The HIV / AIDS epidemic in Thailand: addressing the impact on children

Within the space of a decade, the level of HIV infection in Thailand has grown to epidemic proportions. With regard to children, 16,000 had been born with HIV by the end of 1994, while tens of thousands of child prostitutes and street children are at risk of infection. By the year 2000, more than one million Thai children will have at least one HIV-infected parent. Many of these children will therefore become either orphans or abandoned by their infected parents. The magnitude of these problems over the course of the lives of HIV-affected children depends heavily upon actions taken now. This paper summarizes the joint report of the Thai Red Cross Society and the East-West Center's Program on Population on the impact of HIV on children in Thailand. The current situation, projected impacts, and policy recommendations are described. No other country has had as complete a monitoring system or as early a warning of the problems ahead. Some recommended approaches are familiar and simply need to be strengthened and expanded to the regional or national level, while others require field testing. The authors stress the need for shared commitment, ideas, resources, and efforts of all sectors of society to plan for the future needs of children affected by HIV, to protect them from infection, and to provide them with the social and economic support, medical treatment, and legal protection they need.     

The Impact of HIV/AIDS on Adult Mortality in Zimbabwe

In June 2000, an estimated 25 percent of adults in Zimbabwe were living with HIV/AIDS. Statistical data on the impact of the epidemic, though problematic in many ways, are better for Zimbabwe than for many other countries in sub‐Saharan Africa. This analysis presents estimates of adult mortality in Zimbabwe based on multiple sources, including registered deaths adjusted for incomplete reporting, estimated at approximately 50 percent. Comparison of estimates from different data sources shows that they are subject to substantial errors. At the same time, the estimates leave no doubt that adult mortality risks in Zimbabwe more than doubled between 1982 and 1997. The evidence that this rise is due to AIDS deaths is circumstantial, but very strong; there is no credible competing explanation.     

The consequences of HIV/AIDS in Eastern Africa on mothers,children, and orphans

Orphanhood is a sad and unique problem of the HIV pandemic, compared with other epidemics, for generally both parents will be infected and will tend to die during young adulthood, leaving behind young children. The rising morbidity and mortality of HIV-infected mothers and fathers threaten to decrease the care and resources spent on children and to increase the prevalence of orphanhood. However, the extent and impact of orphanhood due to HIV/AIDS are not known. This paper presents two aspects of HIV infection and its impact on women and children in sub-Saharan Africa: the results of two analyses of the HIV-attributable mortality of mothers and the orphanhood of their young children.     

Mitigating an elephantine epidemic: gendered space for HIV/AIDS outreach through Namibian conservancies

As the reach of HIV/AIDS continues to devastate communities and create potential pressures on natural resources, conservation organizations have increasingly become involved in education and outreach to address the disease. This paper’s purpose is to investigate how increasing HIV infection rates and AIDS deaths relate to community-based conservation and livelihood strategies in the Caprivi Region of northeastern Namibia, and demonstrate that conservation organizations can play a unique role in combating the disease. As the epidemic is more widespread in the Caprivi than in any other region of the country, local organizations such as Integrated Rural Development and Nature Conservation (IRDNC) are responding to the disease by integrating it into conservation work. IRDNC’s efforts reflect a particular focus on gender, including changes in the way that HIV/AIDS is discussed in local communities, strategies to promote access to testing and care, and bringing to light the experiences of individuals and families struggling with HIV/AIDS. This approach shows that there are benefits to be gained from approaching HIV/AIDS mitigation through familiar, existing structures such as those of community conservancies in Namibia—especially the ability to circumvent heavy local stigma. Using data collected through participant observation and participatory discussions, this paper demonstrates that conservation programs can positively affect people with HIV/AIDS, highlighting the importance of mainstreaming outreach efforts that address the particular localized manifestations of the disease in the context of natural resource management.     

The HIV/AIDS Epidemic at the End of 1999

The status of the global HIV/AIDS epidemic is summarized in a report entitled AIDS Epidemic Update: December 1999, issued by the United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization. The generally bleak but regionally diverse picture is conveyed in the series of bulleted statements at the beginning of the report and in two summary tables, reproduced below. The rest of the report discusses the regional situations in more detail. An earlier UNAIDS and WHO surveillance report (June 1998) was excerpted in the Documents section of PDR 24 (3).     

Uncovering the impact of the HIV epidemic on fertility in Sub-Saharan Africa: the case of Malawi

We evaluate the impact of the HIV/AIDS epidemic on the reproductive behaviour for all women in Malawi, HIV-negative and HIV-positive alike, allowing for heterogeneous response depending on age and prior number of births. HIV/AIDS increases the probability that a young woman gives birth to her first child, while it decreases the probability to give birth of older women and of women who have already given birth. The resulting change in the distribution of fertility across age groups is likely to be more demographically and economically important than changes in the total number of children a woman gives birth to.     

