An Overview of the HIV Epidemic in ResourceLimited Countries

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An Overview of the HIV Epidemic in
Resource-Limited Countries

• Elly T Katabira, FRCP
• Makerere University Medical School
• Kampala, Uganda.
• HIV Infection and CNS Developed and Resource
  Limited Settings Conference, June 11, 2005
  Frascati, Italy

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Pneumocystis Pneumonia Los Angeles
During October 1980 May 1981, 5 young men, all
active homosexuals, were found to have confirmed
Pneumocystis carinii pneumonia at 3 different
hospitals in California. Two of the patients
died. All 5 patients had laboratory evidence of
past or current cytomegalovirus (CMV) infection
and candidal mucosal infection. Reports of these
patients follow.
CDC MMWR 1981 June 5 30250-2.
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The Beginning of the HIV Epidemic

• First cases of a new disease described among
  young homosexual men in SF and NY in 1981
• 1st cases described in South West Uganda in 1982
  and called Slim Disease
• Soon more cases reported in developing world
• Today resource-limited countries account for gt70
  of the global HIV burden

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Estimated number of adults and childrennewly
infected with HIV during 2002
Eastern Europe Central Asia 250 000
Western Europe 30 000
North America 45 000
East Asia Pacific 270 000
North Africa Middle East 83 000
South South-East Asia 700 000
Caribbean 60 000
Sub-Saharan Africa 3.5 million
Latin America 150 000
Australia New Zealand 500
Total 5 million
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Estimated Adult and Child Deaths due to HIV/AIDS
from the beginning of the epidemic to 2001
Eastern Europe 21,000
Western Europe 210,000
N. America 470,000
North Africa 70,000
Asia Pacific 3.2 million
Caribbean 210,000
Sub-Saharan Africa 17 million
Latin America 460,000
Total 24 million
Data from UNAIDS
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Spread of HIV over timein sub-Saharan Africa,
1984 to 1999
Estimated percentage of adults (1549) infected
with HIV
20.0 36.0 10.0 20.0 5.0 10.0 1.0
5.0 0.0 1.0 trend data unavailable
outside region
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HIV in Sub-Saharan Africa

• Africa is the epicenter of the HIV epidemic
• Accounts for over 70 of all the cases worldwide
• Yet only contributes 10 of the world population
• Only shares 9 of the world resources
• Inability to mount significant response to
  HIV/AIDS impact
• Therefore dependency on donor communities

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Determinants of the Epidemic in Resource-Limited
Countries

• Poverty
• At family/individual levels
• At community levels
• At national level
• Poor or inadequate HIV related knowledge
• Slow sensitization of the public
• Inadequate response to the epidemic
• Failure to involve everybody
• Limited resources financial and human

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HIV/AIDS impact on population growth

• Dropping life expectancy
• UN predicts 4-11.3 drop in some African
  countries by end of 2005
• Low fertility rates (25-40) among infected women
  
• Increased partner morbidity and mortality
• Avoidance of pregnancy
• Direct effect by the HIV amenorrhea

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Demographic Impact of HIV

• In Africa, life expectancy has declined from 62
  to 47 years.
• In Botswana, Malawi, Mozambique and Swaziland,
  life expectancy is less than 40 years of age.
• In Uganda, 60 of deaths among children under 5
  years are due to AIDS in Zimbabwe the figure is
  70.

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Effect of HIV/AIDS on Economic Growth

• Growth in Africa was reduced by 0.8 per year in
  1990-97
• It is estimated that by 2010 South Africa GDP
  will be 17 lower due to AIDS
• Effects even worse when lost production and
  welfare are counted

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Three Routes to Economic Decline

• Reduced output, reduced productivity by
• Households
• Businesses
• Declining savings leading to lower investments
• Catastrophic costs of illness and disability on
• Household expenditures
• Health and social services

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Impact on Local Business

• Growth and productivity of local companies eroded
  
• Loss of skilled adults
• Kinshasa textile Managers had higher rates than
  foremen who had higher rates than the workers
• Work unit productivity is disrupted as turnover
  rates increase
• Cost of replacing skilled labour is very high
• It is estimated that it will cost Tanzania US
  40M by 2010
• Productivity low as replacements are recruited
  and trained

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HIV/AIDS on Health Systems

• High costs of treating HIV and related infections
  cancers
• Health care for AIDS crowds out the needs for
  other patients
• Increased bed occupancy by HIV related problems
• Patients stay longer in hospitals
• Loss of previous health gains
• Increasing child mortality
• Resurgence of tuberculosis

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TB Notification rates in four countries with a
high prevalence of HIV
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The impact of HIV/AIDS on Health professionals

• Coping with death and dying of patients
• Work overload burnout associated with extra
  time demands of terminal AIDS care
• Identification with patients and maintaining
  professional distance
• Depression associated with witnessing the decline
  and deaths of patients
• Dealing with patients suicidal notions
• Made angry by negative reactions of staffs
  family to their working in this field

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Impact on Families and Social Structures

• Orphans A lost generation
• Numbers are large and growing
• Social support systems are overwhelmed
• Impact on death of an adult
• Vulnerable households become poorer
• In Tanzania, the death costs 60 on treatment
  funerals - gtannual income

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Impact on Families and Social Structures

• Risk of a lost generation
• Poor socialization
• Social upheaval
• Economic underclass
• Effect of losing an adult persists into the next
  generation
• Children withdrawn from school
• School attendance of 15-20 year olds reduced by
  50 if female parent is lost in the previous year
  in Tanzania

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Conclusion

• Resource limited countries have an unfair share
  of the global HIV epidemic
• There is an urgent need of an accelerated
  programs on care and prevention in order to
  reduce the burden of the epidemic
• Global support is a small answer Countries
  themselves need to do more than what there are
  doing now