Transcript Barcelona Report on HIV prevalence and impact

Trends in HIV prevalence among pregnant women
in Kampala, Uganda: 1991-2000
40
Percentage
30
20
10
0
1991 1992 1993 1994 1995
1996 1997 1998 1999 2000
Source: STD/AIDS Control Programme, Uganda (2001) HIV/AIDS Surveillance Report
00002-E-1 – end 2001
HIV prevalence rates among pregnant women attending
antenatal clinics in urban sites in Cameroon: 1989-2000
20
18
Bamenda
16
Limbe
% HIV-positive
14
Yaounde
Garoua
12
10
8
6
4
2
0
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Source: National AIDS Programme, Cameroon (1989-2000). Data compiled by the US Census Bureau
00002-E-2 – end 2001
Condom use among men with non-regular partners
in selected sub-Saharan African countries: 1994-2000
70
60
Malawi
United Rep. of Tanzania
Uganda
Zambia
50
%
40
30
20
10
0
1994
1995
1996
1997
1998
1999
Source: Macro International (1994-2000) Demographic and Health Surveys; Measure Evaluation
00002-E-3 – end 2001
2000
HIV prevalence among sex workers
in selected provinces in China: 1993-2000
12
% HIV-positive
Guangxi
Guangzhou
Yunnan
9
6
3
0
1993
1994
1995
1996
1997
1998
Source: National AIDS Programme, China (1993-2000). Data compiled by the US Census Bureau
00002-E-4 – end 2001
1999
2000
Cumulative reported HIV infections per million
population in Eastern European countries: 1993-2001
Cases per million population
1,800
1,500
Estonia*
Russian Federation
1,200
900
Ukraine
Latvia
600
Belarus
Moldova, Republic of
Kazakhstan
Lithuania
300
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
Projected
* actual 2001 year-end data
Source: National AIDS Programmes (2001) HIV/AIDS surveillance in Europe. Mid-year report. Data compiled by the
European Centre for the Epidemiological Monitoring of AIDS
00002-E-5 – end 2001
HIV prevalence among pregnant women
in Santo Domingo, the Dominican Republic: 1991-2000
% HIV prevalence
2.5
2.0
1.5
1.0
0.5
0.0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Source: National AIDS Programme, the Dominican Republic, 1991-2000
00002-E-6 – end 2001
Annual HIV incidence (%)
HIV incidence among men who have sex with men
in Vancouver, Madrid and San Francisco: 1995–2000
4
3
2
1
0
1995-99 2000
Vancouver
1996
2000
Madrid
Sources: (Vancouver) Hogg RS et al. (2001) AIDS. (Madrid) Del Romero J et al. (2001) AIDS.
(San Francisco) Katz MH et al. (2002) Am. J. of Public Health
00002-E-7 – end 2001
1996
1999
San Francisco
Changes in life expectancy in selected African countries
with high and low HIV prevalence: 1950-2005
65
Life expectancy (years)
60
with high HIV prevalence:
Zimbabwe
South Africa
Botswana
55
50
45
with low HIV prevalence:
40
Madagascar
Senegal
Mali
35
30
1950–
1955
1955- 19601960 1965
19651970
19701975
19751980
1980- 19851985 1990
19901995
1995- 20002000 2005
Source: UN Department of Economic and Social Affairs (2001) World Population Prospects, the 2000 Revision
00002-E-8 – end 2001
Reduction in life expectancy compared to the
'no AIDS' scenario in selected countries: 2000-2005
Botswana
Zimbabwe
Swaziland
South Africa
Kenya
Mozambique
Côte d'Ivoire
Cameroon
Burkina Faso
Haiti
Guyana
Bahamas
Cambodia
Dominican Rep.
