The document discusses HIV and AIDS, providing information on: 1. What HIV and AIDS are and how they are transmitted between people. 2. The global and local impact of the HIV/AIDS pandemic, including statistics on infection rates and numbers of deaths. 3. The effects of HIV/AIDS on communities, including impacts on healthcare systems, education, orphaned children and food security. 4. Strategies for preventing the spread of HIV, caring for infected individuals, and supporting children and families affected by the disease.

1. HIV and AIDS a global emergency © World Vision New Zealand, 2008, First edition published in 2003 Published by World Vision New Zealand, Private Bag 92078, Auckland 1142, New Zealand click to continue

2. What is HIV and AIDS? uman mmunodeficiency irus HIV attacks the cells that fight disease, damaging the immune system. People who have the virus are known as HIV-positive. People who are HIV-positive don't get sick immediately, but the virus slowly wears down the immune system, until the body can no longer fight disease. Once the immune system is damaged, HIV-positive people develop a group of diseases that are known as AIDS . Slide 2 H I V Image copyright Russell Kightley Media

3. A set of diseases that people get once their immune system is damaged by HIV. What is HIV and AIDS? Tuberculosis Herpes (cold sores, genital herpes) Septicaemia (infection of the blood) Pneumonia Recurring fungal infections of the skin, mouth and throat Other skin diseases Unexplained fever Meningitis Cancers such as Kaposi sarcoma Chronic diarrhoea with weight loss ("slim disease") Slide 3 A I D S cquired mmuno eficiency yndrome a pattern of signs or symptoms that indicate the presence of a disease = weakness of the immune system = People with HIV usually develop some or all of: “ caught” not inherited =

4. How do people get HIV? HIV is spread through human body fluids, especially blood and sexual fluids. The most common way to get HIV is: Other common ways: What is HIV and AIDS? Slide 4 - mother to child transmission - dirty medical equipment especially poorly equipped hospitals in developing countries - drug users sharing needles especially in Eastern Europe, South and South-East Asia - unprotected heterosexual sex - blood products if not screened - unprotected male-to-male sex especially in developed countries like New Zealand, but world-wide, only 5% of those who have died from AIDS were men who have sex with men.

5. Slide 5 HIV and AIDS: global impact

6. The HIV and AIDS pandemic Source: UNAIDS – AIDS Epidemic Update 2007 HIV and AIDS: global impact Total 33.2 million Adults 30.8 million Women 15.4 million Children under 15 years 2.1 million Total 2.5 million Adults 2.1 million Children under 15 years 420,000 Total 2.1 million Adults 1.7 million Children under 15 years 290,000 Slide 6 Number of people living with HIV in December 2007 People newly infected with HIV in 2007 AIDS deaths in 2007

7. Adults and children estimated to be living with HIV, 2007 Total: 33.2 million Source: UNAIDS – AIDS Epidemic update 2007 HIV and AIDS: global impact Slide 7 Sub-Saharan Africa 22.5 million Oceania 75,000 Eastern Europe & Central Asia 1.6 million East Asia 800,000 South & South-East Asia 4.0 million North America 1.3 million Caribbean 230,000 Latin America 1.6 million North Africa & Middle East 380,000 Western Europe 760,000

8. Percentage of adults aged 15-49 living with HIV Source: UNAIDS – AIDS Epidemic update 2006 HIV and AIDS: local impact Slide 8 Tanzania: 6.5% Kenya: 6.1% Uganda: 6.7% Mozambique: 16.1% Malawi: 14.1% Zambia: 17% Zimbabwe: 20.1% South Africa: 18.8% Swaziland: 33.4% Lesotho: 23.2% Namibia: 19.6% Botswana: 24.1% Angola: 3.7% D.R. Congo: 3.2% Burundi: 3.3% Rwanda: 3.1%

9. HIV and AIDS is reversing gains in life expectancy Life expectancy Source: UN Population Division HIV and AIDS: local impact Slide 9 40 45 50 55 60 65 1965-1970 1970-1975 1975-1980 1980-1985 1985-1990 1990-1995 1995-2000 Bangladesh: low HIV rate Botswana Kenya Zimbabwe Zambia Uganda Malawi

