**7. References**

244 Social and Psychological Aspects of HIV/AIDS and Their Ramifications

that we may undercount the mortality of children by selecting out mothers who were still alive at time of survey and whose children were under five year of age. However, when women are in an advanced stage of AIDS, and therefore likely to die shortly, they tend to

Our estimates of the contribution of HIV/AIDS to under-five mortality are consistent with some of the early estimates quoted above, but differ from some of the more recent estimates. Most of those are based on the method developed by the UNAIDS / UNGASS group, which is more sophisticated than ours, and takes into account numerous other parameters. Our approach was simpler, and matched basic information about mother to child transmission and AIDS mortality found in case studies. Until the early 2000's these figures were probably correct, since prevention of mother to child transmission and access to HAART (highly active anti-retroviral therapy) took off only in these years. Why the estimates are so different while using similar parameters remains to be further analyzed. The UNAIDS estimates might have been over-optimistic on recent developments of the epidemiology of HIV and its treatment, while ours might be over-pessimistic by assuming that until recently AIDS mortality was quite natural. In particular, some of the estimates quoted by Black et al., [2010], such as the proportion of under-five deaths caused by HIV/AIDS in Botswana, seem abnormally low compared with our estimates, with estimates made by other authors, and

We tried to check the validity of our estimates on the relative contribution of HIV/AIDS in under-five mortality by comparing with independent sources. In South Africa, under-five mortality was decreasing rapidly before 1992, then it increased from 46 per 1000 in 1993 to 85 per 1000 in 2006. According to previous trends, mortality was expected to be about 25 per 1000 in 2006, which, assuming that all the mortality increase was attributable to HIV, suggests that HIV contributed to some 70% of the total in 2006. Similarly, in Zimbabwe, mortality trends predicted a value of 38 per 1000, whereas an under-five mortality of 85 per 1000 was found in 2005, suggesting that 55% of deaths were due to HIV. In Agincourt, a Demographic Surveillance System (DSS) located a rural area of South Africa where causes of death are available, in 2006 HIV/AIDS accounted for 66% of deaths of under-five children, and a similar proportion (64%) was found in nearby hospitals. [updated from Kahn et al. 2007] In Hlabisa, a DSS located in Kwazulu Natal, some 41% of deaths of under-five children were attributed to HIV/AIDS. [Garrib et al., 2006] However, in Manhiça, a DSS located in Mozambique heavily affected by malaria, HIV/AIDS accounted for only 8.3% of the deaths of children age 0-14 years, but possibly more if one considers that deaths attributed to other causes (tuberculosis, malnutrition, diarrhoea, pneumonia) could be also

The large differences in HIV prevalence among African countries remain to be explained. African countries differ in many indicators of economic development as well as in many social indicators. We have argued in another paper that sexual behaviour associated with different marriage patterns, in particular with women's mean age at first marriage, and with permissiveness measured by premarital fertility, were key factors of the dynamics of HIV epidemics. [Garenne & Zwang, 2008; Bongaarts, 2007] This in turn explains some of the patterns found in this study. In more advanced countries of Southern Africa, HIV spread much faster because of later marriage and more permissiveness, and had a stronger relative impact because mortality was much lower at baseline. On the other side of the spectrum, in Sahelian countries, marriage was much earlier, permissiveness much less prevalent, and

have lower fertility, so that the bias might be smaller that anticipated.

with the fast increasing mortality trend seen since 1988.

HIV/AIDS deaths. [Sacarlal et al., 2009]

Adetunji J. (2000). Trends in under-5 mortality rates and the HIV/AIDS epidemic. *Bulletin of the World Health Organisation*; 78(10):1200-6.

Ahmad OB, Lopez AD, Inoue M. (2000). The decline in child mortality: a reappraisal. *Bulletin of the World Health Organization*, 78(10):1175-1191.

The Impact of HIV/AIDS on the Health Transition Among Under-Five Children in Africa 247

Korenromp EL, Arnold F, Williams BG, Nahlen BL, Snow RW. (2004). Monitoring trends in

Maddison, A. (2010). *Historical Statistics of the World Economy: 1 to 2008 AD.* Paris, France: OECD (Organisation for Economic Cooperation and Development).). Mahy M. (2003). Measuring child mortality in AIDS-affected countries. United Nations,

workshop on HIV/AIDS and adult mortality in developing countries). Ndondoki C, Dabis F, Namale L, Becquet R, Ekouevi D, Bosse-Amani C, Arrivé E, Leroy V.