Angola
Myanmar
Thailand
0
5
10
15
20
25
30
Number of years
Source: UN Department of Economic and Social Affairs (2002) World Population Prospects, the 2000 Revision
00002-E-9 – end 2001
35
40
Estimated and projected deaths at ages 15-34,
with and without AIDS in South Africa: 1980-2025
Deaths (thousands)
2,000
Without AIDS
With AIDS
1,600
1,200
800
400
0
1980-1985
1995-2000
2010-2015
1985-1990
2015-2020
2000-2005
1990-1995
2005-2010
2020-2025
Source: UN Department of Economic and Social Affairs (2002) World Population Prospects, the 2000 Revision
00002-E-10 – end 2001
Projected reduction in size of primary-school-age
population by 2010, in selected African countries
30
% reduction
25
20
15
10
5
0
Zimbabwe
Source: World Bank, 2000
00002-E-11 – end 2001
Zambia
Kenya
Uganda
Percentage of workforce lost to AIDS
by 2005 and 2020 in selected African countries
50
2005
2020
40
30
%
20
10
0
Botswana
Cameroon
Côte d’Ivoire
Ethiopia
CAR
Mozambique
Nigeria
Guinea-Bissau
Togo
UR Tanzania
South Africa
Sources: ILO (2000) POPILO population and labour force projection; UN Department of Economic and Social Affairs,
Population Division (1998) World Population Prospects: the 1998 Revision
00002-E-12 – end 2001
Zimbabwe
The impact of HIV/AIDS on industries:
an overview
Increased
absenteeism
Increased
staff turnover
Loss
of skills
Loss
of tacit
knowledge
Declining
morale
Insurance cover
Retirement funds
Health and safety
Medical assistance
Increasing demands
for training and
recruitment
HIV/AIDS in
the country
Declining markets,
labour pool,
suppliers
Declining
intellectual
capital
Reduced
foreign
direct
investment
Funeral costs
Declining
re -investment
Declining
reliability
Declining
productivity
Increased costs
Declining profits
Source: UNAIDS (2000) Adapted from The Business Response to HIV/AIDS: impact and lessons learned
00002-E-13 – end 2001
Proportion of young women who have heard of AIDS and have
at least one negative attitude towards people living with AIDS
Azerbaijan
Tajikistan
Gambia
Moldova
Albania
Bosnia & Herzegovina
Yugoslavia (FR)
Comoros
Guinea Bissau
Sierra Leone
Chad
Cote d'Ivoire
Dominican Republic
Vietnam
Somalia
Philippines
Ukraine
Niger
Note: Respondents
were asked two
hypothetical
questions about men
and women with HIV:
(1) A teacher who
looks healthy but is
HIV- positive should
be allowed to
continue working and
(2) Would they buy
something from an
HIV-positive
shopkeeper.
0%
20%
40%
Source: UNICEF (1999-2001) Multi-Indicator Cluster Surveys
00002-E-14 – end 2001
60%
80%
100%
Percentage of young men and women (15-19)
who had sex before their 15th birthday: 1998-2001
Kazakhstan
Zimbabwe
Haiti
Poland
Latvia
Hungary
Gabon
Malawi
Kenya
UR Tanzania
Mozambique
USA
Finland
Guinea
Cameroon
Togo
Niger
Nigeria
Ethiopia
Boys
Girls
0
10
Source: Measure Evaluation (1998-2001); UNICEF
00002-E-15 – end 2001
20
30
40
50
Percentage of sexually experienced girls
in South Africa who say …
“I have been forced to have sex.”
Yes
39%
“I am afraid of saying no to sex.”
Agree
33%
No
61%
7%
Agree
55%
Disagree
39%
6%
“There are times I don't want to have sex
but I do because my boyfriend
Insists on having sex.”
