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Habitat Debate. 2001 Jun; 7(2): p..Population and household projections are of crucial importance to both policy makers and researchers who depend on timely and reliable projections to make informed decisions and to produce quality research studies. Currently, one of the most problematic areas regarding projections is the demographic impact of the HIV/AIDS epidemic in countries with high prevalence rates i.e. how the epidemic is influencing population and household projections. At the end of the year 2000, 36.1 million people were estimated to be living with HIV/AIDS, of which 1.4 million were children. 47 per cent of the infected adults were women. 5.3 million people will be newly infected during this year. The pandemic does not spread homogeneously. The number of infections, the risk of dying, the access to medication and the principal transmission ways vary worldwide, and so does the impact of the HIV/AIDS epidemic on population structure and on household formation. In countries where the epidemic is endemic in the general population, the impact on the age and gender structure of the population is significant, and changes in the social context and behaviour are certain. (excerpt)
AIDS. 2004; 18 Suppl 2:S67-S73.Objective: To assess the accuracy of demographic estimates that include the effects of HIV/AIDS on adult mortality. Design: To compare estimates of demographic indicators based on UNAIDS/WHO estimates and projections with newly available estimates based on cohort studies, hospital records, national surveys and other sources of data. Methods: New information has become available recently from a number of sites in Africa on the ratio of mortality among the HIV-positive and HIV-negative population, the proportion of all adult deaths attributable to AIDS, and the number of orphans. These data are compared with the same indicators calculated from UNAIDS/WHO estimates to assess the accuracy of those estimates. Results: Differences between demographic indicators based on UNAIDS/WHO estimates and study-based estimates are generally within the uncertainty range of the UNAIDS/WHO figures. Conclusion: Demographic estimates based on surveillance data and demographic models are close enough to study-based estimates to be useful for advocacy and medium-term planning. However, significant differences do exist that should be taken into account for short-term planning. (author's)
Paris, France, UNESCO, Section for Preventive Education, 1994. 45 p. (ED-95NVS-5)The AIDS pandemic confronts us with a full range of development issues...issues of poverty, entitlement and access to food, medical care and income, the relationships between men and women, the relative abilities of states to provide security and services for their people, the relations between the rich and the poor within society and between rich and poor societies, the viability of different forms of rural production, the survival strategies of different types of household and community, all impinge upon a consideration of the ways in which an epidemic such as this affects societies and economies. Across Africa, evidence for the seriousness of... downstream effects is accumulating rapidly; given the nature of the disease and the shape of the epidemic curve ...now is the time to take action to mitigate the worst effects in the next two decades. Because this is a long wave disaster...the effects we are seeing now in Uganda and elsewhere are the result of events (personal, communal, regional, national, and international) that occurred a decade or more ago. Action taken now cannot change the present, nor can it change the immediate future. It can change the way the situation will look in the years after 2010. (excerpt)
Statement by the chairman of the Technical Working Group on the Demographic and Economic Impact of HIV Infection / AIDS in Women and Children.
In: International Conference on the Implications of AIDS for Mothers and Children: technical statements and selected presentations jointly organized by the Government of France and the World Health Organization, Paris, 27-30 November 1989. Geneva, Switzerland, WHO, Global Programme on AIDS, 1989. 44-6. (WHO/GPA/DIR/89.12)Extrapolation modelling of the acquired immunodeficiency syndrome (AIDS) epidemic suggests a cumulative total of 1 million cases of AIDS worldwide in adults by 1991. Although major increases in child mortality rates are anticipated in areas with a high prevalence of human immunodeficiency virus (HIV) infection in women, few projections have been made specifically for women and children. If HIV-infected women and their children are to be allocated adequate resources in terms of their health and social service needs, this deficit must be addressed. In severely affected areas, such as Central Africa, AIDS in women and children can be expected to consume more economic resources than any other disease. Even in developed countries, direct medical car costs for children with AIDS are higher than those for adult AIDS patients. In general, research must prioritize projections of the numbers and trends of HIV infections and AIDS cases in women and children as well as disease-related costs. Attention must also be given to the indirect costs associated with AIDS in women in developing countries. Women's contribution to Third World economies is often equal to that of their male counterparts due to women's role as food producers and homemakers. Evaluations of the costs of HIV infection in women and children should be conducted within the context of the prevalence and costs of other diseases also in need of resource allocation.