Designing appropriate intervention strategies for HIV/AIDS in southern Africa

This research was supported by the U.S. Agency for International Development.     

On the Socioeconomic Impact of the HIV/AIDS Epidemic

The UN General Assembly Special Session on HIV/AIDS met 25–2 7 June 2001 and adopted a Declaration of Commitment on HIV/AIDS. The Declaration, in 103 paragraphs, sets out a comprehensive response strategy for governments and UN agencies, supports establishment of a global HIV/AIDS and health fund, and calls for an annual progress report to be reviewed by the Assembly. As part of the Special Session, four “round tables” were conducted on substantive topics: prevention and care, human rights, socioeconomic impact, and international funding. Round Table 3, Socioeconomic impact of the epidemic and the strengthening of national capacities to combat HIV/AIDS, was led by the United Nations Development Programme. The background document prepared for it is reproduced in full below. It argues that the brunt of the epidemic's impact on human development has been borne by households, communities, and civil society organizations. The emphasis of national and international action has been on prevention and care rather than on counteracting that impact. “Extraordinary efforts” are now required to intensify poverty‐reduction measures, to assist caregivers and orphaned children, to prevent the collapse of public services, and to promote workplace tolerance and flexibility. “While HIV/AIDS must be seen as an emergency of the highest order, steady progress in reducing poverty is still the long‐term and sustainable solution to the health crisis in the developing world. In the long run, prevention and care will only succeed if people and nations can lift themselves out of poverty.” (The Declaration was not much influenced by such arguments. It devotes two paragraphs to socio‐economic impact, both setting diffuse goals: “By 2003, evaluate the economic and social impact of the HIV/AIDS epidemic and develop multisectoral strategies [on poverty alleviation, etc.]” and “By 2003, develop a national legal and policy framework that protects in the workplace the rights and dignity of persons living with and affected by HIV/AIDS.…”) The Millennium Summit referred to in the document was the meeting on the role of the UN in the twenty‐first century held in September 2000 as part of the 55th session of the General Assembly. The Declaration of Commitment on HIV/AIDS and the Round Table 3 document can both be found at http://www.unaids.org/ungass/index.html .     

The African AIDS epidemic: Reflections on a research program

Sub-Saharan Africa has suffered the major impact of the AIDS epidemic, with almost 70 per cent of the world’s HIV-infected persons and almost 80 per cent of AIDS deaths. The primary source of infection has been heterosexual transmission. In the absence of a vaccine, the only protection has been behavioural change. A collaborative program between research teams of the Australian National University and three African universities spent 12 years investigating the social and behavioural context of the African epidemic with the aim of providing an understanding of the social dimension of the epidemic so that behavioural change might be accelerated. This paper provides a history of the project’s activities and summarizes its findings. *** DIRECT SUPPORT *** A01NG004 00005     

Internalized Homophobia,HIV Knowledge,and HIV/AIDS Personal Responsibility Beliefs: Correlates of HIV/AIDS Discrimination among MSM in the Context of Institutionalized Stigma

ABSTRACT

There exists a paucity of research on the psychosocial risk factors of HIV/AIDS among men who have sex with men (MSM) in settings where they are stigmatized or face prosecution. The present study investigates discrimination against people living with HIV (PLHIV), internalized homophobia, HIV/AIDS personal responsibility beliefs and HIV knowledge in a purposive sample of 106 self-identified MSM obtained through a web-based survey disseminated by two voluntary welfare organizations. Results indicate that internalized homophobia is positively associated with discrimination against PLHIV. Internalized homophobia also substantially mediates the effect of HIV/AIDS personal responsibility beliefs on discrimination against PLHIV, highlighting the confounded nature of HIV/AIDS and homosexual stigma in a setting where stigma is deep-rooted and institutionalized. Internalized homophobia may thus serve as a barrier to the effectiveness of HIV prevention efforts among MSM in Singapore.     

The gradient in sub-saharan Africa: Socioeconomic status and HIV/AIDS

Using data from the Demographic and Health Surveys (DHS) for Burkina Faso (2003), Cameroon (2004), Ghana (2003), Kenya (2003), and Tanzania (2003), I investigate the cross-sectional relationship between HIV status and socioeconomic status. I find evidence of a robust positive education gradient in HIV infection, showing that, up to very high levels of education, better-educated respondents are more likely to be HIV-positive. Adults with six years of schooling are as much as three percentage points more likely to be infected with HIV than adults with no schooling. This gradient is not an artifact of age, sector of residence, or region of residence. With controls for sex, age, sector of residence, and region of residence, adults with six years of schooling are as much as 50% more likely to be infected with HIV than those with no schooling. Education is positively related to certain risk factors for HIV including the likelihood of having premarital sex. Estimates of the wealth gradient in HIV, by contrast, vary substantially across countries and are sensitive to the choice of measure of wealth.     

