UNAIDS- Geneva June 27, 2000


         HIV/AIDS is causing dramatic shifts in demographics, with

                                 long-ranging social consequences for hardest-hit nations

                                 Massive increase in resources needed to reduce the

                                 epidemic’s spread and impact


                            The ongoing spread of HIV in the world’s hardest-hit regions, particularly in

                            sub-Saharan Africa, is reversing years of declining death rates, causing

                            drastic rises in mortality among young adults and dramatically altering

                            population structures in the most affected regions.


                            While the epidemic of HIV, the virus that causes AIDS, is stabilizing in many

                            high-income countries, as well as in a handful of developing nations, HIV

                            prevalence rates among

                            15-49-year-olds have now reached or exceeded 10% in 16 countries, all of

                            them in sub-Saharan Africa.


                            As high as these rates are, they greatly understate the demographic impact

                            of AIDS. The probability of dying of AIDS is systematically higher than

                            prevalence rates indicate. Conservative new analyses show that this is true

                            even if countries manage to cut the risk of becoming

                            HIV-infected in half over the next fifteen years. For example, where 15% of

                            adults are currently infected, no fewer than a third of today’s 15-year-olds

                            will die of AIDS. In countries where adult prevalence rates exceed 15%, the

                            lifetime risk of dying of AIDS is even greater, assuming again that

                            successful prevention programmes manage to halve the HIV risk.


                                 In countries such as South Africa and Zimbabwe, where a fifth or a

                                 quarter of the adult population is infected, AIDS is set to claim the

                                 lives of around half of all 15-year-olds.


                                 In Botswana, where about one in three adults are already HIV-infected

                                 -- the highest prevalence rate in the world -- no fewer than two-thirds of

                                 today’s 15-year-old boys will die prematurely of AIDS.


                            These findings are contained in a new United Nations report that shows that

                            current trends in HIV infection will increasingly have an impact on rates of

                            infant, child and adult mortality, life expectancy and economic growth in

                            many countries. The latest Report on the global HIV/AIDS epidemic, which

                            includes a country-by-country update on the global epidemic, was prepared

                            by the Joint United Nations Programme on HIV/AIDS (UNAIDS), and

                            released today in advance of the XIIIth International AIDS Conference being

                            held in Durban, South Africa, from 9 to 14 July.


                            Speaking at the release of the report in Geneva, Peter Piot, Executive

                            Director of UNAIDS, warned: "The AIDS toll in hard-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 its firmest hold, yet the global

                            response is still just a fraction of what it could be. We need to respond to

                            this crisis on a massively different scale from what has been done so far."


                            Long-term demographic impacts threaten social stability


                            In developing countries, where HIV transmission occurs mainly through

                            unsafe sex between men and women, the majority of infected people

                            acquire HIV by the time they are in their 20s and 30s and, on average,

                            succumb to AIDS around a decade later. The resulting decrease in the

                            productive workforce and proportional increase in citizens in the oldest and

                            youngest age groups -- those most likely to require aid from society -- is

                            becoming a key contributor to social instability.


·        So far, a total of 13.2 million children under 15 have lost their mother

                                 or both parents to AIDS since the epidemic began.


·        The epidemic is undermining basic learning in certain parts of Africa:

                                 diminishing funds for school fees, forcing young people into the

                                 workforce earlier, and claiming the lives of teachers well before

                                 retirement age. In Côte d’Ivoire, 7 out of 10 teacher deaths are due to

                                 HIV. In 1998, Zambia lost 1300 teachers in the first ten months of the

                                 year - equivalent to two-thirds of the new teachers trained each year.


·        Agriculture, which in many developing countries provides a living for

                                 as much as four-fifths of the population, is suffering serious disruption.

                                 In West Africa, for example, reduced cultivation of cash crops and

                                 food products is reported.


·        Business is already seeing the impact of AIDS on their bottom line.

                                 On an agricultural estate in Kenya, new AIDS cases and health

                                 spending showed a massive ten-fold increase over a recent 8-year



·        Increased demand for health care for HIV-related illness is taxing

                                 overstretched health services. In countries from Thailand to Burundi,

                                 HIV-positive patients are occupying

                                 40-70% of the beds in big city hospitals. At the same time, the health

                                 sector is increasingly losing its own human resources to AIDS. One

                                 study in Zambia found a 13-fold increase in deaths in hospital staff,

                                 largely due to HIV, over a ten-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

                            relief and epidemic relief", said Dr Piot. "Developing countries, who carry

                            95% of the HIVAIDS burden, owe in total around US$ 2 trillion. But Africa is

                            the priority because this is the region with the most HIV infections, the most

                            AIDS deaths, and the vast majority of the world's heavily indebted poor

                            countries. "


                            "African governments are paying out four times more in debt service than

                            they now spend on health and education. 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."


                            HIV infection rates continue to increase in many countries


                            In sub-Saharan Africa, where the most severe epidemics are to be found,

                            UNAIDS and the World Health Organization (WHO) estimate that some

                            24.5 million adults and children are now living with HIV, and that the

                            proportion of 15-49-year-olds infected with the virus is still increasing in

                            most countries. In countries such as Cameroon, Ghana and South Africa -

                            which now has 4.2 million people living with HIV/AIDS, the highest number

                            in the world -, the adult prevalence rate has shot up by more than half in the

                            past two years.