Newell ML, Brahmbhatt H, Ghys PD. (2004). Child mortality and HIV infection in Africa: a

Preston SH. (1980). Causes and consequences of mortality declines in less developed

Stanecki K, Daher J, Stover J, Akwara P, Mahy M. (2010). Under-5 mortality due to HIV:

Stolnitz G. (1955). A century of international mortality trends, pt. 1, *Population Studies*, 9(1):

Stolnitz GJ. (1965). Recent mortality trends in Latin America, Asia and Africa: review and re-

Szreter S. (2003). The population health approach in historical perspective. *American Journal* 

Timaeus LM. (1998). Impact of the HIV epidemic on mortality in sub-Saharan Africa :

United Nations, Population Division. (1982). *Levels and trends of mortality since 1950*. UN

UNAIDS Reference group on Estimates, Modelling and Projections. (2002). Improved

UNAIDS. (2010). *Report on the global AIDS epidemic*. United Nations, Geneva.

UN Millennium Project. (2005). Combating AIDS in the developing world. Task Force on

methods and assumptions for estimation of the HIV/AIDS epidemic and its

HIV/AIDS, Malaria, Tuberculosis, and access to essential medicines; Working

evidence from national surveys and censuses. *AIDS*; 12(1): S15-S27.

*Economic Change in Developing Countries*. University of Chicago: 289-353. Sacarlal J, Nhacolo AQ, Sigaúque B, Nhalungo DA, Abacassamo F, Sacoor CN, Aide P,

*of Epidemiology*; 33(6):1293-1301.

*Médicale* ; 40(1) (forthcoming)

ii56-61.

24-55.

review. *AIDS*;18 Suppl 2:S27-34.

interpretation. *Population Studies* 19(2):117-138.

UNAIDS. (2008). UNGASS country reports. United Nations, Geneva.

group on HIV/AIDS. Earthcan, London, United Kingdom.

*of Public Health*; 93(3): 421-431.

Population Study No. 74.

impact. *AIDS*; 16:W1-W14.

UNAIDS/10.11E/JC1958E

under-5 mortality rates through national birth history surveys. *International Journal* 

Population Division. Doc. UN/POP/MORT/2003/15 (paper presented to the

(2011). Survie et évolution clinique et biologique des enfants infectés par le VIH traités par les antirétroviraux en Afrique : revue de littérature, 2004–2009. *La Presse* 

countries during the twentieth century. In: R.A. Easterlin, ed. *Population and* 

Machevo S, Nhampossa T, Macete EV, Bassat Q, David C, Bardají A, Letang E, Saúte F, Aponte JJ, Thompson R, Alonso PL. (2009). A 10 year study of the cause of death in children under 15 years in Manhiça, Mozambique. *BMC Public Health*; 9:67.

regional levels and 1990-2009 trends. *Sexually Transmitted Infections*; 86 Suppl. 2:


Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H,

Bongaarts J. (2007). Late marriage and the HIV epidemic in sub-Saharan Africa. *Population* 

Buve A, Bishikwabo-Nsarhaza K, Mutangadura G. (2002). The spread and effect of HIV-1 in

Feachem R, Jamison D., editors. (1991). *Disease and mortality in sub-Saharan Africa,* World Bank

Gakusi E, Garenne M. (2007). Socio-political and economic context of child survival in

Garenne M. (1996). Mortality in Sub-Saharan Africa: Trends and Prospects. In: Wolgang

Garenne M, Madison M, Tarantola D, Zanou B, Aka J, Dogoré R. (1996). Mortality impact of

Garenne M, Gakusi E. (2004) Reconstructing under-five mortality trends in Africa from

Garenne M, Gakusi E. (2006a). Health transitions in sub-Saharan Africa: overview of

Garenne M, Gakusi E. (2006b) Vulnerability and resilience: determinants of under-five

Garenne M, Zwang J. (2008). Premarital fertility and HIV/AIDS in Africa. *African Journal of* 

Garrib A, Jaffar S, Knight S, Bradshaw D, Bennish ML. (2006). Rates and causes of child

Human Life Table Database. (2008). University of California at Berkeley, Department of

Houweling TAJ, Anton E. Kunst AE, Moser K, Mackenbach JP. (2006). Rising under-5

Jamison DT, Feachem RG, Makgoba MW, Bos ER, Baingana FK, Hofman KJ, Rogo KO. 2006.

