HIV/AIDS Weakens the Immune System Opportunistic infections: Pneumonia Meningitis Some cancers Tuberculosis (TB) Other parasitic, viral and fungal infections that weaken the immune system [Note: This is a collection of slides highlighting global and regional HIV/AIDS statistics, as of July 2006. Feel free to use any number of these slides when discussing AIDS with your students.] HIV kills by weakening the body’s immune system until it can no longer fight infection. ((Meningitis - Inflammation of the meninges of the brain and the spinal cord, most often caused by a bacterial or viral infection and characterized by fever, vomiting, intense headache, and stiff neck. (according to dictionary.com))

Global Estimates – HIV/AIDS People now living with HIV New HIV infections in 2005 Deaths due to AIDS by the end of 2005 40 million 4.9 million 25 million The total number of people living with the human immunodeficiency virus (HIV) rose in 2005 to reach its highest level ever: an estimated 40 million. An estimated 4.9 million people were newly infected in 2005 95% in sub-Saharan Africa, Eastern Europe, or Asia 25 million people had died of AIDS by the end of 2005

Growth of the AIDS Epidemic People With HIV/AIDS, Cumulative Regional Totals Millions Sixty-three percent of the world’s HIV population lives in sub-Saharan Africa. The first published report of AIDS was in the United States on June 5, 1981. Source: CDC, www.cdc.gov/mmwr/PDF/wk/mm5021.pdf, accessed July 7, 2006. *Western and Central Europe & North America. Source: UNAIDS/WHO, 2005.

Map of HIV Prevalence Worldwide 2005 The greatest prevalence is in sub-Saharan Africa. [FYI: This map is based on more recent data than the map in PRB’s recent Population Bulletin on this subject. A few countries (such as, Brazil and Peru swapped status; Mozambique is in a higher status), have a different prevalence than the 2004 data determined. Even though the status has changed from one year’s report to another, it is recommended that these changes are not interpreted as a trend.] Adults Ages 15-49 with HIV 15.01% - 34.0% 5.01% - 15.0% 1.01% - 5.0% 0.51% - 1.0% 0.0% - 0.5% Not available Source: UNAIDS, 2006 Report on the Global AIDS Epidemic, 2006.

People Now Living with HIV Western & Central Europe 720,000 Eastern Europe & Central Asia 1.5 million North America 1.3 million East Asia 750 000 Caribbean 330,000 North Africa & Middle East 440,000 South & South-East Asia 7.6 million Sub-Saharan Africa 24.5 million Latin America 1.6 million Oceania 78,000 Sub-Saharan Africa remains by far the worst-affected region, with 24.5 million people living with HIV at the end of 2005, compared to 23.5 million in 2003. Just under two-thirds (63%) of all people living with HIV are in sub-Saharan Africa, as are more than three-quarters (76%) of all women living with HIV. HIV prevalence in the Caribbean is the second-highest in the world, with 1.6% of adults infected with HIV (in comparison with 6.1% in Sub-Saharan Africa). Haiti has the highest HIV prevalence in the Caribbean, with 190,000 people living with HIV and the adult prevalence estimated at 3.8% in 2005. Cuba, as an exception for the region, has very low HIV prevalence (0.1% among adults). The country’s program to prevent mother-to-child transmission of HIV is among the most effective in the world and Cuba offers free, universal access to antiretroviral therapy. Expanding access to antiretroviral treatment is helping a handful of Caribbean island countries make small yet significant progress in fighting the epidemic. Total: 40 million Source: UNAIDS, 2006 Report on the Global AIDS Epidemic, 2006.

HIV Demographics, Worldwide Composition of the Population Living with HIV, 2005 Another pattern of HIV infection is the distribution between genders. Worldwide, the percentage of women and men living with HIV is relatively equal. Source: UNAIDS, 2006 Report on the Global AIDS Epidemic, 2006.

HIV Demographics, Africa Composition of the Population Living with HIV, 2005 Sub-Saharan Africa Rest of the World The proportion of people living with HIV who are adult women (ages 15 to 49) is 1.9 times higher in sub-Saharan Africa than in other regions. In sub-Saharan Africa, women account for more than half of the 24.5 million people living with HIV. In other regions, the proportion of people living with HIV who are women drops to an average of around one-third. Source: UNAIDS, 2006 Report on the Global AIDS Epidemic, 2006.

