The State of the Epidemic in 2010by

Professor Alan WhitesideHEARD

House of Lords 9th March 2010

DFID HIV Leaders Meeting

‘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

The global picture in 2007

Source: UNAIDS Global Report 2008. Geneva: UNAIDS. (2007 data)

Exceptional epidemics: Eastern Europe

Sources: HIV/AIDS Surveillance in Europe. EuroHIV 2007, and World Population Prospects: The 2008 Revision Population database. UN Population Division.

HIV Prevalence in Africa 2007(Adults 15–49)

Source: UNAIDS Global Report 2008. Geneva: UNAIDS (2007 data)

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.

Exceptional epidemics: the Hyper-endemic Countries

Source: Epidemiological Updates. Geneva: UNAIDS 2009.

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

Three Challenges: Three Waves

Time

NumbersHIV

Prevalence

AIDS cases

Impacts

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

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

AIDS Treatment without prevention is mopping the floor while the tap is running

AIDS Impacts

Sources: Swaziland HIV Estimates and Projections. NERCHA and UNIAIDS Workshop report. 2007 and US Census Bureau International Database

Three Critical Responses

What works?

Who pays? (and for what)

Sustainability

What Works

• Prevention of Vertical Transmission• Combination prevention

• Male circumcision• Social change

• Leadership • Changing Gender Relations

• Economic Empowerment• Community Mobilisation

• Treatment

Combination HIV Prevention

Source: Coates et al. (2008) Behavioural Strategies to Reduce HIV Transmission: How to make them work better. Lancet, 372: 669-684

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

Who Pays?

Source: UNAIDS (2009) What Countries Need, Investments Needed for 2010 Targets. Geneva: UNAIDS

Global Resource Needs

Source: Estimating the Long-term Global Resource Needs for AIDS through 2031. Draft Working Paper. 2009. AIDS 2031

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

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?