Democratic Republic of the Congo

HIV/AIDS epidemiological summary

HIV information from among antenatal clinic attendees has been available from the Democratic Republic of the Congo since the mid-1980s. Over the 15-year period 1985 to 1999, the median HIV prevalence rate among antenatal clinic women in Kinshasa, the major urban area, fluctuated between 3% and 7%. In 1999, 4% of antenatal clinic attendees tested were HIV-positive. Prevalence ranged from 3% to 5%. Sentinel surveillance outside of Kinshasa is infrequent. A few studies conducted in Kananga, Likasi, Lubumbashi, Musoshi, Kimpese and Kasumbalesa have shown that HIV prevalence among antenatal women tested ran 3-4% between 1988 and 1993. In 1997, HIV testing was conducted at 14 sites. Four per cent of antenatal clinic women tested HIV-positive, with prevalence ranging from 1% to 6%. In Lubumbashi, 1999, 9% of antenatal clinic women tested were HIV-positive.

Between 1985 and 1997, HIV prevalence among sex workers in Kinshasa fluctuated between 27% and 38% among those women tested. There is limited HIV information on sex workers outside of Kinshasa. A study conducted in Haute-Zaire in 1991 reported that 25% of sex workers tested were HIV-positive. In 1997, 29% of sex workers tested in Mbuji-Mayi were HIV-positive.

There is very little information available about HIV prevalence among STI clinic patients. In 1997, 12% of STI clinic patients tested in Kinshasa and 8% of STI clinic patients tested in Mbuji-Mayi were HIV-positive.

Estimated number of people living with HIV/AIDS, end 1999	Adults and children	Adults (15-49)	Adult rate (%)	Women (15-49)	Children (0-14)
Source: UNAIDS/WHO, June 2000	1 100 000	1 100 000	5.07	600 000	53 000
Demographic impact of HIV/AIDS		Year	Estimate	Source
Children who lost their mother or both parents due to HIV/AIDS at age 14 or younger since the beginning of the epidemic		1999	680 000	UNAIDS/WHO, June 2000
Estimated AIDS deaths		1999	95 000	UNAIDS/WHO, June 2000
Behavioural indicators		Year	Age group	Male	Female
Reported condom use during most recent intercourse with a non-regular partner (%)		-	-	-	-
Reported non-regular sexual partnership over a 12-month period (%)		1993	15-19	24.0	4.0
Measured HIV prevalence		Year	Median	Min.	Max.
Women in antenatal care clinics - major urban areas (%)		1999	4.1	2.7	5.4

Figure

Economic Impact of HIV/AIDS

Summary of the economic impact of HIV/AIDS

Data on the economic impact of AIDS in the Democratic Republic of the Congo are limited. Preliminary results of a recently developed model on the macroeconomic impact of AIDS show that the impact is average for sub-Saharan Africa. Data from the 1980s show that the impact on wealth at the household level is significant. No data were found for the impact on the agricultural or business sectors. However, it is likely that the increased costs and shifting production patterns are leading to reduced net revenues in agriculture as a result of AIDS and that businesses are already facing rising costs in order to cover employees’ AIDS-related medical and funeral expenses. In the public sectors, the education study shows that increasing mortality rates due to AIDS leads to discontinuity in teaching, with many pupils losing or having a change in their teachers. The health sector is coping with hospitals where over 50% of beds are occupied by patients with AIDS-related illness and yet there are still extensive investments required to scale-up AIDS programmes equivalent to US$ 1-2 per capita and 1.7% of GDP.

Macroeconomic impact

Preliminary results of a model developed in 2000 estimate the decline in GDP per capita growth as a result of AIDS by 2010 to be 0.7% (1).

Economic impact of HIV/AIDS on households

A survey of 33 families in the late 1980s found that the average expenditure on a hospital stay for a child was US$ 90 for a child with AIDS, which compares with the average monthly income of US$ 30 (2); a separate study in the same time period found that, on average, the costs of AIDS for an adult prior to hospitalization and subsequent funeral costs were US$ 109 and US$ 320 respectively (3).

Economic impact of HIV/AIDS on agriculture

Not available

Economic impact of HIV/AIDS on firms

Not available

Economic impact of HIV/AIDS on education

Supply: A model developed by UNAIDS and UNICEF in 2000 shows that, of around 830 000 primary school students, 7300 would have lost a teacher to AIDS in 1999 (4).

Demand: Not available

Economic impact on the health sector

Demand: The percentage of hospital beds occupied by people living with HIV/AIDS was 50% at Mama Yemo Hospital, Kinshasa in 1995 (5).

Supply: 6.4% and 8.7% of employees at Mama Yemo Hospital were HIV-positive in 1984 and 1986 respectively, reflecting a two-year incidence rate of 3.2% (6).

