a multisectoral response

7/25/2019 A Multisectoral Response

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1. Introduce HIV/AIDS with Sthn African data

2. Two Epidemic Curves3. Talk about what causes HIV spread

4. Discuss the consequences of AIDS

Demographic Development and

Economic consequences

5. Propose an agenda for action

Outline of the presentation


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0

1

2

3

4

5

6

7

8

Sub-saharan Africa

Middle East & N

AfricaEast Asia & Pacific

South Asia

Growth in Gross Domestic product (%)

World Bank, World Development Report, 2000/01

80-90 90-99

4


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5


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National t r ends in H IV pr evalence

0

5

1 0

1 5

2 0

2 5

3 0

3 5

4 0

4 5

1 9 9 0 1 9 9 1 1 99 2 1 9 9 3 1 99 4 1 9 9 5 1 9 9 6 1 9 9 7 1 99 8 1 9 9 9 2 0 0 0

%

HIV

positive

Namibia

7


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National tr ends in H IV pr evalence

0

5

10

15

20

25

30

35

40

45

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

%

HIV

positive

Namibia

S outh Afr ica

8


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Nati onal tr ends in H IV prevalence

0

5

10

15

20

25

30

35

40

45

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

%H

IVp

ositive

Namibia

S outh Afr ica

S waz iland

9


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Nat ional tr ends in H IV pr evalence

0

5

10

15

20

25

30

35

40

45

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

%H

IV

positive

B ots wana

Namibia

S outh Afr ica

S waz iland

10


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HIV Prevalence

1 - 3%

3 - 6%

6 - 9%

9 - 12%

12 - 15%

15 - 18%

18 - 21%

21 - 24%

24 - 27%

27 - 30%

30 - 33%

33 - 36.2%

Provinces

NorthernCape

Eastern Cape

FreeState

NorthWest

Western Cape

NorthernProvince

KwaZulu-Natal

MpumalangaGauteng

1997

NorthernCape

Eastern Cape

FreeState

NorthWest

Western Cape

NorthernProvince

KwaZulu-Natal

MpumalangaGauteng

1998

NorthernCape

Eastern Cape

FreeState

NorthWest

Western Cape

NorthernProvince

KwaZulu-Natal

MpumalangaGauteng

1999

Northern Cape

Eastern Cape

Free State

North West

Western Cape

Northern Province

KwaZulu-Natal

MpumalangaGauteng

2000

NorthernCape

EasternCape

Free State

NorthWest

WesternCape

NorthernProvince

KwaZulu-Natal

MpumalangaGauteng

1994

NorthernCape

Eastern Cape

FreeState

NorthWest

Western Cape

NorthernProvince

KwaZulu-Natal

MpumalangaGauteng

1995

Northern Cape

Eastern Cape

Free State

North West

Western Cape

Northern Province

KwaZulu-Natal

MpumalangaGauteng

1996

Progression of HIV Prevalence in South AfricaTrends Amongst Provincial AnteNatal Clinic Attendees, 1994-2000

Source: National HIV and Syphilis Sero-PrevalenceSurvey of Women Attending Public AnteNatalClinics in South Africa, 1994 - 2000.

TheHealth Economics&HIV/AIDS ResearchDivisionUniversity of NatalKingGeorgeV AvenueDurban,4041Tel: +2731 2602592Fax:+27 31260 2587Email: [email protected]: www.und.ac.za/und/heard

Developedby Susan Erskine & LucindaFranklin

We wishto acknowledge theassistance of staff atEduActionin thedevelopmentof this output.

In particular, we wishto thank Daniel Wilson for hisinvaluable guidance, time and provision of resources.

Legend

Intro.


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2. Two Epidemic Curves2. Two Epidemic Curves3. Talk about what causes HIV spread


Demographic

Development and





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27Aug01 -Report I:Epidemgy & Lit. p. 27

Epidemic Curve, HIV

T1 T2 Time

Numbers

A1

A2

HIV prevalence

A

B

11


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Epidemic Curves, HIV and AIDS

T1 T2 Time

Numbers

A1

A2

HIV prevalence

AIDS - cumulative

B1

A

B

12


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An te-natal clin ic prevalence (%)

0

5

10

15

20

25

1990

13


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Ante-natal clin ic pr ev alence %

