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The connections between human immunodeficiency virus (HIV) and population features are vast. While HIV has its largest impacts on population size and structure by increasing mortality among young adults, it also affects and interacts with the other key components of population make-up and change, namely, sexual behavior and fertility, and migration. Impacts on these key components in turn affect the well-being of populations in profound ways.
The HIV/AIDS pandemic is likely to surpass all previously recorded epidemics regarding numbers of deaths. Within less than three decades since its introduction, HIV has infected over 60 million persons worldwide, killing more than 25 million of them through the various complications associated with acquired immune deficiency syndrome (AIDS). AIDS ranks fourth among the leading causes of death worldwide and first in sub-Saharan Africa. Unlike earlier epidemics that spread their misfortune across the age distribution, AIDS affects primarily young adults, at the precise ages when childrearing and economic responsibilities are highest. It is not just the epidemiological transition paradigm that was uprooted by the spread of HIV, but also the demographic transition paradigm, which predicted a steady decline of mortality and fertility in the developing world, and a gradual shift from a very young age structure to an older population with a much more evenly distributed age structure. The epidemic has reversed decades of progress in increasing life expectancy and distorted the population pyramids in several hardest-hit sub-Saharan countries. In highly affected countries, population size may decline.
Prevalence of HIV also affects current and future levels of fertility, primarily by increasing mortality among adults of child bearing age, which may reduce the number of births. Other effects of HIV on fertility are mediated through one or more of the classic proximate determinants of fertility. First, widespread widowhood will leave many young adult survivors without child-producing and child-rearing partners. Second, HIV-induced morbidity reduces sexual activity among the infected — in proximate determinants parlance, these first and second mechanisms decrease exposure to intercourse. Third, HIV may increase condom use at the expense of more effective contraceptives, such as the pill, thereby increasing exposure to conception. Fourth, HIV appears to increase fetal loss among infected women; affecting gestation. In addition, HIV may change fertility desires. A wish to compensate for HIV-related child mortality may increase fertility desires; fear of having an infected child and of leaving behind orphans may reduce them.
Migration patterns can be a cause or consequence of HIV transmission. Demographers speculate that migration patterns could facilitate HIV transmission among migrants, and facilitate the spread of HIV across regions. Migration exposes migrants, many of whom are young adults at reproductive age, to new opportunities for sexual experimentation, provides them the discretionary income with which to do so, removes them from the oversight and control of extended kin, and may lead to extended periods of spousal separation. Those conditions potentially increase the likelihood that they visit sex workers or engage in other types of high-risk sexual behavior. Hence, mobile populations often have above-average rates of HIV infection, and may transmit the virus to more permanent partners upon their return. Less studied but also important are patterns of migration that result from AIDS. Urban migrants who are infected often move back home to their villages for care-taking. While the implications for population distribution of such return migrations may not be major, the implications of such widespread moves on intergenerational exchanges (both monetary and in-kind) and the welfare of their parental caregivers are likely to be significant.
HIV also affects other key features of population well-being. The severe morbidity associated with HIV-infection severely diminishes the productivity of those infected, and diminishes scarce labor and financial resources that would have otherwise been available for family investment or consumption. In high-prevalence societies, the loss of highly-trained individuals such as teachers, nurses, and physicians to AIDS will affect critical social institutions such as education and health care. Clinics and hospitals may also become overwhelmed with AIDS patients seeking expensive and sophisticated treatments that the staff are ill-positioned to provide. And traditional patterns of care for children and the elderly, both of whom are dependent upon working age adults for their support, are also being disrupted. Because the use of AZT and other drugs is not yet widespread in some hard-hit countries, the disruption that HIV causes will rival, and perhaps even surpass, the plagues that ravaged Europe in previous centuries and the worldwide influenza epidemic in the most recent one.
- Knodel J. & Van Landingham, M. (2002) The impact of the AIDS epidemic on older persons. AIDS 16 (suppl. 4): S77—S83.
- Stanecki, K. (2004) The AIDS Pandemic in the 21st Century. The Census Bureau, Washington, DC.
- United Nations AIDS (UNAIDS) website: http://www.unaids.org/.