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The State of the Epidemic in 2010by
Professor Alan WhitesideHEARD
House of Lords 9th March 2010
DFID HIV Leaders Meeting
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‘Three Threes’
Three exceptional epidemics Russia and Ukraine Poor countries with low health spends and mid-range HIV burdens Hyper-endemic countries of Southern Africa
Three challenges Prevention Care and treatment (in light of new guidelines) Impact mitigation and looking to the next generation
Three critical responses What works Who pays How can it be sustained
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The global picture in 2007
Source: UNAIDS Global Report 2008. Geneva: UNAIDS. (2007 data)
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Exceptional epidemics: Eastern Europe
Sources: HIV/AIDS Surveillance in Europe. EuroHIV 2007, and World Population Prospects: The 2008 Revision Population database. UN Population Division.
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HIV Prevalence in Africa 2007(Adults 15–49)
Source: UNAIDS Global Report 2008. Geneva: UNAIDS (2007 data)
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Mid-level prevalence in low resourced countries
Malawi Tanzania Uganda
Government Health Expenditure Per Capita $62 $72 $71
Average Cost of treatment per person/per year * $257 $850 $850
People living with HIV ** 930,000 1,400,000 940,000
People receiving ARV treatment *** 100, 649 373, 265 111, 232
GDP per capita $800 $1,300 $1,100
Sources: *Rosen, S. and Long, L. ‘How Much Does it Cost to Provide Antiretroviral Therapy for HIV/AIDS in Africa?’ 2006, **UNAIDS Global Report 2008 and ***UNGASS Country Reports 2008.
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Exceptional epidemics: the Hyper-endemic Countries
Source: Epidemiological Updates. Geneva: UNAIDS 2009.
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HIV and AIDS
Country Population Numbers living with HIV/AIDS at a 18.8% prevalence rate
Swaziland 1,200,000 225,600
UK 60,776,000 11,425,888
EU 492,964,000 92,677,000
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Three Challenges: Three Waves
Time
NumbersHIV
Prevalence
AIDS cases
Impacts
Source: Barnett, T. & Whiteside, A. (2006) AIDS in the Twenty-First Century. Palgrave MacMillan
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Three Challenges
T1 T2 Time
Numbers
A1A2
Prevention
B1
A
B
Care & Treatment
Impacts
Source: Barnett, T. & Whiteside, A. (2006) AIDS in the Twenty-First Century. Palgrave MacMillan
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AIDS Treatment without prevention is mopping the floor while the tap is running
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AIDS Impacts
Sources: Swaziland HIV Estimates and Projections. NERCHA and UNIAIDS Workshop report. 2007 and US Census Bureau International Database
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Three Critical Responses
What works?
Who pays? (and for what)
Sustainability
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What Works
• Prevention of Vertical Transmission• Combination prevention
• Male circumcision• Social change
• Leadership • Changing Gender Relations
• Economic Empowerment• Community Mobilisation
• Treatment
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Combination HIV Prevention
Source: Coates et al. (2008) Behavioural Strategies to Reduce HIV Transmission: How to make them work better. Lancet, 372: 669-684
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Adherence to HIV Prevention Technologies
Source: Coates et al. (2008) Behavioural Strategies to Reduce HIV Transmission: How to make them work better. Lancet, 372: 669-684
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Who Pays?
Source: UNAIDS (2009) What Countries Need, Investments Needed for 2010 Targets. Geneva: UNAIDS
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Global Resource Needs
Source: Estimating the Long-term Global Resource Needs for AIDS through 2031. Draft Working Paper. 2009. AIDS 2031
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Sustainability
• Do we agree on importance of AIDS in the global development context and in global health
• The rich world needs to keep promises • Africa needs to honour the Abuja Declaration (Only
Botswana and Gambia have achieved this)• Treatment is not sustainable without prevention and
international commitment • Political and financial commitment are both needed
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Conclusions
• Targets set in 2005 much has been done• MDG targets in Southern Africa not sure?• Should we change targets (treatment)?• Keeping ‘exceptional’ epidemics on the agenda?
• Moving forward? Who makes decisions?• Partnerships?