IS HIV-1 LIKELY TO BECOME A LEADING CAUSE OF ADULT MORTALITY IN SUB-SAHARAN AFRICA

Concerns are sometimes expressed at the extent to which HIV-1 is prior itized within international and national health budgets and as a resea rch issue, on the grounds that much larger numbers of people in develo ping countries currently die from other diseases, such as malaria and tuberculosis. We use a previously described mathematical model to expl ore how the HIV-1 epidemic could develop within a sub-Saharan African context and investigate the trends and patterns of adult mortality whi ch could follow. Two contrasting scenarios are studied, one which turn s population growth rates negative and another which does not. In both cases, HIV-1-related disease accounts for over 75% of annual deaths a mong men and women aged 15-60 years by year 25 of the epidemic. Relati vely little change in mortality is seen in the early years of the simu lated epidemics. However, by year 15, expectation of life at age 15 ha s fallen from 50 to below 30 years. The fragmentary evidence now avail able from empirical studies supports the impression that HIV-1 is rapi dly emerging as a leading cause of adult deaths in areas of sub-Sahara n Africa. Observed patterns of age-dependent mortality reflect those p rojected in the model simulations.