HIV/AIDS now causes more deaths than any other infectious or parasitic disease. Heterosexual intercourse remains the major mode of HIV transmission (as it has been from the start), although illicit intravenous drug use and blood transfusions are also sources of infection (in the absence of funds to purchase sterile needles or medical equipment). Trans- mission from childbearing women to their babies, however, has declined sharply because of the use of antiretroviral drugs by pregnant women.
Still, in the hardest-hit countries, around one-quarter of adults are infected with HIV/AIDS. Sub-Saharan Africa accounts for almost two-thirds of all new infections. HIV infection is also spreading rapidly in Eastern Europe and Central Asia, primarily among individuals who inject heroin and their sexual partners. Life expectancies for infected individuals have increased because of the development of antiretrovi- ral drugs but remain under 50 years in the developing world.
As stunning as these numbers might appear, they understate the impact of HIV/AIDS. Unlike most illnesses, HIV/AIDS commonly strikes at midlife, nor- mally the most economically productive years. In the hardest-hit countries, agricultural production is declining steeply, causing food shortages. Moreover, unlike most diseases, HIV/AIDS has struck not only the poor but also the middle and upper classes (because of their greater access to sexual partners, reduced commit- ment to traditional and more conservative sexual norms, and residence in cities where the disease is more common). Deaths among teachers, doctors, businesspeople, and the like have crippled schools and the econ- omy in numerous countries. The resulting increase in unemployment and poverty is sending ripples of illness and death throughout these countries. In addition, the deaths of many young mothers have produced a corresponding rise in deaths among children who lose their only (or best) provider.
Poverty primarily explains why HIV/AIDS has hit Africa especially hard. In addition, the epidemic has been stoked by labor migration, women’s low status, and sexual behavior patterns. Labor migration is common across Africa because the need to earn a living draws African men from small villages to cities and other areas where factories, mines, and plantations offer jobs. These men often must live apart from their wives and families for weeks, months, and even years at a time. Such conditions foster the use of prostitutes and consequently foster the spread of sexually transmitted diseases (STDs), including HIV/AIDS. In turn, some migrants may eventually carry these diseases back to their villages.
Meanwhile, health conditions also deteriorate among women and children left in rural villages. The loss of men’s labor makes it more difficult for women to grow sufficient crops to feed themselves and their children, leaving them increasingly malnourished and susceptible to disease. Faced with these conditions, women’s only option is to seek employment in cities, where many find that they must trade sex for cash or other favors to survive, even if doing so increases their risk of HIV/AIDS