDS
2020
?ig. 3A Estimates of life exptancy at binh eo
with No AIDS and With AIDS - AFRICA
54-«"
62-1- 60H-
58-r
54+
52--
50-r
64^-
62t 60t
COT
54+
52t
1980 1990 2000 2010
NO AIDS —»— WITH AIDS
Estimaies of life exptancy at birth eo
with No AIDS and With AIDS -EASTERN
58- : "" " " ~7^™
50-i T --—-: "
1980 1990 2000 2010
3C
66-
Estimates of life exptancy at birth eo
with No AIDS and With AIDS — CENTRAL
64-i-
62-:~
60H 53
?
■¥■
56+
54-1-
?ig. 3D
OUT*
48-i~
46-
72-
1980 1990 2000 2010 2020
NO AIDS
WITH AIDS
Estimates of iife exptancy at birth eo
with No"AIDS and With AIDS- SOUTHERN
70-;-
68r
66-r
64-'
62t
60-
58t
56-
1980 1990 n2020
64-
Estimates of life exptancy at birth eo
with No AIDS and With AIDS — WESTERN
8-i 6-i
50 t
46- 1980 1990 2000 2010
NO AIDS WITH AIDS
