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Presented in Cape Town at the Structural Drivers of HIV Conference in 2013
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The end of AIDS: possibility or pipe dream? A tale of transitions
Alan Whiteside and Michael Strauss
Slides to back up the article in African Journal of AIDS Research
Vol 13 Issue 2 2014 http://www.tandfonline.com/raar
5 - 6 December 2013
Years of life lost (women) by cause: Global, 2010
Source: 2010 Global Burden of Diseases Studyhttp://www.healthmetricsandevaluation.org/
0-1 1-4 5-14 15-24 25-49 50 – 80 +Age
Years of life lost (women): Western Europe 2010
Source: 2010 Global Burden of Diseases Studyhttp://www.healthmetricsandevaluation.org/
Maternal
Neonatal
HIV & TB
0-1 1-4 5-14 15-24 25-49 50 – 80 +Age
Years of life lost (women): Southern Africa, 2010
Source: 2010 Global Burden of Diseases Studyhttp://www.healthmetricsandevaluation.org/
Maternal
Neonatal
HIV & TB
0-1 1-4 5-14 15-24 25-49 50 – 80 +Age
New Infections Deaths of HIV Positive People
Time
Nu
mb
er
of
pe
op
le
Understanding curves: new Infections and deaths
Treatment needed
Time
Nu
mb
er o
f p
eop
le
People Requiring Treatment
Treatment requirements
Treatment requirements
People living with HIV (needing
treatment)
People currently receiving treatment
Incidence
Death Death
Initiation on ART
Attrition
New Infections Deaths of HIV Positive People
Time
Nu
mb
er o
f p
eop
le
Economic Transition Credit Mead Over
Economic transition
New Infections Deaths of HIV Posive PeopleTreatment New people needing treatment
Time
Nu
mb
er o
f p
eop
leEpidemiologic transition
Epidemiological TransitionProgrammatic Transition
New Infections Deaths of HIV Posive PeopleTreatment New people needing treatment
Time
Nu
mb
er o
f p
eop
leEpidemiologic transition
Real data from South Africa
ASSA 2008 – Comparing the estimates to the latest HSRC data:
• Prevalence is higher than ASSA estimates for 2012• There were fewer AIDS deaths than predicted in 2012,
possibly due to drug improvements• Incidence rates are in 2012 were higher than ASSA
estimates• In 2008, the benefits from treatment as prevention were not
fully understood
Real data from South Africa
0
1000000
2000000
3000000
4000000
5000000
6000000
7000000
HIV infec-tions
AIDS cases
AIDS deaths
Real data from South Africa
0
100000
200000
300000
400000
500000
600000
700000
New infections (Incidence)
AIDS deaths
No Economic Transition on the horizon
Real data from South Africa
0
100000
200000
300000
400000
500000
600000
700000
New infections (Incidence)
Real data from South Africa
0
100000
200000
300000
400000
500000
600000
700000
New infections (Incidence)
New HIV infections minus AIDS deaths
Real data from South Africa
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
2015
2017
2019
2021
2023
2025
0
100000
200000
300000
400000
500000
600000
700000
New infections (Incidence)
New patients on ART (over the past year)
New HIV infections minus AIDS deaths
Real data from South Africa
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
2015
2017
2019
2021
2023
2025
0
100000
200000
300000
400000
500000
600000
700000
Total new infec-tions (Inci-dence)
New patients on ART (over the past year)
New HIV infec-tions minus AIDS deaths
New HIV infec-tions minus AIDS deaths plus ART attri-tion (70% reten-tion 3yrs)
Sustained financial and political comittment means we will catch up
Programmatic Transition
Epidemiological Transition
