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Chapter II: Demographic Impact of AIDS II. DEMOGRAPHIC IMPACT OF AIDS Since 1981, when the first cases of AIDS Table 1 presents the countries for which the were diagnosed, the world has been facing the demographic impact of AIDS is incorporated in deadliest epidemic in modern history. Nearly 22 the 2002 estimates and projections. Of the 53 years after the start of the epidemic, mortality countries, 38 are in Africa, five are in Asia, eight caused by AIDS has attained orders of magnitude are in Latin America and the Caribbean and one comparable to those associated with other visita- each is in Europe and Northern America. Of the tions of pestilence. In Europe alone, it is thought 37.1 million adults in the world infected by HIV that over 20 million people died during the period by 2001, 34.6 million, or 93 per cent, resided in 1347 to 1351 as a result of the Black Death. In the 53 countries. contrast, the human immunodeficiency virus is a slow killer. However, the Joint United Nations In most of the countries that are severely af- Programme on HIV/AIDS (with the World Health fected by the epidemic, HIV/AIDS is responsible Organization, 2002) estimated that by the end of for stopping or even reversing the long-term 2002 42 million people were living with health and mortality improvements that had been HIV/AIDS and that an additional 22 million peo- registered until recently. The spread of HIV has ple had already lost their lives to AIDS. thus compromised the first stage of the epidemi- ological transition in developing countries—that In spite of the progress made in treating peo- is, the passage from high to low mortality as in- ple infected with HIV, in particular in the more fectious diseases are brought under control and developed countries, AIDS remains an incurable are no longer the major cause of death (Omran, disease, and, coupled with malnutrition, it is a fa- 1971; 1982). Indeed, with the emergence of tal disease. UNAIDS estimated that 29.4 million HIV/AIDS, several countries of sub-Saharan Af- of the 42 million persons infected with HIV were rica, which already lagged behind in the epidemi- living in sub-Saharan Africa, 6 million in South ological transition, have experienced a major set- and South-east Asia and 2 million in Latin Amer- back in terms of combating infectious disease and ica and the Caribbean (UNAIDS and WHO, avoiding premature death. Furthermore, the inter- 2002). action of HIV with other infectious agents exacer- bates its detrimental impact on longevity. The in- Since people infected with HIV remain creasing incidence and lethality of tuberculosis in healthy for long periods before showing overt a number of developing countries is one instance signs of immunodeficiency, the first stages of the of such interaction. In rural Malawi the incidence HIV epidemic are difficult to detect. However, of tuberculosis doubled between 1986 and 1994, social scientists and epidemiologists modelling largely because HIV-positive persons are seven the impact of the epidemic have long known that times more likely to develop tuberculosis than its cumulative impact can be serious. In World those who are not infected by HIV (Glynn and Population Prospects: The 2002 Revision (United others, 1997). Nations, 2003d), the United Nations Department of Economic and Social Affairs Population Divi- A. METHODOLOGY AND DATA sion incorporated the impact of AIDS into the es- timates and projections of the populations of 53 1. Estimating and projecting the impact of countries. In most of those countries, HIV preva- HIV/AIDS lence is estimated to be 2 per cent or more among the adult population aged 15-49. In addition, a few Chapter II assesses the impact of the epidemic populous countries with lower prevalence levels in countries that are severely affected by were included owing to the large number of per- HIV/AIDS by comparing population estimates sons living with HIV (more than one million per- and projections based on realistic assumptions sons). about the course of the epidemic with hypothetical United Nations Department of Economic and Social Affairs/Population Division The Impact of AIDS 11 TABLE 1. COUNTRIES FOR WHICH THE DEMOGRAPHIC IMPACT OF HIV/AIDS IS EXPLICITLY INCLUDED IN THE 2002 REVISION OF THE OFFICIAL UNITED NATIONS ESTIMATES AND PROJECTIONS Prevalence in 2001 Country (adults 15-49) Africa 1 Angola ...................................................................................................... 5.5 2 Benin ........................................................................................................ 3.6 3 Botswana .................................................................................................. 36.5 4 Burkina Faso............................................................................................. 6.4 5 Burundi..................................................................................................... 8.3 6 Cameroon ................................................................................................. 11.8 7 Central African Republic.......................................................................... 12.9 8 Chad ......................................................................................................... 3.6 9 Congo ....................................................................................................... 7.1 10 Côte d'Ivoire ............................................................................................. 9.6 11 Democratic Republic of the Congo .......................................................... 4.9 12 Djibouti..................................................................................................... 7.1 13 Equatorial Guinea..................................................................................... 3.4 14 Eritrea....................................................................................................... 2.8 15 Ethiopia .................................................................................................... 6.5 16 Gabon ....................................................................................................... 3.6 17 Gambia ..................................................................................................... 1.6 18 Ghana ....................................................................................................... 2.8 19 Guinea ...................................................................................................... 1.8 20 Guinea-Bissau .......................................................................................... 2.8 21 Kenya ....................................................................................................... 15.0 22 Lesotho..................................................................................................... 30.1 23 Liberia ...................................................................................................... 6.5 24 Malawi...................................................................................................... 16.1 25 Mali .......................................................................................................... 1.6 26 Mozambique............................................................................................. 12.8 27 Namibia .................................................................................................... 22.2 28 Nigeria...................................................................................................... 5.8 29 Rwanda..................................................................................................... 9.1 30 Sierra Leone ............................................................................................. 6.7 31 South Africa ............................................................................................. 21.3 32 Sudan........................................................................................................ 2.6 33 Swaziland ................................................................................................. 33.7 34 Togo ......................................................................................................... 6.0 35 Uganda ..................................................................................................... 4.4 36 United Republic of Tanzania.................................................................... 7.8 37 Zambia...................................................................................................... 21.6 38 Zimbabwe................................................................................................. 33.9 United Nations Department of Economic and Social Affairs/Population Division 12 The Impact of AIDS TABLE 1 (continued) Prevalence in 2001 Country (adults 15-49) Asia 1 Cambodia.................................................................................................. 2.7 2 China ........................................................................................................ 0.1 3 India.......................................................................................................... 0.8 4 Myanmar .................................................................................................. 2.0 5 Thailand.................................................................................................... 1.8 Latin America and the Caribbean 1 Bahamas ................................................................................................... 3.5 2 Belize.......................................................................................................
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