AIDS in Africa: Past and Future

Peter Piot

Souleymane Mboup

Meskerem Grunitzky Bekele

Spread of HIV in Africa

1985 1990 1995

2001 2007

Incidence by Modes of Transmission

Sources: Draft results from Know your Epidemic project

Uganda0

20

40

60

80

100

Kenya Mozambique

Percentnew infections

Clients of female sex workers

Injecting drug users

Men having sex with men

Casual heterosexual sex

Fishing community

Partners (Casual heterosexual sex)

Low risk heterosexual

Other

Partners of clients of female sex workers

HIV prevalence (%) among 15-24-year-olds, by gender, selected sub-Saharan African countries, 2005‒2007

SwazilandSouth Africa

ZimbabweCentral African Republic

Côte d'Ivoire

Sierra Leone

Rwanda

Guinea

Ethiopia

Benin

DR Congo

NigerSenegal

Uganda

Chad

Mali

0 5 10 15 20 25% HIV prevalence

Female

Male

Southern Africa

Central Africa

Eastern Africa

Western Africa

10 top causes of death in Africa

1. AIDS2. Malaria3. Lower respiratory infections4. Diarrhoeal diseases5. Perinatal conditions6. Cerebrovascular disease7. Tuberculosis8. Ischaemic heart disease9. Measles10. Road traffic accidentsExtrapolated from WHO data

Research – the early years

Projet Sida, 1984

Research

Heterosexual transmission

SIV and SIV cpz

HIV2

TB and HIV

PMTCT, breastfeeding and HIV transmission

Genetic diversity of HIV

Risk factors for sexual transmission

Intervention research

1980s HIV prevention among sex workers

1990s Impact of STI treatment on HIV infection

1999 Nevirapine for PMTCT

2000 Cotrimoxazole to prevent opportunistic infections

2007 Male circumcision for HIV prevention

Social Science Research

1980s Sex and sexual behaviour1990s Sex work, STIs and HIV

Socio-economic impact Counselling and testing

2000s Orphans Political science Sexual networking & behaviour patterns Stigma Establishment of SAHARA

Political Leadership

Ab

OAU, Abuja, 2001

Community mobilization

TASO, 1987

Activism

Tipping point: 2000-2001

• African Development Forum, Addis• International AIDS Conference, Durban• UN Security Council session on AIDS in Africa• G8 Okinawa Declaration• World Bank Multi-Country AIDS Programme for Africa• Millennium Development Summit• World Trade Organisation Agreement on TRIPS• UN General Assembly Special Session on HIV/AIDS• OAU Summit, Abuja

Drug Access Initiative

Drug prices fall

International expenditure on AIDS and STIs in sub-Saharan Africa, 2002-6

2000

2002 2003 2004 2005 2006

1000

500

0

1500

220

554

1093

16121688

0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

2007 2008 2009 2010 2011 2012 2013 2014 2015

Projected Financial Resources Required in sub-Saharan Africa if current scale-up trends continue

(US$ Millions)

Expansion of HIV treatment in Sub-Saharan Africa

Mill

ions

Year

0.5

2.0

1.0

1.5

2.5

0.0end-2001

end-2002

end-2005

end-2006

end-2003

end-2004

end-2007

1997

HIV Prevalence among pregnant women attending Antenatal clinics in Sub Saharan Africa

1997-2006

HIV Prevalence among pregnant women attending Antenatal clinics in Sub Saharan Africa

1997-2006

0

5

10

15

20

25

30

35

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Years

HIV

%

Cote d'Ivoire

Ethiopia

Kenya

Burkina Faso

Zimbabwe

The next 25 years

Add long-term approach to crisis management:

• aids 2031 project

• scenarios for Africa