POPULATION AND DEVELOPMENT REVIEW. 2000 Sep; 26(3):629-33.A report prepared by the Joint UN Programme on HIV/AIDS and released in Geneva on 27 June 2000 (just prior to the XIIIth International AIDS Conference held in Durban, South Africa) updates estimates of the demographic impact of the epidemic. It characterizes AIDS in the new millennium as presenting "a grim picture with glimmers of hope"--the latter based on the expectation that national responses aimed at preventing and fighting the disease are in some places becoming more effective. According to the report, which emphasizes the considerable statistical weaknesses of its global estimates, the number of people living with HIV/AIDS in 1999 was 34.3 million (of which 33.0 million were adults and 1.3 million were children under age 15; slightly less than half of the adults affected, 15.7 million, were women). Deaths attributed to AIDS in 1999 amounted to 2.8 million, bringing the total since the beginning of the epidemic to 18.8 million. These figures represent moderate upward revisions of earlier UN estimates shown in the Documents section of PDR 25, no. 4. The revised estimate of the number of persons newly infected with HIV in 1999 is, in contrast, slightly lower: 5.4 million, of which 4.7 million were adults and 2.3 million were women. An excerpt from the 135-page Report on the Global HIV/AIDS Epidemic, focusing on countries in the worst affected area, sub-Saharan Africa, is presented in this document. (author's)
[Unpublished] 1999. Presented at the United Nations Commission on Population and Development, Thirty-second session, New York, New York, March 22-31, 1999  p.In its statement at the Thirty-second Session of the UN Commission on Population and Development, the Swedish delegation praises the achievements of the Population Division in the methodology of population projections, and is particularly appreciative of the frequent revisions made in some assumptions behind mortality trends, more precisely in the demographic effects of AIDS. AIDS is just one of the fatal diseases that may take an increasing toll on humanity. Malaria is another one. In some regions, undernutrition is widespread and may worsen. Food insecurity is a serious issue of everyday life for many millions of people. The prospect of growing shortages of water and agricultural land make it unlikely that real advances will be made in reducing undernutrition in the short and medium terms. In its concluding remarks, the Swedish delegation proposes that the Commission should resolve the issues surrounding alternative mortality projections during its 34th session in 2001.
POPULATION AND DEVELOPMENT REVIEW. 1998 Sep; 24(3):655-8.The UN Program on HIV/AIDS and the World Health Organization jointly monitor the global HIV/AIDS epidemic. The agencies' most recent survey tracking the spread of the pandemic, published in June 1998, estimates that by the beginning of 1998, 30.6 million people were infected with HIV, including 12.1 million women and 1.1 million children under age 15 years, and that 11.7 million had already died from AIDS. An estimated 5.8 million people were newly infected with HIV in 1997, and 2.3 million people died during the year from AIDS. An estimated 8.2 million children under age 15 years since the beginning of the epidemic lost either their mother or both parents to AIDS. 21 million of the 30.6 million people living with HIV/AIDS reside in sub-Saharan Africa. Indeed, approximately 83% of the world's AIDS deaths have been in sub-Saharan Africa. Newly available sophisticated estimates of the impact of the epidemic upon adult mortality in some of the most severely affected sub-Saharan African countries are presented.
