EG3244 Development Geographies The AIDS crisis Dr Mark Cresswell

EG3244Development Geographies

The AIDS crisis

Dr Mark Cresswell

TOPICS

• Background to STDs

• HIV: Introduction

• HIV: Aetiology & History

• Global and Regional Analysis

• Treatments

• Online resources

Sexually Transmitted Diseases

• STDs are one of the few emerging diseases that are not strictly related to economic wealth (love is free!!!!)

• Most STDs are really lifestyle diseases rather than emerging diseases – many STDs were caught and spread by amorous sailors from European colonial powers visiting islands and previously unchartered lands

Sexually Transmitted Diseases

• What we might term as “emerging diseases” are those STDs which are relatively new and for which there is no cure – principally HIV

• Human Immunodeficiency Virus (HIV) is a retrovirus• HIV leads to a clinical condition known as Acquired

Immune Deficiency Syndrome (AIDS) which may take a decade to develop

HIV: Introduction

• HIV was isolated in 1983 and was often linked to mainly homosexual activity – paticularly in the Los Angeles and San Francisco regions of the US

• It has claimed a number of high profile people (actors and scientists) who have been active in raising public awareness

HIV: Aetiology & History

• In fact, HIV is known to be transmitted through unprotected heterosexual activity, blood transfusions and medical procedures and drug use where hygiene rules are ignored

• Once HIV develops into AIDS the result is a progressive decline in immune status. Cause of death may be a common cold or septicaemia from cut


• HIV is believed to have resulted from a “crossing over” from a known animal disease affecting chimpanzees – Simian Immunodeficiency Virus (SIV)

• Two main types of HIV– HIV-1 most prevalent in western societies– HIV-1 & HIV-2 found mainly in Africa– HIV-2 is less aggressive form


• HIV-1 sub-types (known as “clades”) are very strongly associated with geography and vary from country to country

• Epidemiology of all STDs in human society is usually a direct result of:– Social and moral beliefs– Urbanisation and household occupancy patterns– Religious belief

Statistical Measures - Incidence

This is the number of new cases in a particular time period:

P

NI

I = IncidenceN = Number of new cases in a given time periodP = Person years at risk during same time period

Note that person years at risk means the total amount of time (in years) that each member of the population being studied (the study population) is at risk of the disease during the period of interest.

Statistical Measures - Prevalence

This is the proportion of current cases in a population at a given point in time:

P = PrevalenceNc = Number of cases in the population at a given point in timeP = Total population at the same point in time

P

NcP

06/06 e 2006 Report on the

global AIDS epidemicFig

25 years of AIDS25 years of AIDS

9 In 1991-1993, HIV prevalence in young pregnant women in Uganda and in young men in Thailand begins to decrease, the first major downturns in the epidemic in developing countries

10 Highly Active Antiretroviral Treatment launched

11 Scientists develop the first treatment regimen to reduce mother-to-child transmission of HIV

12 UNAIDS is created

13 Brazil becomes the first developing country to provide antiretroviral therapy through its public health system

14 The UN General Assembly Special Session on HIV/AIDS. Global Fund to fight AIDS, Tuberculosis and Malaria launched

15 WHO and UNAIDS launch the "3 x 5" initiative with the goal of reaching 3 million people in developing world with ART by 2005

16 Global Coalition on Women and AIDS launched

40

30

20

10

0

50

35

25

15

5

45

Mill

ion

1980 1985 1990 1995 2000 2005

1 2 3 45 6

8

9

11

12

13

14

1516

7

10

1 First cases of unusual immune deficiency are identified among gay men in USA, and a new deadly disease noticed

2 Acquired Immune Deficiency Syndrome (AIDS) is defined for the first time

3 The Human Immune Deficiency Virus (HIV) is identified as the cause of AIDS

4 In Africa, a heterosexual AIDS epidemic is revealed

5 The first HIV antibody test becomes available

6 Global Network of People living with HIV/AIDS (GNP+) (then International Steering Committee of People Living with HIV/AIDS) founded

