5th SAHARA Conference, 30 November-3 December 2009

Acceleration of HIV Prevention: Where are we?

I.Ntaganira, Regional adviser HIV Prevention, WHO Regional Office for Africa

5th SAHARA Conference, 30 November-3 December 2009

Outline

• Background information;• Actions taken;• Progress made• Issues and challenges • Way forward

5th SAHARA Conference, 30 November-3 December 2009

Resolution AFR/RC55/R6

• Adoption by the 56th Session of the Regional Committee;• Calling the 46 Member States to accelerate HIV

prevention;• Declaring 2006 the Year to launch acceleration of HIV

prevention

5th SAHARA Conference, 30 November-3 December 2009

Brazzaville, November 2005

5th SAHARA Conference, 30 November-3 December 2009

Addis Ababa, 11 April 2006

5th SAHARA Conference, 30 November-3 December 2009

Country actions

• 2006: Launch of acceleration of HIV prevention in all countries;

• Appointment of HIV prevention focal persons and establishment of HIV prevention task forces;

• Development of HIV prevention road maps;• multisectoral HIV/AIDS strategies and plans

(stronger component on HIV prevention);

• Resource mobilization (GFATM proposals with stronger focus on HIV prevention)

5th SAHARA Conference, 30 November-3 December 2009

Other actions

• Establishment of HIV prevention units within UN agencies

• Establishment of UN interagency technical teams on HIV prevention;

• Organization of regional think tank meetings with setting up of regional targets for HIV prevention;

• Organization of national summits on HIV prevention;

• Regional efforts to mobilize financial resources

5th SAHARA Conference, 30 November-3 December 2009

Progress made

5th SAHARA Conference, 30 November-3 December 2009

Prevention of Mother-to-Child Transmission of HIV

2008: 600,000 HIV positive

pregnant women

received ARV for PMTCT

5th SAHARA Conference, 30 November-3 December 2009

Ensuring Individuals know their HIV status

2007-2008

Total number of health facilities providing HTC

increased by 50%

More than 17 millions people aged 15 and above received HTC

services

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Male Circumcision for HIV prevention:Male Circumcision for HIV prevention:

Botswana, Burundi, Kenya, Lesotho,

Malawi, Mozambique,

Namibia, Rwanda, South Africa,

Swaziland, Zambia, Zimbabwe, Uganda, United Republic of

Tanzania,

5th SAHARA Conference, 30 November-3 December 2009

Trends in the Prevalence of Syphilis among ANC Women in Selected Countries in Southern Africa

0

5

10

15

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

Malawi South Africa Swaziland Lesotho Zimbabwe

Source: WHO/AFRO, From national surveillance reporting

%

5th SAHARA Conference, 30 November-3 December 2009Towards Universal Access – Scaling up priority HIV/AIDS interventions in the health sector. WHO/UNAIDS/UNICEF, Sep 2009

Number of people receiving antiretroviral therapy in low- and middle-income countries,

by region, 2002–2008

5th SAHARA Conference, 30 November-3 December 2009

Issues and Challenges

5th SAHARA Conference, 30 November-3 December 2009

Knowledge of HIV status among HIV-infected persons

2016

23

0

20

40

60

80

100

Kenya Malawi Uganda

Per

cen

t*Sources: most

recent DHS/AIS

►Large unmet desire for HIV testing among HIV-infected Kenyans(79%)

►Knowledge of partner status among HIV-infected Ugandans (9%)

5th SAHARA Conference, 30 November-3 December 2009

HIV status of spouses of HIV-infected persons in Kenya, DHS, 2003

►In Kenya, 50% of married HIV+ persons have an HIV-negative spouse

HIV DISCORDANT:

One partner positive, one partner negative: 50%CONCORDANT POSITIVE:

Both partners HIV-infected: 50%

5th SAHARA Conference, 30 November-3 December 2009

Sexual behavior of people living with HIV Kenya, Malawi, Uganda (%)

Kenya Malawi Uganda

Sexually active (last yr) 84 85 77

Of sexually active:One partner (last yr) 88 92 86

Used condom last sex 10 10 17

Used condom last sex with spouse

3 6 -

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Knowledge about HIV/AIDS

Country Comprehensive correct knowledge (15-49 year old)

Heard of HIV/AIDS (15-49 year old)

Male female Male Female

Benin 31.4% 13.8% 98.7% 94.2%

Ethiopia 30% 15.8% 96.5% 89.9%

Cameroon 32.2% 22.5% 99.2% 97.8%

Swaziland 51.4% 51.9% 99.3% 99.8%

5th SAHARA Conference, 30 November-3 December 2009

ART: Challenges

• Patients often tested at late stage of the disease;

• Patient retention on antiretroviral therapy• 75% at 12 months and • 67% at 24 months

• Late initiation of treatment – Botswana, average 67 cells per mm3 and 80 % of

patients at stages 3 and 4; – Province of Cape Town ( 23 % started treatment with

CD4 lower than 50 cells per mm3)

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Way forward: Going to scale

• District based programming;• Scale up HIV prevention along side treatment and care;• Implementation of combination HIV prevention which are

known to be working (enabling people living with HIV to know their status; PMTCT, ART, Male circumcision);

• Invest more financial in HIV prevention while addressing health systems bottlenecks;