Source: Kaiser Family Foundation/KLA (2000) South African National Youth Survey
00002-E-16 – end 2001
Disagree
60%
Percentage of men who used a condom with a recent
non-regular partner, by level of formal education: 1995-2000
100
None
Primary
80
Secondary or more
60
%
40
20
Source: Macro International (1995-2000) Demographic and Health Surveys; UNICEF
00002-E-17 – end 2001
Dominican
Republic
Brazil
Zimbabwe
Zambia
Uganda
Togo
UR Tanzania
Niger
Mali
Malawi
Kenya
Chad
CAR
Cameroon
Benin
0
Scenario of the epidemic in Thailand, had there been
no intervention through 2020, and observed epidemic curve
10,000
8,000
Number
of HIV
infections
(thousands)
No Intervention
Observed
6,000
4,000
2,000
0
1985
1990
1995
2000
2005
2010
2015
Source: Division of AIDS, Ministry of Public Health in Thailand; Thai Working Group on HIV/AIDS Projection (2001)
HIV/AIDS Projections for Thailand: 2000-2020
00002-E-18 – end 2001
2020
HIV prevalence among injecting drug users
in Kathmandu, Nepal: 1991-1999
60
% HIV-positive
50
40
30
20
10
0
1991 1992 1993 1994 1995 1996 1997 1998 1999
Sources: Peak A et al. (1995); AIDS. Gurubacharya RL et al. (1998); 12th World AIDS Conference, Abstract 23246.
Oelrichs RB et al. (2000) J. Virol.
00002-E-19 – end 2001
HIV prevalence rates among sex workers and injecting
drug users in selected sites, Indonesia: 2000-2001
SW
6.4%
SW
40%
1.5%
IDUs
24.5%
IDUs
SW
8.0%
SW
IDUs
6.0%
SW
53%
26.5%
HIV prevalence rates
0%
SW - Sex Workers
< 1%
1-5%
>5%
IDUs – Injecting Drug Users
Source: Indonesian National AIDS Commission (2001) HIV/AIDS and other sexually transmitted infections in Indonesia:
challenges and opportunities for action
00002-E-20 – end 2001
Increase in reported condom use with non-regular
partners in selected districts in Uganda: 1996-2000
% condom use
80
60
40
20
0
1997
1999
Mbara
1996
1999
Mpigi
1997
Masindi
Source: STD/AIDS Control Programme, Uganda (2001) HIV/AIDS Surveillance Report
00002-E-21 – end 2001
2000
1997
2000
Pallisa
Condoms per man per year
Condom procurement gap in sub-Saharan
African countries in 1999
Six countries
with highest
condom
procurement
rate
30
25
20
Average condom procurement of top 6 countries = 16.9
15
10
Additional condoms needed to get all
countries to the level of 16.9 = 1.9 billion per year
5
0
1
3
5
7
9
11
13
15
17
19
21
23
25
27
29
31
33
35
37
39
41
43
45
47
Countries in sub-Saharan Africa, ordered by condom procurement rate
Source: Shelton JD, Johnston B (2001) Condom gap in Africa: evidence from donor agencies and key informants,
British Medical Journal
00002-E-22 – end 2001
HIV prevalence among men who have sex with men,
in selected countries: 1986-2000
35
% HIV positive
30
25
20
15
10
5
Latin
America
Asia
North Africa &
Middle East
Latvia 1998
Slovenia 1997
Poland 1996
Egypt 11999
Cambodia 2000
Bangladesh 1998
India 1994-98
Pakistan 1997
Japan 1986-97
Malaysia 1988-97
Sao Paulo, Brazil
1997
Uruguay 1997
Mexico (8 studies)
1988-97
Costa Rica 11995
0
Eastern
Europe
Sources: Country data compiled by U.S. Census Bureau (1996-2000); Cambodia data reported in: Monitoring the AIDS
Pandemic (MAP): the status and trends of HIV/AIDS/STI epidemics in Asia and Pacific (2001)
00002-E-23 – end 2001
Knowledge and behaviour among sex workers and their clients
in Jakarta, Surabaya and Manado, Indonesia: 1996-2000
90
80
70
Percent
60
Know that consistent condom use prevents HIV - sex workers
50
Know that consistent condom use prevents HIV - clients
40
Always use a condom in commercial sex - sex workers
30
Always use a condom in commercial sex - clients
20
10
0
1996
1997
1998
1999
Source: FHI (2001) What drives HIV in Asia? A Summary of Trends in Sexual and Drug-Taking Behaviours
00002-E-24 – end 2001
2000
HIV prevalence and reported consistent condom use
among female sex workers, Abidjan, Côte d'Ivoire: 1992-1998
100
100
HIV prevalence
Reported consistent condom use
80
80
60
% HIVpositive
60
% consistent
condom use
40
40
20
20
0
0
1992
1993
Source: Ghys PD et al. (2002) AIDS
00002-E-25 – end 2001
1994
1995
1996
1997
1998
Estimated need for, and probable uptake
of HIV/AIDS vaccine
High-efficacy vaccine
Probable uptake:
260 million
Total estimated need: 690 million
Source: UNAIDS/WHO, 2002
00002-E-26 – end 2001
Low/moderate-efficacy vaccine
Probable uptake:
49 million
Total estimated need: 260 million
Estimated need for, and probable uptake
of HIV/AIDS vaccine
High-efficacy vaccine
Probable uptake:
260 million
Total estimated need: 690 million
Source: UNAIDS/WHO, 2002
00002-E-27 – end 2001
Low/moderate-efficacy vaccine
Probable uptake:
49 million
Total estimated need: 260 million
Voluntary counselling and testing as
an entry point for HIV prevention and care
Planning for th e future
(care of orphans
and family, making will
etc.)
