"HIV/AIDS in Southern Africa: A Dispatch from

the Battlelines" By

Prof. Alan Whiteside

Director, HEARD

Southampton

January, 2005

Headlines

• HIV/AIDS prevalence rises• Impact becoming apparent• Response picks up momentum

-Governments-International agencies-NGOs-CHGA

• Treatment slow

Presentation Outline

• Prevalence• Impacts

– Demographic– Political– Economic

• Response • Treatment

Freedom!

2nd Democratic

Election

0

5

10

15

20

25

30

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

% H

IV P

osit

ive

HIV Prevalence South AfricaWomen Attending Public Antenatal Clinics

FREEDOM!

2nd General Election

National trends in HIV prevalenceWomen attending Public Antenatal Clinics

0

5

10

15

20

25

30

35

40

45

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

% H

IV p

os

itiv

e

Botswana Namibia South Africa Swaziland

Epidemic Curve: HIV

27Aug01 -Report I: Epidem’gy& Lit. p. 27

T1 T2 Time

Numbers

A1

A2

HIV prevalence

A

B

Epidemic Curves: HIV and AIDS

Epidemic Curve: HIV, AIDS and Impact

27Aug01 -Report I: Epidem’gy & Lit. p. 27

T1 T2 Time

Numbers

A1

A2

HIV prevalence

B1

A

B

AIDS - cumulative

Impact

Year Province Group N %

1985 KwaZulu Natal Rural community 441 0.00

1986 Transvaal Miners 17 021 0.01

Transvaal Sex workers 1 200 0.00

1987 KwaZulu Natal Antenatal women 500 0.00

Outpatient 268 0.00

Source: Abdool Karim SS. S Afr Med J, 1999; 89: 609-611 Dusheiko GM. Am J Epidemiol. 1989; 129(1):138-45.

HIV infection in selected groups from HIV infection in selected groups from 1985 - 19871985 - 1987

Source: Wilkinson D, Abdool Karim SS, Williams B, Gouws E. JAIDS 2000; 23: 405-409

Age Group 1992 1995 1998 2001

20-24 6.9% 21.1% 39.3% 50.8%

25-29 2.7% 18.8% 36.4% 47.2%

30-34 1.4% 15.0% 23.4% 38.4%

35-39 0.0% 3.4% 23.0% 36.4%

Temporal trends in the age-specific Temporal trends in the age-specific prevalence of HIV infection in antenatal prevalence of HIV infection in antenatal

clinic attendees in Hlabisaclinic attendees in Hlabisa

A model of futureAIDS and non-AIDS Deaths

0

200000

400000

600000

800000

1000000

1200000

1995 2000 2005 2010 2015

year

num

ber o

f dea

ths

Other deaths AIDS Deaths

All orphans & orphans due to AIDS by HIV prevalence Uganda

1985 1990 1995 2000 2005 20100

0.5 million

1 million

1.5 million

2 million

Total Number

0

6%

12%

HIV Prevalence

Total Orphans

AIDS Orphans

HIV Prevalence

Impact of HIV/AIDS

• Demographic

• Political

• Economic

Changing life expectancy in African countries with high and low HIV prevalence: 1950-2005

Source: UNAIDS, 2002. Report on the global HIV/AIDS epidemic

By-Elections in Zambia

0

20

40

60

80

100

120

1964-1984 1985 - 2003

total due to deathresignation/expulsion

Source: IDASA

Non-registration

HIV prevalence_

_

+

+

Pearson’s r = .7

Level of analysis: the nine provinces

Non-participation by young women in South Africa

Estimates of the impact of AIDS Estimates of the impact of AIDS on economic growth, 1992on economic growth, 1992−−20002000

Source: (1) Botswana, Lesotho, Namibia data: Sackey and Raparla, 2000. (2) South Africa data: Arndt and Lewis 2000. (3) Botswana data: Greener, Jefferis and Siphambe, 2000. (4) 30 Countries data: Over, 1992. (5) Cameroon data: Kambou et al, 1992.

