Chapter Six: Subtypes and a Speculative Structure

Summary Point Countries with the highest rates of HIV prevalence–currently clustered in Southern Africa–are experiencing unprecedented age structures. High rates of mortality among adults who should be in the most productive years of their lives have resulted in costs to employers, shortages of employees in critical sectors such as education and health care, and increased dependency ratios with more children and adolescents relying on fewer adults for their survival and well-being.

Policy Recommendation All necessary steps must be taken by country governments and the international community to prevent as many new HIV infections as possible, both in countries already experiencing high prevalence and those in which the epidemic has not become entrenched. To that end, together with care and treatment of those affected, comprehensive and evidence-based HIV-education programs and provision of prevention supplies, namely condoms, should be a priority. International donors should help national governments care for the young people left behind by funding education, health and employment opportunities, and working to ensure that the infection is not continued in the next generation. Donor assistance should be as unfettered as possible by policies that restrict the autonomy of recipient countries to determine how to address their particular HIV/AIDS situation.

Summary Point Countries that receive high numbers of immigrants, particularly those seeking employment opportunities, experience changes in their age structures. In countries with developed economies, high fertility rates and a youthful native-born population, immigration concentrated among working-age adults makes countries' age structures more mature than they would otherwise be. Meanwhile, in aging countries, immigrants boost fertility rates and make age structures younger.

Policy Recommendation In the case of both youthful and aged countries, immigration that boosts the labor force can have economic benefits. Countries should determine if their current immigration rates, whether high or low, create a more or less favorable age structure and should consider tailoring their migration policies accordingly. In doing so, native and immigrant populations should be fully integrated into society, especially in their access to high-quality education and health care. Immigrants should have equal access to family planning and sexual and reproductive health programs in order to have control over their own reproductive decisions.