The HIVAIDS Epidemic Orphans, Vulnerable Children and the Future

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The HIV/AIDS EpidemicOrphans, Vulnerable
Childrenand the Future

• TONY BARNETT

The London School of Economics and Political
Science
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HIV/AIDS
The London School of Economics and Political
Science
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HIV ATTACHING ITSELF TO HUMAN CELL
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VIRUS PARTICLES BUDDING FROM HUMAN CELL
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HIV/AIDS - specific features

• a cloud of mainly sexually transmitted slow
  acting viruses
• Progressive break down of immune system (AIDS)
• A history-changing event the epidemic and its
  effects lasts for many decades
• morbidity and mortality are concentrated in
  mature adult cohorts
• an HIV/AIDS epidemic has marked social and
  economic impacts in societies where infection
  levels are in the range 10-40 per cent in
  populations aged 15-50 years

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Number of people living with HIV/AIDS in
sub-Saharan Africa, 1980-2001
30
Millions
25
20
15
10
5
0
1980
1983
1986
1989
1992
1995
1998
2001
Source UNAIDS, 2002
7
Number of people living with HIV/AIDS in Asia
1980-2001
Source UNAIDS/WHO, 2002
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Global estimates for adults and childrenend 2002

• People living with HIV/AIDS
• New HIV infections in 2002
• Deaths due to HIV/AIDS in 2002

42 million 5 million 3.1 million
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About 14 000 new HIV infections a day in 2003

• More than 95 are in poor countries
• 2000 are in children under 15 years of age
• About 12 000 are in persons aged 15 to 49 years,
  of whom
• almost 50 are women
• about 50 are 1524 year olds

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Typical Age and Sex Distribution of AIDS cases
in a population in Africa
Sexually active socially and economically
productive age groups
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Orphan what does it mean?
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BENUE STATE NIGERIAINCREASING NUMBERS OF ORPHANS
SOURCE SAMPLE SURVEY 2002, UNPUBLISHED DATA,
DEPARTMENT FOR INTERNATIONAL DEVELOPMENT
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The impact of HIV/AIDS on a Ugandan rural
household 1980-89
T. Barnett and P. Blaikie, AIDS in Africa its
present and future impact, Wiley, London and
Guilford Press, NY, 1992.
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ZAMBIA STUDY 2003 UN ILO

• CHILD LABOURERS AGE 5-16
• 1/3 LOST ONE OR BOTH PARENTS
• LOW OR NO SCHOOL
• POOR HEALTH, HAZARDOUS WORK
• SEX TO SURVIVE - GIRLS 14-16 PAID 0.80 FOR SEX,
  4 CLIENTS PER DAY

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LOW LIFE EXPECTANCY
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Changes in life expectancy in selected African
countries with high and low HIV prevalence
1950-2005
65
60
with high HIV prevalence
Zimbabwe
55
South Africa
Botswana
50
Life expectancy (years)
45
with low HIV prevalence
40
Madagascar
Senegal
35
Mali
30
1950 1955
1955- 1960
1960- 1965
1965- 1970
1970- 1975
1975- 1980
1980- 1985
1985- 1990
1990- 1995
2000- 2005
1995- 2000
Source UN Department of Economic and Social
Affairs (2001) World Population Prospects, the
2000 Revision
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Life expectancy

• We need to reflect what reduced life expectancy
  and reduced expectancy of adult life really mean
• This has serious implications for social,
  economic and cultural futures

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HIGH CHANCES OF INFECTION
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Lifetime risk of AIDS death for 15-year-old boys,
assuming unchanged or halved risk of becoming
infected with HIV, selected countries
risk halved over next 15 years
current level of risk maintained
100
Botswana
80
Zimbabwe
South Africa
Botswana
Zambia
60
Zimbabwe
Kenya
Risk of dying of AIDS
South Africa
Côte dIvoire
Zambia
40
Cambodia
Kenya
Côte dIvoire
Burkina Faso
20
Cambodia
Burkina Faso
0
0
5
10
15
20
25
30
35
40
Current adult HIV prevalence rate
Source Zaba B, 2000 (unpublished data)
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THE CHALLENGE OF ART

• ANTI RETROVIRAL THERAPY
• EXTENDS LIFE EXPECTANCY
• KEEPS PEOPLE PRODUCTIVE AND CARING
• EXPENSIVE BUT GETTING CHEAPER
• A MAJOR ISSUE FOR ORPHANS AND VULNERABLE CHILDREN
  
• HOPE FOR THE FUTURE - A FACTOR IN PREVENTION!

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COSTS DRUGS or CHILDRENS FUTURES?

• FAILURE TO PROVIDE ARVs WILL MAKE SOCIETIES MORE
  VULNERABLE TO DISORDER AND POVERTY
• SOCIAL DISORDER AND POVERTY CONTRIBUTE TO DISEASE
  SPREAD
• DISORDER AND POVERTY HAVE INTERNATIONAL
  IMPLICATIONS
• THE PILGRIMAGE IN SEARCH OF TREATMENT
• POLITICAL RESENTMENT FROM GENERATION TO
  GENERATION

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Orphan what futures for our children?
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HOW WE CHOOSE TO TREAT DISTANT ORPHANS TODAY AND
TOMORROW AFFECTS THE FUTURES OF OUR CHILDREN AND
GRANDCHILDREN
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Orphan what does it mean?