Normalization and
destigmatization of
HIV/AIDS
Acceptance of
and coping with
serostatus
VCT
Peer, social and
community support,
including PLHA support
groups
Access to family
planning and condoms
(male and female)
Source: UNAIDS (2002)
00002-E-28 – end 2001
Promotes facilitates
behaviour change
(sexual, safe injecting)
Access to
early medical care for
opportunistic infections,
preventive therapy for TB,
including ARVs
Prevention of motherto-child transmission
and maternity services
STI prevention,
screening and
treatment
Percent of women aged 15-49* who know where
to get a HIV test and have been tested: 1998-2000
90
Know a place to get tested
80
Have been tested
70
60
50
40
30
20
Source: UNICEF (2000) Multi-Indicator Cluster Survey 2
00002-E-29 – end 2001
Vietnam
Ukraine
Surinam
Sierra Leone
Senegal
Niger
Mongolia
Republic
Cote d'Ivoire
Comoros
0
Dominican
10
Azerbaijan
%
* except for the Dominican
Republic, where female
aged 12-49 were tested
Roles, training and responsibilities
of VCT counsellors
Level of Counsellor
Roles and responsibilities
•Senior counsellor
•Experienced counsellor with advanced counselling
training
•Support and supervision of other counsellors
•Mentoring role
•Training of other cadres of counsellors
•Accept referrals of difficult or complex cases
•Facilitating/supervising support clubs (on an
occasional basis)
•Professional counsellor
•Counsellor with a professional back ground (e.g.
nursing, teacher etc.) with pre- and post test and
ongoing counselling training
•Pre- test and post-test counselling
•Couple counselling
•Follow up counselling
•Support for lay and peer counsellors
•Lay counsellor
•Counsellor with pre- and post- test and ongoing
counselling training
•Pre- test and post-test counselling of routine case
•Follow- up and supportive counselling for
uncomplicated cases.
•Peer counsellor
•Counsellor who comes from the same background as
clients (may include PLHAs). For example women who
have been through PMTCT projects, peer workplace
counsellors, youth peer counsellors
•Advocacy and community mobilisation
•HIV education and preventive counselling
•Follow- up and supportive counselling for
uncomplicated cases.
