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Why Population Matters to Infectious

diseases and HIV/AIDS

Fertility, migration and urbanization affect the spread of diseases including tuberculosis, malaria
and HIV/AIDS. Increased population densities and unhealthy living conditions in urban slums can
ease the transmission of infections. Migration may also increase vulnerability to disease.

Infectious diseases such as HIV/AIDS have had a large impact on demographic trends, altering the
age structures of heavily affected countries.1 Access to family planning services has the ability to
reduce the spread of disease, especially when integrated with existing HIV prevention programs.

The State of Infectious

FIGURE 1: Deaths from Infectious and Parasitic Diseases are
Diseases and HIV/AIDS
High in Low-Income Countries
In 2004, about one-fifth of all global
deaths were a result of infectious and 30 28
parasitic diseases, according to the
World Health Organization.2 Diseases 25
previously controlled through public
Percentage of Total Deaths

health measures are also increasing in

20
frequency. These include tuberculosis,
malaria, dengue fever and cholera.
New diseases have also emerged 15
within the last century, such as HIV/
AIDS, Severe Acute Respiratory 10 8
Syndrome (SARS), Lyme disease and
West Nile fever.3 Developing countries 5 2
are the most affected. The rate of
death from infectious and parasitic
0
diseases is almost 14 times higher High-Income Middle-Income Low-Income
in low-income countries than in high- Countries Countries Countries
income countries (Figure 1).4 Source: World Health Organization (WHO). 2008. The Global Burden of Disease: 2004 Update. Geneva: WHO.
se Education & Labor Poverty Food Security Migration & Urbanization Security Climate Change Biodiversity Forest
ange Biodiversity Forests Water Maternal Health Infectious Disease Education & Labor Poverty Food Security Migr
overty Food Security Migration & Urbanization Security Climate Change Biodiversity Forests Water Maternal Healt

Changing environmental conditions as raising poultry in close proximity percent of the adult population is living
and human behavior affect the spread create conditions that are favorable with HIV, has the second-highest average
and impact of infectious diseases. to outbreaks of avian influenza.10 prevalence rate.16
In 2008, there were an estimated Administering antibiotics to livestock
9.2 million new cases of tuberculosis and poultry flocks also poses a threat Women in sub-Saharan Africa are
globally.5 Poor health conditions to humans. When humans eat food more likely to be infected with HIV than
(including co-infection with HIV/AIDS) treated with antibiotics, it can lead to men. In Southern Africa, new infections
increase the likelihood of developing drug-resistant bacteria, rendering some affect one-third more women than
active tuberculosis, which can then be common antibiotics less effective.11 men. Women’s vulnerability to HIV is
spread.6 Migration and interactions compounded by gender inequalities.
with the environment also influence Currently, 33 million people are For example, lower socioeconomic
infectious disease emergence and infected with HIV, more than half of status and levels of education can
transmission. Diseases passed from whom are women and girls. Nearly increase their likelihood of infection
wildlife to humans, such as malaria, 2 million people die each year through disempowered sexual
are a growing threat to human health, globally from AIDS-related causes.12 relationships and diminished access to
and human pathogens originating from In the most heavily affected countries, health services.17
wildlife have increased substantially in life expectancies have declined by
recent years.7 decades.13 Furthermore, 17 million HIV/AIDS’ toll is devastating, but there
children, mostly in sub-Saharan Africa, are some positive signs. The global
Economic growth and development have been orphaned,14 labor force number of new infections each year
can contribute to the emergence productivity has weakened, and has declined, and HIV prevalence
of new diseases, even as they household incomes have declined.15 has declined significantly in dozens
bring many benefits.8 Some of the of countries. Successful prevention
industrialized agricultural farming and Sub-Saharan Africa, where more than outreach, which has resulted in safer
food production practices that often two-thirds of all people infected with sexual behavior in many settings,
accompany development increase HIV live, is the hardest-hit region. Sub- has been a critical factor in this
the risk of food products becoming Saharan Africa’s HIV prevalence rate of development. In sub-Saharan Africa,
contaminated with E. coli and 5 percent is higher than any other region. HIV incidence has generally stabilized
Salmonella.9 Farming practices such The Caribbean, where an estimated 1 or declined.18

Links between Population

and Infectious Diseases
Population density and urbanization
are two major factors affecting
disease spread. People who live in
close proximity to one another spread
diseases more quickly and easily.19
Slums around urban areas are extremely
vulnerable to infectious diseases due
to poor sanitation, high population
density and high levels of poverty, all
of which increase disease incidence.
For example, the increasing number of
people living in urban areas around
the world will continue to facilitate
tuberculosis transmission and weaken
attempts to control the disease.20

Migration also affects the spread

of disease. The probability of
Integrating HIV and family planning services can increase access to health care and
improve outcomes. encountering new diseases increases
 ts Water Maternal Health Infectious Disease Education & Labor Poverty Food Security Migration & Urbanization S
ration & Urbanization Security Climate Change Biodiversity Forests Water Maternal Health Infectious Disease Edu
lth Infectious Disease Education & Labor Poverty Food Security Migration & Urbanization Security Climate Change