10. Over 20% of the agriculture workforce in Botswana, Mozambique, Namibia and Zimbabwe will be lost to AIDS by 2020. In northern Zambia, female-headed households caring for people living with HIV also supported on average 3.6 orphans each. Providing enough food for the household is difficult. Sources: UNAIDS 2006 Report on the Global AIDS Epidemic: The Impact of AIDS on People and Societies HIV and AIDS: local impact The impact of HIV and AIDS It is estimated that on average, HIV-related care can absorb one- third of a household’s monthly income. In sub-Saharan Africa children miss out on an education because income is used to pay for treatment instead of school fees. Tanzania needs around 45,000 additional teachers to make up for those who died or left the system because of AIDS. Botswana lost 17% of its healthcare workforce due to AIDS between 1999 and 2005. Agriculture and food production Slide 10 Family income Social services

11. Source: UNAIDS Socio-Economic Impact of HIV/AIDS in Africa HIV and AIDS is overwhelming health and social services HIV and AIDS: local impact The cost of treating one AIDS patient is equivalent to putting ten children through primary school Source: World Bank (Africa) 1999 Slide 11 2000 % hospital beds occupied by AIDS patients in Zambia AIDS patients Non-AIDS patients 1990

12. HIV and AIDS impacts children and young people 2.1 million children (under 15) live with HIV and AIDS 1150 are infected with HIV everyday 795 die of AIDS everyday 15.2 million have been orphaned by AIDS World-wide... HIV and AIDS: local impact Source: UNAIDS 2006 Report on the Global Epidemic Slide 12

13. HIV is a major contributor to child mortality in sub-Saharan Africa HIV and AIDS: local impact Slide 13 Source: UNAIDS, Towards universal access, June 2008, Table 5.2.

14. HIV and AIDS: local impact rphans and ulnerable hildren O V C Who are orphans and vulnerable children? Children who have lost one or both parents to AIDS Children whose parents are living with HIV Children whose families have taken in orphans Children who are living with HIV Other children that communities consider to be vulnerable Slide 14

15. HIV and AIDS: local impact Slide 15 Source: UNICEF/UNAIDS, Children on the Brink 2002, 2004 ; UNICEF, Africa’s Orphaned and Vulnerable Generations, 2006 *Proportion of orphans who are orphans due to HIV all years except 2005 are based on figures for children <15 as used in CoB 2002 5% 10% 15% 20% 25% Orphans due to all causes Orphans due to AIDS Botswana Malawi Uganda Zambia Zimbabwe % of all children <15* who are orphans 1990 1990 1990 1990 1990 1995 1995 1995 1995 1995 2000 2000 2000 2000 2000 2005 2005 2005 2005 2005 2010 2010 2010 2010 2010

16. HIV infection with ARV treatment is a completely different proposition to HIV infection without treatment. dying from AIDS vs. living with HIV HIV and AIDS: hope for the future Slide 16 time

17. Source: UNAIDS, Towards universal access, June 2008 HIV and AIDS: hope for the future Slide 17

18. HIV and AIDS: strategies Slide 18 Strategies for HIV and AIDS 1. Prevention Education and behaviour change Tackle stigma so people can talk openly about HIV and AIDS Education on how HIV is spread and avoiding high-risk behaviours (ABC) Addressing barriers to behaviour change: gender relations, economic barriers, cultural practices Focus on high risk groups, like truck drivers, migrant workers and sex workers Focus on pregnant & breast-feeding mothers Education on prevention strategies Healthcare during and after pregnancy Mother-to-child transmission Trained in AIDS-prevention curriculum, teacher Ng’ona Robert runs a school assembly with the help of peer educators. RAPIDS results Reached 62,752 youth with AIDS-prevention methods.

19. Caregiver Charity bathes Patrick’s sores. Before she leaves she encourages him and cooks a meal. 2. Care for the sick HIV and AIDS: strategies HIV testing Counselling and emotional support Education about living with HIV Advocating for wider availability of drug treatments Preventing other infections through healthcare, clean water, and sanitation Providing practical support such as food, blankets, sheets Training and support for care-givers Home-based care and counselling, especially where hospital beds are scarce Slide 19 RAPIDS results Includes: HIV counselling and testing for 16,894 people; home-based care to 43,868; helping 24,939 people adhere to ARV treatment.