-2.00%

-1.50%

-1.00%

-0.50%

0.00%

Cameroon**30 Countries*Botswana***South Africa**Botswana,Lesotho,Namibia*

Methodology:

* Demographic and economic modelling ** CGE Simulations *** Economic

2004 Report on the Global AIDS Epidemic (Fig 14)

By 2010 orphans will account for 15-25% of all children in 12 countries in SAA

Source: UNICEF

Conclusions 1

• Prevention

• Care and treatment

• Mitigation

World HIV Chart World HIV Chart 20012001

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Annual income per person in US dollar (ppp & log)

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anka

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Sw

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Tajik

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Turk

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ted

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dom

United Statesof America

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tan

Venezuela

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Zimbabwe

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AIDS deaths per year

300 000100 00010 000

1 000

Africa

Americas

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Asia

Europe

Continents

0.2

0.3

World HIV Chart World HIV Chart 20012001

Perc

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0.1

Annual income per person in US dollar (ppp & log)300 40 000

1 000

5 000

10 000

20 000

2 000

500

0.5

1

5

10

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20

7

3

2

Alg

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Argentina

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Barbados

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Belize

Benin

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tan

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ivia

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garia

Burundi

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Chad

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and

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rgia

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man

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en

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300 000100 00010 000

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Asia

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0.2

0.3

X200?

World HIV Chart World HIV Chart 20012001

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0.1

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0.5

1

5

10

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ia

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jan

Bahrain

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Barbados

Belarus

Belgium

Belize

Benin

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tan

Bol

ivia

Botswana

Brazil

Bul

garia

Burundi

Cambodia

Cameroon

Canada

Central African Rep.

Chad

Chile

Chi

na

Colombia

Costa Rica

Côte d'Ivoire

Cro

atia

Cub

a

Cyprus

Cze

ch R

epub

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Dominican Republic

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El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Fiji

Finl

and

France

Geo

rgia

Ger

man

y

Ghana

Greece

Guatemala

Guinea-Bissau

Guyana

Haiti

Honduras

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gary

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Indo

nesi

a

Irel

and

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el

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Jamaica

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n

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Lith

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Madagascar

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way

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sta

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ania

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Singapore

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anka

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Suriname

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Swed

en

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ista

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ey

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men

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ted

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dom

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Uruguay

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ekis

tan

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en

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300 000100 00010 000

1 000

Africa

Americas

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Asia

Europe

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0.2

0.3

10 X20=200

HEARD Research

• Educator reported Orphan Incidence in Amabuja District, Newcastle, KwaZulu-Natal

• GIS (with Southampton)

Projected Number of schools with learners experiencing new parent death

between April-July 2004 Amajuba District, Newcastle, April-July 2004

N = 43 Schools

Source: HEARD, 2004

Number of new orphans reported in schools

Amabuja District, Newcastle, April-July 2004

N = 43 Schools

Source: HEARD, 2004

34

39

27

0

5

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20

25

30

35

40

45

5 or more orphans 1-4 orphans No orphans

Per

cen

tag

e

A Spatial Framework for the Management & Support

of Orphans and Vulnerable Children in KwaZulu-Natal

“The care and protection of children is a practice and ethic rooted deep in the wisdom and culture of all societies” – James Grant

Daniel Wilson, Su Erskine, Peter Badcock-Walters, HEARD/MTT

(Study supported by Rockefeller Brothers Fund)

Aims and Objectives

• Define, identify and geolocate OVC and service organisations;

• Establish relationships between OVC & service providers;

• Develop adaptive management tools & share accessible data.

The Geographic Information System Approach (GIS)

• Analyse & visualise layers of information

• Tools for data exploration

• Outputs tables, graphs & maps

State Social Service Delivery

Source: EduAction

Access to Magistrates Courts

TargetsSA ARV treatment target announced in Cabinet Statement on 19th November 2003.

Operational target of 53,000 people on ARV treatment by March 2004, (extended March 2005).

The Medical Research Council says 400 000 people fulfil criteria for treatment already

Achievements (?)

• In September 2004, close to 8000 people were on ARV treatment at public health facilities nationally.

• At end of November 2004, approx. 18,500 people on treatment. Most in Gauteng, the Western Cape and KwaZulu-Natal.

Current patient numbers by provinceProvince Operational Plan

March 2004 (05)Total patients

(Adults and Children)% on

Western Cape 2728 5137 188

Eastern Cape 2750 1525 55

Northern Cape 790 [150] 19

Gauteng 10,000 5588 178

KZN 24,902 [3004] 2500 12

Limpopo 6965 [300] 4

North West 1808 1124 62

Free State 2127 602 28

Mpumalanga 1934 [500] 26

TOTAL 54004 (53,000) Approx 18,500 34

Source: Treatment Action Campaign (www.tac.org.za) [ ] denotes unsure of accuracy *A site usually means a hospital plus several feeder clinics

Aluta continua

• Leadership

• Prevention

• Treatment

• Social development