By 2009-10, approximately one third of the total investment was from domestic public budgets, mostly in the middle-income countriesApproximately a further one third was in the form of technical assistance, and not directly spent in countries
In both prevalence among 18-49 is 31%. Decline in youth rates.
Alan whitside - HEARD
WHAT IS GOING ON IN HIV AND AIDS IN 2013 AND BEYOND Prof Alan Whiteside RATN MEETING JOHANNESBURG March 2013
Outline 1. Context: Epidemiology • Where the epidemic is • Hyper-epidemic countries 2. What does this mean • For development (and MDGs) • Economic growth • Donors 3. Responding • Prevention (first prize) • Treatment • Impact mitigation 4. Conclusion • Understand your epidemic • Prioritize
2009 Global HIV Infection33.3 million people [31.4–35.3 million] living with HIV2.2
Exceptional Epidemics: Prevalence in Africa2009 (Adults 15–49) Source: UNAIDS Global Report 2010 Geneva: UNAIDS (2009data)
HIV prevalence & no of HIV+ people countries with >1% of SSA HIV+ population. HIV prevalence and number of HIV positive people in countries with 1% or more of the total Sub-Saharan African HIV positive population. Data from: UNAIDS (http://www.unaids.org/en/dataanalysis/epi demiology/
HIV and AIDSCountry Number of adults HIV/AIDS living with HIV Prevalence rateSwaziland 190,000 26.1%South Africa 5,700,000 18.1%Botswana 300,000 23.9%
Comparison of Epidemics•Scale of the epidemic: Southern Africa unbelievablyhigh over 15%,•Numbers•Mode of transmission: SA - unprotectedheterosexual intercourse•Ability to respond: a function of wealth and politicalcommitment
What does this mean (more) • For development (and MDGs) • Economic growth • Donors
Epidemic Curves: HIV, AIDS and Impact Numbers HIV prevalence Impact A2 A1 A AIDS - cumulative B B1 T1 T2 Time Epidem’gy& Lit. p. 27 27Aug01 -Report I:
Logic for Prevention 1. Growing case load • For every two people put on treatment there are five new infections 2. Stretched health systems • Lack of buy-in, time for adequate training, intervention that ‘speak to’ individuals 3. Strained human resources • 13 providers per 100,000 people in SSA • 5,100 new doctors per year in Africa (compared to 173,800 in Europe) 4. Money
AIDS Treatment without prevention is moppingthe floor while the tap is running
What Works in Prevention? Currently: PMTCT Male circumcision Male and female condoms Potentially: Microbicides PREP Vaccine Cure Behaviour change that works
What Should Work in Prevention Behaviour change Fewer partners Less concurrency Later sexual debut What Needs to be Addressed… • Poverty/ economic inequalities • Gender inequalities • Leadership and policy • Etc.
Total annual resources available for AIDS in low and middle income countries Domestic contributionSource: UNAIDS analysis based on (1) Kaiser Family Foundation and UNAIDS , financing the Response to AIDS in low andmiddle income countries from the G8, European Commission and other Donor Governments in 2009, July 2010; (2)UNAIDSOECD/DAC online database (last visited on January 05, 2011); (3) Funders Concerned About AIDS (FCAA), 2010; (4)European HIV/AIDS Funders Group (EFG, 2010; (5) UNAIDS Unified Budget of Work (UBW) for 2010 & 2011); (6) Disbursementsreports and pledges and contributions reports from the GFATM (last visited on Jan 06 2011(7) budget review from Donorgovernments and multilateral organizations.
Donor funding for Africa flattened, domesticfunding increasing (UNAIDS)
Global Positioning 2012The United States:Terra Nova: How to achieve a successful PEPFARTransition in South Africa, A report of the CSIS GlobalHealth Policy Centre, December 2011The Global Fund:Round 11 Cancelled Pledges not metUNAIDS:AIDS Dependency Crisis Sourcing African Solutions
AIDS Dependency Crisis: Sourcing African Solutions (UNAIDS)1. Strengthen African ownership, exploit & diversifysources • Negotiate long-term predicable money from donors • Grow African investments • Compact for shared differentiated responsibilities • Explore sustainable innovative financing2. Quality Assured Medicines sooner to those in need3. Establish centres of excellent for local production of medicines in Africa
2007 DHS and 2011 SHIMS HIV Prevalence in Swaziland (ages 18-49)Men: Prevalence by Age Women: Prevalence by Age
Conclusion • The HIV epidemic is no longer on the top of the agenda – it is being overtaken and mainstreamed • Understand your epidemic • Prioritize • Be realistic