Aids/Hiv in Developing Countries, Impact of
Aids/Hiv in Developing Countries, Impact of
Developing countries include low- and middle-income economies as well as those in transition from central planning. A wide diversity of political, economic, social, religious, and cultural systems is embraced within such countries, resulting in markedly different HIV/AIDS experiences between neighbors as well as within the nations themselves.
Several HIV epidemics often operate in tandem, including injecting drug-use, unprotected heterosexual or male-to-male sexual contact, mother-to-child infection (either in the womb or by breast feeding), and contaminated blood products. Even within a country, epidemics can be extremely diverse.
Ninety-five percent of the 38 million adults and 2.2 million children estimated to be living with HIV worldwide at the end of 2005 lived in developing countries. Worst affected is Sub-Saharan Africa, where an estimated 25.8 million have the disease, including the 3.2 million new infections during 2005. South and Southeast Asia follow with 8.3 million, Latin America and the Caribbean with 2.1 million, Eastern Europe and Central Asia with 1.6 million, East Asia with 870,000, and North Africa and the Middle East with 510,000. Worldwide, 26 million people have died from AIDS and related illnesses, 3 million of these in 2005 alone.
During that year some 4.8 million adults and children were newly infected with HIV in developing countries, 98 percent of the global total. The full extent of the problem is hidden because of inadequate testing and reporting facilities in some countries and regions within them. People may not want to be tested, and continue living with HIV without being aware of it, but even if testing positive, they may not tell their partners, seek treatment, or negotiate safer sex.
THE EMERGENCE OF EPIDEMICS
Epidemics usually pass through stages, beginning with injecting drug-users sharing needles and syringes, commercial sex workers having unprotected sex with clients, and men having unprotected sex with men. As HIV spreads more widely among these groups, it begins to percolate into the wider population, as has occurred in Indonesia, Vietnam, and Malaysia. Then, when the overall infection rate exceeds one percent, as in Thailand, Cambodia, and Myanmar, the epidemic is considered to have become generalized.
In most countries high rates of infection are associated with marginalized groups like sex workers, truck drivers, and men having sex with men. Epidemics in India, Pakistan, Libya, Uruguay, and Ukraine are being driven by injecting drug-use; in the Russian Republic HIV prevalence is four times greater in prisons than in the population at large. Some groups are especially at risk. Women and girls with little income may turn to risky commercial sex. In Sub-Saharan Africa, for example, those aged between fifteen and twenty-four are three times more likely to be HIV-positive than men in a similar age group.
The origins and early spread of HIV/AIDS remain controversial but it seems to have emerged in Central Africa toward the end of the 1970s and in the United States and Europe in the early 1980s. Elsewhere it appeared later, with the first HIV cases being reported in Thailand and the Philippines in 1984, in India and the People’s Republic of China in 1985, and in Myanmar in 1988. The early data are very unreliable. In 1992, for instance, estimates of total HIV infections in Thailand ranged from 333,000 to 696,000 depending on how studies of military conscripts were analyzed and varying assumptions about the age and gender distribution of the disease. In societies where religious and political leaderships had close relationships, HIV was initially explained away as an outcome of lax morals in Western societies. Sometimes there were disputes between departments, as in Thailand, where the Tourism Ministry was concerned that health authority warnings about HIV/AIDS would deter foreign visitors.
By the mid-1990s HIV/AIDS had emerged in virtually every country. The vast differences in population make raw numbers misleading. In India the 2,095 cumulative AIDS cases in adults and children reported to the World Health Organization in December 1995 represented a rate per 100,000 population of less than one, whereas the forty-three cases in New Caledonia represented a rate of twenty-five. The wide geographical spread of the disease in Asia alone can be seen from the fact that by 1995, 570 cases had been reported in Myanmar, 292 in Vietnam, 259 in Malaysia, and 220 in the Philippines. Actual numbers were probably much higher.
Most people living with HIV/AIDS are in the prime of their working life. Industry and commerce thus suffer from absenteeism, lower productivity, and lack of investment. Police recruitment, and the maintenance of law and order, become more difficult. Dwindling government revenues and rising expenditures (on health care, for example) can put at risk decades of development progress. In twenty-five Sub-Saharan countries average life expectancy rates have fallen dramatically since about 1988, due mainly to HIV/AIDS. Worst affected is Botswana, with life expectancy expected to fall from 60 to 27 years by 2010. In Asia, the Caribbean, and the Russian Republic steep declines are also in evidence.