•Running/supporting support clubs
Source: UNAIDS (2001) Report from WHO/UNAIDS Technical Consultation on Voluntary HIV Counselling and Testing
00002-E-30 – end 2001
Percentage of children aged 10-14 who are still
in school, according to whether their parents are alive:
selected countries, 1997-2001
96
84
70
91
43
91
82
50
94
45
67
37
90
52
31
81
85
65
70
54
85
65
45
77
68
61
34
24
Both parents alive, living with at least one parent (%)
Both parents dead (%)
Source: UNICEF (1997-2001) Multi-Indicator Cluster Surveys; Macro International (1997-2001) Demographic
and Health Surveys
00002-E-31 – end 2001
HIV/AIDS deaths in 2001 and number of people
using antiretroviral drugs by end 2001: by region
Thousands
2,500
HIV/AIDS deaths
People using ARV drugs
2,000
1,500
1,000
500
0
sub-Saharan
Africa
Source: UNAIDS/WHO, 2002
00002-E-32 – end 2001
Asia
(excluding
Central Asia)
Latin
America &
Caribbean
High -income
Countries
(excluding
Japan)
Eastern
Europe &
Central Asia
North Africa
&
Middle East
Cost of antiretroviral drug purchases, avoided expenditures
and final costs to the Ministry of Health Brazil, 1997 - 2001*
400
350
ARV purchases
Avoided expenditures
Final costs
US$ million
300
250
200
150
100
50
0
-50
1997
Source: Ministry of Health Brazil, 2001
00002-E-33 – end 2001
1998
1999
2000
2001
* Estimated data
Prices (US$/year) of a first-line antiretroviral
regimen in Uganda: 1998-2001
14,000
Launch of Accelerating Access Initiative
12,000
Negotiations with R & D Pharma within
the AAI
10,000
Price
US$
Cipla offer of price reductions
to Uganda
8,000
Further price
reductions by BristolMyers Squibb and
Merck
6,000
4,000
Further discussion
with Cipla
2,000
0
Jun
Jul
1998
Source: WHO/UNAIDS, 2002
00002-E-34 – end 2001
Aug
Apr
2000
Oct
Nov
Dec
Jan
Feb
2001
Mar
Apr
May
Jun
Jul
Aug
Projected annual expenditure requirements
for HIV/AIDS care and support by 2005, by region
South and Southeast
Asia: US$670M (15.09%)
Sub-Saharan Africa:
US$3,070M (69.14%)
East Asia, Pacific:
US$80M (1.80%)
Latin America, Caribbean:
US$550M (12.39%)
Eastern Europe, Central
Asia: US$20M (0.45%)
North Africa, Middle East:
US$50M (1.13%)
Total: US$4,440 million
Source: Schwartlander B et al (2001) Resource needs for HIV/AIDS, Science
00002-E-35 – end 2001
The HIV/AIDS continuum of care
Primary health
care
Secondary
health care
District hospitals
HIV clinics
Social/legal support
Hospices
Health posts
Dispensaries
Traditional
healers
Orphan care
Community care
NGOs
Churches
Youth
groups
Volunteers
Voluntary
counselling
and testing
Specialists and
specialized care
facilities
The entry point
PLWHA
Peer support
Tertiary health
care
Palliative
emotional and
spiritual support
Self-Care
Home care
Source: WHO/UNAIDS (2000) Key Elements in HIV/AIDS Care and Support. Draft working document
00002-E-36 – end 2001
Public, private and donor funding for HIV/AIDS,
in selected Latin-American and Caribbean countries*: 2000
Private funds
35%
External sources
1%
Public funds
64%
* Argentina, Bolivia, Brazil, Chile, Costa Rica, Mexico, Peru, and Uruguay
Source: FUNSALUD, SIDALAC, UNAIDS, 2001
00002-E-37 – end 2001
Projected available resources and resource needs
in low- and middle-income countries: 2003-2005
10,000
International
US$ millions
8,000
National
6,000
Private
4,000
Global Fund
to Fight AIDS,
Tuberculosis and
Malaria
2,000
Unmet need
0
2003
2004
2005
Source: Adapted from joint WHO/UNAIDS presentation, 27 January 2002, Geneva
00002-E-38 – end 2001
Guinea-Bissau*
Libya
Sao Tome & Principe*
CAR
Burundi
Morocco
Cape Verde
Congo
Togo
Egypt
Sudan
Eritrea
Somalia
Nigeria
Botswana
Niger*
Cameroon*
Djibouti
Cote d'Ivoire
Benin*
Angola
Gabon
Tunisia
Mauritius
Sierra Leone*
