The Demographic Impact of HIVAIDS in 15 Developing Countries

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The Demographic Impact of HIV/AIDS in 15
Developing Countries

• Laura M. Heaton, Timothy B. Fowler, Brynn G.
  Epstein, Tammany Mulder, and Peter O. Way
• International Programs Center
• Population Division
• U.S. Census Bureau

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The U.S. Census Bureau presents preliminary
results of population estimates and projections
for15 focus countries covered under President
George W. Bushs Emergency Plan for AIDS Relief.
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Fifteen Focus Countries

• Sub-Saharan Africa Botswana, Côte dIvoire,
  Ethiopia, Kenya, Mozambique, Namibia, Nigeria,
  Rwanda, South Africa, Tanzania, Uganda, Zambia
• Latin America/Caribbean Guyana, Haiti
• Asia Vietnam

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Recent Trends in HIV Prevalence Levels

• According to the Joint United Nations Programme
  on HIV/AIDS (UNAIDS), variations in the epidemic
  are evident in the 15 focus countries.
• Rising epidemics
• Stable epidemics
• Declining epidemics

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• Population Estimates and Projections Process

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Two Series With AIDS versus Without AIDS

• With AIDS shows what has happened and what is
  projected to happen in each country because of
  AIDS mortality and its demographic consequences.
• Without AIDS shows a hypothetical series of what
  the Census Bureaus modeling work indicates would
  have happened if a country had not been affected
  by the HIV/AIDS epidemic. This modeling takes
  into account not only lower death rates but also
  associated changes to a countrys age-sex
  structure and, indirectly, the combined effects
  of lower mortality and changing population
  composition on demographic indicators.

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Population Estimates and Projections Process

• Analyze recently available survey, census, and
  other relevant data.
• Estimate and project levels of fertility,
  non-AIDS mortality, and international migration.
• Use the Rural-Urban Projection (RUP) program to
  obtain hypothetical, without AIDS, projections of
  all components of population change to the year
  2050.

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Estimating HIV Prevalence

• Estimation and Projection Package (EPP) World
  Health Organization (WHO)/UNAIDS modeling
  software, an epidemiologically realistic model to
  estimate adult HIV prevalence.

• We use UNAIDS country-specific adult HIV
  prevalence estimates from EPP for years from the
  beginning of the epidemic to 2010.
• EPP produces a national best fit curve of adult
  HIV prevalence using sentinel surveillance data
  pertaining to pregnant women

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Example of EPP Model
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Estimating AIDS Mortality (1)

• Utilize a new application developed at the U.S.
  Census Bureau that incorporates the EPP adult HIV
  prevalence estimates through 2010 to obtain
  AIDS-related mortality.
• The application uses WHO/UNAIDS Epidemiological
  Reference Group assumptions about age-sex
  distribution and sex ratio of new infections,
  mother-to-child transmission rate, and disease
  progression.

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Estimating AIDS Mortality (2)

• Assume no anti-retroviral therapy.
• Allow for competing risk of death.
• Project HIV incidence rates from the 2010 rate,
  assuming a decline of50 percent by 2050.

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• U.S. Census Bureau Population Estimates and
  Projections for the 15 Focus Countries
• A Comparison of 2004 and 2015 Key Indicators,
  With and Without AIDS

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Percent Change in Population Size, With and
Without AIDS Mortality2004 and 2015
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Trends in Population Size, With and Without AIDS
1990-2015
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Percent Change in Growth Rate, With and Without
AIDS 2004 and 2015
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Infant Mortality RateWith and Without AIDS 2004
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Infant Mortality RateWith and Without AIDS 2015
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Male Life Expectancy at Birth 1995-2015
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Female Life Expectancy at Birth 1995-2015
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Age-Specific Central Death Rates, With and
Without AIDS, by Sex, Mozambique 2015
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• Conclusions

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Demographic Impact by 2015

• Botswana and South Africa are projected to have
  negative population growth by 2015 as HIV/AIDS
  continues to cause elevated mortality while
  fertility levels decline.
• Population structures are projected to differ,
  with some resembling chimneys.
• Due to AIDS mortality, life expectancy at birth
  is projected to be quite different from what
  would have been expected without AIDS.

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References

• UNAIDS Reference Group on Estimates, Modeling and
  Projections. 2002. "Improved methods and
  assumptions for estimation of the HIV/AIDS
  epidemic and its impact Recommendations of the
  UNAIDS Reference Group on Estimates, Modeling and
  Projections." AIDS 16W1-W14.
• UNAIDS/WHO. 2003. The UNAIDS/WHO Estimation and
  Projection Package Multigroup Version (EPP
  Multi). Version 1. Available at
  http//www.unaids.org/EN/resources/epidemiology/ep
  i_softwaretools.asp.
• U.S. Census Bureau, International Programs
  Center. 2003. Rural-Urban Projection (RUP)
  Program. Available at http//www.census.gov/ipc/
  www/rup/.

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Need more information?

• International Programs Center
• Population Division
• U.S. Census Bureau
• Washington, D.C. 20233-8800
• U.S.A.
• FAX [phone]
• E-Mail address ipc-hiv_at_census.gov

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