IRIN Focus on the AIDS pandemic

A shocking new report this week by the United Nations AIDS programme - UNAIDS - said that there were an estimated 24.5 million people living with HIV/AIDS in sub-Saharan Africa, with 4 million new infections in the region during 1999 and that AIDS now killed ten times more people a year than wars on the continent. The report said the pandemic was reversing years of declining death rates causing drastic rises in mortality among young adults and dramatically altering population structures in the most affected regions. It said the HIV prevalence rates among 15-49 year olds had now reached or exceeded 10 percent in 16 countries, all of them in sub-Saharan Africa. In countries such as Cameroon, Ghana and South Africa the adult prevalence rate had shot up by more than half in the past two years. Speaking at the release of the report in Geneva, Peter Piot, Executive Director of UNAIDS, warned: “There is a whole generation which is being taken out....The AIDS toll in hardest-hit countries is altering the economic and social fabric of society. HIV will kill more than one third of the young adults of countries where it has the firmest hold.” The figures In seven countries, all in the southern part of the continent, at least one adult in five is living with HIV, said the report. It added that in countries where 10 percent of the adult population has the HIV infection, almost 80 percent of all deaths in young adults aged 25-45 will be associated with HIV. The report added that the HIV prevalence rate in young women aged 15-24 was typically two or three times higher than among young men and that in the 15-19 age group the sex differentiation was even wider. “Girls who consent or are coerced into early intercourse are especially vulnerable to infection,” it said. South Africa, long believed to be one of the most developed nations in southern Africa has an estimated 4.2 million people living with HIV/AIDS. One fifth of the population is estimated to be infected with the disease, and that it is expected to claim the lives of around half of all 15 year olds. “Already one in four South African women between the ages of 20-29 are infected with the virus,” UNAIDS said. There are now an estimated 420,000 AIDS orphans in South Africa. But these figures by UNAIDS have been contested by South African health officials. Dr Nono Simelela, Chief Director of the National HIV/AIDS project in the Department of Health, said on Wednesday that the department would request the authors to furnish it with the source of the figures. Simelela said that the UN statistics did not correlate with the figures that the department released earlier this year. Dr Bernhard Schwartlander, Senior Epidemiologist and Team Leader of the Epidemiology, Monitoring and Evaluation Unit at UNAIDS told IRIN: “The figures released by UNAIDS have been prepared in collaboration with the Department of Health in South Africa. The estimates on the number of people living with HIV/AIDS are the same ones published by the department of health. We collaborate very closely.” “There might potentially be some minor differences when it comes to the calculation 15-49 years of age. We use the latest figures that were made available to us from the United Nations Population Division,” he said. Mark Heywood of the advocacy group AIDS Law Project at the University of the Witwatersrand in Johannesburg told IRIN that AIDS statistics in South Africa were generally gathered in October and November each year through surveys at anti-natal clinics around the country. “This possibly gives the most accurate figure,” he said. “One possible problem with the UNAIDS report is that it focuses on high prevalence areas such as Carletonville which is a mining town, with large numbers of migrant workers and sex workers.” Heywood said that the UNAIDS figure was based on an extrapolation. “Which to my mind is scientifically unsound and to my mind very dangerous,” he said. The rest of the continent The report said that nearly 2,000 Zimbabweans died of AIDS each week, with AIDS set to kill around half of all 15 year olds. In Botswana where about one in three adults are already HIV positive, “no fewer than two-thirds of today’s 15 year-old boys will die prematurely of AIDS”. According to the report, about one in four adults living in Zambian cities were HIV positive, with about one in seven adults infected in the country’s rural areas. It said that in the first 10 months of 1998 Zambia lost 1,300 teachers, “equivalent to two-thirds of the new teachers the country trained each year.” In West Africa, which has so far been relatively less affected; the report noted, HIV infections were creeping up. In Cote d’Ivoire, seven out of 10 teachers died because of HIV. The country is already among the 15 worst affected in the world. Nigeria, the report estimates, has over 2.7 million people infected with HIV. In Cameroon by the year 2010, death rates would have more than doubled because of HIV/AIDS. An estimated 340,000 people in Ghana are currently living with HIV/AIDS. Infection rates in Eastern Africa, once the highest on the continent, are slightly above those in West Africa but have been overtaken by the pandemic in the southern part of the continent. In Tanzania there are an estimated 1.3 million people living with HIV/AIDS. In Kenya there are an estimated 2.1 million people. HIV positive patients now occupied about 39 percent of beds in Kenyatta National Hospital in Nairobi, the report noted. AIDS, development and poverty Increasing illness and HIV/AIDS deaths are reversing years of development. Increased demand for health care from people with HIV-related illnesses has overstretched the public health systems and the pressure is expected to increase. In seven out of 16 African countries, spending on AIDS has exceeded 2 percent of the gross domestic product (GDP). At the same time a tuberculosis epidemic is developing in many African countries. TB has become the leading cause of death among people with HIV/AIDS. The report noted that in West Africa, many cases had been reported of reduced cultivation of cash crops or food crops. It said that there had been a marked decline in cotton, coffee and cocoa production in Cote d’Ivoire. In one district in Tanzania, time spent on farming had changed radically because of AIDS. “A woman with a sick husband spent 60 percent less time on agricultural activities than usual,” UNAIDS said. On one agricultural estate in Kenya, new AIDS cases and health spending showed a ten-fold increase over a 10-year period. “Because of AIDS, poverty is getting worse just as the need for more resources to curb the spread of HIV and alleviate the epidemic’s impact on development is growing. It’s time to make the connection between debt and relief and epidemic relief,” Piot added. Piot said that African countries were paying out four times more in debt service than they now spend on health care. “If the international community relieves some of their external debt, these countries can reinvest the savings in poverty alleviation and AIDS prevention and care. If not, poverty will just continue to fan the flames of the epidemic.” Success stories HIV rates in Uganda peaked at 14 percent in the early 1990s. It was the first country in sub-Saharan Africa to reverse the epidemic’s spread. It has nearly halved its HIV rate to about 8 percent through strong intervention measures. “Even rural areas which are frequently among the last to evidence signs of both the advent and the reversal of an HIV/AIDS epidemic, have shown a reduction in HIV rates. In some areas in rural Uganda the HIV infection rate among teenage girls dropped to 1.4 percent in 1996-1997, from 4.4 percent in 1989-1990,” the report noted. By 1993, HIV rates among young women in Lusaka exceeded 25 percent, but this has almost halved in six years because of successful HIV prevention. New data also shows that the proportion of pregnant girls aged 15-19 infected with HIV also halved in the past six years. “This holds out hope that Zambia might follow the course chartered by Uganda,” UNAIDS said. According to the report, experiences from Malawi and Uganda show that micro-credit schemes have worked successfully even in communities with high HIV infection rates. These schemes grant small loans to individuals for small business development and “play a greater role in alleviating poverty and mitigating the economic impact of AIDS”.