0

5

10

15

20

25

1990 1991 1992 1993

14


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Ante-natal clinic pr evalence (%)

0

5

10

15

20

25

1990 1991 1992 1993 1994 1995 1996 1997 1998

T hailand

15


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A n te-n atal cl in ic pr ev alen ce (% )

0

5

10

15

20

25

1990 1991 1992 1993 1994 1995 1996 1997 1998

S outh Afr ica

T hailand

16


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2. Two Epidemic Curves

3. Talk about what causes HIV3. Talk about what causes HIV

spreadspread4. Discuss the consequences of AIDS Demographic

Development and Economic consequences




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HIV Epidemic Determinants and Responses A Medical View

DeterminantsBiomedical

Virus sub-types

Stage of infection

Presence of

other STDs

Gender

Circumcision

Other

HIV Infection

Aids

19


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HIV Epidemic Determinants and Responses Sexual Behaviour

Determinants

Biomedical

Virus sub-types

Stage of infection

Presence of other STDs

Gender

Circumcision

Other

HIV Infection

Aids

Sexual behaviour

Rate of partner change

Concurrent partners

Sexual mixing patterns

Sexual practices

Condom use

Other

20


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HIV Epidemic Determinants and Responses Upstream Causes

Determinants

Biomedical

Virus sub-types

Stage ofinfection

Presence ofother STDs

Gender

Circumcision

Other

HIV Infection

Aids

Sexual behaviour

Rate of partner

change

Concurrentpartners

Sexual mixingpatterns

Sexual practices

Condom use

Other

Micro-environment

Mobility

Urbanisation

Access to healthcare

Levels ofviolence

Womens rightsand status

Other

Macro-environment

Wealth

Income distribution

Culture

Religion

Governance

Other

21


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Wealth and HIV

1000 $

2000 $

3000 $

Per capita

1999

Adult HIV prevalence end 1999

Botswana

South Africa

Namibia

Swaziland

ZimbabweUganda

Cote dIvoire

Zambia

22

10

10 20 30


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Debswana Diamond Company (Pty) Ltd

HIV Prevalence by Job Band

30.9% 30.7%27.6%

19.3% 18.8%

0

5

10

15

20

25

30

35

A Band B Band C Band D Band F Band

%H

IVpositiveemployeesineachjobb

and

23


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HIV Epidemic Where we responded

Determinants Biomedical

STD treatment

Blood safety

Anti-retroviraltherapy duringpregnancy

Provision ofcondoms

Sexual behaviour

Behaviour change

communication

Condom

Promotion andmarketing

Micro-environment

Macro-environment

Interventions

24


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HIV Epidemic Where we should respond

Determinants

STD treatment

Blood safety

Anti-retroviral

therapy duringpregnancy

Provision ofcondoms

Behaviour changecommunication

Condom promotionand marketing

Micro-environment

Social Policy

EconomicPolicy

Legal Reform

Employmentlegislation

Macro-environment

Social policy redistribution

Legal Reform

Human Rights

Taxation

Debt reliefTerms of Trade

Interventions

25

Sexual behaviour Biomedical


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2. Two Epidemic Curves3. Talk about what causes HIV spread

4. Discuss the consequences of4. Discuss the consequences of

AIDSAIDS DemographicDemographic

Development andDevelopment and Economic consequencesEconomic consequences




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Epidemic Curves, HIV and AIDS

T1 T2 Time

Numbers

A1

A2

HIV prevalence

AIDS - cumulative

B1

A

B

12


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Percent who know a close friend orrelative who died of AIDS?

0

10

20

30

40

50

60

70

B o ts w a n a M a la w i N a m ib ia Z a m b ia Z im ba b w e L e s o th o S o uth

A fr ic a

P ercent


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Percent whose physical health reducedthe amount of work they do?

