The impact of AIDS

Posted: 28 January 2008

At the end of 2007, the number of people living with HIV was estimated at 33.2 million worldwide, a reduction of 16 per cent compared to the same estimates in 2006. UNAIDS attributes this revision to signifcant reductions in infection rates in six countries: Angola, India, Kenya, Mozambique, Nigeria and Zimbabwe. Over 2.5 million people - including 420,000 children under the age of 15 - were infected with HIV during 2007. UNAIDS attributes the reductions in infection rates to a new study in India which dramatically revised estimates of the number of people infected. In both Kenya and Zimbabwe, there is evidence that declines in infections were due to a reduction in risky behaviour.

Global numbers living with HIV 2007
Global numbers living with HIV 2007
Adults and children estimated to be living with HIV, 2007. Source: UNAIDS. Click on image for full-size graphic.

The most disturbing long-term feature of the HIV/AIDS epidemic is its impact on life expectancy, making HIV an unprecedented catastrophe in the world's history. There were estimated to be 2.1 million deaths from HIV/AIDS in 2007 - three-quarters of them in sub-Saharan Africa.

  • Sub-Saharan Africa bears the brunt of AIDS. Over 20 million Africans have already died from AIDS - over 1.6 million in 2007 alone. And at the end of 2007, 22.5 million Africans, including nearly 3 million children, were living with HIV/AIDS, some two-thirds of the world-wide total, although the region is only home to 10 per cent of the world's population. Some 1.7 million Africans were newly infected with the virus in 2007.

  • In the world's seven hardest-hit countries (all of them in Africa) where at least one-fifth of the adult population has HIV, the average life expectancy for a child born in 2000-2005 will fall to under 40 years, from the pre-AIDS expectation of 60 years. This represents a reversal of most development gains of the past 30 years - affecting an entire generation.
Regional HIV graph 2007
Regional HIV graph 2007
Regional HIV and AIDS statistics and features, 2007. Source UNAIDS. Click on image for full-size table
  • The highest prevalence of HIV in the world is currently in Botswana and Swaziland, with more than one in three of the population infected. Life expectancy has dropped from 65 years in 1990-1995 to 56.3 years in 1995-2000 and is currently (2005) around 40, a figure about 28 years lower than the life expectancy projected in the absence of AIDS.

  • UNAIDS graphic showing the projected population deficit in Botswana due to AIDS in 2020 (as of July 2002)
    UNAIDS graphic showing the projected population deficit in Botswana due to AIDS in 2020 (as of July 2002)
    Click on the thumbnail for a larger UNAIDS graphic showing the projected population deficit in Botswana due to AIDS in 2020 (as of July 2002)
    Because of increased mortality, population growth in Botswana has already been significantly reduced, and population decline is projected to begin in the period 2005-2010. The average annual population growth rate dropped from 3.3 per cent per year in 1980-1985 to 2.1 per cent in 1995-2000, and has dropped to -0.4 per cent in 2005-2010. By 2050, Botswana's population is likely to be total 1.4 million, 20 per cent lower than in 2000.

  • Ten countries (Botswana, Central African Republic, Lesotho, Malawi, Mozambique, Rwanda, Sierra Leone, Swaziland, Zambia and Zimbabwe) now have a life expectancy of less than 40 years. In most of the affected countries of Africa, high fertility rates will offset the deaths due to AIDS, and population will continue to grow throughout the projection period. However, in Botswana, Lesotho, South Africa, and Swaziland, the population in 2050 is projected to be below that in 2000.

  • In Zimbabwe, the second hardest-hit country, life expectancy at birth, estimated at 41 years in 1995-2000, is 25 years lower than it would have been without AIDS (66 years). In 2045-2050, the life expectancy projected with AIDS will still be 30 years lower than that projected in the absence of AIDS.

  • As in Botswana, the impact of HIV/AIDS on population growth has been staggering. From 3.9 per cent per year in 1980-1985, the annual growth rate fell to 1.5 per cent in 1995-2000 to 0.6 per cent in the current period (2005-2010). By 2050, Zimbabwe's projected population will be 61 per cent lower than the population projected without AIDS.

  • In South Africa, the largest of the hardest hit countries, average life expectancy is only 47 years, instead of 66, if AIDS were not a factor. HIV prevalence among pregnant women reached nearly one in three in 2004, and in the country's worst affected province, KwaZulu-Natal, prevalence has reached 40 per cent.

South Africa population with and without AIDS
South Africa population with and without AIDS
South African population in 2015, with and without AIDS. Source: UN World Population Prospects: 2006 Revision. For full size graphic, click on image.

  • Deaths due to HIV/AIDS in Africa will soon surpass the 20 million Europeans killed by the Black Plague epidemic of 1347-1351.

