Population growth in most of Africa is expected to rise sharply over the next 50 years. But, in southern Africa, AIDS is cutting a deadly swath through two major segments of the population - the most productive group aged between 19 and 45, and society's youngest - those under five years of age.
"Yes - I like to play soccer but I don't have a chance," says 15-year-old Bongani, who no longer has a chance to play soccer because he must now take care of his two younger siblings, aged 11 and 9.
Their mother, a single parent, died just months ago from complications of AIDS. Instead of joining his friends in their daily game of after-school street soccer, now Bongani must oversee his siblings' homework, prepare an evening meal, and clean the house. His schoolwork receives attention only after his charges are asleep.
Bongani is one of 10 million children orphaned by AIDS in southern Africa, and among millions forced to take on the role of parent to younger siblings. Others, perhaps more fortunate, now live under the care of a grandparent - usually a grandmother. But Professor Clifford Odimgegwu of the University of the Witwatersrand, says the senior generation is consequently being denied the natural fruits of a long life.
"A pattern that is emerging, that grandparents now are taking care of the orphans, their orphans, grandsons and daughters who are left by their mothers and fathers. Now instead of the reverse, the normal African system whereby children take care of grandparents, grandparents are now the people who are taking care of orphans," he said.
Odimegwu, a social demographer who coordinates the university's demography and population studies unit, told VOA that, in southern Africa, the pandemic has already upset what he calls the population pyramid. It is a pyramid, he says, based on an emerging generation of infants and toddlers, topped by a pre-adult generation - a productive generation - and senior citizens.
Odimegwu says AIDS is decimating two important layers in the pyramid, those under five years old who, as the emerging generation, should be the long-term future of the region's population. And, 19 to 45-year-olds, those who must sustain and build economies for the future. He says alarm bells should be ringing throughout the governments of the region.
"The implication of this really is that the future of this region, if proper care is not taken, the future of this region is in jeopardy," he said.
By 2010, in some countries, such as South Africa and Botswana, most deaths of children under five will be the result of AIDS. In the same period, life expectancy at birth will drop by at least 39 years. Odimegwu says the impact of the disease, whether caused by illness, death or bereavement, affects every sector of societies and economies in the region.
Even without AIDS, most of the regions' health systems were functioning far below the World Health Organization recommended ratio between patient and health professional. Instead of one doctor per 5,000 people, most countries in the region have less than one doctor per 20,000. And most southern African countries have just 10 percent of the nurses per patient that developed nations do.
Now, some experts say, the region's health systems are already buckling under the impact of the epidemic. And Soraya Elloker, an official with the People's Health Movement, says that not only are health workers ill, dying and bereaved but that the disease has added to the demands on their time.
"They have also indicated there [are] a lot of additional services they are providing . . . The prevention of mother to child transmission program is added. HIV services is added. We have never had those before. They see more sick children, more children with pneumonia, with diarrhea," she said. "They are also finding that a lot of children are not being cared for by their biological parents because of the epidemic. There are a lot of social problems."
Elloker tells VOA the impact on health workers affects every aspect of their work and that doctors and nurses worry that they are often not able to maintain high standards, such as spending time obtaining detailed patient histories. Also, she says, they are forced to make ethical decisions, such as who to treat first, in highly pressured, fraught working environments.
Education systems are also already reeling under the impact of AIDS. Carol Coombe, an independent education specialist who often advises regional governments, says that, for 20 years, educators and government officials assumed that teachers would impart knowledge about the disease to students and teach them life-skills to avoid becoming infected.
But Coombe says the problem for education systems is much more complex. She says regional governments need to know how to sustain such systems while tens of thousands of teachers die and the already huge number of orphans becomes bigger. She says they also need to learn how to respond to the high levels of trauma being experienced by both teachers and learners.
Beyond that, says Coombe, governments need to know how to manage these issues.
"In no country, including South Africa, could we say that we had a management structure and sufficient skills to meet the challenge of HIV/AIDS - we simply we could not do it," she continued. "So although I think at the moment we know more or less what needs to be done . . . the question remains, are we able to do it. And, for some some of us the answer is, certainly as far as governments are concerned, and some of their closest partners, no."
The challenges faced by the health and education sectors in southern Africa are replicated throughout these societies, from public services, to mining, to banking, to agriculture.
In his recent book, Buckling, researcher Hein Marais likens the impact of AIDS on South Africa's population to that of the plague in 14th century Europe. Marais predicts that, like the plague, the consequences of AIDS will be both widespread and far-reaching, causing collapse in some sectors of society, and regeneration in others.