In Sub-Saharan Africa there are 12.1 million orphans (80 percent of the global total), children under eighteen who have lost one or both parents to AIDS. In Nigeria alone AIDS orphans number 1.8 million and in South Africa 1.1 million. Some live with relatives or in institutions, but many end up as abused street kids who will be ill-equipped as adults to become professionals such as teachers and doctors, drive industry and commerce, or run the bureaucracy.
Often the opportunity for early intervention was missed. Thus, the Chinese government maintained that homosexuality and prostitution were not only illegal but contrary to Chinese morality. Despite warnings by health officials in 1993 that 100,000 people could be living with HIV by 2000 and 20,000 with full-blown AIDS, it was not until 2001 that the government admitted to a semiofficial estimate of 600,000 infections spread over almost all parts of the country. Earlier and more vigorous intervention might have slowed the spread of the disease.
Large variations exist between individual countries, between rural and urban areas, and between men and women. Thus HIV prevalence rates are below 1 percent in Mauritania and Senegal but reach almost 40 percent in Botswana and Swaziland. Prevalence among some pregnant women in Namibia exceeds 50 percent.
In Asia the main driver of HIV infection is injecting drug-use, often accompanied by unsafe sexual practices. The huge populations of some countries reduce the average adult HIV prevalence rate to only about 0.4 percent, disguising the fact that in Asia as a whole at least 8.3 million adults and children were living with the disease in 2005. During the previous year 1.1 million people were newly infected and 520,000 died of AIDS.
In most countries several epidemics are underway: in India (which had 5.1 million people living with HIV in 2003) the disease is being mainly spread by unprotected sex in the south and injecting drug-use in the northeast.
Widespread ignorance about safe sex and a growing propensity for youngsters to engage in sexual activities are further boosting the spread of HIV in countries like Indonesia, Vietnam, Pakistan, Malaysia, and Japan.
HIV/AIDS has a massive impact on societies. It places a huge financial burden on health care (even without costly antiretroviral therapy) and on medical facilities, hospitals, and nursing staff. Households and nutrition suffer when people are too ill to work, while caring for the sick reduces the time other household members can spend on activities such as farming. Children, especially girls, may be taken out of school to reduce costs or to help look after the sick, which has implications for literacy, skill development, and even dissemination of knowledge about diseases.
More than 15 million people had already died of AIDS in Sub-Saharan Africa by 2005 and, without massively expanded intervention programs and antiretroviral therapy, deaths will increase as people infected with HIV eight to ten years ago succumb to full-blown AIDS.
The AIDS epidemic continues to outstrip the global efforts to contain it. In mid-2005 only one person in ten in Africa and one in seven in Asia who needed antiretroviral treatment was receiving it. Progress is mixed. An estimated one-third of the people in need of antiretroviral treatment in Botswana and Uganda were receiving it in mid-2005, but in many African countries it is available to less than one in ten. Since 1996 Brazil has been providing free treatment, to 170,000 people in 2006, while Indian drug companies are making treatments available at more affordable prices. For most of the developing world, however, more basic initiatives are needed, with HIV/AIDS being seen as part of the wider problems of access to clean water, malnutrition, poverty, discrimination, and unemployment. Much has to be done to educate people, especially women and those living in rural areas, about this and related diseases and ways of avoiding them, but perhaps only one in ten people living with HIV has been tested and knows that he or she is infected.
SEE ALSO AIDS; Demography; Developing Countries; Disease; Drugs of Abuse; Economic Growth; Medicine; Morbidity and Mortality; Sexual Orientation, Social and Economic Consequences; Sexuality
BIBLIOGRAPHY
Armstrong, Sue, Chris Fontaine, and Andrew Wilson. 2004. Report on the Global AIDS Epidemic. XV International AIDS Conference Bangkok, July 11-16, 2004. UNAIDS. http://www.unaids.org/bangkok2004/GAR2004_html/GAR2004_00_en.htm.
Garrett, Laurie. 2005. The Lessons of HIV/AIDS. Foreign Affairs, July/August 2005.
Joint United Nations Program on HIV/AIDS, World Health Organization. 2004. AIDS Epidemic Update: December 2004. Geneva: UNAIDS.
Joint United Nations Program on HIV/AIDS, World Health Organization. 2005. AIDS Epidemic Update: December 2005. Geneva: UNAIDS. http://data.unaids.org/Publications/IRC-pub06/epi_update2005_en.pdf.
Linge, Godfrey, and Doug Porter, eds. 1997. No Place for Borders: The HIV/AIDS Epidemic and Development in Asia and the Pacific. New York: St. Martin’s Press.
Godfrey Linge