Contents
Chapters
- The Invisible Epidemic
- How Young People Become Infected
- Why So Vulnerable?
- Addressing the Epidemic
- Reaching Out
- Consequences of Inaction
- HIV/AIDS: What Young People Want to Know
- Profiles
- Youth at the Center
Highlights
- Why young women face more risk
- Culture can hurt
- Profile: Going public
- Education should start early
- Condoms for dual protection
- Orphans: A new challenge
- What can parents do?
- Reaching street children
- Putting youth at the center
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Published by the Population Information Program, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA.
Volume XXIX, Number 3
Fall 2001
Series L, Number 12
Issues in World Health
The Consequences of Inaction
Worldwide, there is little chance of curbing the AIDS epidemic among youth without a comprehensive strategy and a full-scale campaign to end HIV infection. Even vigorous efforts taken right away to curb AIDS globally will be too late for many young people. In Zimbabwe, for example, a 15-year-old boy in 1983 had just a 15% chance of dying before reaching his 50th birthday, compared with a 50% chance for a 15-year-old boy in 1997 because of AIDS. In Botswana, 90% of girls and 88% of boys who turned 15 in 2000 are projected to die of AIDS at current risk levels. In Zimbabwe and South Africa AIDS will cause the deaths of nearly three-quarters of males now age 15 (162, 420).
Worse yet, deaths from AIDS would be reduced only a little in the countries worst affected with the epidemic even if the risk of HIV infection could be cut in half before 2015, UNAIDS estimates. This is because so many people already are infected and likely to infect many others (162). In Botswana even if the risk of infection were cut in half by 2015, nearly 80% of males now age 15 would die of AIDS. Similarly, in Zambia, even with HIV risk cut in half by 2015, over half of males now age 15 would die of AIDS (see Figure 4). These grim statistics are similar for females now age 15.
Unless immediate and concerted AIDS-prevention efforts can reduce the risk of HIV infection to almost zero, it may already be too late to avoid catastrophic numbers of AIDS deaths among the current generation of young men and women in countries where HIV prevalence is highest, such as in southern Africa. In other countries where HIV is not yet widespread, adopting strategies that prevent HIV among youth can help millions of young people avoid the same fate.
Preventing HIV/AIDS among youth is central to the goal set at the 2001 United Nations General Assembly Special Session on AIDS (166)—reducing HIV prevalence by 25% in the hardest-hit countries by 2005. Efforts must reach a wide range of youth, including children approaching puberty, adolescents, and young adults, and must address a variety of factors for developing and sustaining healthy behavior (see Youth at the Center).
 CARE Ethiopia |
This poster from Ethiopia depicts AIDS as the scourge that it is. Worldwide, only a large-scale campaign against HIV/AIDS can hope to end the suffering. |
Social and Economic Consequences
The high levels of HIV infection among younger and younger people signals society's failure to protect its children (158). In failing to protect children, the world risks its future. If levels of HIV prevalence rise, not only will the health consequences be serious but also the demographic, economic, and social consequences (111).
Because of high mortality from AIDS, populations in some sub-Saharan African countries will begin to shrink within the next three years (338). By 2010 average life expectancy could decline to about 30 years in some countries hard-hit by AIDS, such as Botswana, Mozambique, Namibia, Swaziland, and Zimbabwe. In Lesotho, Malawi, Rwanda, and South Africa, life expectancy is projected to fall to around 35 years. In some places AIDS is pushing life expectancies down to levels of about a century ago (338).
Assessing and predicting the social and economic impact of HIV/AIDS is more difficult than making demographic projections. For one thing, the AIDS epidemic has yet to run its full course in any country (398). For another, certain impacts of HIV/AIDS, such as despair and grieving, cannot easily be measured (334). Nevertheless, it is likely that the premature death of so many adults will lead to shortages of labor and to new needs for public welfare (4, 165).
As more and more adults die of AIDS, younger and younger adults would become responsible for managing government, including such key services as civil security, the courts, education, and health care (222). Already, in the countries hardest hit by AIDS over one-quarter of the medical staff are themselves infected with HIV (166).
In some communities many adolescents head their own households, raise children, and care for their parents who are dying of AIDS (165). Without immediate action, what is true of these communities today could become true of towns, cities, and even entire nations in the future.
Teacher shortages. For unknown reasons, HIV/AIDS rates are extremely high among teachers and school administrators, especially in Africa. In the Central African Republic 107 schools have closed because of teacher shortages, largely due to HIV/AIDS. In Zambia in the first 10 months of 1998, an estimated 1,300 teachers died—two-thirds the number of new teachers trained annually (361). In Botswana mortality among primary school teachers has increased by 60% in the last five years (364).
Researchers estimate that in Africa a teacher with HIV loses 6 months of professional time before developing AIDS and then loses an additional 12 months before dying of the disease (2, 162). In 1999 an estimated 860,000 children in sub-Saharan Africa lost their teachers to AIDS (361). Even more severe turbulence in the education sector could lie ahead. In a four-country survey—Kenya, Uganda, Zambia and Zimbabwe—the number of new teachers needed will exceed their availability at least through 2010, particularly in rural areas (2, 162).
In response, some education planners are proposing efforts to help teachers themselves learn how to avoid AIDS, as well as reinvigorating codes of conduct prohibiting sexual contact between teachers and students (212). Some already are calling for new approaches to education, such as distance learning for both teachers and students, on-the-job training, and expansion of teacher training facilities (62).
The impact of teacher shortages on the future of young people is likely to be felt in many ways, including lost opportunities for schooling and larger class sizes. For students, the presence in the classroom of a teacher who gradually succumbs to AIDS is likely to have a debilitating psychological impact (364).
Lost childhoods. Where AIDS deaths have forced many adolescents to take on adult roles, the transition from childhood to adulthood is disappearing. Often, children must leave school to care for a dying parent or relative. Because AIDS consumes family budgets, fewer funds remain available for children's education, health care, and other needs. In Thailand, for example, 15% of rural families affected by AIDS took a child out of school. In Côte d'Ivoire family outlays on education have been cut in half (4, 162). In Uganda, following the deaths of one or both parents, the chances of children going to school is cut in half, and young people who attend school spend less time there than before. Moreover, children who care for relatives with AIDS but who remain in school are often older than their classmates and thus more likely to drop out of school early (4, 222).
Some strategies being proposed to alleviate the impact of HIV/AIDS on children include subsidizing school expenses such as school uniforms and school fees. Others include offering food vouchers or otherwise assuring children of a meal (4).
Diminished productivity. The loss of adults to AIDS probably will diminish productivity in countries most afflicted. Some economists expect that in the manufacturing sector AIDS mortality will lead to a decline in revenues and result in slower economic growth (406). HIV/AIDS is likely to lead to severe labor shortages in agriculture particularly . Some regions already are reporting diminished cultivation of food crops (162). Youth who lack experience as farmers are unlikely to know much about such key practices as irrigation, soil enhancement, and effective livestock management. They would be able to grow only what they could manage by themselves—implying a shift away from cash crops and toward subsistence farming (162). Combined with such anti-social practices as grabbing land from widows or children orphaned by HIV/AIDS, such trends could jeopardize food security in some regions—already a serious problem in many low-income countries (124).
