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AIDS will cause early death in as many as half of the teenagers living in the hardest hit countries of southern Africa, causing population imbalances nearly without precedent, according to a report released last week by UNAIDS, the Joint United Nations Programme on HIV/AIDS.
Demographers predict that two thirds of the 15 year olds in Botswana will die of AIDS before reaching age 50. Although that is clearly the world's worst scenario, researchers predict that in any country where 15% of adults are now infected, at least 35% of those who are currently teenagers will eventually die of AIDS.
The AIDS epidemic is already measurably eroding economic development, educational attainment, and child survival—all key measures of a nation's health—in much of sub-Saharan Africa, according to the report.
The disease's ultimate toll on the region, however, is likely to be far more severe than what is evident today, the report found. “The demographic effects will only be getting worse in the coming years, even if by some miracle HIV infection suddenly stopped,” said Peter Piot, director of UNAIDS. “I believe we are only at the beginning of the actual impact on societies of AIDS.”
According to the report, there are now 34.3 million people infected with HIV worldwide, of whom 1.3 million are children under the age of 15. About 5.4 million people were infected last year.
Last year 2.8 million people died of AIDS; a total of 19 million have died since the epidemic was first recognised 20 years ago. About 13.2 million children, the vast majority in Africa, have lost at least one parent to the disease.
There are a few success stories in an otherwise grim picture. The infection rate in Uganda has fallen to around 8% of the adult population from a peak of 14% in the early 1990s, thanks to strong prevention campaigns and the increased use of condoms.
Despite earlier fears of an epidemic in Asia, the rate of infection remains generally low. In Thailand the heterosexual epidemic has been curbed, although the virus is spreading fast through shared needles and unprotected sex between men.
Strong campaigns in some of these countries have shown that it is possible to slow the epidemic. But the report also said that there must be a massive increase in political will.
Report on the Global HIV/AIDS Epidemic 2000 is available from UNAIDS, 20 Avenue Appia, 1211 Geneva 27, Switzerland, or at www.unaids.org.
Full story in News Extra at bmj.com