females aged 15 to 24 in sub-Saharan Africa ranged from 6.4 to 11.4 percent, as compared with 1.0 to 1.8 percent for women of similar ages around the world (UNAIDS, 2002). Ignorance of AIDS is widespread among young people, who are at the greatest risk. Half of all teenage girls in sub-Saharan Africa do not know that a healthy-looking person can be living with HIV/AIDS. A study in Mozambique found that 74 percent of girls aged 15–19 were unaware of any means to protect themselves from infection (WHO, 2002a).

An estimated 1.9 million people were living with HIV in Latin America and the Caribbean in 2002 (UNAIDS, 2002), making it the second most affected region of the world. Recent reports suggest that India, China, Russia, Ethiopia, and Nigeria each are on the cusp of an exploding epidemic. Together, these countries will account for 50 million to 75 million cases of HIV infection by 2010 (National Intelligence Council, 2002). In northeast India, the widespread use of illicit injection drugs accounts for most HIV transmission; in other parts of the country, most cases of infection appear to have been acquired through contact with infected sex workers. By the mid-1990s, approximately one-fourth of the prostitutes in cities such as New Delhi, Hyderabad, Madurai, Pune, Tirupati, and Vellore tested positive for HIV (UNAIDS, 2000). China has recognized these same risky behaviors—intravenous drug use and prostitution—as the primary modes of HIV transmission in that country (Monitoring the AIDS Pandemic Network, 2000). The number of HIV-infected persons in Russia has increased progressively, virtually doubling every year from 1993 to 1998, mainly as a result of an increase in intravenous drug use (Netesov and Conrad, 2001). Furthermore, it is estimated that the official statistics on HIV in Russia may reflect only 10 to 20 percent of the actual number of carriers, since many patients treated in private clinics are not officially reported.

Most infectious diseases have severe consequences at the two ends of the spectrum of life: infants/children and the elderly. In contrast, HIV is spread predominantly among young adults, who represent the most economically active segment of the population (United Nations Economic Commission for Africa, 2000); thus HIV infection dramatically changes a country’s demographics. AIDS is erasing decades of progress made in extending life expectancy; average life expectancy in sub-Saharan Africa is now 47 years, whereas it would have been 62 years without AIDS (UNAIDS, 2002). Of the 14 million orphans resulting from the AIDS pandemic, 80 percent reside in sub-Saharan Africa (UNAIDS, 2002). By 2010, nearly 42 million children in 27 countries are expected to have lost one or both parents to AIDS (National Intelligence Council, 2000). Many countries in South and Southeast Asia are expected to undergo similar demographic changes as HIV/AIDS and associated diseases (e.g., tuberculosis) reduce



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