Assessing the Impact of HIV/AIDS: Information for Policy Dialogue

Transcription

1 Assessing the Impact of HIV/AIDS: Information for Policy Dialogue Timothy B. Fowler International Programs Center Population Division U.S. Census Bureau For presentation at the International Expert Group Seminar on Population Census Data Dissemination and Use, Pretoria, South Africa, November 11, 2003 This presentation reports the results of work undertaken by U.S.Census Bureau staff. It has undergone a Census Bureau review more limited in scope than that given to official Census Bureau publications. This presentation is released to inform interested parties and to encourage discussion of work in progress. The use of data not generated by the U.S. Census Bureau precludes performing the same statistical reviews on those data which the U.S. Census Bureau does on its own data. 1 The AIDS Pandemic in the 21st Century Continues to Have Its Greatest Impact in the Developing World Over 90 percent of the people infected with the Human Immunodeficiency Virus (HIV), which causes AIDS, live in the developing world An estimated 70 percent of the global total of HIV-positive people, 26 million out of 37.1 million, live in Sub-Saharan Africa. Sub- Saharan Africa contains only 11 percent of the global population Source: U.S. Census Bureau

2 At the Beginning of the 21st Century, AIDS Is the Number One Cause of Death in Africa and Fourth Globally In four countries of Sub-Saharan Africa over 30 percent of adults (15-49 years) are infected with HIV/AIDS In seven Sub-Saharan African countries, at least one out of five adults are living with HIV/AIDS In an additional six Sub-Saharan African countries, one out of ten adults is HIV positive Source: UNAIDS/WHO A Census Offers a Picture of the Current Situation for a Population Population distribution Estimates of mortality including HIV/AIDS Infant mortality Childhood mortality Deaths by age and sex Basis for demographic projections 4

3 0 The Population Distribution of Botswana with and without AIDS Mortality in 2003 Male Including AIDS mortality Without AIDS mortality Female 140, , ,000 80,000 60,000 40,000 20,000 20,000 40,000 60,000 80, , , , Population Source: U.S. Census Bureau, International Programs Center, International Data Base. 5 By 2010 the Population Distribution of Botswana is Projected to Change Dramatically Because of HIV/AIDS Male Including AIDS Mortality Without AIDS Mortality Female 140, , ,000 80,000 60,000 40,000 20,000 20,000 40,000 60,000 80, , , , Population Source: U.S. Census Bureau, International Programs Center, International Data Base. 6

4 The U.S. Census Bureau is Working with Countries Affected by HIV/AIDS to Project Demographic Indicators for Use by Policymakers Using specialized software from UNAIDS, the U.S. Census Bureau, and The Futures Group International Rural-Urban Projection (RUP) Estimation and Projection Package (EPP) Spectrum At various geopolitical levels National Provincial District 7 Census Data Needed for the Projection Process Population by age and sex as base for projections (pre-hiv/aids) Population by age and sex from censuses after HIV/AIDS epidemic starts (to serve as control for projected population) Information on fertility Information on migration of population, both internal and international 8

5 Mortality Data Needed for the Projection Process Pre-HIV/AIDS estimates of mortality from censuses and/or surveys Hypothetical projections of mortality without HIV/AIDS for years of projection period affected by HIV/AIDS Estimates of mortality that include HIV/AIDS from censuses and/or surveys 9 Information on HIV Epidemic Needed for Population Projections Adult HIV prevalence estimates from sentinel surveillance systems Adult HIV prevalence estimates from populationbased representative survey, if available By age and sex By place of residence (urban/rural, province, etc.) Assumptions about HIV/AIDS situation during the projection period 10

6 Census-Based Population Projections Result in Demographic Indicators for Each Year Population by age and sex Births Infant, child, and adult mortality Life expectancy at birth HIV-infected population HIV/AIDS deaths Numbers of orphans 11 Census-Based Population Projections Provide Data on the Population for Decision-Making Numbers and location of children needing childhood vaccinations Numbers and location of children of school age Numbers and location of the elderly who may need support services Numbers and location of women who may need antenatal care Numbers needing reproductive health services 12

7 Census-Based Population Projections Provide Data on HIV+ Population for Policy Decisions Annual number of new HIV infections Annual number of infants born HIV+ Annual number of deaths due to HIV/AIDS in the adult population Number of orphans due to HIV/AIDS Numbers of HIV+ and AIDS patients needing health care 13 Census-Based Population Projections Provide Direct Information for Decision Makers The demand for voluntary counseling and testing (VCT) for HIV The demand for antiretroviral drugs (ARVs) needed for HIV+ pregnant women and their newborn children The demand for ARVs for HIV+ adult population Note: These allow for estimates of the cost of supplying ARVs and caring for sick population 14

8 Other Implications of HIV/AIDS for Policy Decisions Economic Loss of workforce to illness and death Increased business costs due to increased health care and death benefit costs, need for training of replacement staff, etc. Infrastructure Health Added demand on health care providers Added demand on clinics and hospitals for beds, drugs, supplies, etc. Loss of health care workers to illness and death Additional strain on health budgets 15 Infrastructure (Continued) - Education Loss of teachers to illness and death Reduced attendance of children kept out of school to help HIV/AIDS affected households cope - Agriculture Loss of farm workers Reduction of land under cultivation and decline in crop yields Switch to less labor intensive crops - Military Armed forces personnel in Sub-Saharan Africa are 2 to 5 times more likely to be infected with HIV than the general population Loss of military readiness can lead to increased security risk 16

9 HIV Prevalence in Nigerian Military Personnel According to Years of Duty as Peacekeepers, HIV prevalence (%) Years of duty as peacekeepers Source: UNAIDS 2000, Socio-Economic Impact of HIV/AIDS in Africa. Original source: Adefolalu A. 3rd All African Congress of Armed Forces and Police Medical Services, 1999, Pretoria. 17 Societal Implications of HIV/AIDS At the household level: Change in traditional family structure Loss of income and resources Children caring for children Increase in the number of orphans Stigma and discrimination attached to HIV/AIDS affected households Societal breakdown leading to conflict Increase in poverty Increase in income inequality 18

10 The Share of Orphans Due to HIV/AIDS is Increasing Percent of children less than 15 that are orphans by region, year, and cause Africa Latin America Asia All other causes AIDS Percent Source: USAID 2002, Children on the Brink Thank you for your interest. International Programs Center Population Division U.S. Census Bureau Website: ipc@census.gov 20