HIV Epidemic
Restructuring
Africa'sPopulation:
- a population
- a shortage
generation
A missing
of orphans
of women
The HIV epidemic raging across
Africa is a tragedy of epic proportions, one that is altering the region's
demographicfuture. lt is reducinglife
expectancy,raising mortality, lowering
fertility, creating an excess of men
over women, and leavingmillions of
orphans in its wake. This year began
with 24 million Africans infected with
the virus. ln the absenceof a medical
miracle, nearly all will die before
2010. Each day, 6,000 Africans die
from AIDS. Each day, an additional
| 1,000are infected.Theepidemichas
proceededmuch faster in some countries than in others. In Botswana.36
percent of the adult population is
H|V-positive. In Zimbabwe and
Swaziland,the infection rate is 25
percent. Lesotho is at 24 percent. In
Namibia, South Africa, and Zambia,
the figure is 20 percent. In none of
these countries has the spread of the
virus been checked.
Life expectancy,
a sentinelindicator of
economic progress,is falling precipitously. In Zimbabwe, without AIDS,
life expectancyin 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 ofthe modern age.
The demographyof this epidemic is
not well understood simply because,
in contrast to most infectious diseases.which take their heaviesttoll
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 l0 years.
This meansthat Botswana can expect
to lose the 36 percent of its adult
populationthat is H|V-positivewithin
this decade,plus the additionalnumbers who will be infected within the
next year or two. The HIV toll, plus
normal deathsamongadults,means
that close to half of the adults in
Botswana
todaywill be deadby 2010.
demic on fertility, but we do know
that with other socialtraumas,such
asfamine,the effectof fertility decline
on populationsize can equal the
effect of rising mortality. For examOther countries with high infection ple,in the 1959-61
faminein China,
rates,suchas SouthAfrica,Swaziland, some 30 millionChinesestarvedto
likelylosenearlya death, but the actual reduction in
andZimbabwe,will
third of their adultsby 2010. Adults China'spopulationas a resultof the
are not the only ones dying from faminewas closerto 60 million.The
AIDS. In Africa. infantsof mothers reasonsare well understood.ln a
who are H|V-positivehavea 30 to 60 famishedpopulation,
the levelof sexpercent chance of being born with ual activity declines,many women
the virus.Theirlife expectancyis typi- stop ovulating,and even the women
cally less than 2 years.Many more who do conceiveoften abort spontainfants acquire the virus through neously.
In a prolongedfamine,
the fall
breastfeeding.
Few of them will reach in births can contribute as much to
school age.Thus far, attention has the populationdeclineas the rise in
focusedon the effectof risingmortal- mortality.How much the HIV epiity on future populationtrends, but demic will eventuallyreduce fertility
the virus also reduces fertility. no one knows.
Research
is limited,but earlyevidence
indicatesthat from the time of infec- One thing is known:The wholesale
tion onward,fertility among infected deathof youngadultsin Africa is crewomen slowly declines.
By the time ating millionsof orphans.By 2010,
symptomsof AIDS appear,
womenare Africa is expectedto have40 million
70 percentlesslikelyto be pregnant orphans.Although Africa's extended
than those who are not infected. family system is highly resilient and
Femalesare infectedat an earlierage capableof caring for children left
than malesbecausethey havesexual alone when parentsdie, it will be
relations with older men who are staggeredby this challenge.There
is a
more likelyto be HIV-positive.
real possibility that millions of
orphanswill becomestreet children,
Femaleinfectionratesare also higher trying to surviveby whatevermeans
than those of males.Among 15- to they can. Africa is also facinga genl9-year-olds,five times as many der imbalance,
a uniqueshortageof
femalesare infectedas males.Because women.After wars. countries often
they are infectedso earlyin life,many face a severe shortage of males,as
women will die before completing Russiadid after World War ll. This
their reproductive years, further epidemic,however,is claimingmore
reducing births. A demographically femalesthan malesin Africa,promisdetailed study in Kisumu, Kenya, inga futurewhere menwill out numfound that 8 percent of I S-year-old ber women | | to 9. This will leave
girls are H|V-positive.For l6-year- manymaleseither destinedto bacheolds,the figure is 18 percenqand by lorhood or forced to migrate to
age 19,it is 33 percent.Among the countriesoutsidethe regionin search
I 9-year-olds,
the averageageof infec- of a wife.The demographic
effectsof
tion was roughly l7 years.Witha life the HIV epidemicon Africa will be
expectancy of perhaps nine years visiblefor generations
to come.
