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Briefing Document 30

HIV in Global Perspective

This Briefing Document explores issues surrounding HIV/AIDS and the Global Perspective including 1999 Global Statistics and Hot Spots, the Effects of the Global HIV Epidemic, Complacency and HIV, Contributing to the Global Struggle Against HIV, and the Benefits of Organizational Twinning.

Briefing Document #30 is one of an on-going series. Visit the catalogue of Briefing Documents.

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Global HIV/AIDS: 1999 Statistics

  1. 5 million adults, 2.3 of whom were women, were newly infected with HIV.
  2. 570 000 children under the age of 15 were newly infected with HIV.
  3. 32.4 million adults, 14.8 of whom were women, were living with HIV/AIDS.
  4. 1.2 million children under the age of 15 were living with HIV/AIDS.
  5. 33.6 million people in the world were living with HIV/AIDS - that’s more than the current population of Canada (30.5 million).
  6. 2.1 million adults, 1.1 million of whom were women, died due to AIDS.
  7. 470 000 children under the age of 15 died due to AIDS.
  8. As of Dec. 31. 1999, 16.3 million people, 3.6 of whom were children, had died due to AIDS.

(Source: Joint United Nations Programme on HIV/AIDS: 1999)

 

HIV Global Hot Spots

Sub-Saharan Africa

For many years, sub-Saharan Africa has been most heavily affected by the HIV/AIDS epidemic. A staggering 23.3 million people are living with HIV/AIDS - that is almost 70% of the global number of HIV infections in an area inhabited by only 10% of the world’s population (UNAIDS 1999). It is estimated that in some areas of southern Africa, 20% to 26% of individuals aged 15 to 49 are living with HIV or AIDS (ICAD 1999).

HIV rates among African women are climbing rapidly. More than 4 out of 5 HIV-positive women in the world live in Africa and 60% to 80% of these women are monogamous and have been infected by their husbands (ICAD 1999).

Children in sub-Saharan Africa are particularly affected by HIV/AIDS. While prevention efforts elsewhere are reducing maternal transmission of HIV to infants, rates in this area continue to rise. "UNAIDS/WHO estimate that nearly 90% of the half million children born with the virus or infected through breastfeeding in 1999 were living in sub-Saharan Africa" (UNAIDS 1999). In addition, more than 8 million children in sub-Saharan Africa have lost their mother or both parents to AIDS. In some areas in Eastern Africa, 40% of children under the age of 16 have been orphaned due to the epidemic.

High infection levels and limited access to care have contributed to the disintegration of social and economic safety nets which might help families cope with the disastrous effects of illness and death due to HIV/AIDS (UNAIDS 1999).

 

Asia and the Pacific

Asia and the Pacific are quickly becoming focal areas of HIV spread. An estimated 6.5 million people are currently living with HIV/AIDS. The epidemic was initially concentrated among sex workers and injection drug users, HIV is being transmitted rapidly through more mainstream populations (ICAD 1999).

India now holds the dubious honour of being the country with the largest number of HIV-positive individuals in the world - an estimated 4 million people. As in other parts of Asia, it has been assumed that HIV was found predominantly among commercial sex workers and their partners, however one urban pregnant woman in 50 tests positive for HIV and among rural households, an infection rate of 2.1% was found. The epidemic is taking its toll on injection drug users as well. More than 70% of injection drug users in Manipur and almost two-thirds in Myanmar are HIV-positive (ICAD 1999).

In China, though infection rates have remained relatively low, an estimated half a million people are HIV-positive. Most new infections involve injection drug use, which itself appears to be on the rise. An often cited and alarming statistic involves the coastal province of Guandong. "HIV prevalence in drug injectors in Guangdong rose from virtually nothing at the start of 1998 to 11% by the start of 1999" (UNAIDS 1999). Behaviour surveys indicate that over half of injectors share needles. It may be assumed, then, that HIV infections will likely continue to rise rapidly (UNAIDS 1999).

