by Carl Haub, senior demographer

HIV/AIDS in Cameroon. The preliminary report of the 2011 Cameroon Demographic and Health Survey/HIV (DHS/HIV) has been released (in French). This survey tested 13,503 women and men ages 15-49 and 699 men ages 50-59 for HIV infection. The results indicate that 4.3 percent of the 15-49 age group were HIV positive, 5.6 percent among females and 2.9 percent among males. The males ages 50-59 were 2.9 percent positive. The 2011 prevalence was lower than that reported in the 2004 Cameroon DHS, which was 5.5 percent for 15-49 year-olds, 6.8 percent among females and 4.1 percent among males.

Youth Tax in Germany. Germany is likely to impose a 1 percent additional income tax on workers over the age of 25 as a “demographic reserve” to prepare for the time when German baby boomers of the 1950s and 1960s will swell the ranks of pensioners. Official projections show that there will be 7 million fewer workers by 2025 to support retirees. Germany’s total fertility rate fell below the replacement level over 40 years ago and is currently about 1.35 children per woman.

Latest Data on the Sex Ratio at Birth (SRB) in India. Following up on an earlier blog post on this subject, progress on this measure has clearly stalled for a number of years. The national campaign against the abortion of female fetuses may be in for a difficult stretch. The graphs below update the Sample Registration System data to the period 2008-2010. Since there about 5 percent more male births than female births worldwide, a normal sex ratio at birth in India would be 950 female births per 1,000 male births. India’s SRB is the reverse of most other countries which typically show male births per 100 female births. Note particularly the two states with the lowest SRB, Punjab and Haryana. Improvement in their SRBs stopped three or four years ago. A somewhat similar trend can be seen in the five states in the second graph although their ratios are better. The national SRB in India is 905, 898 in urban areas and 907 in rural. More data from the new report will be in the next blog post.

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by Carl Haub, senior demographer

News from Uganda. Press reports quote the Bureau of Statistics of Uganda (UBOS) with leaked data from the not-yet-released 2011 Demographic and Health Survey. The country’s total fertility rate (TFR) reportedly declined to 6.2 from 6.7 in the 2006 DHS, still very high but a drop nonetheless. The infant mortality rate also declined from 76 deaths to infants below age 1 per 1,000 live births to 54, a notable drop in a short time. In addition, the results of the 2011 AIDS Indicator Survey (AIS) shows that 6.7 percent of adults ages 15 to 49 were infected with HIV, an increase from 6.4 percent in the 2004- 2005 AIS.

Fewer babies in the Czech Republic. A March 2012 survey in the Czech Republic found that 85 percent of Czechs think the country’s low birth rate is a serious problem. The Czech TFR has declined to 1.42 in 2011 from 1.49 in 2010. In the survey, 29 percent said that financial difficulties among young couples were the primary cause; 24 percent blamed insufficient state support; and 16 percent cited “careerism.”

Urban USA. The U.S. population surpassed 80 percent urban in the 2010 Census (80.7 percent), up from 79 percent in 2000. The Census Bureau identifies two types of urban areas: “urbanized areas” of 50,000 or more people and “urban clusters” of at least 2,500 and less than 50,000 people. There are 486 urbanized areas and 3,087 urban clusters nationwide. The Los Angeles-Long Beach-Anaheim urbanized area is the most densely population with 7,000 people per sq. mile. The New York-Newark, NJ was only the fifth most densely populated at 5,316 per sq. mile. But New York easily maintains the top spot in population with 18,391,295 residents to the 12,150,996 in second-place Los Angeles. The smallest urban area is Lake Rancho Viejo, California, barely making the cutoff at 2.500 inhabitants.

by Jay Gribble, vice president, International Programs

As part of World AIDS Day, ICFP 2011 included a special session on the recently published The Lancet article that found an increase—a two-fold increase—in the risk of contracting HIV among women who use injectable contraceptives. One of the speakers, a professional journalist, focused her comments on how she covered the study and how responsible journalists might cover such studies. I found her comments especially interesting given PRB’s longstanding work in training journalists to better understand health and population issues.

