As recently as 1990, there were some regions of the world that had remained relatively unscathed by AIDS. Today, however, there is not a single country around the world which has wholly escaped the AIDS epidemic. As the epidemic has matured, some of the developed nations which were hard hit by the epidemic in the 1980s such as the United States have reported a slowing in the rate of new infections and a stabilization among existing cases with lower mortality rates and an extension of post-diagnosis lifespan. However, despite the changing face of the global AIDS pandemic, one factor remains unchanged: no region of the world bears a higher AIDS-related burden than sub-Saharan Africa. This paper examines the demographic effects of AIDS in Africa, focusing on the hardest-hit countries of sub-Saharan Africa and considers the present and future impact of the AIDS epidemic on major demographic measures such as fertility, mortality, life expectancy, gender, age, and family structure.
Although the sub-Saharan region accounts for just 10% of the world’s population, 67% (22.5 million) of the 33.4 million people living with HIV/AIDS in 1998 were residents of one of the 34 countries of sub-Saharan Africa, and of all AIDS deaths since the epidemic started, 83% have occurred in sub-Saharan Africa (Gilks, 1999, p. 180). Among children under age 15 living with HIV/AIDS, 90% live in sub-Saharan Africa as do 95% of all AIDS orphans. In several of the 34 sub-Saharan nations, 1 out of every 4 adults is HIV-positive (UNAIDS, 1998, p. 1). Taxing low-income countries with health care systems inadequate to handle the burden of non-AIDS related illnesses, AIDS has devastated many of the sub-Saharan African economies. The impact of AIDS on the region is such that it is now affecting demographics - changing mortality and fertility rates, reducing lifespan, and ultimately affecting population growth.
Although Africa is the region of the world hardest hit by AIDS, and although no country has entirely escaped the virus, prevalence rates vary dramatically between regions, countries, and even within countries. In general, the southern region is the most affected, with Botswana, Namibia, Swaziland and Zimbabwe showing the highest rates, while West Africa has been less affected. In almost all countries, the HIV/AIDS prevalence rate is significantly higher in urban areas than in rural areas. Within the general population, the highest prevalence rates are found among the sexually active adult (15 to 49 years old) population. Women tend to get infected at earlier ages than males for a variety of biological and sociocultural reasons.
In recent years an intensive government-sponsored HIV prevention campaign focusing on use of condoms and changes in sexual behavior has produced impressive results. Researchers however, have yet to satisfactorily explain the broad variation in HIV seroprevalence between Western and Eastern sub-Saharan Africa. As Gilks (1999) observes, “in some of the countries of Western Africa such as Senegal, low levels of HIV prevalence in adults have been maintained for about a decade, despite many circumstances highly conducive to appreciable and sustained transmission” (p. 181). In some Western African nations, early and sustained prevention programs may be responsible for the differences, although other reports indicate that comparatively low transmission rates prevail in most of the Western countries regardless of programs designed to encourage safer sex (UNAIDS, 1998, p. 2). Reports also show that differences in the rate of HIV spread between East and West Africa cannot be explained by differences in sexual behavior alone.
AIDS researchers typically make a distinction between concentrated and generalized transmission patterns of the virus. In a concentrated transmission pattern, infection tends to be concentrated within “vulnerable groups” such as homosexual men, prostitutes, and IV drug users. In the generalized pattern, infection is diffused broadly through the population, typically by means of heterosexual transmission. In sub-Saharan Africa, where heterosexual transmission predominates, the pattern is that of generalized transmission. Compared to the U.S. little HIV transmission in Africa is related to IV drug use or unprotected homosexual sex. In addition to heterosexual transmission, transmission via transfusion and through contaminated medical equipment is not uncommon in sub-Saharan Africa. Africans infected with HIV die much sooner after diagnosis than HIV-infected persons in other parts of the world. Studies in industrialized countries that were conducted prior to the introduction of treatment