Kahn K, Garenne M, Collison M, Tollman SM. (2007). Mortality trends in a new South

mortality changes in Zambia, *World Development;* 34(10): 1765-1787.

Demography. Available on web site: http://www.mortality.org/

Maryland, USA. [Available on www.measuredhs.com web site]

Rwanda over the 1950-2000 period. *European Journal of Development Research*;

Lutz ed*.: The Future Population of the World : what can we assume today?*. Earthscan

demographic sample surveys. *DHS Working Papers No* 26. IRD-Macro, Calverton,

mortality trends in children under-5-years-olds (1950-2000). *Bulletin of the World* 

mortality in an area of high HIV prevalence in rural South Africa. *Tropical Medicine* 

mortality in Africa: who bears the brunt? *Tropical Medicine & International Health*;

*Diseases and mortality in sub-Saharan Africa*. The World Bank, Washington DC. 2nd

Africa: Hard to make a fresh start. *Scandinavian Journal of Public Health;* 35(Suppl

*Studies*, 61(1): 73-83.

19(3):412-432.

sub-Saharan Africa. *Lancet*; 359:2011–2017.

/ Oxford University Press, New-York, NY, USA.

Publications and IASSA, Laxenburg : 149-169.).

AIDS in Abidjan, 1986-1992. *AIDS*, 10:1279-1286.

*Health Organisation;* 84(6): 470-478.

*Reproductive Health*; 12(1): 64-74.

11(8): 1218–1227.

edition.

69): 26-34.

*and International Health*; 11(12):1841-8.

Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C, and the Child Health Epidemiology Reference Group of WHO and UNICEF. (2010). Global, regional, and national causes of child mortality in 2008: a systematic analysis. *Lancet*; 375:1969e87


**14** 

**HIV/AIDS and the Productivity** 

*1Department of Industrial Psychology & People Management* 

Wilfred I. Ukpere and Lazarus I. Okoroji

*University of Johannesburg* 

*1South Africa 2Nigeria* 

**of Selected Sub-Saharan African Regions** 

*2Department of Transport Management, Federal University of Technology Owerri* 

More than 42 million people around the world are currently infected with the Human Immunodeficiency Virus (HIV), which causes the Acquired Immunodeficiency Syndrome (AIDS) (Ojukwu, 2004). Although new cases of HIV/AIDS infections have declined in most developed countries, the virus has spread rapidly through much of the developing world. In some areas of sub-Saharan Africa, one in four adults is infected with the virus (Saloner, 2002). Acquired Immunodeficiency Syndrome (AIDS) comprises a collection of symptoms and infections, which result from specific damage to the immune system as a result of HIV. Latter stages of the condition leave individuals susceptible to opportunistic infections and

Most European researchers believe that HIV originated from sub-Saharan Africa. Although this allegation may appear to be libellous, sub-Saharan Africa has become one of the worst affected regions (UNAIDS, 2003). An estimated 38.6 million people currently live with the disease worldwide (Nunn, Baggaley, Melby & Thomas, 2004). According to the joint United Nations Program on HIV/AIDS (UNAIDS, 2006), HIV/AIDS has killed more than 25 million people since it was first recognized in 1981, which makes it one of the most destructive epidemics in recorded history. HIV/AIDS has claimed an estimated 2.4-3.3 million lives, of which more than 570,000 were children in 2005 (WHO, 2006). Almost one third of the deaths accruing to HIV/AIDS, occurred in sub-Saharan Africa. This development has adversely impacted on economic growth and human capital development

Antiretroviral treatment reduces both mortality and morbidity regarding HIV infection, however, routine access to antiretroviral medication is not available in all countries (WHO, 2003). HIV/AIDS stigma is more severe than that associated with other life-threatening conditions and extends beyond affected individuals, care providers and even volunteers

Evidently, the physical size of a country, its population and its national income level per head, are important determinants of economic potential- a major factor, which differentiates one country from another. A country's potential for economic growth is influenced by its

who are involved with caring for people who live with the disease (Salati, 2004).

**1. Introduction** 

within this region.

tumours (Arnett 2001; UNAIDS, 2004).

