AIDS to Cut Africa Life Expectancy to Under 30

Life expectancies in some African countries will soon drop below age 30 because of the staggering number of AIDS deaths, experts said Monday. And for perhaps the first time in their history, some nations in southern Africa will experience negative population growth as a result of AIDS, according to the U.S. Census Bureau.

The gloomy projections, announced at the 13th International Aids Conference in Durban, South Africa, contrasted with more encouraging statistics on the spread of AIDS among heterosexual teenagers in the United States. Authorities reported that growing numbers of American teenagers have been heeding anti-AIDS alarms by reducing sexual activity and increasing condom use.

The epidemic in Africa is the continent’s “worst social catastrophe since slavery,” said Dr. Kevin DeCock of the U.S. Centers for Disease Control and Prevention.

Nearly three-quarters of the 34 million people living with AIDS reside in sub-Saharan Africa, and deaths are increasing at a rate that scientists would have found incomprehensible only a few years ago.

Since the beginning of the AIDS epidemic, 11.5 million people have died of the disease in sub-Saharan Africa. About 5,500 now die of AIDS every day, but researchers predict that about 13,000 will die daily by 2010. AIDS now accounts for 21% of all deaths in the region, with malaria a distant second at 9.1%.

As the death rate rises, the average life expectancy will fall sharply, said epidemiologist Karen Stanecki of the census bureau.

“It’s hard to comprehend the amount of mortality we will see in those countries,” she said at a Monday news conference.

Stanecki predicted that within three years, the populations of Botswana, South Africa and Zimbabwe will begin to drop by 0.1% to 0.3% per year because of AIDS deaths. In the absence of the epidemic, those populations would have risen about 1% to 3% per year.

Population growth will be essentially zero in several other countries, she said, including Malawi, Namibia, Swaziland and Zambia.

She projected that by 2010, life expectancy will be 29 in Botswana, 30 in Swaziland and 33 in Namibia and Zimbabwe. A recent report by the World Health Organization estimated that 35.8% of the population of Botswana is HIV-positive. Without AIDS, life expectancy would be near 70.

“This is a level of life expectancy that has not been seen since the start of the 20th century,” Stanecki said.

The news from the United States, meanwhile, was more encouraging.

Despite recent reports that risky sexual behavior is increasing among gay males, heterosexual intercourse among 14- to 18-year-olds declined by 8% during the 1990s and condom use rose by 25%, according to new data from the CDC. The decline in intercourse marked the first sustained drop in two decades.

“We now have extensive evidence that prevention can and does work,” said Dr. Ronald O. Valdiserri, deputy director of the CDC’s National Center for HIV, STD and TB Prevention.

At the same time, officials cautioned that HIV infection rates are alarmingly high among African Americans in some northeastern and southern U.S. cities and are rising in young adult women.

CDC officials had first noticed a slight reduction in sexual activity among teenagers two years ago, but the new data indicate that the reduction constitutes a trend, not an aberration, said CDC epidemiologist Laura Kann, who led the study. “Fewer high school students in the United States are engaging in behaviors that place them at risk for HIV infection,” she said Monday.

Among Kann’s findings:

* High school students who reported having sex declined from 54.1% in 1991 to 49.9% in 1999.

* Those having sex with multiple partners dropped from 18.7% to 16.2%.

* Those having sex before age 13 dropped from 10.2% to 8.3%.

* Condom use among sexually active high school students increased from 46.2% to 58%.

In a separate study, Dr. Mary Lou Lindegran of the CDC reported that about 2,100 American teenagers now are HIV-positive as a result of mother-to-child transmission. Overall, there are about 10,000 HIV-positive children and adolescents in this country.

The CDC estimates that about 40,000 new infections occur in the United States each year, with about half of those among African Americans and about 15% among Latinos. Rates vary widely across the country, however, said Dr. Hazel Dean-Gaitor of CDC.

The incidence of HIV infection among blacks in Jersey City, N. J., the highest in the study, was 13 times higher than the rate among blacks in Flint, Mich., the lowest, she said. Other New Jersey cities also showed very high infection rates in blacks as well as Latinos.

The incidence of HIV infections among Latinos in Newark, N.J., was five times as high as that of Latinos in Albuquerque, N.M. Comparative data were not available for Los Angeles because California does not have mandatory HIV reporting.

The overall number of HIV infections among women, surprisingly, declined by 9% between 1994 and 1998, said CDC epidemiologist Lisa M. Lee. That decrease resulted primarily from a steep drop in HIV diagnoses among women born before 1970 who were infected through intravenous drug use.

Among young women, however, the incidence of infection doubled during the same period--although the overall number of cases remained small: 498 in 1998.

Although similar anti-AIDS messages, along with condom distribution, have slowed the spread of HIV in a handful of African countries such as Zaire and Uganda, officials are looking for other ways to interrupt its expansion. One valuable tool, researchers said Monday, would be wider use of circumcision.

Whether circumcision can interfere with AIDS transmission has been a matter of debate for several years, but several new studies suggest that it can play a significant role.

Dr. Robert Bailey of the University of Illinois at Chicago studied the Luo, a tribe of 3 million in Kenya that does not practice circumcision. He reported that the Luo have a much higher rate of HIV infection than nearby groups that practice circumcision.

About 30% of Luo women and 25% of the men are HIV-positive. “This is two to three times higher than in other [nearby] areas,” he said.

Dr. John Gray of Johns Hopkins University and colleagues at Makerere University in Kenya studied 5,500 Ugandan men for several years. They found that circumcised men had an average of about 1.1 HIV infections per 100 men, compared with a rate of 1.6 per 100 for uncircumcised men. The uncircumcised men were also more likely to infect their wives.

Several other studies produced similar results.

“I believe the evidence is now compelling enough to consider adding circumcision to the limited armament we already have against HIV/AIDS,” Bailey said.

Meanwhile, the Bill and Melinda Gates Foundation announced Monday that it will donate $50 million to the battle against AIDS in Botswana, and Merck & Co. said it will donate anti-AIDS drugs worth a similar amount. The Gates money will be used to build up the health infrastructure so that the drugs can be distributed efficiently.

“This is going to make a world of difference for people living with HIV in Botswana,” said Jeffrey Turchio, a spokesman for Merck.

But many activists were not impressed by the announcement.

“We don’t want giveaways,” said Sharon Ekambaram of the HIV/AIDS People’s Treatment Action Campaign. “We want them to reduce the price of all their drugs.”