Despite the major effects of the HIV/AIDS epidemic on mortality and life expectancy, populations are continuing to grow even in the hardest-hit countries. With so much uncertainty about the number of people living with HIV/AIDS, the demographic impact is still incompletely understood. Late last year, UNAIDS estimates of the global scope of HIV/AIDS were significantly revised. As we know from the 2007 AIDS Epidemic Update [9], the number of people living with HIV/AIDS globally is now estimated at 33 million (down from 40 million) and annual infections are now assumed to number about 2.5 million (half the previous estimate). Recent revisions to United Nations population projections and HIV/AIDS prevalence estimates have rendered much of the previous data outdated (such as the data used in an earlier post on RH Reality Check [10]).
The 2006 revision of the UN Population Division's projections (PDF [11]) includes more recent HIV prevalence survey data, showing lower prevalence rates in some countries than was previously believed, and also assumes greater access to treatment than the 2004 version. This means that the projected demographic impact of HIV/AIDS is slightly less according to the newer 2006 data. As the methodology of estimating HIV prevalence continues to be refined, the 2008 UN population estimates may show an even smaller demographic impact due to the epidemic.
Therefore, from 2005 through the foreseeable future, HIV/AIDS is not projected to lead to either negative population growth rates or shortened life expectancy in any country. As the UN report summary for the 2006 estimates says [11],
All the countries with the highest prevalence in 2005 are expected to experience positive population growth rates between 2005 and 2050. This trend marks a reversal from previous projections which expected outright reductions of population (that is, negative population growth rates) in countries such as Botswana, Lesotho or Swaziland.
For those of us working to ensure that sexual and reproductive health are well integrated into HIV/AIDS prevention and treatment programs, it is important to stay on top of these shifting numbers and their meaning in the lives of real people. In particular, as the UN Population Division makes clear in its printed materials, these estimates rely on optimistic policy assumptions. Fertility rates in less developed countries are assumed to decline to below replacement level by 2045-2050, a dramatic change from current levels that will require greater investments and a sustained effort to achieve the Millennium Development Goals target of universal access to reproductive health by 2015. As the data have shown, sexual and reproductive health services still need strong financial and human support. For more information, read PAI's new analysis "U.S. HIV/AIDS and Family Planning/Reproductive Health Assistance: A Growing Disparity Within PEPFAR Focus Countries [12]."