  • The number of African children who had lost their mother or both parents to the epidemic by the end of 2003 - 12 million - is forecast to more than double over the next decade. These orphans are especially vulnerable to the epidemic, and the impoverishment and precariousness it brings.
UNAIDS graphic showing the impact of AIDS on life expectancy in selected African countries with high and low prevalence
UNAIDS graphic showing the impact of AIDS on life expectancy in selected African countries with high and low prevalence
Source: UNAIDS report on the global HIV/AIDS epidemic 2002 /UN Department of Economic and Social Affairs (2001) World Population Prospects, the 2000 Revision

Other impacts on developmentAlthough AIDS will have a devastating demographic impact on some African countries, its long-term effect on African population growth will be relatively limited. Even in the 38 most affected African countries, the projected total population in 2025 will only be some 14 per cent less than it would have been without AIDS. Other impacts on development are arguably far more important.

AIDS affects almost every aspect of social and economic life:Health care systems are stretched beyond their limits as they not only deal with a growing number of AIDS patients and the loss of health personnel due to death and illness, but also cope with rising cases of tuberculosis, the most common infection associated with AIDS.

  • In Côte d'Ivoire, Zambia and Zimbabwe, HIV-infected patients occupy 50 to 80 per cent of all beds in urban hospitals.

  • Spending on AIDS care is crowding out spending on other life-saving, cost-effective programmes. On average, treating an AIDS patient for one year is about as expensive as educating 10 primary school students for one year.

Another sector feeling the impact of AIDS is education.

  • Over 30 per cent of teachers in Malawi and Zambia are already infected. A World Bank study in Tanzania estimated that AIDS would kill almost 15,000 teachers by the year 2010 and 27,000 by 2020. The cost of training replacement teachers would be nearly $40 million.

  • In Côte d'Ivoire, around one schoolteacher dies of AIDS every school day.

  • Families affected by HIV/AIDS are more likely to keep children - especially girls - out of school to care for the sick.

Many of the countries most affected by HIV/AIDS are heavily reliant on agriculture and agricultural exports to pay for raw materials and essential imports for development.

  • FAO has found that in the 10 African countries most severely affected by HIV/AIDS, the agricultural labour force will decline between 10 and 26 per cent by 2020. Botswana, Mozambique, Namibia and Zimbabwe are each expected to lose at least one fifth of their agricultural workers.

  • The loss of adults to AIDS often leads to a shift from cash crops to subsistence farming.

  • It can also reduce investments in soil enhancements, irrigation, and other capital improvements.

  • AIDS forces families to make irreversible decisions to sell livestock, equipment, and land to cover AIDS-related expenses, leaving surviving family members in poverty, from which it is hard to escape.

Economic productivity falls. AIDS primarily affects people who are at the most productive stage of their lives, often those from higher socio-economic brackets and those who have benefited from many years of investment in their training.

  • In the private sector, AIDS-related costs are eating up as much as one-fifth of all profits in some countries. In Zambia, for instance, Barclays Bank has been losing 36 employees a year out of some 1,600, ten times the death rate at most US companies.
Click here for UNAIDS PowerPoint graphic showing reduction in agricultural workforce due to HIV/AIDS by 2020 in selected African countries.

The HIV/AIDS epidemic is stretching the capacity of social safety nets to the limit.

  • In Côte d'Ivoire, in urban families where a member has AIDS the average income drops by 50-65 per cent, family spending on education is halved, and food consumption drops by 41 per cent, while individual expenditures on health care more than quadruples. Other consequences include the dissolution, or part dissolution, of families: children are sent away to live with relatives; a spouse or a child migrates to earn an income; and sometimes, on the death of a spouse, the widow has to move to a brother's house.

Poverty and HIV are closely linked in a downward spiral, so poor societies and communities are particularly hard hit. Poverty increases vulnerability to infection. Lack of education and low literacy rates make information less accessible, and marriage, sex, and pregnancy are likely to be earlier, putting younger girls at risk of infection.

  • Once HIV becomes established, food and money become scarcer, children are more likely to be taken out of school, women may be widowed and forced into earning money through sex, and children may be orphaned - reducing even further their chances of education.
Projected reduction in size of primary-school-age population by 2010, in selected African countries
Projected reduction in size of primary-school-age population by 2010, in selected African countries
Women and their children suffer disproportionately from the AIDS epidemic. According to State of the World 2003, the scourge of HIV/AIDS is hitting women hard. For the first time, half of the people living with HIV are women; their biological vulnerability to the disease is compounded by their lack of social and economic power. Already women account for 61 per cent of HIV-positive adults in Africa. Factors such as polygamy, malnutrition, lack of access to care, ear piercing, genital mutilation and menstruation, all lead to easier transmission of HIV. When women are sick with AIDS or die, their children suffer, even if they were not infected themselves at birth.