Post on 04-Jan-2016
HIV and AIDS Epidemic: Potential Contribution from
DSS sites
Nyovani Madise, PhD
Centre for Global Health, Population, Poverty & Policy
What Do We Already Know?
• 39 million infected with virus
• 4 million new infections per year
• Globally, HIV infections are unevenly spread- 29 million of those infected living in Africa
Geography of HIV and AIDSPrevalence in adults, 2005
Number of people living with HIV
% HIV prevalence, adult (15-49)
1985 1990 1995 2000 2005
0
5
10
15
20
25
30
0.0
2.5
5.0
7.5
12.5
15.0
% HIV prevalence, adult (15‒49)
HIV epidemic in sub-Saharan Africa, 1985‒2005*
Number of peopleliving with HIV (millions)
This bar indicates the range around the estimate
*
10.0
2.2
Source: UNAIDS 2006 Report on Global AIDS Epidemic
Increasing Mortality
Male adult mortality (15 - 49 years) 1992 & 2000 Malawi DHS
0
5
10
15
20
25
15-19 20-24 25-29 30-34 25-39 40-44 45-49
Age in years
Death
s p
er
1000
1992
2000
Population by age and sex, South Africa, 2020 (under “no AIDS” scenario)
Source: United Nations, World Population Prospects: The 2004 Revision, CD-ROM Edition, Extended Dataset (2005).
South Africa in 2020 Without AIDS:
Source: United Nations, World Population Prospects: The 2004 Revision, CD-ROM Edition, Extended Dataset (2005).
South Africa in 2020 With AIDS (Medium AIDS Scenario)
Stagnation or Increase in Childhood Mortality
Changes in infant mortality in selected African countries with high HIV prevalence
0
20
40
60
80
100
120
140
160
Malawi Coted'Ivoire
Kenya Uganda Zambia Zimbabwe
De
ath
s p
er
10
00
live
bir
ths
Early 90s
Late 90s-2000
Social and Economics Aspects
National Wealth & HIV Prevalence
1000 $
2000 $
3000 $
Per capita 1999
Adult HIV prevalence end 1999
Botswana
South Africa
Namibia
Swaziland
ZimbabweUganda
Cote d’Ivoire
Zambia10
10 20 30
Household Wealth and HIV Prevalence
Malawi
0
5
10
15
20
Lowest Second Middle Fourth Highest
Wealth Quintiles
HIV
prev
alen
ce (%
)
Women Men
Kenya
0
2
4
6
8
10
12
14
Lowest Second Middle Fourth Highest
Wealth Quintiles
HIV
prev
alenc
e (%
)
HIV Prevalence by Age at First Sexual intercourse
0
2
4
6
8
10
12
14
16
18
20
Kenya Malawi Uganda
Ad
ult
HIV
pre
val
ence
(%) <15 years
15-17
18-19
20+
Sources: DHS surveys
Women
Gender Differences in HIV Prevalence
What We Know and Don’t Know…
BIOCHEMISTRY
POTENTIAL IMPACTS
TREATMENT
BEHAVIOURALSTUDIES
DSS Sites Can Advance Knowledge
A Population-based Longitudinal Assessment of ART Rollout:
Effects on Individuals, Populations, and, Health Systems
Proposal by INDEPTH Network
5-year evaluation of the antiretroviral therapy (ART) roll-out programmes at INDEPTH sites in West, East and Southern Africa
Collaborating Sites
• Agincourt (South Africa)
• Nairobi (Kenya)
• Bandim (Guinea Bissau)
• Ifakara (Tanzania)
• Kisumu (Kenya)
Overall Objectives
Effect of ART roll-out on
• Individuals under treatment & families
• The population
• Health systems
Effect on Individuals and Their Families
• Survival after starting ART
• Quality-of-life on ART
• Sexual behaviour of individuals taking ART
• Economic impact on households with member taking ART
Effect of ART on the Population
• Trends in mortality, morbidity, and survival in DSS communities
• Household structure and childcare
• Sexual behaviour in the population
• Stigma at population level
• Access to ART- what % of those who need it are receiving it?
Effect of ART and the Health System
• Understanding ART roll-out national policies, how they are developed/revised
• Interpretation and application of policies at district level
• Equity in provision of ART
• ART impacts on other health services
• Improving effectiveness of ART roll-out programmes
Proposed Activities
Existing DSS activities• Verbal autopsies on cause of death• Population and household structure• Socio-economic status
Additional activities• Population-based HIV testing• Morbidity, sexual behaviour studies• Closer linkage with health service provider
Thank You