                            In all countries of the region, HIV prevalence rates in young women aged

                            15-24 are higher -- typically two or three times higher -- than those for young

                            men the same age. In the 15-19 age bracket, the sex differential is even

                            wider. Girls who consent or are coerced into early intercourse are

                            especially vulnerable to infection, not only because of their immature genital

                            tract but because they often have older partners, who are more likely to be



                            On other continents, too, the epidemic has not lost its momentum.


                                 Determined HIV prevention programmes in several countries in Asia

                                 and Latin America have, for now, stemmed what threatened to be a

                                 massive rise in heterosexual infection rates. However, unsafe sex

                                 between men and women is contributing to a growing epidemic in

                                 some populous states of India where more than 2% of

                                 15-49-year-olds are infected. Heterosexual transmission also

                                 dominates in the Caribbean, where the Bahamas and Haiti have adult

                                 HIV prevalence rates higher than anywhere in the world outside Africa.


                                 HIV is becoming more firmly entrenched among injecting drug users

                                 and men who have sex with men. Globally, injecting drug users

                                 continue to be exposed to the virus, and in many places at least one in

                                 three is infected. Over the past two years, the relative increase in the

                                 proportion of adults living with HIV has been steep in the Baltic states,

                                 but the number of infections is far higher and still growing in the

                                 Russian Federation and in Ukraine, where around 1 adult in 100 is

                                 now infected nationwide. Among men who have sex with men, the

                                 prevalence of HIV is 15-20% in many places and there is no sign that

                                 the rate of new infections is slowing down.


                                 AIDS deaths have declined drastically in high-income countries and

                                 parts of Latin America thanks to expensive therapy with antiretroviral

                                 drugs. However, there is good evidence that -- as a result of

                                 complacency and other factors -- risky sexual behaviour is on the rise.

                                 In San Francisco, the proportion of gay men reporting multiple

                                 partners and unprotected anal sex rose between 1994 and 1998, in

                                 parallel with a steep rise in rectal gonorrhoea after years of falling



                            Signs of hope, but response needs urgent and massive expansion


                            While the overall picture is a sobering one, the UNAIDS report presents

                            new information showing once again that the world is not helpless against

                            the epidemic. Countries that tackled the epidemic with sound approaches

                            years ago are already reaping the rewards in the form of falling or low and

                            stable HIV rates, greater inclusiveness of people already affected by HIV or

                            AIDS, and diminished suffering. Countries that began to apply those

                            approaches more recently can look forward to similar gains.


                                 As a result of AIDS education and information campaigns, there is an

                                 encouraging increase -- though by no means sufficient -- in the

                                 number of young people using the full range of prevention

                                 approaches, from delaying their sexual debut to having fewer casual

                                 partners and engaging in protected sex.


                                 Developing countries and donor agencies are increasingly looking on

                                 AIDS-related care as a good investment having direct benefits for

                                 people with HIV/AIDS and indirect spin-offs for AIDS prevention in the

                                 wider community. Collaborative ventures of various kinds are opening

                                 the door to better access to care and support. In Latin America and

                                 the Caribbean, for example, a multicountry survey on the prices being

                                 paid for HIV-related drugs and commodities brought major price

                                 differences to light and led to reductions through negotiations with

                                 pharmaceutical companies.


                                 Inspired by Thailand’s successful campaign, Cambodia launched a

                                 pilot programme in Sihanoukville promoting "100% condom use" in

                                 commercial sex. In just two years, 65-75% of male clients (military,

                                 police and motorbike taxi drivers) were reporting that they always

                                 used condoms with commercial partners -- up from less than 55% --

                                 while similar high rates were reported by brothel-based sex workers.


                                 Experience from Malawi and Uganda shows that micro-credit

                                 schemes can work very successfully even in communities with high

                                 HIV prevalence. These schemes, which grant small loans to

                                 individuals who want to start up a small business and who seem likely

                                 to be able to repay, could play a greater role in alleviating poverty and

                                 mitigating the economic impact of AIDS.


                                 Condom use for first intercourse has become impressively high in

                                 Brazil, where the government has taken an active lead in HIV

                                 prevention, care and protection of the rights of people affected by

                                 AIDS. In 1986 less than 5% of young men reported using a condom

                                 the first time they had sex. The figure in 1999 was close to 50% -- and

                                 among men with higher education, it was over 70%.


                                 In Zambia, new surveillance data from the capital Lusaka show that

                                 the proportion of pregnant girls aged 15-19 infected with HIV dropped

                                 by almost half over the past six years. This holds out hope that Zambia

                                 might follow the course charted by Uganda, where a decline in

                                 infection rates in young urban women heralded the turnaround in the

                                 epidemic. Uganda’s nationwide rate of adult HIV prevalence has now

                                 fallen to just over 8% from a peak of close to 14% in the early 1990s.


                            "Achievements like these keep hope alive by proving that the world is not

                            powerless against the epidemic", said Dr Piot. "But up to now the gains

                            have been scattered, not systematic. We need an all-out effort to turn the

                            tide of the epidemic everywhere, with a massive increase in resources from

                            domestic budgets and international development assistance."