Demographic patterns of AIDS deaths and differences in willingness to have more children in Rural Southwest Uganda Muhangi Lawrence Medical Research Council Programme on AIDS in Uganda/Uganda Virus Research Institute

Background/Objectives To assess and document facts about demographic characteristics of AIDS deaths in rural Southwest Uganda. To assess the percentage of cohort participants dying before life expectancy (44 years) due to AIDS. To compare the willingness to have more children among HIV negatives and positives.

Methods Annual surveillance using door-to-door census was conducted in a population of 25 villages. Individual questionnaires were applied to generate demographic characteristics. Blood was collected for HIV serology. Monthly village-based birth and death registration was maintained continuously. Data was entered using Foxpro and transferred to STATA for analysis.

AIDS related deaths and total deaths

AIDS related deaths and gender Males Females  In 1991 AIDS death toll was the same as that of other deaths in both males and females and there after AIDS death toll is declining.  In 1992 AIDS deaths were higher than other deaths among females

Premature death (dying before 44 years old) Premature death in AIDS deaths Premature death in none-AIDS deaths  In the AIDS related deaths there were few cases who died after their life expectancy (dying after 44 years old). Dying before life expectancy was common due to AIDS in this community.  Dying after 44 years old was common in none-AIDS related deaths.

How different is premature death in AIDS deaths compared to none AIDS deaths

Population change and HIV/AIDS deaths =-0.56 p-value = 0.32  Decrease in annual population census was observed for years 1993, 1995, 1996, 2000 and the decreases not associated with AIDS deaths.

Comparison of mean number of children produced among HIV positives and negatives Mean number of children produced by HIV positives was significantly lower than that of HIV negatives. This may have an effect on the community workforce replacement.

Willingness to have more children among female HIV positives and negatives  Willingness to have more children was systematically lower in HIV positives compared to negative mothers. This situation likely to affect replacement level of children in this community.

Summary (1) 39% of the deaths were from AIDS. Premature death was high 81% in the AIDS related deaths compared to 35% in the none AIDS deaths (chi=217, p<0.001) A high proportion 85% of females died prematurely due to AIDS compared to 77% of males (chi=4.3, p=0.036) The mean age of death from AIDS was 37 years significantly lower than mean age of death due to other reasons 58 years (p<0.001) Willingness to have more children was high in both HIV negatives and Positives at 86% and 73% respectively.

Summary (2) Dying before life expectancy (44 years) was common in this community due to AIDS. Community workforce replacement momentum likely to be affected.

Conclusion/Recommendations A large section of people die prematurely due to AIDS. Promoting access to ARVs in this community likely to reverse the trend. Intention to have more children high in HIV positives. More education on PMTCT recommended for the HIV positive mothers.

Acknowledgements MRC data collectors who maintained village based death registration. MRC statistics for computerising deaths records.