HIVAIDS

1
HIV/AIDS MDGMicronesia RegionMDG-Consistent
HIV/AIDS Costing

• Kazuyuki Uji
• HIV/AIDS Practice Team
• UNDP Regional Centre in Colombo

2
Outline

• What is HIV / AIDS?
• Linkage between HIV and MDGs
• Overview of the epidemic in the North Pacific
• Overview of the MDG-Consistent HIV/AIDS Costing
  model

3
What is HIV?

• HIV
• Human Immunodeficiency Virus
• The virus that causes AIDS
• Transmitted by
• (1) blood and blood products
• (2) genital fluids (semen and virginal fluid) and
  
  
• (3) breast milk

4
What is AIDS?

• AIDS
• Acquired Immuno-Deficiency Syndrome
• Not a disease
• The physical state in which the bodys immune
  system becomes too weak to defend against a range
  of diseases (opportunistic infections)

5
How does HIV cause AIDS?
HIV
White Blood Cells (CD4) coordinate bodys defenc
e system
against diseases
6
HIV and MDGs

• Halting the spread of HIV is not only an
• MDG in itself, it is a pre-requisite for
  reaching most of the others.
  
• - Kofi Annan

7
MDG 1HIV/AIDS drives people
deeper into poverty
million
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
2003
2005
2007
2009
2011
2013
2015
Source ADB (2004) Asia Pacifics Opportunity
Investing to Avert an HIV/AIDS Crisis
8
MDG 1Large economic loss in Asia Pacific due to
HIV/AIDS
US billion
18
16
Annual losses
14
12
10
8
6
4
2
0
2001
2010
Source ADB (2004) Asia Pacifics Opportunity
Investing to Avert an HIV/AIDS Crisis
9
MDG1 HIV could put enormous financial burdens on
government
PNG
Source ADB
10
MDG 1Already high health cost in the North
Pacific could increase due to HIV/AIDS
Total health expenditure as GDP (2004)
Source WHO
11
MDG2 HIV impacts both children and teachers
12
MDG 3 HIV disempowers women
40000
35000
30000
25000
20000
15000
10000
5000
0
Number of people living with HIV in PNG
Source UNAIDS
13
MDG 3 Particularly girls and young women are
vulnerable
Distribution of HIV cases by sex and age in PNG
Source PNG NACS DoH (2004)
14
MDG4 HIV worsens under-five child mortality
Source Lancet (2002)
15
MDG 5 HIV worsens maternal mortality
Maternal deaths
Source Khan M et al. (2001)
16
MDG6 HIV increases TB incidence
160
35
TB
140
30
HIV-national
120
25
HIV-Kampala
100
20
()
HIV prevalence adults
TB incidence/100,000
80
Uganda
15
60
10
40
5
20
0
0
1975
1980
1985
1990
1995
2000
Source WHO (2002)
17
HIV and MDGs

• Halting the spread of HIV is not only an
• MDG in itself, it is a pre-requisite for
  reaching most of the others.
  
• - Kofi Annan

18
HIV/AIDS in the Pacific
19
HIV in the Pacific (1)Low number except for PNG
HIV Cases
Source SPC (2004)
20
HIV in the Pacific (2)But the impact is visible
Cumulative HIV cases per 100,000 people
Source SPC (2004)
21
HIV in the Micronesia Region

• Still low prevalence
• But presence of vulnerability factors

22
Factor 1 High Mobility

• Outward migration to Guam
• Large number of seafarers
• Large inflow mobility

Sources UNAIDS/ UNFPA/ Palau census (2000)
23
Mobile men can be vulnerable to HIV
Percentage of non-mobile/mobile men paying for
sex in the past 12 months
0
China
Cambodia
Indonesia
Viet Nam
FHI, 2006
24
Factor 2 Young population
Source US Census Bureau
25
Factor 3 Low contraceptive use
Contraceptive prevalence rate (modern methods)
(2000)
Source UNFPA
26
Factor 4 High prevalence of sexually-transmitted
infections (STI)
Prevalence of Chlamydia among antenatal women
Source WHO (2001)
27
Other factors

• Strong stigma and discrimination
• Geographical difficulty in accessing services

28
Low to high prevalence doesnt take too long
HIV prevalence among pregnant women in Thailand
Source Science magazine (2003)
29
Costing of Responses for MDG 6
30
The MDG-consistent HIV/AIDS Costing Model (MHM)
An Overview
Resource Needs Model (Futures Group)
Cape Town Model (U of Cape Town)
(ARV treatment)
UNDP RCC, MDG-S(UNMP), UNAIDS
Improvements New functions New interventions
MDG-consistent HIV/AIDS Costing Model
(part of integrated health model or independent)
31
What does the model do?

• Designed to calculate the total cost of HIV/AIDS
  responses
  
• NOT designed to
• Assess the impact of a response on the future
  course of the epidemic
  
• Assist in priority-setting

32
MDG-consistent HIV Costing Model (MHM) Key
characteristics

• Compared with existing HIV costing models, MHM
  is
  
• Simpler and more transparent
• More flexible
• Equipped with a greater scope of interventions
• Consistent with the MDG timeframe and
  target-based approach
  
• Compatible with UNAIDS targets for 2010 universal
  access
  
• More user-friendly interface

33
(No Transcript)
34
?
?
?
?
35
?
?
?
?
36
ENABLING ENVIRONMENT
37
(No Transcript)
38
PREVENTION
39
Proxy 1 2.6 customers per sex worker per day (
2.65 days 51 wks 663 commercial sex acts per
year) (Study of sex workers in Kolkatta, India)
Proxy 2 XYZ..
40
TREATMENT
41
(No Transcript)
42
CARE SUPPORT
43
COST SUMMARY
44
COST SUMMARY
45
Thank you.
46
(No Transcript)
47
PICs with highest cumulative HIV incidence per
100,000
Source ADB (2005)
Return
48
Seafarers and their spouses are vulnerable to HIV
Spouses of seafarers (13)
63
Seafarers (50)
Source ADB (2005)
Return
49
(No Transcript)
50
WTO Status in Micronesia