Is HIV/AIDS still exceptional?

                 Alan Whiteside
Health Economics and HIV/AIDS Research Division,
         ...
Lancet editorial 18/10/08

It is time to unwind the rhetoric, and
   reposition the responses to HIV/AIDS as
   one of sev...
Key Points

• The State of the Epidemic
• Why AIDS is exceptional
  – Three waves and long periods
  – AIDS and the global...
2007 Global HIV Infection
      33 million people [30–36 million] living with HIV,




2.2
Global numbers living with HIV and
       adult HIV prevalence




  Source: UNAIDS 2008
Epidemic Curve: HIV, AIDS and
           Impact
    Numbers


              HIV prevalence

                              ...
Global Baseline Death Projections
  (Non-Communicable Diseases)




Source: Mathers and Loncar 2002, Projections of Global...
Global Baseline Deaths Projections
    Communicable Diseases




Source: Mathers and Loncar 2002, Projections of Global Mo...
Cause of Death by Income and
            Percentage in 2030
Ranking       Low income          Middle income        High in...
2007 Global HIV Infection
      33 million people [30–36 million] living with HIV,




2.2
2007 HIV Prevalence, African Adults (15–49)




2.8
HIV Prevalence in Antenatal Clinic
    Surveys: Southern Africa




   Source: UNAIDS Global AIDS report 2008
Demographic and Health Survey
      HIV Prevalence
HIV and AIDS
Country      Population       Number living with
                              HIV/AIDS 18.8%
               ...
Republican Voters in 2008
56 000 000
Number of American’s who
 would be infected if the USA
 had Swaziland's prevalence
 5...
The Demographic Impacts

•   Young people die
•   Children are not born
•   Population decline
•   Falling life expectancy...
Population Decline: Russia & Ukraine
                                                                            Ukraine

...
Ukraine
Demographics:
Population Growth
Swaziland 2007 Preliminary
      Census Results
Population Data (de facto)
1997        929 718
2007        912 229

There ...
Demographics:
Population Growth
Demographics:
Life Expectancy
AIDS can not be cured

• People will need treatment
• For life
• And it is expensive
Per capita health expenditure
             Country                                   Health Expenditure                   ...
Mopping the Floor while the tap is
            running
Long term impacts

The impact of the epidemic is still
 unfolding and will do so for at least a
 generation

Lessons from ...
Agriculture
Big Issues
• AIDS interest (& funding) may have peaked
  –   Financial melt-down and recession
  –   Global environmental ...
What needs to be done differently

• Honest discussion about costs, choices,
  sustainability and prospects
• Prevention
 ...
Is Hivaids Still Exceptional
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Is Hivaids Still Exceptional

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Is Hivaids Still Exceptional

  1. 1. Is HIV/AIDS still exceptional? Alan Whiteside Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal Durban Presentation to Daniel J. Evans School of Public Affairs University of Washington Monday 9th February 2009 www.heard.org.za
  2. 2. 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!
  3. 3. Key Points • The State of the Epidemic • Why AIDS is exceptional – Three waves and long periods – AIDS and the global disease burden – The hyper epidemic countries – The demographic impacts in Africa and Eastern Europe – The cost of care • Big issues
  4. 4. 2007 Global HIV Infection 33 million people [30–36 million] living with HIV, 2.2
  5. 5. Global numbers living with HIV and adult HIV prevalence Source: UNAIDS 2008
  6. 6. Epidemic Curve: HIV, AIDS and Impact Numbers HIV prevalence Impact A2 A1 A AIDS - cumulative B B1 T1 T2 Time 27Aug01 -Report I: Epidem’gy & Lit. p. 27
  7. 7. Global Baseline Death Projections (Non-Communicable Diseases) Source: Mathers and Loncar 2002, Projections of Global Mortality and Burden of Disease from 2002 to 2030, World Health Organization, Geneva, Switzerland
  8. 8. 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
  9. 9. Cause of Death by Income and Percentage in 2030 Ranking Low income Middle income High income World 1 Ischaemic heart Cerebrovascular Ischaemic heart Ischaemic heart disease 13.2 disease 14.4 disease 15.2 disease 13.4 2 HIV/AIDS 13.2 Ischaemic heart Cerebrovascular Cerebrovascular disease 12.7 disease 9.0 disease 10.6 3 Cerebrovascular COPD 12.0 Trachea, bronchus HIV/AIDS 8.9 disease 8.2 lung cancers 5.1 4 COPD 5.5 HIV/AIDS 6.2 Diabetes mellitus COPD 7.8 4.8 5 Lower respiratory Trachea, bronchus COPD 4.1 Lower respiratory tract infections 5.1 lung cancers 4.3 tract infections 3.5
  10. 10. 2007 Global HIV Infection 33 million people [30–36 million] living with HIV, 2.2
  11. 11. 2007 HIV Prevalence, African Adults (15–49) 2.8
  12. 12. HIV Prevalence in Antenatal Clinic Surveys: Southern Africa Source: UNAIDS Global AIDS report 2008
  13. 13. Demographic and Health Survey HIV Prevalence
  14. 14. HIV and AIDS Country Population Number living with HIV/AIDS 18.8% prevalence rate Swaziland 1,200,000 225,600 USA 301,140,000 56,614,320 UK 60,776,000 11,425,888 EU 492,964,000 92,677,000
  15. 15. Republican Voters in 2008 56 000 000 Number of American’s who would be infected if the USA had Swaziland's prevalence 56 614 320
  16. 16. The Demographic Impacts • Young people die • Children are not born • Population decline • Falling life expectancy • Orphaning
  17. 17. Population Decline: Russia & Ukraine Ukraine 5.4 population (millions) 5.2 5 Ukraine 4.8 4.6 4.4 1990 1995 2000 2002 2004 2006 year Russia 14.9 14.8 population (millions) 14.7 14.6 14.5 14.4 Russia 14.3 14.2 14.1 14 13.9 1990 1995 2000 2002 2004 2006 year Source: World bank HNP Statistics
  18. 18. Ukraine
  19. 19. Demographics: Population Growth
  20. 20. Swaziland 2007 Preliminary Census Results Population Data (de facto) 1997 929 718 2007 912 229 There were 17 499 fewer people over 10 years Estimated for 2006 1 200 000
  21. 21. Demographics: Population Growth
  22. 22. Demographics: Life Expectancy
  23. 23. AIDS can not be cured • People will need treatment • For life • And it is expensive
  24. 24. Per capita health expenditure Country Health Expenditure Cost of ARV Per capita (USD) treatment per person/year (USD) Botswana 171 1500* Swaziland 66 168 Mozambique 11 960** Rwanda 11 400 Source: Summary country profiles for HIV/AIDS treatment scale up, WHO 2005. *ARV treatment publicly funded. Source: Introducing ARV Therapy in the Public sector in Botswana Case study, 2004. ** Mozambique offers subsidized ARV therapy at approx. 80 USD/month. Source: Provision of Antiretroviral Therapy in resource limited settings: a review of experience. WHO/DFID 2003
  25. 25. Mopping the Floor while the tap is running
  26. 26. Long term impacts The impact of the epidemic is still unfolding and will do so for at least a generation Lessons from climate change??
  27. 27. Agriculture
  28. 28. 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)
  29. 29. What needs to be done differently • Honest discussion about costs, choices, sustainability and prospects • Prevention – A reassessment of existing programmes – Ownership (leadership in Africa does not own the epidemic) – Male female dynamics – Sexual networks • Impact – Save the human capital • Leadership
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