Complex Demographic Impact of HIV/AIDS


Despite the major effects of the HIV/AIDS epidemic on mortality and life expectancy, populations are continuing to grow even in the hardest-hit countries. With so much uncertainty about the number of people living with HIV/AIDS, the demographic impact is still incompletely understood. Late last year, UNAIDS estimates of the global scope of HIV/AIDS were significantly revised. As we know from the 2007 AIDS Epidemic Update, the number of people living with HIV/AIDS globally is now estimated at 33 million (down from 40 million) and annual infections are now assumed to number about 2.5 million (half the previous estimate). Recent revisions to United Nations population projections and HIV/AIDS prevalence estimates have rendered much of the previous data outdated (such as the data used in an earlier post on RH Reality Check).

The 2006 revision of the UN Population Division's projections (PDF) includes more recent HIV prevalence survey data, showing lower prevalence rates in some countries than was previously believed, and also assumes greater access to treatment than the 2004 version. This means that the projected demographic impact of HIV/AIDS is slightly less according to the newer 2006 data. As the methodology of estimating HIV prevalence continues to be refined, the 2008 UN population estimates may show an even smaller demographic impact due to the epidemic.

Therefore, from 2005 through the foreseeable future, HIV/AIDS is not projected to lead to either negative population growth rates or shortened life expectancy in any country. As the UN report summary for the 2006 estimates says,

All the countries with the highest prevalence in 2005 are expected to experience positive population growth rates between 2005 and 2050. This trend marks a reversal from previous projections which expected outright reductions of population (that is, negative population growth rates) in countries such as Botswana, Lesotho or Swaziland.

For those of us working to ensure that sexual and reproductive health are well integrated into HIV/AIDS prevention and treatment programs, it is important to stay on top of these shifting numbers and their meaning in the lives of real people. In particular, as the UN Population Division makes clear in its printed materials, these estimates rely on optimistic policy assumptions. Fertility rates in less developed countries are assumed to decline to below replacement level by 2045-2050, a dramatic change from current levels that will require greater investments and a sustained effort to achieve the Millennium Development Goals target of universal access to reproductive health by 2015. As the data have shown, sexual and reproductive health services still need strong financial and human support. For more information, read PAI's new analysis "U.S. HIV/AIDS and Family Planning/Reproductive Health Assistance: A Growing Disparity Within PEPFAR Focus Countries."

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    Asia: Poverty Forcing Teenage Girls into Risky Sex Work

    Women and girls make up a growing proportion of those infected by HIV/AIDS. The United Nations estimates that every day 6,000 young people aged 15 to 24 become infected with HIV. A staggering two-thirds of these new cases are adolescent women. Economic, social, and cultural factors contribute to the disparity of new HIV/AIDS cases between men and women. At the end of 2004, UNAIDS reported that women made up almost half of the 37.2 million adults (aged 15 to 49) living with HIV/AIDS worldwide. The hardest-hit regions are areas where heterosexual contact is the primary mode of transmission. This is most evident in sub-Saharan Africa, where close to 60% of adults living with HIV/AIDS are women.

    Child prostitution in India is on the rise, and one third of the sex workers are being under 18 years old. The underlying causes of child trafficking include poverty and lack of economic opportunities for young people, the low status of girls, high demand for commercial sex, cheap labour, weak law enforcement, discrimination and conflict. Surveys on trafficking and sexual exploitation conducted in South Asia, including in India, Nepal and Bangladesh, show that trafficking of children is lucrative, well organized and linked to criminal activity and corruption. It is also transnational, often hidden and therefore hard to combat.

    This depressing picture is compounded by the use of teenage girls as prostitutes in countries throughout the world. An unknown but vast number of teenage girls are used for commercial sexual purposes every year, often ending up with their health destroyed, victims of various STDs (sexually transmitted diseases) or HIV/AIDS. Teenage girls are sought with the expectation that clients will not be exposed to HIV. But prostitutes do not have bargaining power. That belongs to the customers, it has confirmed almost impossible to give prostitutes bargaining power in terms of condoms. Teenage prostituted can be raped, beaten, emotionally abused, tortured, and even killed by pimps, brothel owners or clients. Some have been trafficked from one country to another. Moreover, teenage prostitutes are frequently treated as criminals by law enforcement and judicial authorities, rather than as teenage girls who are victims of sexual exploitation.

    AIDS Researcher Ms. Muslem Khan Bulon said poverty, trafficking & HIV/AIDS are interrelated; especially women and girls are trafficking for use of prostitution. Teenage girls trafficked to India are at high risk of contracting sexually transmitted diseases(STDs), including HIV/AIDS, because of India is the second largest HIV/AIDS infected country in the world, It is estimated that half of the girls in Mumbai brothels who are under the age of 18 years have been infected with HIV.

    Most of trafficking girls or women would face several physical & sexual abuses. When a girl or women newly enrolls a sex industry, she tries to safe herself heard & soul, but most of the time they couldn’t free her. A survey conducted by Rainbow Nari O Shishu Kallyan Foundation that the girls forced (trafficking) into the brothels do not want to return to their homes once they are into it for more than one year. Such girls believe, they would be victim of social stigma and face discrimination from the society. They also believe, their family would suffer several social taboo, self-respect, and social-dignity.

    AIDS researcher Mohammad Khairul Alam said, “Trafficking in girls and women is warmly linked to movements in search of employment opportunities. Poverty and gender discrimination make girls and women more vulnerable to traffickers and buyers. The traffickers are not accompanying the women while crossing the border. So it is difficult for the border police to arrest them. There are some female members in the trafficking gang, which helps to hide their identity. Initiatives to reduce poverty and promote gender equality are therefore of direct importance in efforts to combat trafficking.”

    Mahmuda Begum
    Teacher
    Udayan High School
    Dhaka, Bangladesh

    Mahmuda.dhaka@gmail.com