Getting HIV research into use: A

reflection

Professor Alan Whiteside

HEARD

DFID

7 January 2013

Outline

• The history of the HIV and AIDS epidemic

• Researching HIV and AIDS

• Practical experiences from HEARD

• Examples of success (remembering contestation)

Three challenges

T 1 T 2 Time

Numbers

A 1

A 2

Prevention

B 1

A

B

Care & Treatment

Impacts

Source: Barnett, T. & Whiteside, A. (2006) AIDS in the Twenty-First Century. Palgrave MacMillan

Swazi antenatal clinic HIV prevalence

DHS HIV prevalence Swaziland 2006

HIV prevalence & no of HIV+ people countries

with >1% of SSA HIV+ population

HIV prevalence and number of HIV positive

people in countries with 1% or more of the

total Sub-Saharan African HIV positive

population. Data from: UNAIDS

(http://www.unaids.org/en/dataanalysis/epi

demiology/

What we know

• HIV is new, only 30 years old

• It varies geographically

• No cure, treatment still expensive

• Most impact is still to come

• We still don’t know what AIDS means

Research

Type

Timing Quality

Application

Epidemiology

Early Excellent Mixed

Science

Early Excellent Rapid in west slow

LDCs

Social science

Slow Mixed Mixed

Economics

Late Mixed Ignored to 2012

Outline

• The history of the HIV and AIDS epidemic

• Researching HIV and AIDS

• Practical experiences from HEARD

• Examples of success (remembering contestation)

Incidence by modes of HIV transmission (sexual)

0

20

40

60

80

100

Uganda Mozambique Swaziland Lesotho Zambia Kenya

Percent

new

infections

Sources: Results from Know your Epidemic project in Southern and East Africa .

Reports available http://www.unaidsrstesa.org/hiv-prevention-modes-of-transmission

Clients of female sex workers Injecting drug users

Men having sex with men Casual heterosexual sex Partners (Casual heterosexual sex)

Long Term cohabitating monogamous heterosexual sex (low risk heterosexual sex)

Other Partners of clients of female sex workers

Demographics: population growth rate

Men: Prevalence by Age Women: Prevalence by Age

2007 DHS and 2011 SHIMS HIV prevalence in

Swaziland (ages 18-49)

What happened in Zimbabwe (Halperin et al,

2011)

B

0

10

20

30

40

0

2

4

6

8

10

1980 1985 1990 1995 2000 2005 2010

Prev

alen

ce a

nd A

IDS

deat

hs

Inci

denc

e

Year

Incidence(per 100pyar)

Prevalence(%)

AIDS deaths(per 1000)

0

20

40

60

80

15-19s men had sex [DHS]

15-19s women had sex [DHS]

Men with extra-marital

partners [DHS]

Men paid for sex last year

[DHS]

Men with multiple

concurrent partners

[Manicaland]

Men with casual

partners in last month

[Manicaland]

Men using condom at last

casual sex [DHS]

Starting sex Multiple partnerships Condom use

%

Late 1990s

Early/Mid 2000s

What happened in Zimbabwe and why (Halerin et al 2011)

Demographic and epidemiological module E. Lule M. Haacker

Based on:

• Projections of scaling-up of access to ART, including numbers of those 1st and

2nd line treatment as per the NSF

Economics is about choice

• Economic

• Political

• Human rights

• Short term or long term

There are no easy answers.

Outline

• The history of the HIV and AIDS epidemic

• Researching HIV and AIDS

• Practical experiences from HEARD

• Examples of success (remembering contestation)

• Staff buy-in (part of strategy)

• Support (communications staff)

• Tools

– Website

– HEARD alerts

– HEARD news

– Annual report

– Briefs and news including multi media

– Community feedback

Policy Brief (4 pages)

News and Press

By Defeating the Generic-drugs Bill, Ottawa has Endangered Millions of

Lives: The Globe and Mail Editorial by HEARD's Executive Director Alan

Whiteside and UKZN Fulbright Scholar Jamie Cohen

Inclusivity

Social Media and Press

• Facebook www.facebook.com/HEARDUKZN

• Twitter: www.twitter.com/HEARD_UKZN

• Website www.heard.org.za

• Multimedia: films and slide show

• Brochure

• Stands at key conferences

• Champions

But ……

It must be based on good research

Well designed projects

Fits into strategy and plan… (and researchers interest and agendas)

Each project has internal and external review

Funded

2012 output from HEARD: 36 peer reviewed articles and chapters from

10 researchers

Outline

• The history of the HIV and AIDS epidemic

• Researching HIV and AIDS

• Practical experiences from HEARD

• Examples of success (remembering contestation)

Success

• The red country Swaziland

• Gender NSPs

• ACHWRP child tracking tools

• Alumni

• Influence

The commercial

HEARD: an applied research unit in South Africa working regionally

We welcome visitors

• PhD research

• Post Docs

• People wanting a place to locate for a while

• Fellows

Our rules

• Apply (with support from your institution)

• Bring resources: we offer space and a work environment

• Be prepared to give as well as get

• Spend at least 4 months in Durban

www.heard.org.za