Care and support for people living with HIV/AIDS
Care and support for people living with HIV/AIDS
Care and support for people living with HIV/AIDS
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Waking up to devastationThere is no phenomenon apart from the <strong>AIDS</strong> epidemic that could possibly explain thisrecent drastic rise in mortality after years of declining death rates. Indeed, smaller community-basedstudies <strong>with</strong> in<strong>for</strong>mation on the cause of death show that in countrieswhere just under 10% of the adult population has <strong>HIV</strong> infection, almost 80% of alldeaths in young adults aged 25–45 are associated <strong>with</strong> <strong>HIV</strong>. The proportion of <strong>HIV</strong>relateddeaths is likely to be even higher in areas <strong>with</strong> higher <strong>HIV</strong> prevalence rates.In some countries, over a third of 15-year-olds may die of <strong>AIDS</strong>High <strong>and</strong> stable <strong>HIV</strong> prevalence rates are bad news. But there is worse news.Prevalence rates do not reflect the true impact of the epidemic. The 15–49-year-oldage group includes <strong>people</strong> who are not yet infected <strong>with</strong> <strong>HIV</strong> but who will be one day.And it excludes men <strong>and</strong> women born 15–49 years ago who were infected <strong>with</strong> <strong>HIV</strong>but have already died. If the probability that a person will become infected at any timein his or her life is summed up, the cumulative figure is higher than the “snapshot” providedby current prevalence rates.To give a better idea of the actual risk of dying of <strong>HIV</strong>-associated disease, researchershave built models to follow <strong>people</strong> throughout their lives, examining their exposure torisks of infection <strong>with</strong> <strong>HIV</strong> at each age. The risks are calculated from patterns of <strong>HIV</strong>infection at each age observed in African communities. In general, the rate of newinfections peaks among women in their early 20s <strong>and</strong> among men slightly later, <strong>and</strong>tapers off at older ages. The rate of new infections at each age is determined by thecurrent phase of the <strong>HIV</strong> epidemic in a country. In the model, men <strong>and</strong> women alsoface the competing risk of dying of other causes at rates similar to those recordedbe<strong>for</strong>e the <strong>HIV</strong> epidemic.The results of this exercise are illustrated in Figure 10 <strong>for</strong> men. Along the bottom of thegraph is the current prevalence of <strong>HIV</strong> in adults aged 15–49. The vertical axis showsthe probability that a boy who is now 15 years old will die of <strong>AIDS</strong>. Clearly, the likelihoodthat a boy now aged 15 will eventually die of <strong>AIDS</strong> is much higher than the likelihoodthat a man now aged 15–49 is currently infected <strong>with</strong> <strong>HIV</strong>. This sobering factremains true even if the rates of new infection fall in the future. The grey line shows therelationship between current prevalence <strong>and</strong> the risk of a 15-year-old eventually dyingof <strong>AIDS</strong> if infection rates stay at current levels – a pessimistic scenario. The red lineshows the relationship if the risk <strong>for</strong> new <strong>HIV</strong> infection at each age drops by half overthe next 15 years – in other words, if prevention campaigns are very successful. Evenin this optimistic scenario, however, the proportion of young <strong>people</strong> who will die of<strong>AIDS</strong> is appallingly high in many countries: in virtually any country where 15% or moreof all adults are currently infected <strong>with</strong> <strong>HIV</strong>, at least 35% of boys now aged 15 will dieof <strong>AIDS</strong>.In countries where <strong>HIV</strong> infection is concentrated in specific sub-populations – <strong>for</strong>example, men who have sex <strong>with</strong> men – there is a similar relationship between current<strong>HIV</strong> prevalence in that group <strong>and</strong> the lifetime risk of dying of <strong>HIV</strong>-related disease.25