One of her points that stood out in my mind is the weighing of risks and benefits—a critical aspect of the ethical considerations of undertaking a study that involves human subjects. Evaluating risks and benefits is useful in helping an individual decide whether  to participate in a study. While there isn’t necessarily an algorithm that can help individuals estimate their own risks and benefits, risks and benefits are frequently expressed at an aggregate level, based on the experience of all people participating in the study.

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by Jay Gribble, vice president, International Programs

Given the sustained attention to the HIV/AIDS pandemic, one could wonder why it is necessary for family planning to share the stage at ICFP 2011 with the issues of HIV/AIDS. Yet given how family planning, reproductive health, and HIV/AIDS are intrinsically linked, the ICFP 2011 is taking advantage of the opportunity to talk about the need for comprehensive sexual and reproductive health—a topic that is broader than the more focused issue of family planning. And given the recent research finding that use of injectable contraception may increase the risk of HIV infection, the relationship between these two issues has received increased attention. So it is both appropriate and responsible to turn attention to the links between FP and HIV. And as the Honorable Stephen O’Brien observed, the commonalities between efforts to address women’s and men’s FP/RH and HIV needs further reinforce the importance of considering these two issues jointly :

• Both require a comprehensive approach that responds to the need for high-quality information, services, and supplies that allow women and men to make informed choices about their sexual and reproductive lives.
• There is a need to expand integrated services so that people can address their needs for sexual and reproductive health needs together with those related to HIV/AIDS prevention and treatment.
• Programs that respond to the reproductive health and HIV need to be tailored to the needs of vulnerable populations—youth, sex workers, the poor, men, men who have sex with men—among others.

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by Eric Zuehlke, editor

Thomas Frieden, director of the Centers for Disease Control and Prevention, talked this week at the Center for Strategic & International Studies about an important and sometimes overlooked area in global health: proven prevention strategies. He went through a laundry list of simple, low-cost interventions that have saved millions of lives worldwide and their policy implications. For example, immunizations are a low-cost intervention that prevent disease and debilitating conditions. Frieden pointed out that over 12 million lives have been saved through measles immunization over past 10 years, and in the case of polio, we are almost at the finish line in terms of eradication (even though the final push remains stubbornly difficult). But, as he says, success is fragile and requires vigilance. Sanitation was another example; it’s so often overlooked, but can save millions of lives. Clean indoor cookstoves, in addition to their environmental benefits, can prevent pnemonia. Addressing neglected tropical diseases through public education (prevention) along with treatment is doubly effective. Reducing the sodium content of processed foods can lower high blood pressure that often lead to heart attacks. There are countless other examples. Each dollar invested pays itself back many times over.

One aspect of the talk worth higlighting is his focus on the Kenya AIDS Indicator Survey (see the PRB Data Sheet on it here) because it conveys how tranformative understanding data can be in prevention strategies. According to Frieden, before this survey, Kenyan policymakers had a vague sense of the scope of the AIDS . The survey showed that the vast majority of HIV-positive people didn’t know their status, and therefore couldn’t change their behavior and prevent the further spread. This finding led to a change in policy.

With all the talk of rising health care costs in the United States, tough public budget austerity in the face of massive deficits, and increasing access to treatements such as antiretrovirals to fight HIV/AIDS in poorer countries, this is an important message. Prevention behaviors and strategies not only allow people to live longer and healthier lives, it saves money in the long run.

There’s a lot more in this dense, fascintating presentation that gives a great birds-eye view of the current state of global health (for example, tobacco is the world’s leading cause of death — more than AIDS, TB, and malaria combined). Highly recommended: http://csis.org/multimedia/video-new-twist-old-concept-prevention-interventions-global-health

by Jason Bremner, program director, Population, Health, and Environment

When I tell friends and colleagues that I’ve just returned from a trip to Kenya to participate in a seminar on HIV/AIDS and the environment I’m usually rewarded with a puzzled look. “HIV and the environment…” (long pause) “What’s the link?”  The regional seminar on HIV/AIDS and environment linkages organized by International Planned Parenthood Federation-Africa Regional Office (IPPFARO) and the International Union for the Conservation of Nature’s (IUCN) East and South Africa Regional Office brought together professionals from diverse organizations from Ethiopia, Kenya, Tanzania, and Uganda to share knowledge and experiences concerning these relationships.