Adults with HIV Who are Women 2005 Percent Women make up almost one-half of HIV infections worldwide and 59 percent of infections in sub-Saharan Africa, where the virus is spread predominantly through heterosexual transmission and has reached the general population. In a generalized epidemic, women’s low status and inability to negotiate with men puts them at great risk of contracting the disease. Women account for smaller percentages of infected people where the AIDS epidemic is limited to high-risk populations such as injecting drug users or men having sex with men. Source: UNAIDS, 2006 Report on the Global AIDS Epidemic, 2006.

Effect of AIDS on Life Expectancy 2015-2020 Projections for Selected Countries Life expectancy at birth, in years AIDS has reduced life expectancy in several countries around the world. [Definition: Life Expectancy The average number of additional years a person could expect to live if current mortality trends were to continue for the rest of that person's life. Most commonly cited as life expectancy at birth. Provides a sense of the distribution of health services, the level of infant mortality rates, and general well-being of the population.] In Lesotho, for example, without accounting for the impact of AIDS, life expectancy would have been 69 years; however, with AIDS, life expectancy has dropped to 39 years. Because life expectancy says so much about a country’s well-being, It is a key indicator of social and economic development All of these countries have lower life expectancies than industrialized nations. This is in large part the result of high infant mortality rates. Source: United Nations, World Population Prospects: The 2004 Revision, 2005.

Effect of AIDS on Child Mortality Selected Countries in Sub-Saharan Africa, 2002-2005 Deaths of children under age 5 per 1,000 live births Another key indicator of social and economic development can be traced by looking at child mortality. The child mortality rate is defined as the death rate for children under age 5. So far, the epidemic has stalled or reversed progress in child survival in highly affected countries. For example: In South Africa and Swaziland, child mortality rose between the late 1990s and early 2000s. If not for AIDS mortality, the rate would have dropped (the right bar) to 43 in South Africa and 73 in Swaziland today. Instead, the rate in South Africa went from 62 in the late 1990s to 74 in the early 2000s; for Swaziland, the rate went from 109 to 143 during the same time period. Children infected with HIV through their mothers (mother-to-child transmission) have a difficult chance surviving. One-third die before reaching age 1 and approximately 60% die by age 5. [The Millennium Development Goal #4 – Reduce child mortality: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate.] Source: UNAIDS and UNICEF, A Call to Action: Children, The Missing Face of AIDS, 2005; and United Nations, World Population Prospects: The 2004 Revision, 2005.

AIDS’ Toll on Population Structure, South Africa Population Structure in 2020 Millions Age 80+ 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5 Females Males An unique aspect of this disease is the effect it is having on the adult population. [As the outer bars show….] If we use South Africa as an example, between now and 2020, the adult population will shrink, with especially high losses among women in their 30s and 40s, and men over 40. (Largest number of AIDS deaths tends to occur approximately 10 years after HIV prevalence rates peak). By the year 2020, fewer children will be born because of deaths and lower fertility among HIV-positive women. South Africa embodies many of the changes projected for populations severely affected by AIDS. With AIDS Without AIDS Source: United Nations, World Population Prospects: The 2004 Revision (CD-ROM Edition—Extended Dataset), 2005.

Slower Population Growth Populations continue to grow in many heavily affected countries, although the growth is less than it would be in the absence of AIDS.

South Africa’s Population With and Without AIDS Millions In South Africa, deaths from AIDS will nearly halt population growth in the next 15 years despite high fertility. (The fertility rate of South Africa is: 2.8 children per woman, according to PRB’s 2005 World Population Data Sheet) Source: United Nations, World Population Prospects: The 2004 Revision (CD-ROM Edition—Extended Dataset), 2005.

HIV – Only Health Problem or a Development Issue? Public Health Burden Overwhelms health systems in many countries Labor, Business, and Agriculture Losses in skilled labor Decreases productivity; having an economic impact Threatens agricultural production and food security Governance and Public Service Country losses of political leaders and civil servants Revenues decline and costs rise Demand for social services increases This slide provides a few possible answers to Question #6 from Handout 1: The Food and Agricultural Organization, when speaking about HIV/AIDS, said, “The disease is no longer just a health problem but has become a development issue as well.” The possible answers are in more detail on the slide and generally noted as follows: AIDS affects people in their prime working ages. Business level – having a high turn over rate among employees can lead to decreased productivity. On the national level, this can lead to fewer exports, reducing the country’s Gross Domestic Product. The disease is crippling progress at the personal, family, community, and national levels.

