|Poverty and HIV/AIDS in Sub-Saharan Africa (UNDP, 1998, 11 p.)|
Of the global total of 30 million persons living with HIV in 1997 some two-thirds (21 million) are in sub-Saharan Africa. Infection is concentrated in the socially and economically productive groups aged 15-45, with slightly more women infected than men. There are significant differences in the ages of infection of girls and boys with infection occurring at younger ages for girls (with girls and young women in some countries outnumbering boys and young men by factors of 5 or 6 in the age range 15-20). It is estimated that 12 million persons have died from HIV-related illnesses since the start of the epidemic worldwide, of whom approximately 9 million were Africans. It follows that the cumulative affected population in Africa taking into account spouses, children and elderly dependents must be of the order of 150 million1. This is a staggering proportion of the total population in sub-Saharan Africa - more than one quarter of Africans are directly affected by the HIV epidemic. Few people can remain unaffected in indirect ways, i.e. through the illness and death of relatives and colleagues.
1 21 million currently infected with HIV plus 9 million persons who have died from HIV-related illnesses times a factor of 5 to take account of those directly affected.
The levels of HIV prevalence in parts of Africa are extremely high - in Southern Africa there are now many countries with HIV infection rates in adults in the range of 20-25%. The gap between rural and urban HIV rates - previously substantial - is now narrowing rapidly in many countries. For some urban populations HIV is now as high as 40-50% - rates of infection earlier considered wholly improbable. One consequence of the high HIV infection rates among women is the increasing number of children with HIV (through mother to child transmission). It is estimated that there are presently some 8 million children in Africa who have lost one or both parents to HIV-related illnesses, and that by 2010 these numbers will have increased to some 40 million. In many countries the proportion of children who have lost one or both parents will be as high as 20-25% by the end of the first decade of the new millennium (Fig.1). These trends have direct implications for intergenerational poverty and impose immense challenges for policy makers.
AIDS ORPHANS UNDER 15 YEARS OF AGE AS A PERCENTAGE OF THE TOTAL POPULATION UNDER 15
Source: International Programs Center - Populations Division, U.S. Bureau of the Census, Washington, DC
HIV infection is not confined to the poorest even though the poor account absolutely for most of those infected in Africa. There is limited evidence for a socio-economic gradient to HIV infection, with rates higher as one moves through the educational and socio-economic structure. It follows that the relationships between poverty and HIV are far from simple and direct and more complex forces are at work than just the effects of poverty alone. Indeed many of the non-poor in Africa have adopted and pursued life styles which expose them to HIV infection, with all the social and economic consequences that this entails. It follows that the capacity of individuals and households to cope with HIV and AIDS will depend on their initial endowment of assets - both human and financial. The poorest by definition are least able to cope with the effects of HIV/AIDS so that there is increasing immiseration for affected populations. Even the non-poor find their resources diminished by their experience of infection (morbidity and death), and there is increasing evidence in urban communities of an emerging class of those recently impoverished by the epidemic.
The effects of HIV and AIDS are reflected in the changes in Life Expectancy (Fig.2) which is the best summary indicator of the effects of HIV and AIDS on countries with high levels of HIV prevalence. These data are remarkable for what they illustrate of the demographic impact of the epidemic on African populations. In many countries adult mortality has doubled and trebled over the past decade and this is directly attributable to HIV and AIDS. What is now being experienced by these populations are levels of Life Expectancy which were typical of the 1950s. This is not confined to those living in poverty but nevertheless is concentrated on those living in poverty who account absolutely for most of those who die from HIV-related illnesses. These data reflect HIV infection which occurred in the late 1980s, and since then in many countries HIV prevalence has intensified rather than diminished. Thus the outlook for further declines in Life Expectancy is bleak indeed, both in the aggregate and for those who are the poorest.
LIFE EXPECTANCY RATE* WITH AND WITHOUT AIDS IN AFRICA: 1996
East Africa: 1996
West and Central Africa: 1996
B.F. - Burkina Faso
C.A.R. - Central African Republic
Southern Africa: 1996
* Life expectancy is the number of years an individual is expected to live.
Source: International Programs Center - Population Division, U.S. Bureau of Concensus, Washington, D.C.