I admit that the relationships between HIV/AIDS and the environment are not as intuitive as other population, health, and environment links, however a growing number of research studies and health and conservation programs have explored these relationships.  The simplest explanation is that HIV/AIDS morbidity and mortality may affect people’s natural resource use or may affect institutions that govern resources, thus impacting natural ecosystems.  On the flip side, environmental change may have special impacts on people living with HIV/AIDS or may increase susceptibility to HIV infection among certain groups.

At the meeting in Kenya, we went into far greater detail on the nature of the linkages with the goal being the development of an HIV/AIDS-environment framework to assist organizations in determining priority actions for reducing the impacts on households, their resources, and the natural environment.  A few of the linkages discussed included:

AIDS, Food Security, and Exploitation of Natural Resources
Evidence shows that AIDS exacerbates vulnerability to food security because AIDS disproportionately affects young adults thus decreasing available labor for small-scale agriculture.  A survey in South Africa found that households affected by AIDS are significantly more concerned about food security.  The study also found that households that had experienced AIDS mortality were more likely to use natural resources as cost-saving substitutes (in particular turning to fuelwood from forests) perhaps due to their perceived need to save money for food.  

Impacts on the Conservation Workforce and Loss of Human Capacity
Conservation work tends to take adult males to remote areas and separate them from their families for long periods of time.  Unprotected sex and extramarital sex during these absences puts these workers and their partners at risk of contracting HIV.  For those conservation workers who are already living with HIV, long absences for work can complicate the care and support they need. In sub-Saharan Africa, the conservation workforce has been heavily affected by AIDS morbidity and mortality resulting in a substantial loss of human capacity among conservation institutions.  One conservation organization has reported losing 14 percent of its workforce to AIDS since 1994, and national agencies such Kenya Wildlife Service now have specific HIV/AIDS workplace policies and programs to increase awareness among staff.  

Limited Access to Land Ownership and Resources for Widowed Women and orphans
Women whose husbands have died from AIDS face challenges in maintaining livelihoods and food security in contexts where female ownership of land is prohibited.  In such contexts, widows may lose their household’s land and lose access to agricultural lands and a source of wealth.  Orphans whose parents have died from AIDS are also especially vulnerable to having their parent’s land and wealth taken from them.

Natural Resources, Migration, and HIV
Households dependent on natural resource-based livelihoods that require temporary migration to access resources, such as seasonal fisherman, are at greater risk of contracting HIV due to periodic absences from home, influxes of cash, and extramarital sex.  The increasing prominence of wage employment to supplement agricultural livelihoods may also take individuals away from the household to work in natural resource based industries such as mining, timber, and oil and gas production, and thus place people at greater risk of contracting HIV. 

Complex Emergencies, Resource Scarcity, and HIV
Natural disasters and armed conflict can make gathering food, fuelwood, and water risky endevours.  Traveling farther for food and resources during complex emergencies puts women at greater risk of sexual violence.  In addition, women may be more likely to be coerced into transactional sex to attain resources when a household’s survival depends on a woman bringing home food and resources.  Sexual violence and transactional sex both put women at risk of contracting HIV.

These were just a few of the relationships discussed, and a great deal of work on HIV and environment has been done by the Africa Biodiversity Collaborative Group among others.  Despite this work many participants at the seminar were new to the idea of HIV and environment relationships.  The IPPF and IUCN collaboration is promising, but much remains to be done to popularize these relationships. 

It would be great to hear your thoughts.  Have you thought about HIV and environment relationships before?  Do the linkages mentioned above make sense to you?  Are you already doing work to reduce the impacts of HIV on households, their resources, and the natural environment, or to reduce the impacts of a changing environment on people living with HIV?