Report on the Global HIV/AIDS epidemic

Waking up to devastation

fishing) while 28% of girls said that they had become pregnant and 41% had left to
get married.
Health sector under stress
Since the start of the epidemic, 18.8 million children and adults have fallen sick and
died and almost twice that number are now living with HIV, with some 5.4 million
newly infected people joining their ranks in 1999. As a consequence, the epidemic's
impact on the health sector over the coming decade will be predictably greater than
in the past two decades combined.
Already, however, the increased demand for health care from people with HIV-related
illnesses is heavily taxing the overstretched public health services of many developing countries. In the mid-1990s, it was estimated that treatment for people with HIV
consumed 66% of public health spending in Rwanda and over a quarter of health
expenditures in Zimbabwe. A recent study estimates that in 1997, public health
spending for AIDS alone already exceeded 2% of gross domestic product (GDP) in
7 of 16 African countries sampled - a staggering figure in countries where total
health spending accounts for 3-5% of GDP. In recent years, HIV-positive patients
have occupied half of the beds in the Provincial Hospital in Chiang Mai, Thailand,
39% of the beds in Kenyatta National Hospital in Nairobi, Kenya, and 70% of the
beds in the Prince Regent Hospital in Bujumbura, Burundi. A related impact of the
epidemic is that patients suffering from other conditions are being crowded out. The
hospital sector in Kenya has seen increased mortality among HIV-negative patients,
who are being admitted at later stages of illness.
The shifting and growing demand on health care systems is underscored by the
exploding tuberculosis epidemic in the countries most heavily affected by HIV. As
noted elsewhere in this report, as HIV weakens people's immune systems it makes
them far more vulnerable to developing active tuberculosis (see page 86).
Tuberculosis has become the leading cause of death among people with HIV infection, accounting for about a third of AIDS deaths worldwide. Hospital data from
Africa show that up to 40% of HIV-infected patients have active tuberculosis. With a
greater number of HIV-positive people developing active tuberculosis, there is also
a greater risk that the tubercle bacillus will pass to others in the community. The
World Bank has estimated that 25% of HIV-negative persons dying of tuberculosis
in the coming years would not have been infected with the bacillus in the absence
of the HIV epidemic. Each of these new tuberculosis infections represents a further
cost to the health sector.
The development of new therapies for HIV-infected persons and of vaccines will
further raise health sector costs in infrastructure, drugs, training, and personnel
expenditures. At the same time, HIV-related illness and premature death among
health care workers themselves will continue to create costs of another kind for the
health sector. Sickness and death due to AIDS is growing rapidly among health care

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