1. Demographic and Epidemiological Overview

There are conflicting views regarding the influence of the AIDS epidemic on population growth. Some investigators predict serious reductions in the size of populations in many developing countries, while others foresee a less dramatic effect. Comprehensive and accurate projections are problematical due to the virtual nonexistence of vital statistics in Africa, the inadequacy of population censuses, and the difficulty of direct measurements of the impact of AIDS on demographic variables. HIV prevalence studies, together with better data on the incubation period between infection with HIV and the onset of AIDS, are needed in order to permit more accurate estimates based on mathematical modeling.

HIV prevalence is high among commercial sex workers in many countries, which is a major factor in promoting the rapid spread of infection. It is also high among people with sexually transmitted diseases (STDs), as this condition increases the risk of HIV infection. Many infected men have regular female partners who as a result are also at risk. In some African countries, pregnant women seen in antenatal care settings have moderately high prevalence rates. Large differentials in prevalence exist both between and within countries. Differentials also may exist regarding the incubation period, which has been about eight to ten years in the industrialized countries, hut may be as little as five to six years in the developing world.

A high prevalence of AIDS affects a country’s demographic situation by increasing adult, infant and child mortality, and thus lowering life expectancy. It is also possible that the fertility rate can decline. However, it appears probable that only an HIV prevalence affecting at least 30 percent of a population could lead to an eventual reduction in its size. This might possibly occur in some population sub-groups or certain regions of a country, hut it is unlikely to prevail in an entire country. In a median between extreme analytic scenarios, the population growth rate in some countries in sub-Saharan Africa could be reduced from approximately 3 percent annually to about 2.5 percent. Even a reduction of this magnitude, however, would only delay population doubling time by about four years.

Population growth thus continues at high rates in many countries which are characterized by widespread poverty, unemployment, overburdened health services-and the presence of AIDS. It would be erroneous, therefore, to conclude that the AIDS epidemic will, in purely demographic terms, reduce the pressures of rapid population growth that are already evident in many developing countries. Unfortunately, some sensational media reporting has given the opposite impression. It would be regrettable if political leaders were, as a consequence, tempted to relax national population policies and family planning programmes. It is important to find better ways of involving the media and other vehicles of popular communications with a view to providing both the public and the politicians with objective and balanced information on the demographic implications of the HIV/AIDS epidemic.