need to know how many orphans and unsupported elderly there will be; what social mechanisms are being employed to care for them; what effects orphanhood has on children's own development and on the welfare of the nation; and what services could usefully be provided to these individuals, given resource constraints.

INDIRECT IMPACT OF AIDS ON THE REST OF SOCIETY

This section addresses the indirect impact of the HIV/AIDS epidemic on society at large, focusing in turn on demographic and economic impact.

Demographic Impact

AIDS has a number of demographic and related consequences. Among the more important are effects on future population growth, demand for health services, the size of the potential labor force, educational needs, and support for the elderly. Moreover, household composition and living arrangements are influenced by the AIDS pandemic through orphanhood and widowhood. To understand the consequences of AIDS, a wide range of data is needed. It is necessary to have baseline demographic information and to gather data on the progression of HIV, perinatal transmission, the process of incubation, and mortality risk.

Morbidity and Mortality

In several African countries in the main AIDS belt, AIDS has already become the major cause of adult mortality, doubling or tripling the adult mortality rates over levels that were already eight times higher than those in developed countries. AIDS is also a growing cause of infant and child mortality, threatening to reverse the reductions in infant and child mortality rates achieved to date. In countries such as Uganda, where an estimated 1.3 million persons out of a total population of 17 million are infected, AIDS looms as the predominant health problem for the entire population.

The excess female morbidity and mortality from HIV infection have important implications for the social and economic roles of women. The rising infection rates among women are accompanied by a corresponding rise in the number of children with perinatal HIV infection, estimated at around 1 million cumulative infections as of 1994 (World Health Organization, 1994) (see also Chapter 5). Transmission rates of HIV infection from an infected mother to her child in Africa are estimated to average about 30 percent, so the 70 percent of infants who remain uninfected are potential future orphans as the result of the premature death of one or both parents from AIDS (Chin, 1990).

AIDS has become the leading cause of hospital admissions in such cities as Abidjan, Côte d'Ivoire, and Kinshasa, Zaire. In Abidjan, where the first AIDS



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