Public Policy Making Process is complex

Research results seldom have immediate impact ongovernment policy,

The political system in the country determines the policymaking process

The nature of problems, proposed solutions and politicsmay determine the policy making process, and

A linear approach to policy making is unlikely to succeed.

HIV/AIDS FIGURES

more than 34 million people infected by end of 1999

o more than 67% are in developing countries

15,7 million are women

o some areas 1/3 pregnant women are infected

1,3 million children were infected in 1999

o 90% of these were due to MTCT

more than 2 million Africans died of AIDS in 1999 alone

Distribution of Number of People Infected with HIV

Botswana

Malawi

Lesotho

MozambiqueNamibia

South Africa

Swaziland

Zambia

Zimbabwe

Total = 10.7 million in 2000Total = 10.7 million in 2000

Projected HIV Prevalence

0

5

10

15

20

25

30

35

40

1980 1985 1990 1995 2000 2005 2010 2015

BotswanaLesotho

MalawiMozambiqueNamibia

South AfricaSwaziland

Zambia

Zimbabwe

Women can be Women can be especially vulnerable especially vulnerable to the HIV/AIDS to the HIV/AIDS epidemic...epidemic...… subordinate position to

males can make it difficult to protect selves against HIV

… certain cultural and economic practices can increase the risk of transmission

… burden of care in AIDS - affected households falls on women and children

Women & AIDS

Selected studies documenting STIs and their relativerisk for HIV Transmission

Reference StudyPopulation

STI Studied RelativeRisk

Cameron,et al.

Heterosexualmen (Kenya)

Genital ulcer(mainlychancroid)

4.7

Darrow, etal

MSM (USA) Syphilis 1.5-2.2

Holmberg, et al

MSM (USA) Herpes 4.4

Laga, et al Heterosexualwomen(Zaire)

Gonorrhoea

Chlamydiainfection

Trichomoniasis

3.5

3.2

2.7

Stamm etal.

MSM (USA) Herpes

Syphilis

3.3-8.5

8.4-8.5

Mortality in patients with CD4<100 of antiretroviral (ARV)therapy including a protease inhibitor among those

patients, USA, 1994–1997

0

10

20

30

40

1994 1995 1996 1997

De

aths

per

100

pe

rson

yea

rs

0

20

40

60

80

100 AR

V therap

y including protease

inhibitors (% of p

atient days)Deaths

ARV

Source: Palella et al., New Eng land Journa l o f Medicine , 1998 Mar, 26:338–6098036-E-35 – 15 July 1998

Annual number of deaths due to AIDS,Canada, 1990 to 1999

0

200

400

600

800

1000

1200

1400

1600

90 91 92 93 94 95 96 97 98 99

Num

ber

of A

IDS

dea

ths

Source: Health Canada, HIV and AIDS in Canada. Surveillance Report to December 31, 1999

0

5

10

15

20

25

30

35

40

82 84 86 88 90 92 94 96 98*

Year

Dea

ths

per

100,

000

Pop

ulat

ion

UnintentionalinjuryCancer

Heart disease

Suicide

HIV infection

Homicide

Chronic liverdiseaseStroke

Diabetes*Preliminary 1998 data

Trends in Annual Rates of Death from Leading Causes of DeathAmong Persons 25-44 Years Old, USA, 1982-1998

National Center for Health StatisticsNational Vital Statistics System

0

10

20

30

40

50

60

70

82 84 86 88 90 92 94 96 98*

Year

Dea

ths

per 1

00,0

00 P

opul

atio

n

UnintentionalinjuryHeart disease

Suicide

Cancer

HIV infection

Homicide

Liver disease

Stroke

Diabetes*Preliminary 1998 data

Trends in Annual Rates of Death from Leading Causes of DeathAmong White Men 25-44 Years Old, USA, 1982-1998

National Center for Health StatisticsNational Vital Statistics System

05

10152025303540455055

82 84 86 88 90 92 94 96 98*

Year

Dea

ths

per

100

,000

P

opu

latio

n

Cancer

Heart disease

HIV infection

UnintentionalinjuryHomicide

Stroke

Diabetes

Liver disease

Suicide*Preliminary 1998 data

Trends in Annual Rates of Death from Leading Causes of DeathAmong Black Women 25-44 Years Old, USA, 1982-1998

National Center for Health StatisticsNational Vital Statistics System

0

2040

6080

100

120140

160180

200

82 84 86 88 90 92 94 96 98

Year

Dea

ths

per 1

00,0

00

Popu

latio

n

HIV infection

Homicide

UnintentionalinjuryHeart disease

Cancer

Suicide

Stroke

Diabetes

Liver disease*Preliminary 1998 data

Trends in Annual Rates of Death from Leading Causes of DeathAmong Black Men 25-44 Years Old, USA, 1982-1998

National Center for Health StatisticsNational Vital Statistics System

Number of new AIDS cases, Western Europe1986 – 1997

5 000

10 000

15 000

20 000

25 000

30 000

1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997

Source: European Centre fo r he Epidemiologica l Monito ring o f AIDS (CESES), France

Number of cases

11 22 11 22 11 22 11 22 11 22 11 22 11 22 11 22 11 22 11 22 11 22 11 22 11 22 11 22 11 22 11 22 11 22 11 228282 8383 8484 8585 8686 8787 8888 8989 9090 9191 9292 9393 9494 9595 9696 9797 9898 9999

Semester of DiagnosisSemester of Diagnosis

00200200400400600600800800

1.0001.0001.2001.2001.4001.4001.6001.6001.8001.8002.0002.0002.2002.2002.4002.4002.6002.6002.8002.8003.0003.000

Num

ber

of C

ases

Num

ber

of C

ases

00

22

44

66

88

1010

Rate x 100,000

Rate x 100,000

N. N. casicasi

Correction for notification delayCorrection for notification delay

Incidence rateIncidence rate

Evolution of AIDS Case Notifications in Italy (at december 31, 1999)Evolution of AIDS Case Notifications in Italy (at december 31, 1999)

Drug Companies Auto Companies Oil Companies Security Firms Airlines

$27.5

$16.5$15.3

$13.5

$4.5

1999

Pro

fits

($

bill

ions

)

COMBINED PROFITS OF NINE MOST PROFITABLE COMPANIES IN SELECT FORTUNE 500 INDUSTRIES 1999

Source: Fortune Magazine, April 2000, Fortune 500 (www.fortune.com)

Non-Drug Costs Associated with ARV Therapy (US$)

ITEM UNIT COST

CD4 cell count 30-157

Viral Load Test 130-163

Complete Blood Count 2-21

Chemistry Panel 12-35

Serum amylase 18

Transfusion for ZDV-inducedanaemia

580

HIV ELISA test 3-6

Rapid HIV test (Capillus) 3

Rapid HIV test (Abbot) 10

Pre-test/post-test Counse-llingVisit for HIV- Person

22/33

Pre-test/post-test Counse-llingVisit for HIV+ Person

22/77

Test +Counselling 18/12

Outpatient Visit (not specific toARV therapy related)

17-120

Source: WHO unpublished slide

OPPORTUNITIES TO IMPLEMENT ACCESS TO AIDSDRUG POLICIES

Implement Clinton’s Executive Order on access topharmaceuticals

Import ARV’s and other drugs from countries likeBrazil and Thailand

Learn the technology to produce these drugs

Negotiate cheaper prices for diagnostic kits andreagents

Establish sustainable financing mechanisms toensure reliable distribution and access to drugs.

Use existing tertiary facilities to provide ARV’s