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According to the conventional theory of the demographic transition, mortality
decline has represented the major trigger for fertility decline and eventually sustained economic
development. In Sub-Saharan Africa (SSA), the HIV/AIDS epidemic has had a devastating impact
on mortality, by dramatically reversing (in high HIV-prevalence countries) the long-term positive
trend in life expectancies. Despite SSA is suffering a delayed and slowed fertility transition
compared to other world's regions and despite the existence of a robust empirical evidence showing
the potential for a fertility reversal in countries with severe HIV epidemics, there seems to be a little
concern amongst international organisations about the ultimate impact that HIV might have on SSA
fertility. This work builds on a Unified Growth Theory model supporting the existing evidence of a
HIV-triggered fertility reversal in SSA countries. The model predicts the reversal because of the fall
in education and human capital investments due to the drop in life expectancy for young adults.
This mechanism eventually breaks down the virtuous circle promoting the switch quantity-toquality
of children. Results suggest that the current evidence on the stall in fertility decline and the
declining education in high HIV-prevalent SSA countries should be seriously taken into
consideration to prioritise international interventions.
