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The influence of different sexual-contact patterns between age classes on the predicted demographic impact of AIDS in developing countries.

A model is developed to describe the spread of HIV within heterosexual communities and the demographic impact of AIDS. The model combines epidemiologic and demographic processes and is designed to mirror the impact of AIDS in sub-Saharan Africa. Refinements on past work in this area include unequal probabilities for transmission from females to males and from males to females, the inclusion of an age- and sex-dependent sexual-partner choice function and distributed incubation plus infectious periods. Numerical studies suggest that unequal transmission probabilities (weighted to a greater probability from males to females than vice versa), and the tendency of males to choose sexual partners of the opposite sex younger than themselves, both act to increase the demographic impact of AIDS over that predicted with equal transmission between the sexes and partner choice restricted within given age classes. Analyses support the conclusions of past work that the epidemic will only have a small detrimental impact on the dependency ratio of a population (the ratio of dependents to working adults) even when a weighting is added to take account of the extra burden imposed by the care of adult AIDS patients. However, a small increase in the ratio can imply a significant rise in the number of dependents within the population. Stimulation studies of the impact of changes in behavior to reduce transmission highlight to the need to induce such changes as early as possible in the course of the epidemic in order to minimize its impact. Directions for future research are discussed emphasizing the need to acquire quantitative data on sexual habits and to construct models to represent heterogeneity in sexual behavior.

Acquired Immunodeficiency Syndrome

The global epidemiology of the HIV/AIDS pandemic and its projected demographic impact in Africa.

The global epidemiology of HIV/AIDS has evolved to the point that the pandemic now predominantly affects heterosexuals, especially in developing countries. This article summarizes the status of the HIV/AIDS pandemic as of the early 1990s; provides estimates and short-term projections of AIDS mortality in a hypothetical country of sub-Saharan Africa; projects the potential demographic impact of AIDS in a hypothetical sub-Saharan country; and describes the major problems associated with modelling the long-term demographic impact of this pandemic. Estimated AIDS cases and deaths up to 1992 were extrapolated from public health surveillance data and through use of the WHO model. Estimates of HIV seroprevalence were based on available HIV serological data. For developed countries, HIV estimates developed by national experts and/or national AIDS programmes were used, and for developing countries estimates by regional experts were used or were prepared by WHO. For the first half of the 1990s, projections of AIDS cases and deaths were derived from the WHO model; beyond the mid-1990s, the potential effects of AIDS on selected demographic indicators were derived from a demographic projection model developed by the World Bank. Although estimates and long-term projections cannot be made with great precision, the general dimensions of the HIV/AIDS pandemic have been more clearly delineated now at the start of its second decade. Epidemiological data indicate that in industrialized countries, where extensive spread of HIV began in the late 1970s or early 1980s, the majority of HIV infections occurred during the first half of the 1980s.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome

The demographic impact of the family planning--health services project in Matlab, Bangladesh.

This paper evaluates the demographic impact of the Family Planning-Health Services Project in Matlab Thana of rural Bangladesh. The project was begun by the International Centre for Diarrhoeal Disease Research, Bangladesh in October 1977. Contraceptive services--including pills, condoms, IUDs, sterilization, and injectables--are supplemented by oral rehydration, tetanus toxoid, and other services. About 33 percent of eligible couples are using contraception. Impact is evaluated by direct measurement of birth rates in the treatment and comparison areas. An overall fertility decline of about 25 percent is observed, concentrated among older women. The impact is two-to-three times that of an earlier project that included fewer methods and used lesser trained workers. The study shows that intensive family planning efforts can affect fertility in the absence of socioeconomic changes.

Adolescent

[Demographic impact of AIDS mortality in France in 1990: AIDS before suicide and next to traffic accidents].

This paper presents an evaluation of the demographic impact of mortality by AIDS in the next future years, in France. Future cases are predicted by using a regression technique based on an exponential model. Three demographic indicators are computed: Years of Potential Life Lost (YPLL), Expectancy of Life (EL) and Expectancy of Active Life (EAL) for males. For example, in 1990 AIDS would be responsible of a loss of 0.67 and 0.38 years for EL and EAL respectively. These results would raise AIDS almost to the Accidents level and ahead of Suicide. Moreover, we consider that the estimations presented in this article are rather optimistic, taking into account the fact that there is an increasing proportion of IV drug abusers cases, younger than the other cases.

Accidents, Traffic

The spread of HIV-1 in Africa: sexual contact patterns and the predicted demographic impact of AIDS.

The spread of HIV-1 in Africa is examined here in the light of recent information on the main epidemiological and behavioural determinants of transmission. Mathematical models incorporating demographic, epidemiological and behavioural processes are used to assess the potential demographic impact of the disease AIDS. These analyses highlight the significance of patterns of sexual behaviour, and in particular networks of sexual contact, on the predicted spread of infection. Current data reveal substantial variations in the degree of spread between and in countries, but new analyses support earlier predictions that in the worst-afflicted areas AIDS is likely to change population growth rates from positive to negative values in a few decades.

Acquired Immunodeficiency Syndrome

Some aspects of sexual behaviour and the potential demographic impact of AIDS in developing countries.

