AIDS EXCEPTIONALISM:

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AIDS EXCEPTIONALISM A Southern African
Perspective Alan Whiteside HEARD HIVAN/MRC
Forum Friday 28th November 2008 www.heard.org.za
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Lancet editorial 18/10/08

• It is time to unwind the rhetoric, and reposition
  the responses to HIV/AIDS as one of several
  important health challenges. . UNAIDS needs to
  abandon AIDS exceptionalism.
• Actually no. AIDS is exceptional, but not
  everywhere!

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Key Points

• The State of the Epidemic
• Waves and Consequences
• The Swaziland Case study
• What needs to be done differently

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Global numbers living with HIV and adult HIV
prevalence
Source UNAIDS 2008
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Global Baseline Deaths Projections Communicable
Diseases
Source Mathers and Loncar 2002, Projections of
Global Mortality and Burden of Disease from 2002
to 2030, World Health Organization, Geneva,
Switzerland
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Cause of Death by Income and Percentage in 2030
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2007 Global HIV Infection 33 million people
3036 million living with HIV,
2.2
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(No Transcript)
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HIV Prevalence in Antenatal Clinic Surveys
Southern Africa
Source UNAIDS Global AIDS report 2008
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HIV Prevalence 15- 49 Southern Africa
Southern Africas hot spots
Other countries
Adult 15-49 Source UNAIDS country AIDS
reports,2008
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Adult Prevalence South Africa
Source National Department of Health South
Africa, 2008
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HIV prevalence trends among ANC attendees, South
Africa, 2003 2007.
Source National Department of Health, South
Africa 2008
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Key Points

• The State of the Epidemic
• Waves and Consequences
• The Swaziland Case study
• What needs to be done differently

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Mopping the floor while the tap is running
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Per capita health expenditure cost of ARV
African Countries
Source Summary country profiles for HIV/AIDS
treatment scale up, WHO 2005. ARV treatment is
publicly funded. Source Introducing ARV Therapy
in the Public sector in Botswana Case study, 2004.
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ANC Prevalence results of universal access
HIV Prevalence
T1 NOW
T2 ARV rollout achieved
Time
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Looking ahead Epidemic Curve- HIV, AIDS and
Impact
Numbers
HIV
prevalence
Impact
A
2
A
1
A
AIDS
- cumulative
B
B
1
T3
T
T
1
2
p.
27Aug01 -Report I
Epidemgy
Lit.
27
Time
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SWAZILAND
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Key Points

• The State of the Epidemic
• Waves and Consequences
• The Swaziland Case study
• What needs to be done differently

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Demographic and Health Survey HIV Prevalence
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HIV and AIDS
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• Republican Voters in the USA
• 57 000 000
• Number of Americans who would be infected if the
  USA had Swaziland's prevalence
• 56 614 320
• BBC website 08/11/08

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Declaration of emergency and dead people study

• 1999 declared an emergency but
• 2000 Study of Mortality using newspaper death
  notices trend line from 26-40 age group

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2007 CENSUS PRELIMINARY RESULTS

• Population Data (de facto)
• 929 718
• 912 229
• There were 17 499 fewer people over 10 years
• Estimated for 2006 1 200 000

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DemographicsLife Expectancy
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Population pyramids Southern African hot spots
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Orphans and Vulnerable Children

• 130,000 OVC
• 23.3 of all children are orphans and 11.7 are
  vulnerable
• Swaziland is still at the beginning of the OVC
  epidemic
• BUT Young Heroes

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Agriculture
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HealthIncreased Demand TB Prevalence
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Big Issues

• AIDS interest ( funding) may have peaked
• Financial melt-down and recession
• Global environmental change
• Food availability and prices
• Peak oil
• Treatment challenges
• Cost and Coverage
• Sustainable financing
• Prevention (can we and how)
• Leadership and ownership (who and how)

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Key Points

• The State of the Epidemic
• Waves and Consequences
• The Swaziland Case study
• What needs to be done differently

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What needs to be done differently

• Honest discussion about costs, choices,
  sustainability and prospects
• Prevention
• A reassessment of existing programmes
• Ownership (leadership in ESA does not own the
  epidemic)
• Male female dynamics
• Sexual networks
• Treatment affordable, accessible and sustainable
• Impact
• Save the human capital

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Epidemic Curve HIV, AIDS and Impact
Numbers
HIV
prevalence
Impact
A
2
A
1
A
AIDS
- cumulative
B
B
1
T
T
Time
1
2
27Aug01 -Report I
Epidemgy
Lit.
p.
27
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Key Point 4

• Vision
• Honesty
• Realism
• Out of the box thinking