The impact of AIDS in the developing world

The present and future impact of AIDS in the developing world has been underestimated and it is difficult to describe for two reasons: lack of information and unwillingness to believe the implications of the facts we do have. The impact of HIV infection on the developing world is shaped by several factors: introduction of the virus into whole adult communities not subdivisions of them; heterosexual spread determining an equal sex incidence; traditional customs which do not limit sexual activity to one partner; a different range of potential opportunist pathogens and co-existing climatic, economic, and political problems which fragment attention and action. Africa is in the frontline of the HIV pandemic and our data are derived from that continent. The sex ratio for seropositivity and disease is almost equal with a small excess of men. The mean age at diagnosis (and death) is between 35 and 37 years for men, and between 27 and 30 years for women. We predict serious losses to the economy, including agriculture, medicine and the civil service, and women will die without completing their families, as pregnancy accelerates progression of HIV-related disease. We do not know how many persons infected with HIV will develop related disease, or how fast they will do so, but the pool of seropositive people in Africa is already vast and still increasing. There are surveys (mainly but not exclusively urban) showing seropositivity rates of 10–15% in healthy blood donors, of 9–24% in pregnant women, and of 30% in persons attending clinics for sexually transmitted diseases. Wherever new patients with HIV-related disease have been recorded for two or more years, an exponential increase in numbers is seen and the implications for already overstretched health services are fearful. In developing countries, nearly half the population are dependent children. We predict that numbers of caring adults will fall due to premature deaths, leaving fewer to cope with the needs of the sick, demented, dying and orphaned. Extended families may not be able to care for all the orphans, and most families will be affected in some way. There is no recent model for a community disaster of this magnitude to help us to predict the effects on morale and behaviour to be expected. However, there are grounds for hope. We look forward to a reduction in the rate of spread of HIV as education-for-prevention takes effect, particularly amongst women and children; to a reduction in the incidence of sexually transmitted diseases; to accelerated development of laboratory services and pharmaceutical research; and to the manufacture of a vaccine, although probably not for several years. Affected communities will need new resources to maintain morale and compassion, the courage to face fundamental questions about the meaning of death and life, and the capacity to transcend suffering through story and drama, music and worship. We hope for a renewal of cultural and spiritual life to achieve this.