"HIV is beginning to spread into the general populations of India and China which, with roughly half the world’s population, has explosive potential if left unchecked" (ICAD 1999)

Latin America and the Carribean

An estimated 1.7 million adults and children are living with HIV/AIDS in Latin America and the Carribean. The worst rates of infection outside of sub-Saharan Africa are to be found in this area (ICAD 1999). An overview of the statistics highlights the diversity of the epidemic both within the area and globally:

  1. In Guatemala in 1999, 2-4% of pregnant women tested at postnatal clinics in major urban areas were found to have HIV (UNAIDS) while HIV surveillance among pregnant Haitian women in 1996 more than 6% tested positive (ICAD 1999).
  2. In Guyana, 46% of sex trade workers were found to be HIV-positive. Mexican men who have sex with men experience infection rates of up to 30% (ICAD 1999).
  3. Close to half of Brazilian injection drug users are infected (ICAD 1999).
  4. Infection rates among individuals in Argentina with only primary education have gone from 50% to 66% in only a few years (ICAD 1999).
  5. Among the more than 7 million street youth in Brazil, estimated infection rates range from 1.5% to 7.5% (ICAD 1999).

 

Effects of the Global HIV Epidemic

Further Spread of HIV

High HIV rates increase the number of people capable of transmitting the virus. Without appropriate prevention mechanisms, HIV rates will simply increase, further exacerbating the personal, social, and economic problems related to HIV/AIDS (UNAIDS 1999).

Breakdown of Family Relationships

In areas of the world where extensive kin relationships are important to the functioning of the family, loss of family members to AIDS is disrupting the social fabric of communities. Most people who develop AIDS are in the prime of their adult lives. Specific social and economic responsibilities (such as child rearing, maintenance of the household, care of elders, and religious or traditional roles in the family) are left unfulfilled, particularly in cases where multiple family members are ill or have died. The economic losses to the family may also exacerbate poverty and inequality on a societal scale (World Bank 1997).

High Populations = High HIV Increase

The massive populations of India and China inevitably dominate any discussion of HIV. These countries have so many inhabitants that small changes in percentage rates of infection result in huge jumps in the estimated total number of people infected. "A rise of just 0.1% prevalence among adults in India, for example, would add over half a million people to the national total of adults living with HIV" (UNAIDS 1999).

HIV and Stigmatization

The association between HIV infection and perceived ‘promiscuous’ sexual behavior has led to a belief that those infected somehow ‘deserve’ to suffer. Discrimination, alienation, and abuse often flow from this perception. Paradoxically, attitudes towards HIV-positive women - who are often monogamous wives infected by their husband - are also stigmatized and often blamed for the fate of their husband. Upon the death of her husband, a women in such circumstances may be driven from her home by her in-laws and may lose her children in the process (UNAIDS 1999).

Quality of health care is also affected by stigma. Hospitals in areas where healthcare budgets are minimal (and even where they are not) are reported either to refuse to treat HIV-positive patients or to treat them ineffectively (UNAIDS 1999). "Many health workers said that treating patients with HIV was a waste of time and money because the patients would go on to die anyway. Interestingly, they did not express similar views about other chronic or fatal diseases that strike young adults" (UNAIDS 1999).

AIDS and the Economy

On national and global levels, AIDS will increasingly affect economic infrastructure and stability. In sub-Saharan African countries the projected life expectancy has been reduced by as much as 25 years. The productivity of this area - which has made gains in becoming competitive in a global marketplace - will be reduced with fewer viable years in the workforce for the millions of people living with HIV and dying due to AIDS (World Bank 1997). Indeed, an AIDS epidemic can reduce the per capita income of a country. World Bank projections show that GDP may be reduced by about one third of one percent in the ten countries with the most advanced epidemics. For countries struggling with chronic negative growth rates, this is a tremendous setback (Over 1992). The World Bank is "increasingly concerned that the AIDS epidemic is posing a significant barrier to economic development" (http://www.thebody.com/tag/dec97.html#epidemic).

At the national level, as HIV/AIDS rates rise, so too does the demand for healthcare. As expenditure increases on HIV related concerns, available health dollars decrease or taxpayers must bear the burden. Many governments in areas heavily affected by HIV/AIDS also have limited health budgets and nominal tax bases. AIDS is not the only urgent issue facing such governments, thus infrastructures are often strained and ineffective in dealing with such health crises (World Bank 1997).

The major impact of the global HIV/AIDS epidemics is at the household level. With the loss of household adults, families reallocate their resources. Children are withdrawn from school to help at home, longer hours are worked, household membership is adjusted, household assets may be sold, friends or family are solicited for assistance. In poorer families, particularly with fewer assets to draw upon, children may be permanently disadvantaged through worsening malnutrition or withdrawal from school (World Bank 1997).

