Today there is not a single country around the world which has wholly escaped the AIDS epidemic. As the epidemic has matured, some of the developed nations which were hard hit by the epidemic in the 1980s such as the United States have reported a slowing in the rate of new infections. No region of the world bears a higher AIDS-related burden than sub-Saharan Africa. The impact of AIDS on the region is such that it is now affecting demographics - changing mortality and fertility rates, reducing lifespan, and ultimately affecting population growth. Although Africa is the region of the world hardest hit by AIDS, and although no country has entirely escaped the virus, prevalence rates vary dramatically between regions, countries, and even within countries. In
general, the southern region is the most affected, with Botswana, Namibia, Swaziland and Zimbabwe showing the highest rates, while West Africa has been less affected. In addition to heterosexual transmission, transmission via transfusion and through contaminated medical equipment is not uncommon in sub-Saharan Africa. Within the general population, the highest prevalence rates are found among the sexually active adult (15 to 49 years old) population. Through AIDS-prevention programs aimed at increasing condom use, reducing high-risk sexual behaviors, improving HIV screening, promoting alternatives to breastfeeding, and reducing social stigma associated with AIDS there can be a positive and measurable impact on HIV prevalence. A number of factors have been cited to explain the shorter survival times in African which include lower access to health care, poorer quality of health care services, and greater exposure to pathogens likely to result in opportunistic infection and early death. The most substantial increases in the mortality rate have occurred among adults aged 20 to 40, with more modest mortality rate increases shown for children within this region. The majority of the world"tms estimated 1. On average, in the absence of AIDS, life expectancy for these 29 countries would have averaged 54 years; now, however, the average has dropped to 47 years. little HIV transmission in Africa is related to IV drug use or unprotected homosexual sex. There is now compelling evidence drawn from two decades of AIDS epidemic data in central and east Africa that the AIDS epidemic has had a dramatic and negative impact upon mortality rates and life expectancy in this region. In recent years an intensive government-sponsored HIV prevention campaign focusing on use of condoms and changes in sexual behavior has produced impressive results. Thus far, the AIDS epidemic in sub-Saharan Africa has decreased fertility rates, increased mortality rates, , and disrupted family structure.