Cover Image
close this bookAIDS Epidemic Update: December 1998 (UNAIDS, 1998, 18 p.)
View the document(introduction...)
View the documentGlobal summary of the HIV/AIDS epidemic, December 1998
View the documentAnatomy of the epidemic
View the documentA health crisis and beyond
View the documentHIV - a threat to the world’s young people
View the documentWhat drives the epidemic?

A health crisis and beyond

Invisible no longer

For many years, AIDS was referred to as “the invisible epidemic”. HIV makes its silent way through a population for many years before infections develop into symptomatic AIDS and become a cause of recurring illness and, finally, death. The virus thus spread stealthily for years before AIDS deaths were registered in any significant numbers.

In industrialized countries AIDS activists succeeded in raising the profile of the epidemic early on. But in the developing world where most men and women with HIV live, it is only now, two decades after the virus first started spreading, that the repercussions of AIDS are stripping off its cloak of invisibility.

In countries with mature epidemics - Uganda in East Africa, Zambia and Zimbabwe in Southern Africa, for example - AIDS is leaving highly-visible damage in its wake. Some doctors report that three-quarters of beds on hospital paediatric wards are occupied by children ill from HIV. Millions of adults have died. Most have left behind orphaned children. Many have left surviving partners who are infected and in need of care. Their families struggle to find money to pay for their funerals, and their employers must now train other staff to replace them.

Wiping out the gains of development

Together, the epidemic’s visible and less-visible consequences constitute an urgent and massive threat to development.

Life expectancy crumbles

Life expectancy at birth is one of the key measures that policy-makers look at to assess human development. Because of the extra deaths from AIDS in children and young adults, this indicator is giving off alarm signals. According to a just-released report prepared by the United Nations Population Division in collaboration with UNAIDS and WHO, the epidemic will wipe out precious development gains by slashing life expectancy.

The impact on life expectancy is proportional to the severity of the local epidemic. In Botswana, for example, where more than 25% of adults are infected, children born early next decade can expect to live just past their 40th birthday. Had AIDS not been in the picture, they could have expected to live to the age of 70. Not surprisingly, between 1996 and 1997 Botswana dropped 26 places down the Human Development Index, a ranking of countries that takes into account wealth, literacy and life expectancy.

Taking the nine countries with an adult HIV prevalence of 10% or more (Botswana, Kenya, Malawi, Mozambique, Namibia, Rwanda, South Africa, Zambia and Zimbabwe), calculations show that AIDS will on average cost them 17 years of life expectancy. Instead of rising and reaching 64 years by 2010-2015, a gain which would be expected in the absence of AIDS, life expectancy will regress on average to 47 years.

Deteriorating child survival

The dismal decline in life expectancy is due not only to deaths of adults - most of them young or in early middle age - but also to child deaths. HIV is contributing substantially to rising child mortality rates in many areas of sub-Saharan Africa, reversing years of hard-won gains in child survival.

By 2005-2010, for example, 61 of every 1000 infants born in South Africa are expected to die before the age of one year. In the absence of AIDS, infant mortality would have been as low as 38 per 1000. With AIDS in the picture, the infant mortality rate in Namibia is projected to be 72 per 1000; without the epidemic the country could have expected a far lower rate of 45 per 1000.

Children on the brink

Zimbabwe offers a frightening window onto orphanhood, another aspect of the epidemic’s development impact. In this nation, where over a quarter of the 5.5 million adults are HIV-infected, AIDS is already pushing hundreds of thousands of children to the brink.

The government estimates that in two years’ time 2400 Zimbabweans a week will be dying of AIDS. Most of those deaths will be in adults, and they will be concentrated in the young adult ages when people are building up their families. What is more, they may be disproportionately concentrated among single women whose death would leave a child with no parent at all: one recent study in a farming area showed that single mothers, many of them widowed by AIDS, were twice as likely to be HIV-infected as married women.

As early as 1992, a study in Zimbabwe’s third largest city, Mutare, recorded that over 10% of children in the study area were orphaned, and that nearly one household in five had taken in orphans. By 1995, an enumeration in the same area showed that the proportion of children who were orphaned had grown to nearly 15%.

The number of children in need of care is rising just as AIDS is cutting into the number of intact families able to provide such care. Some 45% of those caring for orphans are grandparents; often they have no income of their own, and there is a limit to how many children they can take on without outside help. One orphan-support programme reports helping an 80-year-old grandmother who lives with 12 children in a single room. Another has received a request for help from a widower with 9 dependants who has just inherited another 3 grandchildren to care for. A study of households headed by adolescents and children (some as young as 11) showed that while the overwhelming majority had lost both parents, most did have surviving relatives. However, in 88% of those cases, the relatives reported that they did not want to care for the orphans.

Children themselves are beginning to worry about orphanhood and to recognize the importance of supporting needy children. A majority of children interviewed in one study said that if orphans’ needs were not met they would become delinquent. Many said the children would drift into prostitution and onto the streets. They also worried about abuse and exploitation of orphans by relatives. With reason. Reports of sexual abuse of girls have risen rapidly in recent years in Zimbabwe, prompting the establishment of a special clinic at a major Harare hospital and an initiative to promote child-friendly courts. In a single rural district of Zimbabwe one study recorded nearly 400 cases of child sexual abuse, at least a quarter of them girls under the age of 12, and at least 10% of them orphans.

AIDS and business: the bottom line suffers

The onslaught of AIDS is denting the prospects for economic development too. In the hard-hit countries of Africa, the epidemic is decimating a limited pool of skilled workers and managers and eating away at the economy. With many economies in the region in flux, it is hard to determine exactly what the impact of HIV is on national economies as a whole. However, it is clear that businesses are already beginning to suffer.

In Zimbabwe, for instance, life insurance premiums quadrupled in just two years because of AIDS deaths. Some companies say that their health bills have doubled. Several report that AIDS costs absorb as much as one-fifth of company earnings. In Tanzania and Zambia, large companies have reported that AIDS illness and death cost more than their total profits for the year. In Botswana, companies estimate that AIDS-related costs will soar from under 1% of the wage bill now to 5% in six years’ time, because of the rapid rise in infection in the last few years.