The impact of HIV/AIDS on mortality and household mobility in rural Tanzania

Abstract

To assess the impact of the AIDS epidemic on mortality and household mobility before and after death. Open community cohort study with a demographic surveillance system and two sero-epidemiological surveys. Ten rounds of demographic surveillance were completed during 1994–1998 in the study area, which has a population of about 20 000 people in a rural ward in north-west Tanzania. Households with deaths were visited for a detailed interview, including a verbal autopsy. Data on HIV status were collected in two surveys of all residents aged 15–44 years. Mortality rates among HIV-infected adults were 15 times higher than those among HIV-negative adults and HIV/AIDS was associated with nearly half of deaths at ages 15–44 years. Verbal autopsies without HIV test results considerably underestimated the proportion of deaths associated with HIV/AIDS. The mortality probability between 15 and 60 years was 49% for men and 46% for women and life expectancy was 43 years for men and 44 years for women. By their second birthday nearly one-quarter of the new-borns of HIV-infected mothers had died, which was 2.5 times higher than among children of HIV-negative mothers. Mobility of household members before and after death was high. In 44% of households in which the head died all members moved out of the household. In this rural population with HIV prevalence close to 7% among adults aged 15–44 years during the mid-1990s, HIV/AIDS is having substantial impact on adult mortality. A common response to death of a head of household in this community is household dissolution, which has implications for measurement of the demographic and socio-economic impact of AIDS.