ICPD 94. 1994 Jun; (16):3.Based on the United Nations study, "AIDS and the Demography of Africa", population growth rates will remain high in African countries south of the Sahara despite high mortality due to acquired immunodeficiency syndrome (AIDS). The Population Division of the UN Department for Economic and Social Information and Policy Analysis (DESIPA) incorporated the demographic impact of AIDS in its biennial population estimates and projections for Benin, Burkina Faso, Burundi, Central African Republic, Congo, Ivory Coast, Kenya, Malawi, Mozambique, Rwanda, United Republic of Tanzania, Uganda, Zaire, Zambia, and Zimbabwe. 9 million additional deaths due to AIDS are projected by 2005; 61% will occur in Uganda, Zaire, Tanzania, and Zambia. From 2000 to 2005, the average life expectancy for the region (51.2 years) will be 6.5 years lower than that without AIDS; that in Uganda (42.9 years) will be 11.1 years less. Mortality is increasing and its hardest impact will be during the prime working and family care years. Socioeconomic effects may include reductions in the size and productivity of the labor force, decreased industrial and agricultural production, and changes in care of children and the elderly. Due to high fertility rates, however, population increases are projected for all 15 countries. Although its nearly 12.4 million years less (4%) than that expected without the effect of AIDS, the total population for the region is projected to be 297.9 million by 2005. The address for obtaining the document discussed is listed with the price.
AIDS. 1992 Aug; 6(8):880-1.In 1985, the WHO proposed an essentially clinical case definition of adult and pediatric AIDS for national and international surveillance of AIDS cases in Africa, the Bangui definition. WHO initially intended this definition to be provisional and envisaged adopting the clinical definition for AIDS only after official evaluation in the field. In adults, the Bangui definition is derived from the most widely encountered picture of African AIDS, characterized by a particular cachectic syndrome (slim disease). The Bangui definition is easily applicable in the field, without laboratory facilities, and is equally applicable to HIV-1 and HIV-1 infections. Its positive predictive value for possible HIV infection is particularly high in endemic areas. Its 90% specificity is acceptable, except in certain patients suffering from cachectic syndromes, such as tuberculosis. However, its 60% sensitivity is relatively low, suggesting that there is substantial underrecognition of HIV-related diseases, notably the acute or subacute affections that tend to differ from slim disease. After 5 years' application in sub-Saharan Africa, the Bangui definition for AIDS in adults has been adopted by all health care workers dealing with AIDS. In contrast to the adult definition, the provisional WHO clinical case definition for pediatric AIDS has 2 major drawbacks that considerably limit its use for the surveillance of AIDS cases in African children. With its combination of 9 criteria, including 1 biological criterion (serological status of the mother), the Bangui definition is difficult to apply in field conditions. Although its 90% specificity is relatively high, its 35% sensitivity and positive predictive value are very low. These factors explain the failure of the Bangui definition to detect the majority of full blown pediatric AIDS cases in endemic areas, particularly when a child suffers predominately from acute or chronic respiratory diseases or from neurological disorders. We propose that the Bangui criteria for AIDS should not be revised. First, the HIV epidemic in Africa continues to spread, and AIDS in certain urban centers is already a major cause of infant death, emphasizing the urgent need for a valid definition of the epidemiological notification of AIDS cases. Second, whenever the laboratory diagnoses of HIV infection is not systematically applied in Africa, a clinical definition for AIDS is necessary. Indeed, since 1985, numerous data on African AIDS have been produced, leading to an improved understanding of the characteristics of African AIDS. Epidemiologists and clinicians should agree on the revised criteria and how to combine them. For example, the addition of neurological signs as a minor criterion could increase the sensitivity of both the adult and pediatric clinical definitions for AIDS and suppression of the criterion chronic cough could increase their specificity. A simple revision of the Bangui definition could increase the notification of AIDS in African countries, particularly in pediatric cases, thus having an important impact on public health. (full text) (6 references cited in original document)
International Conference on the Implications of AIDS for Mothers and Children: technical statements and selected presentations. Jointly organized by the Government of France and the World Health Organization, Paris, 27-30 November 1989.
[Unpublished] 1991. , 64 p.The International Conference on the Implications of AIDS for Mothers and Children was organized by the World Health Organization (WHO) in cooperation with the French Government. Co-sponsors included the United Nations organizations UNDP, UNICEF, and UNESCO, along with the International Labor Organization (ILO), the World Bank, and the Council of Europe. Following assorted introductory addresses, statements by chairmen of the conference's technical working groups are presented in the paper. Working group discussion topics include virology; immunology; epidemiology; clinical management; HIV and pregnancy; diagnoses; implications for health, education, community, and social welfare systems; and economic and demographic impact. Chairman statements include an introduction, discussion of the state of current knowledge, research priorities, implications for policies and programs, and recommendations. The Paris Declaration on Women, Children and Acquired Immunodeficiency Syndrome concluded the conference.
