Forecasted Results

A comparison of the size, composition and other characteristics of the future populations, estimated, either taking account or no account of the HIV epidemic, helps identify the impact of the epidemic on demographic developments. Let us consider some of these characteristics.
 

Number of Infected with HIV

According to forecast assumptions, the epidemic is to peak (a highest number of infected with HIV) in 2015 (except for scenario A), when their number will be between 427,000 and 3,457,000, depending on a given scenario (Table 16). The difference between the extreme scenarios indicates the substantive sensitivity of results, on the one hand, on scenario assumptions, and the assessment of the current stage of the epidemic, on the other. Taking into account that once the HIV virus has penetrated into the human organism it will stay there forever, HIV-infected people will become noticeable in any case among other chronic patients, and in a worst-case scenario, will be «devouring» a greater part of the health-care system’s resources.

Table 16. HIV-positive, 2015 and 2025, thousand people

Fig. 7. Number of Infected with HIV According to Various Scenarios of Forecast. 2002-2025. Thousand.

Table 17. Some of the Groups of Patients (Registered in Disease-Prevention and Treatment Centers), end of 2000

Diagnosis	Ths
Alcoholism and alcoholic psychoses	2,191
malignant tumors	2,098
mental disorders	1,939
syphilis	732
non-arrested tuberculosis	380
narcomania	269
toxomania	12

Source: Health Care in Russia: Statistical Handbook/Goskomstat (or State Statistics Committee of Russia). Moscow, 2001.
 

AIDS Deaths

At the present time, AIDS is going virtually unnoticed in the overall Russian mortality - 15 people diagnosed with AIDS died in 2002, while an annual number of deaths is about 2 million. 

In the foreseeable future the percentage of HIV deaths, given most conservative assumptions, will grow to 1%, and should other scenarios happen, to 12% or even more. It should also be remembered that people at a relatively young age will be dying of AIDS without reaching the age of retirement. Nowadays (2000) nearly half a million men and more than 100,000 women die at a working age. AIDS may become the primary cause of death among this age group. 

Table 18. Annual AIDS Deaths, 2015 and 2025, thousand

Scenarios	2015	2025
R	37	38
R1	25	21
R2	18	16
E	47	45
U	75	73
A	106	105
A1	162	87
A2	232	300
A3	149	215

At the present time, 80% of those who need ART have received it. Let us assume that in future all HIV-infected people will be receiving ART (ART costs $10,000 a year), then (budgetary) spending on ART will be in the range of $4.37 billion to $34.57 billion, the upper bound of this range exceeds the entire current budget of the country’s health care system. It should not be excluded, however, that the cost of ART will be reduced significantly. Some countries, for example, Brazil, have considerable experience in cutting down the cost of treatment and lowering AIDS-caused mortality. 

A comparison of results, given various assumptions about the degree of making ART available (R1 and R2, A2 and A3), enables us to estimate its impact on AIDS-caused mortality. In worst years, medical aid provided to all those who need it (scenarios R2 and A3), compared with 40% being available according toscenarios R1 and A2, could cut the AIDS death toll by 30% to 40% a year. 

In Table 18 data are given on cumulative AIDS deaths according to various assumptions. At least nearly 300,000 Russians can die of AIDS in the next 25 years, but according to the most pessimistic forecasts, the decease may claim 3 million or as many as 4.5 million lives. 

Table 19. Cumulative AIDS Deaths by 2015 and 2025, thousand

Scenarios	2002-2015	2002-2025
R	232	617
R1	187	403
R2	120	296
E	487	954
U	767	1522
A	1068	2147
A1	1444	2533
A2	1564	4518
A3	1021	3090

AIDS deaths, according to our estimates, will be between 16,000 and 300,000 every year. Table 19 shows that this new cause of death, by its force, will just slightly fall short of an sub-total of accidents, poisonings and injuries but, at the same time, will be stronger than each of the causes of death within that aggregate. 

Table 20. Died in 2001 Due to Some Causes of Death

Deaths from all causes	2 254 856
including:
Ischaemie heart diseases	588 684
Accidents, poisonings and injuries	331 634
of them from:
occasional alcohol poisonings	41 091
transport accidents (all types), injuries	40 722
suicides	57 284
homicides	42 921
Diseases of the respiratory system	94 922
Mental and behavioural disorders	8 865
Complications in pregnancy, delivery and postpartum period	479

Source: The Demographic Yearbook of Russia. 2002: Statistical Handbook / Goskomstat of Russia. Moscow, 2002.

According to all assumptions, the AIDS factor as the cause of death will grow increasingly topical in the foreseeable future but may develop into threat No. 1 for the life and health of the people of Russia only if hardly probable «severe» scenarios of the epidemic happen. What is more probable is that other risks (cardiovascular diseases, tumors and psychoses of various etiology) will remain the principal ones. Meanwhile, the rapid expansion of the new deadly disease in the already unhealthy society (male life expectancy is less than 60 years) is fraught with still unknown (synergetic) effects. 
 

Life Expectancy

The AIDS epidemic will have a significant effect on life expectancy in the period to come. The difference in life expectancy, according to the assumed no AIDS assumption and according to the hardest AIDS, will be 6.5 years for men and 4.5 years for women in 2025. What is more, the time of healthy life will be shortened, there will be a significant decrease in the level of the general well-being and prosperity of society. 

Table 21. AIDS Related Decrease in Life Expectancy, 2025, years

Scenarios	Males	Females
R	-1.35	-0.85
R1	-0.81	-0.50
R2	-0.63	-0.38
E	-1.65	-1.09
U	-2.47	-1.65
A	-3.24	-2.16
A1	-3.1	-2.05
A2	-6.54	-4.51
A3	-5.09	-3.51

Population Size

The epidemic of such a scale cannot but have an effect on the total population. N. Eberstadt estimated an excess decrease in the population due to AIDS-caused mortality at 10 million to 20 million people till the year 2025. According to our estimates, the number is much lower, but according to the most pessimistic versions of our forecast, is also very high - nearly 7 million people according to version A2 (Table 21). Meanwhile, 100% provision of ART to all those who need, in the worst-case scenario of the epidemic, will save one million lives by 2025 (the difference between A2 and A3). 

Table 22. Decrease of the Population Size, mln

Fig. 8. Population Size, 2002-2025, mln