Care and support for people living with HIV/AIDS

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Waking up to devastationgreatly over the next decade; however, as changes in future infection rates will principallyaffect men and women under 40 in 2020, the demographic chimney patternfor older adults is hardly affected by this assumption. The “missing adults” – menand women who should have reached their 40s and 50s in 2020 – are now in their20s and 30s, although some have already died. Many more are already infected withHIV, which will kill them before they reach their 50s.What this means for society is hard to predict, since the world has never beforeexperienced death rates of this magnitude among young adults of both sexes acrossall social strata. But there is one certainty: a small number of young adults – thegroup that has traditionally provided care for both children and the elderly – will haveto support large numbers of young and old people. Many of these young adults willthemselves be debilitated by AIDS and may even require care from their children orelderly parents rather than providing it.Increases in adult and child mortality rates are already being recordedEven without analysing the data on death rates, countries with severe long-standingHIV epidemics know from the massive increase in funerals that deaths are on therise. The data show the same rising trend. Demographers have developed techniquesto measure death rates in developing countries by asking about recenthousehold deaths or by studying the reports of surviving relatives in large-scale censusesand surveys. Recent analyses of these household-based data for countrieswith high HIV prevalence rates show clear increases in both adult and child mortalityrates, which often appear after many years of a steady decline in death rates. Itis worth noting that these data represent a “best-case” scenario and may underestimateactual 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 notbe captured in subsequent household surveys.Figure 8 shows the decrease in under-5 child mortality achieved by three African countriesbetween 1981 and 1986 and the subsequent upturn, which has been attributed toAIDS. Almost all AIDS deaths in young children can be traced back to mother-to-childtransmission of the virus. This is why countries such as Zambia and Kenya, with theirhigh 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 comparisonof estimates based on registered deaths and data collected in different censusesand household surveys over the past two decades show remarkably consistentpatterns of increasing mortality among young men (see Figure 9). Even thoughthe data presented here have been adjusted for the under-reporting of deaths that isthe norm in developing countries, the adjustments must be viewed as conservative,because the families most devastated by deaths may no longer exist to report suchevents. 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 in1983 would have had just a 15% chance of dying before reaching his 50 th birthday.23
Report on the global HIV/AIDS epidemic – June 2000Figure 8.110 %Trends in mortality among children under five years old andend-1999 adult HIV prevalence rate, selected Africancountries, 1981-1996relative under-5 mortality (1981=100%)105 %100 %95 %90 %85 %ZambiaHIV prevalence 19.9%KenyaHIV prevalence 14.1%CameroonHIV prevalence 7.7%80 %1980 1982 1984 1986 1988 1990 1992 1994 1996 1998Source: Demographic and Health Surveys, Macro International, USABy 1997, 15-year-old boys faced a much bleaker prospect: half could expect to diebefore the age of 50. The situation was just as bad for women: the likelihood of a 15-year-old dying before the end of her reproductive years quadrupled from around11% in the early 1980s to over 40% by 1997.Figure 9.Probability of a Zimbabwean boy aged 15 dying beforeage 50, trends over time, various national surveys605550probability of dying before age 50 (%)45403530252015105reports from surviving siblingsdeath registrationhousehold reports of death01980 1985 1990 1995 2000Source: Feeney G, 1999 (unpublished data)24
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Prevention: daunting challenges ahe
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Opening new doors with counselling
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Care and support for people living
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National responses to the epidemic:
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Annex 1.How reliable are estimates
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Annex 2. HIV/AIDS estimates and dat
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Table of country-specific HIV/AIDS
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