In the worst-affected countries, steep drops in life expectancies are beginning to occur, most drastically in Untitled sub-Saharan Africa , where four countries (Botswana, Malawi, Mozambique and Swaziland) now have a life expectancy of less than 40 years. Were it not for Untitled HIV/AIDS , average life expectancy in Untitled sub-Saharan Africa would be approximately 62 years; instead, it is about 47 years. In South Africa, it is estimated that average life expectancy is only 47 years, instead of 66, if Untitled AIDS were not a factor (see Figure below). And, in Haiti, it has dropped to 53 years (as opposed to 59). The number of African children who had lost their mother or both parents to the epidemic by the end of 2000 -- 12.1 million -- is forecast to more than double over the next decade. These orphans are especially vulnerable to the epidemic, and the impoverishment and precariousness it brings.

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As more infants are born HIV-positive in badly affected countries, child mortality rates are also rising. In the Bahamas, it is estimated that some 60% of deaths among children under the age of five are due to Untitled AIDS , while, in Zimbabwe, the figure is 70%.

Unequal access to affordable treatment and adequate health services is one of the main factors accounting for drastically different survival rates among those living with Untitled HIV/AIDS in rich and poor countries and communities. Public pressure and UN-sponsored engagements with pharmaceutical corporations (through the Accelerating Access Initiative), along with competition from generic drug manufacturers, has helped drive antiretroviral drug prices down. But prices remain too high for public-sector budgets in low-income countries where, in addition, health infrastructures are too frail to bring life-prolonging treatments to the millions who need it.

Backed by a strong social movement, Brazil's government has shown that those barriers are not impregnable and that the use of cheaper drugs can be an important element of a successful response. Along with Brazil, countries such as Argentina and Uruguay also guarantee Untitled HIV/AIDS patients free antiretroviral drugs. In Africa, several governments are launching programmes to provide similar drugs through their public health systems, albeit on a limited scale, at first.

In all such cases, though, clearing the hurdle of high prices is essential but not enough. Also indispensable are functioning and affordable health systems. Massive international support is needed to help countries meet that challenge.