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close this bookAIDS in Africa; Country by country (ADF Profile Book). (UNAIDS, 2000, 243 p.)
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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.