as humans move into previously

uninhabited lands because of FIGURE 2: Swaziland’s Age Structure is Shaped by HIV/AIDS
population growth, or as humans
100+
migrate into areas where they do not Swaziland 2005 95-99
have resistance to certain diseases. 90-94
People who move from dry highlands Male 85-89
Female 80-84
to wet lowlands can become 75-79
exposed to malaria. Migrants may 70-74
65-69
be particularly vulnerable to malarial
60-64
infection because of the fatigue 55-59
and malnutrition that accompany 50-54
45-49
relocation.21 The risk is highest when 40-44
migrants move to tropical areas, 35-39
which are home to a larger number 30-34
25-29
of infectious disease pathogens than 20-24
areas at higher latitudes.22 15-20
10-14
5-9
0-4
Links between 10 8 6 4 2 0 2 4 6 8 10
Population and HIV/AIDS Percent of Total Population
HIV/AIDS has reshaped demographic
Source: United Nations Population Division. 2009. World Population Prospects: The 2008 Revision. New York: UN Population Division.
trends, while population growth has
added challenges to addressing the
spread of infection. The large number reached the scale to create population Those who seek reproductive health
of young people around the world decline. If Swaziland’s fertility rate services and those who seek HIV
coming into their peak years of sexual remains unchanged, its population will services share many common needs
activity presents a challenge for HIV/ increase by 39 percent in the 20 years and concerns. Therefore, integrating
AIDS prevention. More than one-half between 2005 and 2025.26 these services has the potential to
of the world’s population is under increase access to health services and
age 30, and a quarter is younger High fertility can also mean a high rate improve health outcomes. Integrated
than 15.23 Young people between of new HIV infections through mother- programs that increase women’s
the ages of 15 and 24 are at a to-child transmission. Halting the cycle access to contraceptives result in
higher risk of HIV infection.24 There requires ensuring that women who are healthier families and reduced health
is frequently overlap among countries living with HIV or are at risk of infection care expenditures to treat malaria,
with youthful populations, high rates have access to anti-retroviral treatment tuberculosis and other communicable
of HIV prevalence, and low access to and to contraceptives to prevent diseases. Beyond access to health
family planning. unintended pregnancies. care, HIV and infectious disease
prevention programs must also address
Swaziland, for example, is home the gender inequalities that increase the
to 69,000 children orphaned by Policy Considerations likelihood of infection among women.
AIDS,25 out of a population of 1.2 Comprehensive prevention policies,
million. Swaziland has been heavily programs and services are the most
affected by AIDS-related deaths cost-effective ways of reducing the
among working-age adults and fertility burden of HIV/AIDS and other
remains at an average of four children infectious diseases. One of the
per woman, leaving an age structure primary methods of preventing
with a large base of economically sexually transmitted HIV is through the
dependent young people (see Figure use of male and female condoms.27
2). Although AIDS increases mortality Investment in new prevention
rates and shortens life expectancies, technologies, especially women-
even in countries with the highest HIV initiated methods like microbicides, is
prevalence, the epidemic has not also vital.
 y Climate Change Biodiversity Forests Water Maternal Health Infectious Disease Education & Labor Poverty Food S
tion & Urbanization Security Climate Change Biodiversity Forests Water Maternal Health Infectious Disease Educat
overty Food Security Migration & Urbanization Security Climate Change Biodiversity Forests Water Maternal Heal

Endnotes 12 Joint United Nations Programme on HIV/AIDS (UNAIDS). 2010. UNAIDS Report on
1 United Nations Population Division. 2009. World Population Prospects: The 2008 the Global AIDS Epidemic 2010. Geneva: UNAIDS.
Revision. New York: UN Population Division. 13 United Nations Population Division. 2010. Population and HIV/AIDS 2010. New
2 World Health Organization (WHO). 2008. The Global Burden of Disease: 2004 York: UN Population Division.
Update. Geneva: WHO. 14 UNAIDS. 2010.
3 McMichael, A J. 2004. “Environmental and Social Influence on Emerging Infectious 15 Joint United Nations Programme on HIV/AIDS (UNAIDS). 2006. 2006 Report on
Diseases: Past, Present and Future.” The Royal Society 359: 1049-1058. the Global AIDS Epidemic. Geneva: UNAIDS.
4 WHO. 2008. 16 UNAIDS. 2010.
5 World Health Organization (WHO). 2010. Fact sheet N°104 March 2010 17 Ibid.
(Tuberculosis). Geneva: WHO. 18 Ibid.
6 World Health Organization (WHO). 2005. Addressing Poverty in TB Control: 19 Jones, Patel, Levy, Storeygard, Balck, Gittleman and Daszak 2008.
Options for National TB Control Programmes. Geneva: WHO.
20 Morens, D M, G K Folkers and A S Fauci. 2004. “The Challenge of Emerging and
7 Jones, K E, N G Patel, MA Levy, A Storeygard, D Balck, J L Gittleman and P Daszak. Re-Emerging Infectious Diseases.” Nature 430: 242-249.
2008. “Global Trends in Emerging Infectious Diseases.” Nature 451(21): 990-994.
21 Prothero, R. 1997. “Migration and Malaria.” In Carosi, G and F Castelli, eds.
8 Jones, Patel, Levy, Storeygard, Balck, Gittleman and Daszak 2008. Handbook of Malaria Infection in the Tropics. Bologna: Organizzazione per la
9 Weiss, R A and A J McMichael. 2004. “Social and Environmental Risk Factors in Cooperazione Sanitaria Internazionale.
the Emergence of Infectious Diseases.” Nature Medicine 10(12): S70-S76. 22 Guerneir, V, M E Hochberg and J F Guégan. 2004. “Ecology Drives the Worldwide
10 Weiss and McMichael. 2004. Distribution of Human Diseases.” Public Library of Science Biology 2(6): 740-746.
11 World Health Organization (WHO). 2011. Antimicrobial Disease: Fact sheet 23 UN Population Division. 2009.
N°194. WHO. http://www.who.int/mediacentre/factsheets/fs194/en/. 24 UNAIDS. 2010.
Accessed 20 January 2011.
25 Ibid.
26 UN Population Division. 2009.

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