after infection,the averagewoman in
this group will die at age 26, long Until recently,the officialprojections
before her childbearingyears are at the United Nations indicatedcongrowthin all counover.
tinuingpopulation
tries in Africa. Now this may be
Much work remainsto be done in changing as the United Nations
analysingthe effectsof the HIV epi- acknowledges
that populationscould
fri
irii
frr,.
g.'
decline in some countries.lf the new
U.N. biennialupdate of world population numbers and projections, due
out before the end of this year,
includesthe full effect of the epidemic
on fertility as well as on mortality, it
will likely show future population
declines for many African countries,
includingBotswana,Zimbabwe,South
Africa, andZambia.
social effects of the missing generation of young adults unable to rear
their children or to care for their
parentsl Even though the HIV epidemic may claim more lives in Africa
than World War ll claimed worldwide, the epidemicis simply not being
given the priority it deserves either
within the countries most affectedor
within the internationalcommunity.
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 carel 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
The challengeis to reduce 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 l4 percent in the early 1990sto
8 percent in 2000,a dramaticachieve-
ment. ln Zambia,which has mobilized
the health,education,agricultural,and
industrialsectors,plus church groups,
in the effort to curb the spread of the
virus, the infected share of young
femalesin some cities has dropped by
nearly half since 1993. Zambia may
soon turn the HIV tide. lf all African
countries can do what Uganda has
done and what Zambia appearsto be
doing -- namely,reduce the number
of new infections below that of AIDS
deaths -- they may set the stage for
endingthis history-alteringepidemic.
LesterR.Brown
Re-published
with permission
from
"Worldwotch
lssueAlert2000 - 10"
http:| | www.wo
rldwatch.orgIolertsIind exio.html
Research
in Nineanda HalfMinutes
To the Editor:
One of the tasks
that loom over the heads of anyone
involved in post-graduateeducation is
the "dreaded" research project. The
terms are confusing,the statistics are
frightening and the reading is overwhelming. By the time you have
decided what to research,written a
protocol, constructed a questionnaire, drawn up a budget, got the
approval of the ethics committee,
conducted the survey, analyzed the
data and written it all up, your wife is
threatening to divorce you, your kids
are questioning you sanity and the
dog no longer even wags his tail when
you come home. ls it any wonder that
many give up before even beginning?
can be completed in nine and a half
minutes.
assesswhether he is fulfilled in his
job. After inquiring about his numerous roles, the researchers explore
You need an apple,a piece of string how he feels about his length.Would
and two chocolates.Theapple is ined- he like to be shorter or longer?Did
ible. lt's not a Mackintosh.lt's actually he feel separatedfrom the rest of the
a timer.Any timer will do. The one I string? Had he had a choice in being
use just happensto look like an apple. cut offl Mr. String says he feels he is
unraveling.The researchers recomProject I is to research a piece of mend that Mr. String be linked in a
string. The instructions are simple. support group by being knotted to
The students work in pairs and each other strings.
pair gets a short piece of string.They
have seven and a half minutes to
Project 2 is a beauty contest. After
conduct the research and write a the awkward gigglinghas subsided,get
report.Anythinggoes and the prize is the whole group to stand around a
awarded to the pair with the most table. Each one placestheir left liale
amusingreport.
finger on the table and holds their
right index finger in the air. On the
The best way of learning about It is amazing to see the variety of command of "Go", each votes by
research is to do it! Like travel, once options that are explored.Theanalyti- touching the finger they considerthe
you have successfullycompleted the cal ones measure it, test its proper- most beautiful.The result is usually
first journey, the bug bites and you ties and think up lists of uses,both total chaosand much laughter.
are rearing to set off again.For those probableand improbable,from trying
who have to teach research method- shoes to strangling chickens! The There you have it, two research projology and inspire students to get imaginative ones suggest exploring ects completed in less than ten minstarted, I would like to suggest string as a substitute for dental floss utes. Everyone has had a good laugh
2 short games, which will help to
and plan to carry out the project at and has been inspired to be more
break the ice on the first day of the entrance to the local shopping creative.
the researchworkshop.They are fun, mall.The winners decide to do an inDovidComeron
they teach valuablelessonsand they depth interview with Mr. String to
Pretoria