Report on the Global HIV/AIDS epidemic

Waking up to devastation

greatly over the next decade; however, as changes in future infection rates will principally affect men and women under 40 in 2020, the demographic chimney pattern
for older adults is hardly affected by this assumption. The "missing adults" - men
and women who should have reached their 40s and 50s in 2020 - are now in their
20s and 30s, although some have already died. Many more are already infected with
HIV, which will kill them before they reach their 50s.
What this means for society is hard to predict, since the world has never before
experienced death rates of this magnitude among young adults of both sexes across
all social strata. But there is one certainty: a small number of young adults - the
group that has traditionally provided care for both children and the elderly - will have
to support large numbers of young and old people. Many of these young adults will
themselves be debilitated by AIDS and may even require care from their children or
elderly parents rather than providing it.
Increases in adult and child mortality rates are already being recorded
Even without analysing the data on death rates, countries with severe long-standing
HIV epidemics know from the massive increase in funerals that deaths are on the
rise. The data show the same rising trend. Demographers have developed techniques to measure death rates in developing countries by asking about recent
household deaths or by studying the reports of surviving relatives in large-scale censuses and surveys. Recent analyses of these household-based data for countries
with high HIV prevalence rates show clear increases in both adult and child mortality rates, which often appear after many years of a steady decline in death rates. It
is worth noting that these data represent a "best-case" scenario and may underestimate actual death rates. Because AIDS may kill several members of a household,
it can destroy households completely, with the result that some of the deaths will not
be captured in subsequent household surveys.
Figure 8 shows the decrease in under-5 child mortality achieved by three African countries between 1981 and 1986 and the subsequent upturn, which has been attributed to
AIDS. Almost all AIDS deaths in young children can be traced back to mother-to-child
transmission of the virus. This is why countries such as Zambia and Kenya, with their
high adult HIV prevalence rates, have seen a particularly steep rise in child mortality.
Even more dramatic increases are seen in adult death rates. In Zimbabwe, a comparison of estimates based on registered deaths and data collected in different censuses and household surveys over the past two decades show remarkably consistent patterns of increasing mortality among young men (see Figure 9). Even though
the data presented here have been adjusted for the under-reporting of deaths that is
the norm in developing countries, the adjustments must be viewed as conservative,
because the families most devastated by deaths may no longer exist to report such
events. The true mortality rates could thus be even higher.
Given the death rates prevailing at the time in each age group, a man who was 15 in
1983 would have had just a 15% chance of dying before reaching his 50th birthday.

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