Poverty and HIV/AIDS Inadequate access to accurate information or prevention services Seeing no alternative besides sex work, for some women Labor migration – leads to increased vulnerability and spread of HIV Once infected, inadequate access to health care and treatment Vicious cycle of poverty, such as children orphaned because of AIDS This slide provides a few possible answers to Question #7 on Handout 1: “How might poverty exacerbate the HIV/AIDS problem and increase individual vulnerabilities?” “Inadequate nutrition, health care, education, and economic activities all contribute to the spread of the epidemic, and shorten the life span of those infected.” (according to The Hunger Project) Poverty could mean little access to accurate information or prevention services. Poverty drives some women into the sex industry. Labor migration is another trade that leads to increased vulnerability and spread of HIV. (Without family and community support systems, migrants are more likely to engage in risky behaviors.)   Once infected: The poor tend to have less access to health care and treatment. AIDS often takes the primary wage earner, leaving children to assume responsibility for younger siblings and seek work to help support the family. Instead of staying in school to seek better employment opportunities later, these children usually become trapped in the vicious cycle of poverty. (At the end of 2003, 15 million children had lost at least one parent to AIDS, according to “The Global Challenge of HIV and AIDS,” Population Bulletin, March 2006, Population Reference Bureau.)

Poverty and HIV/AIDS The Hunger Project, A Vicious Cycle – Poverty exacerbates HIV/AIDS, and HIV/AIDS exacerbates poverty, October 2001. http://www.thp.org/aids/cycle.htm United Nations (Population Division), Population, Development and HIV/AIDS with Particular Emphasis on Poverty, 2005. http://www.un.org/esa/population/publications/concise2005/PopdevHIVAIDS.pdf ILO and UNAIDS, Women, girls, HIV/AIDS and the world of work, December 2004. http://www.ilo.org/public/english/protection/trav/aids/publ/women-iloaids-brief.pdf The previous suggested answers came from a variety of sources: The vulnerability section of “The Global Challenge of HIV and AIDS,” Population Bulletin, March 2006, Population Reference Bureau. The other sources listed on the slide. Also useful: Cohen, Desmond, United Nations Development Programme, Poverty and HIV/AIDS in Sub-Saharan Africa, 1998. http://www.undp.org/hiv/publications/issues/english/issue27e.html

About 11,000 New HIV Infections a Day in 2005 More than 95% are in low and middle income countries About 1,500 are in children under age 15 About 10,000 are adults age 15 and older, of whom: almost 50% are women about 40% are ages 15–24 Given the number of new infections, the need for continued prevention efforts is clear. Virtually every region, including sub-Saharan Africa, has several countries where the epidemic is still at a low level or at an early enough stage to be held in check by effective action. As women are increasingly affected, strategies are needed to address the structural dynamics of the AIDS epidemic—particularly the wide-ranging gender inequalities that help power the spread of HIV. It is important that women are more closely involved in designing and guiding programs that are meant to serve them. Source: UNAIDS, 2006 Report on the Global AIDS Epidemic, 2006.

Children Estimated to be Living with HIV Children are defined as under age 15 Western & Central Europe 4,000 Eastern Europe & Central Asia 6,900 North America 11,000 East Asia 6,400 Caribbean 22,000 North Africa & Middle East 31,000 South & South-East Asia 170,000 Sub-Saharan Africa 2.0 million Latin America 32,000 Oceania 3,000 The overwhelming majority of children with HIV contract the infection from their mothers, during pregnancy, delivery, or through breastfeeding. In sub-Saharan Africa, about 2 million children (younger than age 15) were living with HIV at the end of 2005—8% of the total number of people living with HIV in the region. Total: 2.3 million Source: UNAIDS, 2006 Report on the Global AIDS Epidemic, 2006.

Global HIV and AIDS Estimates for Children Children are defined as under age 15 Children living with HIV New HIV infections in 2005 Deaths due to AIDS in 2005 2.3 million 540,000 380,000 It is estimated that: 2.3 million children (under the age of 15) worldwide are living with HIV. 540,000 were newly infected during 2005. 380,000 children died from AIDS during 2005. Source: UNAIDS, 2006 Report on the Global AIDS Epidemic, 2006.

In Summary HIV / AIDS - global epidemic Obvious impacts on demographic trends, especially population projections Visual patterns of mortality and health …. Therefore, the AIDS epidemic is an important and useful topic to cover in AP Human Geography.