The impact of AIDS on adult mortality since 1999 has led to a decline in life expectancy at birth in 23 African countries, according to the “2004 Report on the global AIDS epidemic”, published by the Joint United Nations Programme on HIV/AIDS (UNAIDS). UN agencies have warned that the epidemic has cut to less than forty years the life expectancy in seven countries in sub-Saharan Africa—Central African Republic, Lesotho, Malawi, Mozambique, Swaziland, Zimbabwe and Zambia—and their human development index has been thrown back to the 1990 levels. A Zambian child’s chances of living longer than 32 years are extremely low, whereas in 1990 he or she would have most likely lived until the age of 49. The average life expectancy in those seven African countries of a person born between 1995 and 2000 is 13 years lower than in the absence of AIDS. The cause of this dramatic reversal is AIDS, which in 2003 was responsible for 2.2 million deaths in sub-Saharan Africa alone.
AIDS is accountable for the decline in life expectancy in African countries, affecting mainly the eastern and southern regions of the continent. If the current infection rates continue and there is no large-scale treatment programme, up to 60 per cent of the 15-year-olds will not reach their sixtieth birthday. “The consequences of this decline in the life expectancy are extremely serious and point to greater reversals in overall human development, since AIDS affects all social institutions that are needed to develop and maintain safe and equitable societies”, says Dr. Desmond Johns, Director of the UNAIDS New York Office.
AIDS is much more than just a health problem, particularly in sub-Saharan Africa, where the life expectancy in 2004 has dropped in some instances to the levels during the great famines of the 1970s. Current estimates suggest that countries which reach HIV-prevalence levels of 15 per cent amongst adults will on average lose 1 per cent of their gross domestic product every year. As Dr. Johns points out: “AIDS affects all sectors in society, and in heavily affected countries, it is justifiably characterized as the social and economic productivity indicators and, therefore, is justified to be characterized as a developmental crisis.” Predictions for the longer term suggest that these heavily affected countries will have a disproportionate number of child-headed households. “AIDS deaths have, to date, generated 15 million orphans worldwide. The prospect of a large number of orphans growing up unsupported, unsupervised, uneducated and unemployed must have serious implications for the stability of the societies concerned”, states Dr. Johns.
The epidemic also affects women and girls disproportionately. Women now account for 57 per cent of new infections in sub-Saharan Africa, a vulnerability largely determined by their economic and social status. Dr. Johns also points out that “they are at higher risk of contracting the virus due to intergenerational sex, or to suffer the consequences of the epidemic by being pulled out of school to become caregivers, or to find work in order to maintain the family”. Unless the response to AIDS is dramatically strengthened, it is estimated that because of the disease, some 38 African countries by 2025 will have their population further reduced by 14 per cent more than predicted.
The World Health Organization/UNAIDS “3 by 5 initiative” is an attempt by the international community to expand access to antiretroviral treatment, but these efforts are currently hampered by the lack of human capacity, infrastructure and resources. As Dr. Johns explains: “The particular challenges of this disease are that those affected need lifelong treatment and social support in order to lead healthy and productive lives.” It is, therefore, important that HIV is viewed by the international community as a developmental challenge, he believes, since this change in viewpoint will ensure that attention is not only directed at those who are infected, but also at the root causes of the epidemic, such as poverty, lack of access to basic services like education and health, as well as gender inequality and mobility. “We have a good idea what works”, states Dr. Johns, “and given sufficient resources, we can look forward to turning the corner on this epidemic.”
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