7 The World Health Organisation launches the Global Programme on AIDS

8 The first therapy for AIDS – zidovudine, or AZT -- is approved for use in the USA

People People living living with HIVwith HIV

Children Children orphaned orphaned by AIDS in by AIDS in sub-Saharan sub-Saharan AfricaAfrica

1.1



Global HIV epidemic, 1990‒2005* HIV epidemic in sub-Saharan Africa, 1985‒2005*

Number of people living with HIV

% HIV prevalence, adult (15-49)

% HIV prevalence, adult (15‒49)

Number of peopleliving with HIV (millions)

0

10

20

30

40

50

1990 1995 2000 2005

0.0

1.0

2.0

3.0

4.0

5.0

1985 1990 1995 2000 2005

0

5

10

15

20

25

30

0.0

2.5

5.0

7.5

12.5

15.0

% HIV prevalence, adult (15‒49)

Number of peopleliving with HIV (millions)

Estimated number of people living with HIV and adult HIV prevalenceEstimated number of people living with HIV and adult HIV prevalence

This bar indicates the range around the estimate

*Even though the HIV prevalence rates have stabilized in sub-Saharan Africa, the actual number of people infected continues to grow because of population growth. Applying the same prevalence rate to a growing population will result in increasing numbers of people living with HIV.

10.0

2.2



A global view of HIV infectionA global view of HIV infection38.6 million people [33.4‒46.0 million] living with HIV, 2005

2.4



HIV prevalence (%) in adults in Africa, 2005HIV prevalence (%) in adults in Africa, 2005

2.5



Comprehensive knowledge about HIV and AIDS Comprehensive knowledge about HIV and AIDS among young males aged 15–24, by level of education, among young males aged 15–24, by level of education,

in 11 sub-Saharan African countries, 2000–2004in 11 sub-Saharan African countries, 2000–2004

Sources: Demographic and Health Surveys; HIV/AIDS Indicator Surveys (2000–2004).

0

10

20

30

40

50

60

70

80

BurkinaFaso Cameroon

GhanaKenya

MaliMozambique

NamibiaNigeria

RwandaUganda

Zambia

%

No education Primary education Secondary education and beyond

3.4



Comprehensive knowledge about HIV and AIDS Comprehensive knowledge about HIV and AIDS among young females aged 15–24, by level of education, among young females aged 15–24, by level of education,

in 11 sub-Saharan African countries, 2000–2004in 11 sub-Saharan African countries, 2000–2004

Sources: Demographic and Health Surveys; HIV/AIDS Indicator Surveys (2000–2004).

0

10

20

30

40

50

60

70

80

BurkinaFaso Cameroon

GhanaKenya

MaliMozambique

NamibiaNigeria

RwandaUganda

Zambia

%

No education Primary education Secondary education and beyond

:

3.5



Percentage of young people aged 15–24 reporting the use of a condom during Percentage of young people aged 15–24 reporting the use of a condom during sexual intercourse with a non-regular partnersexual intercourse with a non-regular partner, , Sub-Saharan Africa, 2001–2005Sub-Saharan Africa, 2001–2005

Male

Female

Countries with date of survey indicated

1000 10 20 30 40 50 60 70 80 90

%

Benin 2001

Botswana 2001

Burkina Faso 2003

Cameroon 2004

Chad 2004

Ghana 2003

Guinea 2005

Kenya 2003

Lesotho 2004

Madagascar 2003

Malawi 2004

Mali 2001

Mozambique 2003

Nigeria 2003

Rwanda 2004

Senegal 2005

United Republic of Tanzania 2003

Uganda 2004

Zambia 2003

Sources: Demographic Health Surveys; HIV/AIDS Indicator Surveys (2001-2005).3.6



Estimated total annual resources available for AIDS, 1996‒2005Estimated total annual resources available for AIDS, 1996‒2005

292

1623

8297*

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

US

$ m

illi

on

Signing of Declaration of Commitment on HIV/AIDS

Data include:

• International donors, domestic spending (including public spending and out-of-pocket expenditures)

• International Foundations and Global Fund included from 2003 onwards, PEPFAR included from 2004 onwards

* Projections based on previous pledges and commitments (range of the estimation: US$7.5 to US$8.5 billion).