Washington, D.C., National Academy Press, 1988. x, 239 p.The Committee for the Oversight of AIDS Activities presents an update to and review of the progress made since the publication 1 1/2 years ago of Confronting Aids. Chapter 1 discusses the special nature of AIDS (Acquired Immunodeficiency Syndrome) as an incurable fatal infection, striking mainly young adults (particularly homosexuals and intravenous drug users), and clustering in geographic areas, e.g., New York and San Francisco. Chapter 2 states conclusively that HIV (Human Immunodeficiency Virus) causes AIDS and that HIV infection leads inevitably to AIDS, that sexual contact and contaminated needles are the main vehicles of transmission, and that the future composition of AIDS patients (62,000 in the US) will be among poor, urban minorities. Chapter 3 discusses the utility of mathematical models in predicting the future course of the epidemic. Chapter 4 discusses the negative impact of discrimination, the importance of education (especially of intravenous drug users), and the need for improved diagnostic tests. It maintains that screening should generally be confidential and voluntary, and mandatory only in the case of blood, tissue, and organ donors. It also suggests that sterile needles be made available to drug addicts. Chapter 5 stresses the special care needs of drug users, children, and the neurologically impaired; discusses the needs and responsibilities of health care providers; and suggests ways of distributing the financial burden of AIDS among private and government facilities. Chapter 6 discusses the nomenclature and reproductive strategy of the virus and the needs for basic research, facilities and funding to develop new drugs and possibly vaccines. Chapter 7 discusses the global nature of the epidemic, the responsibilities of the World Health Organization (WHO) Global Program on AIDS, the need for the US to pay for its share of the WHO program, and the special responsibility that the US should assume in view of its resources in scientific personnel and facilities. Chapter 8 recommends the establishment of a national commission on AIDS with advisory responsibility for all aspects of AIDS. There are 4 appendices: Appendix A summarizes the 1986 publication Confronting Aids; Appendix B reprints the Centers for Disease Control (CDC) classification scheme for HIV infections; Appendix C is a list of the 60 correspondents who prepared papers for the AIDS Activities Oversight Committee; and Appendix D gives biographical sketches of the Committee members.
WORLD HEALTH STATISTICS QUARTERLY. RAPPORT TRIMESTRIEL DE STATISTIQUES SANITAIRES MONDIALES. 1987; 40(2):185-92.The human immunodeficiency virus (HIV) epidemic is an international health problem of great scope and urgency. By May 15, 1987, 49330 cases had been reported to WHO from 109 countries. By region, the largest number of reported cases of acquired immunodeficiency syndrome (AIDS), 35219, were from the Americas with 90% of these from the US. Europe has reported 3858 cases from 23 countries, while HIV has only started to appear in Asia. All but 1 case so far reported from Oceania are from Australia and New Zealand. In terms of the proportion of the healthy population already infected and probable numbers of AIDS cases, no area of the world is more affected by HIV than Africa. WHO estimates that there have been at least 100,000 AIDS cases worldwide since the beginning of the epidemic and that 5-10 million persons are infected with HIV. Between 500,000 and 3 million AIDS cases are likely to emerge during the next 5 years, along with 1-5 million cases of AIDS-related illnesses and an unknown number of neurological illnesses. The personal, social and economic costs are very high. In the US, it is estimated that the total cost of direct medical care for AIDS patients in 1991 will reach US $16 billion. Neither vaccine nor therapy for widespread use is likely to become available for several years, and the HIV global control effort will be long-term and likely to go on for several decades. The WHO Special Program on AIDS includes 5 major components: national program support; health promotion; research and development; surveillance, forecasting and impact assessment; and administrative services. The HIV pandemic represents an unprecedented challenge to public health and mandates a response of exceptional creativity, energy and resources.