Resource gap: The annual cost of scaling-up HIV/AIDS programmes is estimated to be between US$ 66 million and US$ 105 million (7).

Management and implementation of the national response to HIV/AIDS

Policy formulation

Existence of National HIV/AIDS policy (either a written document or part of one)

Yes	No
X

Comments/Key elements: Not available
Source: NACP/STD, 1999-2008
Date: 1999

Existence of HIV/AIDS policy in the following sectors:

Sector	Yes	No
Agriculture		X
Education		X
Health	X
Military		X
Workplace		X
Sports		X
Others

Comments/Key elements: Not available
Source: UNAIDS DRC
Date: June 2000

Existence of HIV/AIDS-specific legislation against discrimination on the grounds of HIV

Yes	No
	X

Comments/Key elements:
Source: UNAIDS DRC
Date: June 2000

Organizational structure

Existence of high-level structure in support of the national response

(e.g. National AIDS Committee/Commission, Inter-ministerial Committee, Presidential-level bodies)

Yes	No
X

Comments/Key elements: A multi-sectoral body exists, the National Committee for the Fight against AIDS, presided over by the Minister of Health.

Source: UNAIDS DRC

Date: June 2000

Planning and programming

Existence of national strategic plan on HIV/AIDS

Yes	No
X

Comments/Key elements: Both a strategic plan and a Master Triennial Plan, 1999-2001, exist.
Source: UNAIDS DRC
Date: June 2000

National strategic plan on HIV/AIDS includes clearly identified priorities

Yes	No
	X

Comments/Key elements: The Master Plan gives widely defined directives at many levels.
Source: UNAIDS DRC
Date: June 2000

Existence of budget for implementation of the national strategic plan

Yes	No
X

Comments/Key elements: The budget is widely underestimated.
Source: UNAIDS DRC
Date: June 2000

General demographic and socioeconomic indicators

Demographic Indicators	Year	Estimate	Source
Total population (thousands)	1999	50 335	UNPOP
Population aged 15-49 (thousands)	1999	21 513	UNPOP
Annual population growth (%)	1990-1998	3.4	UNPOP
% of population urbanized	1998	29	UNPOP
Average annual growth rate of urban population (%)	1990-1998	3.7	UNPOP
Economic indicators	Year	Estimate	Source
GNP per capita (US$)	1997	110	World Bank
GNP per capita average annual growth rate (%)	1996-1997	-8.6	World Bank
Human development index rank (HDI)	2000	152	UNDP
% population economically active	-	-	-
Unemployment rate	-	-	-
Education indicators	Year	Estimate	Source
Total adult literacy rate	1995	77	UNESCO
Adult male literacy rate	1995	87	UNESCO
Adult female literacy rate	1995	68	UNESCO
Male secondary school enrolment ratio	1996	36.8	UNESCO
Female secondary school enrolment ratio	1996	22.8	UNESCO
Health indicators	Year	Estimate	Source
Crude birth rate (births per 1000 pop.)	1999	46	UNPOP
Crude death rate (deaths per 1000 pop.)	1999	14	UNPOP
Maternal mortality rate (per 100,000 live births)	1990	870	WHO
Life expectancy at birth	1998	51	UNPOP
Total fertility rate	1998	6.4	UNPOP
Infant mortality rate (per 1000 live births)	1999	87	UNICEF/UNPOP
Contraceptive prevalence rate (%)	1990-1999	8	UNICEF/UNPOP
% of births attended by trained health personnel	-	-	-
% of one-year-old children fully immunized-DPT	1995-1998	10	UNICEF

References

(1) Bonnel, R. What Makes an Economy HIV-Resistant? Draft report presented during the International AIDS Economic Network Symposium, Durban, South Africa, 7-8 July 2000.

(2) Davachi, F. et al. The economic impact of families of children with AIDS in Kinshasa, Zaire. In: Fleming, A. F. et al, editors. The Global Impact of AIDS. New York, Alan R Liss, 1988.

(3) Hassig, S. E. et al. An analysis of the economic impact of HIV infection among patients at Mama Yemo Hospital, Kinshasa, Zaire. AIDS 1990; 4:883-7.

(4) UNICEF. The Progress of Nations 2000. Background paper. New York, UNICEF, 2000.

(5) The World Bank. Confronting AIDS: Public Priorities in a Global Epidemic. New York, NY: Oxford University Press, 1997.

(6) N’Galy, B. et al. Human Immunodeficiency Virus infection among employees in an African hospital. New England Journal of Medicine 1988; 319(17): 1123-7.

(7) World Bank and UNAIDS. Costs of Scaling HIV Programmes to a National Level for Sub-Saharan Africa. Draft report, April 2000.