HIV Epidemic Restructuring Africa's Population
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From the Office of the Chairman
Worldwatch Issue Alert 2000 - 10
For Immediate Release
October 31, 2000
A missing generation - a population of orphans - a shortage of women
Lester R. Brown
The HIV epidemic raging across Africa is a tragedy of epic propor-
tions, one that is altering the region's demographic future. It is
reducing life expectancy, raising mortality, lowering fertility, cre-
ating an excess of men over women, and leaving millions of orphans in
its wake. This year began with 24 million Africans infected with the
virus. In the absence of a medical miracle, nearly all will die be-
fore 2010. Each day, 6,000 Africans die from AIDS. Each day, an addi-
tional 11,000 are infected. The epidemic has proceeded much faster in
some countries than in others. In Botswana, 36 percent of the adult
population is HIV-positive. In Zimbabwe and Swaziland, the infection
rate is 25 percent. Lesotho is at 24 percent. In Namibia, South Af-
rica, and Zambia, the figure is 20 percent. In none of these coun-
tries has the spread of the virus been checked.
Life expectancy, a sentinel indicator of economic progress, is fal-
ling precipitously. In Zimbabwe, without AIDS, life expectancy in
2010 would be 70 years, but with AIDS, it is expected to fall below
35 years. Botswana's life expectancy is projected to fall from 66
years to 33 years by 2010. For South Africa, it will fall from 68
years to 48 years. And for Zambia, from 60 to 30 years. These life
expectancies are more akin to those of the Middle Ages than of the
modern age.
The demography of this epidemic is not well understood simply be-
cause, in contrast to most infectious diseases, which take their
heaviest toll among the elderly and the very young, this virus takes
its greatest toll among young adults. The effect on mortality is most
easily understood. In the absence of a low-cost cure, infection leads
to death. The time from infection until death for adults in Africa is
estimated at 7 to 10 years. This means that Botswana can expect to
lose the 36 percent of its adult population that is HIV-positive
within this decade, plus the additional numbers who will be infected
within the next year or two. The HIV toll, plus normal deaths among
adults, means that close to half of the adults in Botswana today will
be dead by 2010. Other countries with high infection rates, such as
South Africa, Swaziland, and Zimbabwe, will likely lose nearly a
third of their adults by 2010.
Adults are not the only ones dying from AIDS. In Africa, infants of
mothers who are HIV-positive have a 30 to 60 percent chance of being
born with the virus. Their life expectancy is typically less than 2
years. Many more infants acquire the virus through breastfeeding. Few
of them will reach school age. Thus far, attention has focused on the
effect of rising mortality on future population trends, but the virus
also reduces fertility. Research is limited, but early evidence indi-
cates that from the time of infection onward, fertility among in-
fected women slowly declines. By the time symptoms of AIDS appear,
women are 70 percent less likely to be pregnant than those who are
not infected.
Females are infected at an earlier age than males because they have
sexual relations with older men who are more likely to be HIV-
positive. Female infection rates are also higher than those of males.
Among 15- to 19-year-olds, five times as many females are infected as
males. Because they are infected so early in life, many women will
die before completing their reproductive years, further reducing
births. A demographically detailed study in Kisumu, Kenya, found that
8 percent of 15-year-old girls are HIV-positive. For 16-year-olds,
the figure is 18 percent; and by age 19, it is 33 percent. Among the
19-year-olds, the average age of infection was roughly 17 years. With
a life expectancy of perhaps nine years after infection, the average
woman in this group will die at age 26, long before her child-bearing
years are over. Much work remains to be done in analyzing the effects
of the HIV epidemic on fertility, but we do know that with other so-
cial traumas, such as famine, the effect of fertility decline on
population size can equal the effect of rising mortality.
For example, in the 1959-61 famine in China, some 30 million Chinese
starved to death, but the actual reduction in China's population as a
result of the famine was closer to 60 million. The reasons are well
understood. In a famished population, the level of sexual activity
declines, many women stop ovulating, and even the women who do con-
ceive often abort spontaneously. In a prolonged famine, the fall in
births can contribute as much to the population decline as the rise
in mortality. How much the HIV epidemic will eventually reduce fer-
tility no one knows. One thing is known: The wholesale death of young
adults in Africa is creating millions of orphans. By 2010, Africa is
expected to have 40 million orphans. Although Africa's extended fam-
ily system is highly resilient and capable of caring for children
left alone when parents die, it will be staggered by this challenge.
There is a real possibility that millions of orphans will become
street children, trying to survive by whatever means they can.
Africa is also facing a gender imbalance, a unique shortage of women.
After wars, countries often face a severe shortage of males, as Rus-
sia did after World War II. This epidemic, however, is claiming more
females than males in Africa, promising a future where men will out-
number women 11 to 9. This will leave many males either destined to
bachelorhood or forced to migrate to countries outside the region in
search of a wife. The demographic effects of the HIV epidemic on Af-
rica will be visible for generations to come. Until recently, the of-
ficial projections at the United Nations indicated continuing popula-
tion growth in all countries in Africa. Now this may be changing as
the United Nations acknowledges that populations could decline in
some countries. If the new U.N. biennial update of world population
numbers and projections, due out before the end of this year, in-
cludes the full effect of the epidemic on fertility as well as on
mortality, it will likely show future population declines for many
African countries, including Botswana, Zimbabwe, South Africa, and
Zambia.
There are many unknowns in the effects of the HIV epidemic on the
demographic equation. Will health care systems, overwhelmed by AIDS
victims, be able to meet the need for basic health care? How will the
loss of so many adults in rural communities affect food security?
What will be the effect on fertility of women surrounded by death?
What will be the social effects of the missing generation of young
adults unable to rear their children or to care for their parents?
Even though the HIV epidemic may claim more lives in Africa than
World War II claimed worldwide, the epidemic is simply not being
given the priority it deserves either within the countries most af-
fected or within the international community. The challenge is to re-
duce the number of new infections as rapidly as possible. Nothing
should deter societies from this goal. One of the earliest countries
hit by the epidemic, Uganda, has become a model for other countries
as the infected share of its adult population has dropped from 14
percent in the early 1990s to 8 percent in 2000, a dramatic achieve-
ment. In Zambia, which has mobilized the health, education, agricul-
tural, and industrial sectors, plus church groups, in the effort to
curb the spread of the virus, the infected share of young females in
some cities has dropped by nearly half since 1993. Zambia may soon
turn the HIV tide. If all African countries can do what Uganda has
done and what Zambia appears to be doing -- namely, reduce the number
of new infections below that of AIDS deaths -- they may set the stage
for ending this history-altering epidemic.
COPYRIGHT: 2000 Worldwatch Institute
Contact:
Reah Janise Kauffman
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