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Bull Acad Natl Med. 1990 Nov;174(8):1209-19; discussion 1219-21.

[Socioeconomic aspects of human immunodeficiency virus (HIV) infection in developing countries].

[Article in French]

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Département des maladies infectieuses et tropicales et de santé publique, Unité INSERN 313, Groupe hospitalier Pitié-Salpêtrière, Paris.


The assessment of the socio-economical aspects of the human immunodeficiency virus (HIV) infection is difficult because of the relative scarcity of information. This study addresses mainly the socio-economic aspects of the AIDS pandemic in the inter-tropical zone of Africa, which, at the moment, constitutes the epicenter of the disease. In the absence of a possible radical treatment, the HIV infection prevalence should range between 25 and 30 million individuals by the year 2000 in the world, and the number of cases of AIDS, between 5 and 6 million, among which 4 to 5 million in the developing world alone. At the current rate, the overmortality rate related to AIDS in Africa is estimated at 0.1%, which should result in a drop by 30% of the Gross National Products advance (GNP). Each case of AIDS in Africa leads to a loss of productivity of 8.8 years. Already, losses caused by AIDS screening and its medical treatment in five countries of Central Africa should exceed the total amount of the foreign assistance received by each country. The estimated economic weight of the AIDS attendance is 15 to 20 times more heavy for a developing country than for an industralized one. Overcoming economically the cost of AIDS is an objective impossible to reach for deprived countries.


Tropical Africa is the epicenter of the AIDS epidemic, with an estimated 500,000 AIDS cases and 5 million seropositive individuals as of October 1990. The World Health Organization estimates that 3 times as many persons will be infected by HIV in 1991-2000 as in 1981-90. In the absence of an effective treatment, the worldwide prevalence of HIV infection is expected to reach 20 million adults and the number of reported cases 5-6 million by the year 2000. 400,000 children are estimated to have contracted AIDS since the beginning of the epidemic, in addition to some 8800,000 adults. It is projected that from now to the year 2000, at least 10 million children will be infected by Hiv, 90% of them in sub-Saharan Africa. The direct costs of treating AIDS are enormous and far outstrip available resources in Africa. The annual budget of the principal hospital in Kinshasa is lower than a cost of treating 10 AIDS patients in the US. The funds destined for AIDS prevention programs in Africa and other developing areas are not likely to increase significantly. On the other hand, some indicators such as total condom sales in some African countries suggest that public awareness of protective measures may be growing. The World Health Organization estimates that of 3 million persons affected by both AIDS and tuberculosis, 2.4 million are in Africa. A chemotherapy has been developed that shortens tuberculosis treatment from 12 to 6 months, but its cost, about US $30-50 per person or $200 if hospitalization is required, will further burden health budgets. It will be difficult for Africa to meet the direct costs alone of AIDS, given that annual per capita health expenditures are much lower than the cost of a diagnostic test for HIV infection. The age group most affected by AIDS is 25-45 years. The World Bank estimates that excess mortality related to AIDS in Africa amounts to .1%, which may result in a 30% decline in the progress of the GNP. Each case of AIDS results in a loss of productivity of 8.8 years. HIV prevalence is higher in urban areas and among the upper classes and elites. Airline pilots, physicians and nurses, and members of the armed forces have particularly high rates in some countries. Despite the lack of reliable statistics, the epidemic is known to be spreading into rural areas. The zones of greatest prevalence is in countries bordering Lakes Victoria and Tanganyika, with prevalence nearing 20% of the population. Estimated prevalence is 4-10% among adults in Congo, the Central African Republic, and Zaire. AIDS has reversed the infant mortality declines in many developing countries. It is estimated that expenditures for AIDS diagnosis and medical care in 5 Central African countries exceed their total amount of foreign assistance. Millions of small children will be orphaned, requiring a massive effort to provide support.

[Indexed for MEDLINE]

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