**7. References**

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

It is evident from the results that in the past, most Batswana discriminated against people living with HIV and AIDS. Letamo (2003) found that close to two-thirds of people in 2001 expressed discriminatory attitudes toward people living with HIV and AIDS and the majority of these people were males. This percentage dropped to 44.3% in 2004 and later in 2008 to 23.5%. The reductions in the proportion of people who discriminate against those living with HIV/AIDS are believed to be due to government efforts to reduce stigma and discrimination. The consistent declining trends in discriminatory attitudes towards people living with HIV and AIDS may be suggestive of the fact that the Government of Botswana initiatives in fighting stigma and discrimination associated with HIV and AIDS are starting

A consistent finding emerging out of the data is that people tend to express accepting attitudes toward people living with HIV and AIDS if they are family members but more discriminating if they are unrelated to them. Like it was earlier stated in Letamo (2003), the more tolerant attitude to care for a family member who is living with HIV/AIDS probably reflect the government intervention of promoting community home-based care programmes. The concept of community home-based care was introduced in 1992 to reduce the relieve public hospitals of the burden of caring for increasing number of AIDS patients. Community home-based care is a programme desired to ensure that family members of people living with HIV and AIDS actively participate in the care of their members. In other words, one can conclude that community home-based care indirectly promotes tolerant

Another emerging observation from the results is that females rather than males have more tolerant attitudes toward people living with HIV and AIDS. The more tolerant attitudes toward people living with HIV and AIDS of females may reflect the current set-up where a disproportionate number of women provide care to all members of the family. Community home-based care is almost exclusively shouldered by women (Population Reference Bureau,

This study found that although HIV/AIDS-related discrimination has been decreasing over the years, there are still those who harbour these negative attitudes toward people living with HIV and AIDS. Unattended to, these negative attitudes may hamper utilization of various HIV/AIDS care services. It is evident that government efforts or interventions to address HIV/AIDS-related stigma and discrimination are producing desirable outcomes, even though there is room for improvement. Current anti-stigma interventions need to be strengthened in order to uproot HIV/AIDS-related stigma and discrimination completely. It is also important to conduct further studies to understand why people stigmatise and

The author would like to express his sincere gratitude to the comments made by colleagues during the presentation of the draft manuscript to the STARND Consortium members before it was submitted for consideration of publication as a book chapter. The comments made were invaluable and helped to improve the current manuscript. The author would

to produce desired results.

n.d.).

**5. Conclusions** 

**6. Acknowledgement** 

attitudes towards people living with HIV and AIDS.

discriminate against those living with HIV or have AIDS.


**13** 

*France* 

Michel Garenne

**The Impact of HIV/AIDS on the Health** 

*Institut Pasteur, Epidémiologie des Maladies Emergentes, Paris,* 

 *Institut de Recherche pour le Développement (IRD),* 

**Transition Among Under-Five Children in Africa** 

Child survival improved dramatically throughout the world over the past century. Measured as the under-five death rate (the probability of dying before reaching the fifth birthday), child mortality declined from values as high as 300 to 600 per 1000 live births to values as low as 5 to 10 per 1000 in most advanced countries, sometimes even lower, and values around or below 100 per 1000 in most developing countries. [Stolnitz, 1955 & 1965; United Nations, 1982; Ahmad et al., 2000] In industrialized countries this mortality decline was associated firstly with the development of hygiene, clean water supply, sanitation, improved nutrition, and more recently with major advances in preventive and curative medicine. [Szreter, 2003] In developing countries of Africa and Asia, child mortality decline seems more associated with preventive and curative medicine, and less so with hygiene and nutrition, although these have also improved in most cases. [Preston, 1980; Feachem and

Beyond regular improvements associated with economic development, social change and modern medicine, reversals in the health transition might occur as a result of external shocks, such as emerging diseases. When a new very lethal disease appears, it may cause an increase in child mortality, despite a decline in mortality from other causes of death. Since 1980, the most important of these emerging diseases is HIV/AIDS, and the continent the most hardly hit by HIV is sub-Saharan Africa. [Newell et al., 2004; UNAIDS, 2010; Jamison et al., 2006] In addition to emerging infectious diseases, other heath threats could also contribute to increasing mortality, for instance various pollutions or exposure to health hazards which may cause cancer, and behavioural changes such as smoking, substance abuse and obesity, although these are more likely to affect adults than under-five children. Sub-Saharan Africa is very heterogeneous in terms of level of income, level of education, hygiene and sanitation, as well as culturally. Some countries are already quite advanced and modern (e.g. countries in the Southern cone), whereas others lag behind, with low income, low education, low hygiene and poor public health (e.g. Sahelian countries). The effects of an external shock such as an emerging disease are therefore likely to differ among these countries, partly because the spread of the disease might differ, partly because the response to it might differ, and partly because baseline values also differ. Trends in under-five mortality are also determined by other dynamics, and are often related with political

Jamison, 1991; Ahmad et al., 2000; Jamison et al., 2006]

**1. Introduction** 