0

5

10

15

20

25

30

35

40

45

B o ts w a n a M a la w i N a m ib ia Z a m b ia Z im ba b w e L e s o th o S o uth

A fr ic a

P ercent


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Mortality in Swaziland

0

20

40

60

80

100

120

140

160

180

200

95(1) 96(1) 97(1) 98(1) 99(1)

Deathsforfirstsixmonthsofeach

year

0-15

16-25

26-40

41-55

55+

17


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Estimated increase in adult death rates

relative to the 1985 rates

Women

0.000

0.500

1.000

1.500

2.000

2.500

3.000

3.500

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

Ag e

Ratio

1994

1996

1997/8

1998/99

1999/2000


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Estimated increase in adult death rates

relative to the 1985 rates

Men

0.000

0.500

1.000

1.500

2.000

2.500

3.000

3.500

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

Age

Ratio

1994

19961997/8

1998/99

1999/2000


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Life expectancy 2000 and 2010

2000 2010

30

40

50

60

70

80

Botswana

20

2000 2010

30

40

50

60

70

80

Cote dIvoire

20

2000 2010

30

40

50

60

70

80

South Africa

20

Without AIDS Without AIDS Without AIDS

With AIDS With AIDS With AIDS

28


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Under Five Mortality 2000 and 2010

2000 2010

50

100

150

Botswana

0

2000 2010

50

100

150

Cote dIvoire

0

2000 2010

50

100

150

South Africa

0

With AIDS With AIDS With AIDS

Without AIDS

Without AIDS Without AIDS

Rate per 1000live births

29


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South Africa Botswana

Changes in Population Structure due to AIDS 2000-2025

32


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Pathways to Economic Impact

MORTALITY

MORBIDITY

Smaller

population

Change in

age structure

INDIVIDUAL

FIRM/SECTOR

GOVERNMENT

M

ACRO-ECONOMY

HOUSEHOLD

LABOUR

MARKETAIDSAIDS

HIVHIV

Productivity

27


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Forecast GDP Growth 2002-15

0

0.5

1

1.5

22.5

3

3.5

4

4.5

2002-

2005

2006-

2010

2011-

2015

Average

No AIDS

With AIDS


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Conclusions re Households

Households will try toadapt.

New forms of household.

Coping & distress can bothbe found.

Assets will be sold.

Households

poorer

Householdsdisappear

Zambia

5 year retrospective study of AIDS-affected families

(232 urban +101 rural)

Monthly disposable income

fell by >80%

Rakai, UgandaBicycles & radios in

houses with adult AIDS death

Bike Radio

First vist 39 40

Last visit 35 36

30


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0

500000

1000000

1500000

2000000

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

AIDS orphans in South Africa

33


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AIDS deaths as a % of total mortalityASSA2000 model (no interventions)

0.1% 0.3% 0.6%1.3%

2.5%4.4%

7.3%

11.4%

16.4%

22.8%

29.6%

36.4%

42.8%

48.6%

53.6%

57.7%

60.9%

63.2%64.7% 65.6%

65.9%

0 .0 %

20 .0%

40 .0%

60 .0%

80 .0%

1 99 0 1 99 1 1 99 2 1 99 3 1 99 4 1 99 5 1 99 6 1 99 7 1 99 8 1 99 9 2 00 0 2 00 1 2 00 2 2 00 3 2 00 4 2 00 5 2 00 6 2 00 7 2 00 8 2 00 9 2 01 0

Y e ar (s tartin g 1 Ju ly)

P

e

rce

n

ta


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34

1998 1999 Ch i G d 1 E l t


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1998 - 1999 Change in Grade 1 Enrolment

35

Increase in enrolment required in 2002 to


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Increase in enrolment required in 2002 to

return to 1998 levels of Grade 1 enrolment


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2. Two Epidemic Curves

3. Talk about what causes HIV spread


Demographic Development and


5. Propose an agenda for5. Propose an agenda foractionaction



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9/11: The Day the WorldChanged & HIV/AIDS

Focus: switching to terrorism.

Context: global economic slowdown creates

an environment for HIV spread.

Resources:

international aid will follow the focus.African governments own resources

reduced.


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prevention and mitigation for the nextgeneration towards an AIDS free

generation

opportunity and rights for women

leadership

Put HIV/AIDS into development anddevelopment into HIV/AIDS

The Priorities

43


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A Virtuous Circle

HIV Prevention Treatment and care

Pre-empts need for treatment

Mitigation of Impact

Reduces risk, strengthens communities

Makes communities

less vulnerablePre-empts need forfuture mitigation

Makes communities

less susceptible

Pre-empts

need forfuturemitigation

Strengthens

systems fordelivery of care

42


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An Action Agenda

There are no:

Simple solutions

Short term solutions

Technical/medical solutions Imposed solutions

Money is not the answer Drugs are only part of the answer

A multisectoral response40

a multisectoral response

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