Liberia
Madagascar*
Kenya*
Seychelles
Swaziland
Equatorial Guinea
Mali*
Ghana*
Uganda*
Comoros
Ethiopia*
Rwanda*
Mauritania*
Burkina Faso
Lesotho
Mozambique*
South Africa
Gambia
Namibia
Algeria
Chad*
Zambia*
Guinea*
Senegal*
DR Congo*
Malawi*
UR Tanzania
Zimbabwe
% expenditure on health
Public expenditure on health as percentage of general
government expenditure in African countries: 1998
18
15
Abuja Target = 15%
12
9
6
3
0
* Heavily indebted, poor countries
Source: WHO (2001) World Health Report
00002-E-39 – end 2001
Documented available international
resources for HIV/AIDS: 2002
United Nations
system organizations
27%
Other donor
countries*
*Members of the
Development Assistance
Committee of the OECD
13%
Canada, France, Germany,
Italy, Japan
9%
Source: UNAIDS, 2002
00002-E-40 – end 2001
United States
of America
30%
United Kingdom
14%
Foundations
7%
Identified available resources for the Global Fund
to Fight AIDS, Tuberculosis and Malaria,
by source, as of April 2002
350
US$ millions
300
250
200
150
100
50
0
US
Other
donor
countries*
Italy
France, UK,
Canada,
Germany
Japan
Foundations/
corporate
sector
• Other member countries of the Development Assistance Committee of the Organisation
for Economic Cooperation and Development and the European Union
Source: Joint WHO/UNAIDS presentation, 27 January 2002, Geneva
00002-E-41 – end 2001
How effective are poverty-reduction strategy
papers (PRSPs) in tackling AIDS?
70
Strong
Average
Weak
Nil
60
% of PRSPs
50
40
30
20
10
0
Anti-poverty
analysis
AIDS
strategies
Medium-term
goals
Short-term
goals
Note: Based on 5 full and 20 interim poverty-reduction strategy papers from Africa, as of November 2001
Source: Hecht R et al. (2002) Making AIDS Part of the Global Development Agenda, Finance and Development
00002-E-42 – end 2001
Net Official Development Assistance (ODA) as
percentage of gross domestic product (GDP): 2000
0.00
UN target 0.70%
Denmark
Netherlands
Sweden
Norway
Luxembourg
Switzerland
Belgium
France
United Kingdom
Finland
Japan
Germany
Portugal
Australia
Canada
Ireland
Austria
New Zealand
Spain
Greece
Italy
United States
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
%, ODA/GDP
Source: For GDP data, OECD, National Accounts of OECD Countries, Volume 1, for ODA data, OECD
00002-E-43 – end 2001
0.90
1.00
1.10
Worldwide assessment of HIV/AIDS
programme preparedness (114 countries)
114
Number of countries
95
76
57
38
19
0
National
Strategic
Plan
Implementation Plan
Costed
Plan
Source: Joint WHO/UNAIDS presentation, 27 January 2002, Geneva
00002-E-44 – end 2001
Monitoring & Coordination
Evaluation
Mechanism
Plan
Updated version
Cumulative reported HIV infections per million
population in Eastern European countries: 1993 - 2001
1,500
Estonia
Russian Federation
1,200
Cases
per million
population
900
Ukraine
Latvia
600
Belarus
Moldova, Republic of
300
0
1993 1994
1995 1996 1997 1998 1999 2000
2001
Kazakhstan*
Lithuania
Georgia
Uzbekistan
* based on 2001 mid-year data
Source: European Centre for the Epidemiological Monitoring of AIDS. HIV/AIDS surveillance in Europe. End-of-year
report 2001. Saint-Maurice: Institut de Veille Sanitaire, 2001. No. 66
00002-E-45 – end 2001
Updated version
Net Official Development Assistance (ODA) as
percentage of gross domestic product (GDP): 2001
0.00
UN target 0.70%
Denmark
Netherlands
Norway
Sweden
Luxembourg
Belgium
Switzerland
France
United Kingdom
Finland
Spain
Ireland
Germany
Portugal
Austria
Japan
Australia
Canada
New Zealand
Greece
Italy
United States
0.10
0.20
0.30
0.40
0.50
0.60
0.70
%, ODA/GDP
Source: For GDP data, OECD, National Accounts of OECD Countries, for ODA data, OECD
00002-E-46 – end 2001
0.80
0.90
1.00
1.10