The fragility of the available data to some extent limits the scope of any assessment of complex phenomena such as the impact of the HIV/AIDS pandemic.

But analysing the impact of HIV/AIDS in Mozambique requires a brief review of the situation of the epidemic in the country, in order to situate better the context in which this analysis unfolds. The challenges presented by the tragedy of HIV/AIDS are not confined merely to Mozambique; long before frightening statistics began to make headlines in the national press, other countries in the region, under conditions of peace, were already feeling the damaging effects of the so-called "plague of the 20th century".

Since HIV/AIDS is a global problem, and considering the scarcity of domestic data, comparison with other countries provides a basis for a better understanding of the nature of the emergency, and to transmit experiences in managing the impacts of the epidemic.

Table 4.1: Comparative data on HIV/AIDS prevalence and impact
Country	Number of people with HIV/AIDS 1999			Deaths	Orphans
	Rate of prevalence among adults (%)	Number of people infected (15-49 years)	Number of children infected (0-14 years)	Deaths caused by AIDS	Number of AIDS orphans
Botswana	35.80	280,000	10,000	24,000	66,000
Burundi	11.32	340,000	19,000	39,000	230,000
Ethiopia	10.63	2,900,000	150,000	280,000	1,200,000
Kenya	13.95	2,000,000	78,000	180,000	730,000
Lesotho	23.57	240,000	8,200	16,000	35,000
Malawi	15.96	760,000	40,000	70,000	390,000
Mozambique*	15.4	1,173,878	93,969	83,648	257,981
Namibia	19.54	150,000	6,600	18,000	67,000
Rwanda	11.21	370,000	22,000	40,000	270,000
South Africa	19.94	4,100,000	95,000	250,000	420,000
Swaziland	25.25	120,000	3,800	7,100	12,000
Tanzania	8.09	1,200,000	59,000	140,000	1,100,000
Uganda	8.30	770,000	53,000	110,000	1,700,000
Zambia	19.95	830,000	40,000	99,000	650,000
Zimbabwe	25.03	1,400,000	56,000	160,000	900,000
Total over 15 years old	13.95	16,560,000	692,600	1,531,100	8,080,000
Sub-Saharan Africa	8.57	23,400,000	1,000,000	2,200,000	12,100,000
Global total	1.07	33,000,000	1,300,000	2.800.000	13,200,000
Source: MJ Kelly, UNAIDS (2000). HIV/AIDS and Education, African Development Forum * MISAU-MPF-INE-CEP/UEM, 2000. Impacto Demografico do HIV em Mocambique, Maputo.

In Mozambique there is a tendency to view the HIV/AIDS epidemic as less serious than that facing the neighbouring countries. Unfortunately this is not the case. Despite the fragility of the data, arising from the methods and the small number of sentinel sites, the available estimates indicate that the levels of infection in Mozambique are, at best, only a few years behind the most severely affected countries in the region.

By the end of 2000, about 40 million people in sub-Saharan Africa were carriers of HIV.A substantial part of this population of HIV-positive people were living in countries located near Mozambique, such as Botswana, Swaziland, Namibia and Zimbabwe, which have prevalence rates among the adult population of 20% or more - the highest rates in the world.

Three of these countries have extensive borders with Mozambique, and it would be pretentious to imagine that the country can maintain its position as a relative oasis for a long time. At worst, 2000 seroprevalence data could point to a maturing epidemic on a par with neighbouring countries. The following table compares the HIV/AIDS situation with that of other countries in southern and eastern Africa:

As table 4.1 shows, the prevalence rate among adults in Mozambique is somewhat lower than the regional average, but much higher than the average for sub-Saharan Africa, and about 14 times higher than the world seroprevalence average.

In the 14 years since the first case was diagnosed in 1986, cases of HIV/AIDS in Mozambique have risen at a gallop. It is estimated that 1.5 million people in Mozambique are HIV-positive, with an incidence in 1999 of about 15.4% for the adult population (those aged between 15 and 49). According to some estimates, every day there are 700 new infections. The number of people who have already died from AIDS-related illnesses is estimated at over 100,000, and projections indicate that the cumulative number of deaths will rise rapidly, reaching 1.6 million in 2010.

Prevalence among women is, on average, 1.6% higher than among men, meaning that women are 10.4% more likely to be HIV-positive than men. The age gap among women is particularly worrying. For the year 2000, for example, 35.4% of all new HIV infections among women will occur in women under the age of 30, compared to only 13.2% for men. The inference is obvious: women are being infected at a younger age, and are therefore dying at a younger age.

There are major regional differences in HIV prevalence, resulting from the differentiated evolution between the regions, as Graph 4.1 shows. Prevalence is highest in the central provinces of Zambezia, Sofala, Manica and Tete, with an estimated prevalence rate of 20.7% in 2000, compared with 13% in the north (Cabo Delgado, Niassa, Nampula) and 11% in the South (Maputo, Gaza, Inhambane).

This suggests that, in a first phase, the epidemic will have a differentiated impact on the various regions, even after it has stabilised. In the central region it is forecast that prevalence will level of f at 21.4%, compared to 14.3% in the south and 14.4% in the north, as shown in table 4.2.

The reasons for assuming that the epidemic will begin levelling off in 2004 are not yet clear . This is particularly relevant if we take into account the limitations of the statistics and of the models that are described in Box 4.1. Furthermore, given the experience of neighbouring countries, this assumption that Mozambique will achieve early stabilisation may be overly optimistic. Adjustments to the model used in the projections, and access to new data, may result in modifications to these trends and assumptions, thanks in part to more representative ante-natal samples from 22 sentinel sites rather than four.

Table 4.2: HIV/AIDS prevalence between 15-49 years
Year	National	Region
	(%)	South (%)	Centre (%)	North (%)
1999	15.4	11.0	20.3	13.0
2000	16.0	12.0	20.7	13.6
2001	16.4	12.8	20.9	13.9
2002	16.7	13.3	21.1	14.1
2003	16.8	13.7	21.2	14.2
2004	17.0	13.9	21.3	14.3
2005	17.0	14.1	21.3	14.3
2006	17.1	14.2	21.4	14.4
2007	17.1	14.2	21.4	14.4
2008	17.1	14.3	21.4	14.4
2009	17.1	14.3	21.4	14.4
2010	17.1	14.3	21.4	14.4
Source: "HIV/SIDA em Mocambique" INE, MISAU, MPF, CEP (UEM)