3.8



Impact of AIDS on life expectancy in five African countries, 1970–2010Impact of AIDS on life expectancy in five African countries, 1970–2010

Life expectancy at birth (years)

Source: United Nations Population Division (2004). World Population Prospects: The 2004 Revision, database.

Botswana

South Africa

Swaziland

Zambia

Zimbabwe

1970–1975 1975–1980

1980–19851985–1990

1990–19951995–2000

2000–20052005–2010

70

65

60

55

50

45

40

35

30

25

20

4.1



Impact of three scenarios on HIV infection Impact of three scenarios on HIV infection in sub-Saharan Africa, 2003–2020in sub-Saharan Africa, 2003–2020

0.0

1.0

2.0

3.0

4.0

5.0

2003 2005 2010 2015 2020

Year

Treatment-centered

Prevention-centered

Baseline

Comprehensive response

Number of new HIV infections (millions)

Source: Salomon JA et al. (2005). Integrating HIV prevention and treatment: from slogans to impact6.1



Percentage of people on treatment who are children, Percentage of people on treatment who are children, by country, 2005by country, 2005

Zambia

0% 2% 4% 6% 8% 10% 12% 14% 16%

AfricaAfrica [Median: 7%] UR Tanzania

UgandaCentral African Republic

South AfricaKenya

ZimbabweNamibiaRwanda

MozambiqueMalawi

Côte d'IvoireNigeriaGhana

Haiti

Latin America and CaribbeanLatin America and Caribbean [Median: 8%] Panama

HondurasArgentina

GuyanaBrazil

El SalvadorVenezuela

Peru

0% 2% 4% 6% 8% 10% 12% 14% 16%

0% 2% 4% 6% 8% 10% 12% 14% 16%

CambodiaViet Nam

IndiaChina

AsiaAsia [Median: 4%]

Source: WHO/UNAIDS (2005). Progress on global access to HIV antiretroviral therapy: An update on “3 by 5.”7.3



Distribution by region of the funding required for preventionDistribution by region of the funding required for prevention

Latin America/Caribbean: 9%

Eastern Europe: 12%

North Africa/Middle East: 3%

Africa: 29%

South/South-East Asia: 21%

East Asia/Pacific: 26%

Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.10.3



Distribution by region of the funding required for treatment and careDistribution by region of the funding required for treatment and care

Latin America/Caribbean: 17%

Eastern Europe: 7%

North Africa/Middle East: 1%

Africa: 55%

South/South-East Asia: 4%

East Asia/Pacific: 16%

Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.10.6

Treatments

• There is currently no cure for HIV/AIDS• Current treatments are therapies which attempt to slow

down the virus (combination therapy)• Lifestyle changes to boost natural immune system can

extend life• Antiretrovirals are used. Typical combinations include

two drugs from the NRTI group (nucleoside reverse transcriptase inhibitors, also known as 'nukes') plus an NNRTI ('non-nuke') or a protease inhibitor

• A vaccine is some way off

Reading

• UNAIDS: http://www.unaids.org/en/• CDC: http://www.cdc.gov/hiv/default.htm• AIDS portal: http://www.aidsportal.org/• UK Development: http://www.aidsconsortium.org.uk/• TH Trust: http://www.tht.org.uk/

• Check papers with Science Direct/Web of Knowledge and library texts

Any Questions?

Documents

EG3244 Development Geographies The AIDS crisis Dr Mark Cresswell