This review examines recent research on the influence of heterogeneity in sexual behaviour on the transmission dynamics of the human immunodeficiency virus (HIV), the aetiological agent of AIDS. Attention is focused on the potential demographic impact of AIDS in developing countries and how this is influenced by the structure of networks of sexual contacts (who mixes with whom), age-dependency in rates of sexual partner change and differences in the ages of female and male sexual partners. Analyses based on the construction of simple and complex mathematical models of the spread of HIV via heterosexual contact serve as a template for the interpretation of observed pattern and as a guide to the major aspects of sexual behaviour that govern the transmission dynamics of the virus. It is argued that much greater attention must be addressed to the quantification of patterns of sexual behaviour in defined communities, despite the many practical problems that surround data collection and interpretation.

Acquired Immunodeficiency Syndrome

National health objectives for the year 2000: the demographic impact of health promotion and disease prevention.

BACKGROUND: The national objectives in Healthy People 2000, drafted by health professionals aware of currently available public health interventions, represent a wealth of information about near-term future mortality and morbidity. METHODS: Life table methods were used to calculate the impact of projected changes in mortality and activity limitation rates on life expectancy and expected disability years. RESULTS: Meeting the mortality objectives would increase life expectancy at birth by 1.5 to 2.1 years, raising life expectancy to 76.6 to 77.2 years. In addition, meeting the target for disability from chronic conditions would increase the number of years of life without activity limitations from 66.8 years to 69.3-69.7 years. If the targets for coronary heart disease and unintentional injury were changed to reflect recent trends, a greater improvement in life expectancy at birth would be achieved: from 1.8 to 2.7 years to 76.9 to 77.8 years. CONCLUSION: Meeting the targets would have an important demographic impact. Including changes in the coronary heart disease and injuries targets, life expectancy in the year 2000 would be above the middle of the ranges used in current Census Bureau projections.

Aged

The genetic and demographic impact of immigrants in a largely endogamous community.

Historical demographic data extending back approximately 300 years were analysed to determine the demographic and genetic impact of in-migrants to an endogamous Swiss Alpine village. In-migrants were involved in only 14% of the marriages recorded in the village. In addition, only slightly more than 50% of the in-migrants were represented in the 1970 gene pool of the village. However, in-migrants accounted for nearly 38% of this gene pool. This seemingly anomalous situation can be explained by the fact that while the fertility of in-migrants and the marriage rate among their children are reduced (accounting for the near 50% "drop-our rate" of in-migrants from the gene pool), the fertility of the children of in-migrants and the marriage rate among the grandchildren of in-migrants are increased relative to village natives (accounting for the high proportion of genes in the gene pool ultimately attributable to in-migrants). Our results clearly demonstrate that although this community forms an endogamous population, it is definitely not a genetic isolate. Other investigators are cautioned against automatic invocation of the simplifying (and, thus, extremely tempting) assumption that endogamy is equivalent to genetic isolation.

Emigration and Immigration

A model of the spread of HIV infection and the demographic impact of AIDS.

The objective of the computer simulation model described here is to project, for periods up to one or more decades, the annual incidence and prevalence of HIV infection and AIDS in a population with given epidemiological, behavioural and demorgraphic characteristics. In addition, the epidemic's impact on a range of demographic variables is calculated. The epidemiological components of the model use a compartmental approach and they are described with sets of linear differential equations. The demographic framework in which the epidemiological components are integrated, is based on a standard cohort component method of population projection. The simulated population is stratified by age, gender, sexual behaviour, marital status and infection/disease status. The concluding section provides an illustrative application of the model to a Central African population. In this hypothetical simulation covering the period from 1975 to 2000, HIV prevalence in the adult population rises from 0 to 21 per cent. By the end of the projection period mortality is about double the level that would have prevailed in the absence of the epidemic, but, owing to the very high birth rates that prevail in most of Africa, the growth rate of the population remains substantially positive.

Acquired Immunodeficiency Syndrome

The demographic impact of family planning programs.

In response to concerns about the adverse consequences of rapid population growth, family planning programs have been implemented in many developing countries. The aim of the present study is to assess the impact of this programmatic approach on long-range population growth. The result of a new and hypothetical population projection indicates that in the absence of family planning programs the population of the developing world could be expected to reach 14.6 billion in the year 2100 instead of the 10 billion that is currently projected by the World Bank. Despite the apparent success of existing interventions, fertility control is far from complete, as many women continue to bear unwanted births. To assess the impact of this unintended childbearing a second hypothetical projection is made. With perfect implementation of reproductive preferences, the population size of the developing world in 2100 would be reduced by an estimated 2.2 billion below the current projection. Further strengthening of family planning programs and improvements in birth control technology are therefore likely to provide important demographic benefits.

Contraception Behavior

The demographic impact of the contraceptive distribution project in Matlab, Bangladesh.

This paper evaluates a study fielded in Bangladesh in 1975 to test the hypothesis that ubiquitous availability of pills and condoms in a rural, traditional, noncontracepting population would increase contraceptive use and reduce fertility. Treatment and comparison areas were designated in Matlab, an area with accurate and complete demographic data. Use prevalence peaked at 18 percent in the first three months of the project and declined thereafter. Project activities continued until 1977. Results show that between-treatment fertility differentials were 10 percent in the first year of program impact, but that effects dissipated with time.

Adolescent