 

The Next Epidemic: Complacency

"There is evidence that safe sexual behaviour is being eroded among gay men in some western countries, perhaps because of complacency now that life-prolonging therapy is available" Dr. Peter Piot (Woodman 1999).

AIDS deaths are falling significantly in countries that provide antiretroviral therapy for a majority of those diagnosed with HIV. However, the absolute number of HIV-positive individuals is likely growing due to these antiretroviral drugs. This has ominous consequences, as an increase in the pool of HIV-infected individuals likely translates to an increased risk of transmission of the virus through a population (UNAIDS 1999).

In addition, there is no sign that new infections rates in these countries are following the downward trend of AIDS deaths.

For example, rates of unprotected anal intercourse among men having sex with men in San Francisco have risen from one-third in 1993-1994 to one-half in 1997. It may or may not be coincidental that in the latter survey, life-prolonging therapies had become available (UNAIDS 1999).

Despite gains resulting from antiretroviral therapies, "The disease remains fatal, and information from North America and Europe suggests that the decline in number of deaths due to antiretroviral therapy is tapering off" (Woodman 1999). In the US, for example, AIDS deaths decreased by 42% between 1996 and 1997, and only 21% between 1997 and 1998. This suggests that there is a limit to the effectiveness of currently available therapies (UNAIDS 1999).

 

Contributing to the Global Struggle Against HIV/AIDS

HIV/AIDS continues to affect disproportionately those already faced with other social, economic, or health-related challenges. Whether it be on a local, national, or global level, HIV/AIDS affects women, young people, sexual and ethnic minorities, refugees, drug users, and economically disadvantaged populations.

National governments are not alone in the effort to protect citizens from the spread of HIV and mitigate the effects of an epidemic. Local and international donors and Non-Government Organizations (NGO) have provided funding and leadership for AIDS prevention programs, particularly in lower-income countries. However, in "Confronting AIDS: Public Priorities in a Global Epidemic", World Bank sources contend that "despite their substantial contributions to combating the epidemic, bilateral donors and multilateral organizations have invested too little in international public goods, including knowledge about prevention approaches and treatment methods and research on a vaccine that will work in developing countries" (1999). The same document asserts that public opinion and politics shape AIDS policy in heavily affected countries. Governments and outside organizations can work with multiple partners to "minimize and overcome the obstacles to sound policies for fighting AIDS" (World Bank 1999).

An expanded response from the industrialized countries is essential today but also tomorrow, as more effective drugs, HIV barriers, and hopefully vaccines are developed and access by people in the developing countries becomes an ever-greater moral imperative (http://www.thebody.com/encyclo/lessons.html).

 

Confronting the Global AIDS Epidemic Through Twinning

Twinning between service organizations may be one avenue through which HIV/AIDS can be challenged. Twinning can be defined as "a formal, substantive collaboration between two organizations" (Health Canada, ICAD 1999). This contract or agreement based relationship should involve more than one-time interaction, and should allow organizations to exchange resources (including information or skills) or to collaborate on a specific project. Twinning projects can include training exchanges, internships, study tours, information exchanges, and technical exchanges (Health Canada, ICAD 1999). Benefits of such relationships and projects involve capacity building, identification of best practices, increased programme effectiveness, broadening of horizons, building of relationships, networking, solidarity, and forging an international movement to combat the spread and effects of HIV/AIDS.

For more information on how organizations can contribute through twinning, please see "Beyond our Boarders: A Guide to Twinning for HIV/AIDS Organizations", available on the World Wide Web at http://www.twinningforAIDS.com.

 

Literature Cited

Health Canada and Interagency Coalition on AIDS and Development (ICAD)
1999 Beyond Our Borders:A Guide to Twinning for HIV/AIDS Organizations. Ottawa: ICAD

ICAD
1999 Fact Sheet Package. Interagency Coalition on AIDS and Development. December 1999. Ottawa: ICAD

Over, Mead
1992 "The Macroeconomic Impact of AIDS in Sub-Saharan Africa". Population and Human Resources Department, The World Bank

UNAIDS
1999 "AIDS Epidemic Update: December 1999". Joint United Nations Programme on HIV/AIDS

Woodman, Richard
1999 "UN warns that AIDS deaths are set to reach record level". British Medical Journal; 319: 1387. November 27

World Bank
1997 Confronting AIDS: Public Priorities in a Global Epidemic. Oxford: Oxford University Press

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