HIV/AIDS and Cross-National Convergence in Life Expectancy

This article analyzes the effect of HIV/AIDS on the cross-national convergence in life expectancy as well as infant and child survival rates by comparing three scenarios. One is based on historical and future best-guess estimated values given the existence of the epidemic. The second scenario assumes that the effect of the epidemic is much worse than expected. The final scenario is based on hypothetical values derived from estimations where the mortality caused by the epidemic is removed. For life expectancy, convergence becomes stalled in the late 1980s (without weighting by country population size) or 1990s (with weighting). Convergence in infant and child survival rates does not become stalled, but slows down. These results are mainly attributable to the epidemic since all signs of stalled convergence or even divergence disappear in the “No AIDS scenario.” Given the existence of the epidemic, however, the reduced degree of inequality in life expectancy attained by 1985 is only expected to be achieved again by 2015 at the earliest. If the epidemic turns out much worse than expected, divergence could continue to 2050. No divergence is to be expected in infant and child survival rates in any of the scenarios.     

中国老年艾滋病的流行状况分析

艾滋病在中国的迅速流行已是不争的事实,但是人们普遍认为“艾滋病是年轻人的病”。调查资料显示,50岁及以上的老年艾滋病病毒感染者报告人数已达到全国感染者的1/10,并呈快速增长趋势。老年感染人群的主要感染渠道以既往有偿献血感染为主。老年艾滋病病毒(HIV)感染者和艾滋病(AIDS)病人增多无论对家庭还是对社会均产生严重的后果,在艾滋病预防和控制战役中,老年是一个不可忽略的人群,应引起高度重视。     

Probabilistic population projections for countries with generalized HIV/AIDS epidemics

In 2015, the United Nations (UN) issued probabilistic population projections for all countries up to 2100, by simulating future levels of total fertility and life expectancy and combining the results using a standard cohort component projection method. For the 40 countries with generalized HIV/AIDS epidemics, the mortality projections used the Spectrum/Estimation and Projection Package (EPP) model, a complex, multistate model designed for short-term projections of policy-relevant quantities for the epidemic. We propose a simpler approach that is more compatible with existing UN projection methods for other countries. Changes in life expectancy are projected probabilistically using a simple time series regression and then converted to age- and sex-specific mortality rates using model life tables designed for countries with HIV/AIDS epidemics. These are then input to the cohort component method, as for other countries. The method performed well in an out-of-sample cross-validation experiment. It gives similar short-run projections to Spectrum/EPP, while being simpler and avoiding multistate modelling.     

艾滋病人口扩散的空间差异机制及其对策研究——以云南为例

通过分析1990到2004年云南省艾滋病地域空间的分布特点．得出云南省艾滋病流行扩散的空间差异机制。在此基础上指出需根据艾滋病流行状况的空间差异,在对艾滋病采取系统防治的基础上,对不同等级区域采取差异化的预防控制对策,提高艾滋病防治的针对性。     

The contribution of HIV to fertility decline in rural Zimbabwe, 1985-2000

HIV-related sub-fertility has been reported for those populations in sub-Saharan Africa in which contraceptive use is low. We use data from a retrospective survey in rural Zimbabwe and multivariate logistic regression models to show that recent birth rates and current pregnancy rates are also lower among HIV-positive women than among HIV-negative women in those African populations where contraceptive use is high. The fertility reduction is smaller than where contraceptive use is low because age at first sexual intercourse is later and birth rates at older ages are already low. Nevertheless, total fertility is approximately 8.5 per cent lower and HIV-associated sub-fertility may account for as much as one-quarter of fertility decline in Zimbabwe since the late 1980s. Mechanisms for HIV-associated sub-fertility in rural Zimbabwe include more frequent widowhood and divorce, reduced coital frequency, increased amenorrhoea, and possibly, pelvic inflammatory disease. Miscarriage appears to be a less important factor than elsewhere possibly because syphilis is rare.     

Late marriage and the HIV epidemic in sub-Saharan Africa

The causes of large variation in the sizes of HIV epidemics among countries in sub-Saharan Africa are not well understood. Here we assess the potential roles of late age at marriage and a long period of premarital sexual activity as population risk factors, using ecological data from 33 sub-Saharan African countries and with individual-level data from Demographic and Health Surveys (DHS) in Kenya and Ghana in 2003. The ecological analysis finds a significant positive correlation between HIV prevalence and median age at first marriage, and between HIV prevalence and interval between first sexual intercourse and first marriage. The individual-level analysis shows that HIV infection per year of exposure is higher before than after first marriage. These findings support the hypothesis of a link between a high average age at marriage and a long period of premarital intercourse during which partner changes are relatively common and facilitate the spread of HIV.