Impact of AIDS in the developing world
Carswell, J.W.
British Medical Bulletin 44(1): 183-202
1988
ISSN/ISBN: 0007-1420 PMID: 3058246 DOI: 10.1093/oxfordjournals.bmb.a072240Document Number: 362398
Some features of the HIV infection are unique to the developing world (as exemplified by Africa, which is the frontline continent for AIDS). The infection affects all social groups, and since it is spread by heterosexual activity, it affects equal numbers of men and women, and the infection of women has dire consequences for population structure. Opportunistic infections are caused by organisms against which there is no effective treatment. Health budgets, with an average of $10 per capita, cannot buy such drugs as are available. Political instability and poverty create a climate favorable to casual sex and prostitution. Infection is highest among adults in their 20s and 30s, when the men are most productive economically, and the women have begun but not completed their childbearing. In Zaire the mean age at infection is 37 for men and 30 for women, and the mean age at death in Zambia is 35 for men and 26 for women. Seroprevalence is as high as 76% (among barmaids in Uganda), and at least half of the spouses of seropositive persons are infected. The number of new cases at 1 hospital in Kampala was 3-8/day in 1986. Using what is known about AIDS and what is know about the population structure in African countries, it is possible to model the impact of AIDS on a typical developing country with a population of 10 million. If seropositivity were 5%, 20.000 cases of AIDS could be expected each year among 15-50-year olds, with an additional 1500 cases among newborns. At least half of the babies of seropositive women will be seropositive. For every adult death, 20 man- or 40 woman-hours of work will be lost. The deaths of young married women will leave an immense burden of sick and dying orphans on extended families whose kinship ties are no longer close enough to cope, in countries which have no institutional facilities for orphan care. The number of opportunistic infections will increase, and, unless AIDS patients are turned away, health resources will be drained from potentially curable diseases. The number of people willing to practice medicine, nursing, and midwifery will diminish, and the burden of AIDS care will fall on already overcrowded, large urban hospitals. Blood transfusions will become unavailable because no one will want to be tested for HIV seropositivity. Xenophobia will characterize international relations, and governments will collapse, as educated decision-makers and managers die and cannot be replaced. The only bright spots in this otherwise dismal prospect are the increased awareness of young people of the need for chastity and monogamy, with an attendant fall in the level of sexually transmitted diseases generally; an acceleration in the development of health services and diagnostic facilities; the possibility of the development of a vaccine from the more benign HIV-2; a renewal of social life not based on sex; and a return to transcendental values and faith in God.