The document discusses the global epidemiology of HIV/AIDS, outlining transmission modes, prevalence and incidence statistics by region, and differences in risk factors. It also examines various public health models for HIV prevention and treatment, highlighting the need for comprehensive strategies that incorporate epidemiological data, cultural factors, and address vulnerabilities in high-risk populations through community-based and clinical interventions. Effective prevention requires reducing stigma, increasing access to testing and treatment, integrating HIV messaging into healthcare, and utilizing a combination of behavioral and biomedical approaches tailored to local contexts.

2. Objectiv
es
 Provide an update of HIV/AIDS epidemiology
globally
 Illustrate transmission modes, public health
and ecological models via discussion of a
comprehensive HIV/AIDS Program;
 Discuss HIV risk, vulnerability, and similarities
of indigenous populations;
 Enumerate and discuss prevention / mitigation

3. • 64.9 million people infected with
HIV since the pandemic began
• 39.5 million (34.1–47.1 million)
PLWHA
• Will be 3rd leading cause of death in
roughly 10 years.
• Why does HIV become even more
critical?

4. Worldwide Incidence and Prevalence
 Total 4.3 million (3.6–6.6 million) new
infections in 2006
 Total deaths in 2006 = 2.9 million
 HIV/AIDS is the fourth (set to be
third) leading cause of death globally,
but leading cause age 20-24
 4.9 million new HIV infections (2004)
 5 million new HIV infections (2006)

5. Gender Differences
by Area
Suggestive of transmission categories and models

6. Suggestive of transmission categories and models
 Epidemiology helps us
determine ways to
• identify the problem,
• track and predict disease
progression
• enumerate intervention
strategies.
 The sheer number and gender
differences between sub-

7. Transmission Modes and Models
 4 modes of transmission…
 Blood
 Semen
 Vaginal fluid
 Breast milk
 Global models reflect modes of transmission,
epidemiology and higher risk groups
 African Model vs Asian Model
 US Model? Half-full or half-empty

8. Models of
Intervention
 Treatment – Centered
 greater impact on short and near-term mortality
 can enable more effective prevention
 data modeling: 10 % increase in infections and 9-13%
reduction in mortality within 5 years
 Prevention – Centered
 greater impact on incidence
 long-term mortality trend more favorable
 data modeling: 36% reduction in infections and mortality reductions
are similar treatment-centered model after
10-15 years1
 Variable results based on current prevalence

9. Impact of
Models
 Demonstrates the importance of epidemiology,
transmission modes, and mitigation models;
 Given limited resources, budgets can be directed
in the most appropriate way;
 In the long term, both preventive and combination
strategies will
reduce resource needs for treatment;
 Effective treatment as preventive strategy;
 Comprehensive strategies are most effective both in
theory and in
practice.

10. Comprehensive HIV/AIDS Program Model
(Priority
areas)
Policy
Capacity
Building
Prevention
Tx &
Care
Advocacy
Research / Epidemiology
Monitoring
and
Evaluation

11. Indigenous
Populations:
Vulnerabilities
 Access to healthservices
 Resource-constrainedsettings
 Mobilepopulations
 Health is interwoven with culture
 Tradition may suppress open discussion or
implementation strategies
 Socioeconomic may affectimpact
 Lack of indigenousworkforce
 Healthdisparities

12. Global “Contexts” of
Vulnerability
 Government‘s Policy
 Socio-economic status
 Spirituality
 Gender /Youth
 Culture
 Challenges of a Cultural Approach

13. Co-Factors of HIV
Risk STD Rates /
Sexual behavior
Substance Use Violence/Abuse
Health Disparities, stigma, access,
social norms
↑HIV Risk

14. Intervention
Model Broad sociocultural /
traditionalism/ spiritual
Constructed Environment
Individual
Community
Clinical / Facility

15. • Stigma in facilities and communities
• Jurisdiction in certain situations
• Lack of open discussion and education at all levels
• Lack of human resources with expertise
• Appropriate but competing priorities….
• Complacency(# of cases in US, effect ofARV)
• Gathering data remains complex
• Complexity of treatment and care
• Challenges of developing targeted intervention for coverage
of vulnerable, hard-to-reach groups

16. Proven Mitigation/ Prevention Strategies
 Increase knowledge of status
 Changes behavior
 Credible Prevalence
Education/Outreach
 Peer Intervention
 Integrate with other prevention messages
 Client-centered, interactive sessions
 What about school sex-education?

17. Behavior Change
 Normalize HIV
 High risk groups targeted
 BCC tailored to culture
 Multiple sessions
Harm Reduction**
Effective Treatment as prevention (3 ways)
Prevent MTCT (augmented by knowledge of status
prior to conception)

18. New Prevention Technologies
 HIV vaccines
 Vaginal and rectal Microbicides
 Adult male circumcision
 Treatment of other STIs
 Pre-exposure prophylaxis (PrEP) using
antiretroviral drugs

19. SUMMARY
Routinize and Normalize HIV testing & services
Reduce stigma and discrimination
Support testing and knowledge of status
Integrate HIV message in all other appropriate health
promotion messages
Behavior component integrated in primary care
Adoption of indigenous perspective and workforce
Utilize evidence-based strategies - focus on
outcomes

20. y
Questions?
IV IDS Homep e: w alprogr ivaids

21. ASSIGNMENT
•It has become abundantly clear
that efforts to promote behavioral
change, the so-called "ABC"
(abstinence, "be faithful" and
condoms) approach, has failed to
stem the tide of new HIV infections.
DISCUSS?