20. HIV and AIDS: strategies Slide 20 RAPIDS results About 228,000 orphans and vulnerable children assisted. Now about 90% are in school. Three years ago only 30% were in school. 3. Care for those left behind Meeting the immediate and long term needs of orphans and elderly caregivers in the absence of mums and dads. Counselling and support for children who have lost their parents Helping orphans or elderly guardians to strengthen their income and food supply Making sure orphans have access to education Improving living conditions HIV+ orphan Enouch, visits with his caregiver Roderick.

21. She thought things could not get worse, and then she got sick. Most days she was confined to bed. She was dying. Agnus sought the help of a World Vision-trained caregiver. She was persuaded to get an HIV test, which turned out positive. Agnus, 42, once had a husband, five sisters and a brother. They all died of AIDS leaving her to care for their children. Agnus, a widow, is now responsible for 13 children. Her caregiver reassured Agnus, saying there were plenty of others who were HIV-positive but through antiretroviral therapy (ARV) were getting well. Agnus began taking ARVs. Within weeks she felt better and was able to start work again. Slide 21 Agnus - Zambia

22. Slide 22 Nancy – Papua New Guinea Nancy received counselling at a World Vision drop-in-centre. Nancy said, “It helped me to think and live a positive life. Before this I thought everything was meaningless knowing that I was going to die. Now, most days I forget that I am HIV positive and this helps me to remain healthy and strong. I enjoy my life like any other normal person.” Nancy (not her real name), 45, found out she was HIV positive when she went for a blood test without her husband knowing about it. She knew straight away that she got the virus from her husband. She said, “The thought of walking around with the deadly virus in my body is very frightening and this is causing me to have sleepless nights. I worry about my 12-year-old daughter, whether I will be around to see her grow up.”

23. My son Pirirani is four. He has been ill with diarrhoea, stomach pains, weight loss, a cough and fever for more than three years. My baby Davis is 13 months old, and he is wasting away. I also am unwell, and my wife Celina. And I look after my parents, who are old, and two orphans. I had a lot of pigs, but I would sell anything to save the life of my children. I always thought I would live a happy life with my beautiful wife, working hard on my land for my children’s future. I thought we would own cattle and I would have a pleasant home. But the story has come out differently to my dreams because of this sickness. We have no cash, but I need 400 kwacha (NZ$13) for the next round of medicine for the children. A chicken sells for 150 kwacha. Slide 23 Vincent - Malawi

24. And my staff are not safe. If you stick yourself with a needle – and that’s a common thing – there is no chance of getting anti-retroviral treatment if you get HIV. So you find you don’t always want to know, and most staff don’t get tested after a needle-stick. In most cases we strongly suspect AIDS based on the symptoms, but we don’t always carry out tests because of the lack of resources and the workload. You should counsel people before and after the test, and we don’t have enough staff for that. It’s desperate if you really look at it. We have 240 beds in this hospital, and we have more than 300 patients, with people sleeping on the floor. The overcrowding is very definitely related to HIV. AIDS is making the related problem of tuberculosis very serious and complicated. Frankly, sometimes you give a treatment and you just pray that it will work. Slide 24 Ntcheu Hospital - Malawi

25. Sophy is often kicked out of children's groups when she tries to play with them. The shame and the pain inside Sophy have completely changed her. She is quiet and rarely laughs. This is my great-grandniece, Sophy. She is three years old. First her father and then her mother died of AIDS. When Sophy’s mother started to get sick she and her three children came to live with my sister and I. My name is Eng. I am 79 years old. Sophy has HIV from her mother. She has a skin infection on her head. Wherever she goes, she wears this hat to protect her head from flies and to hide her infection from other children. Most children don’t like Sophy much because of her infection and the bad smell from her body. Slide 25 Sophy - Cambodia

26. I know that men my age are the ones getting HIV. With this killer disease that is affecting our country, I try and keep myself safe. Zione too, she is not safe. She is too young to date, to go out with boys. I’m doing my best to help her and look after her. I work at anything I can, for 50 kwacha a day to buy enough food (about NZ$1.20). Sometimes we have two meals a day and sometimes only one. I have gone as far as I can with free education. I did well in school, and I would like to continue. My English is very strong, and I would like to be a mechanic. But I can't afford my school fees if I am to look after my sister. Our mother died a year ago, she was sick for a long time. I left school right away to look after Zione. She is 13 and she wants to be a nurse. If she continues at school, and she wants to, she could start nursing training after she finishes Form 4. Slide 26 Muziona and Zione - Malawi