Deputy Vice-Chancellor (Research), University of Natal Director: CAPRISA - Centre for the AIDS...
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Deputy Vice-Chancellor (Research), University of Natal Deputy Vice-Chancellor (Research), University of Natal Director: CAPRISA - Centre for the AIDS Programme of Research in SA Director: CAPRISA - Centre for the AIDS Programme of Research in SA Professor in Clinical Epidemiology, Columbia University Professor in Clinical Epidemiology, Columbia University Adjunct Professor in Medicine, Cornell University Adjunct Professor in Medicine, Cornell University 20 August 2003 20 August 2003
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Transcript of Deputy Vice-Chancellor (Research), University of Natal Director: CAPRISA - Centre for the AIDS...
Deputy Vice-Chancellor (Research), University of NatalDeputy Vice-Chancellor (Research), University of NatalDirector: CAPRISA - Centre for the AIDS Programme of Research in SADirector: CAPRISA - Centre for the AIDS Programme of Research in SA
Professor in Clinical Epidemiology, Columbia UniversityProfessor in Clinical Epidemiology, Columbia UniversityAdjunct Professor in Medicine, Cornell UniversityAdjunct Professor in Medicine, Cornell University
20 August 200320 August 2003
NUMBER OF PEOPLE LIVING WITH HIV/AIDS Adults 38.6 millionWomen 19.2 millionChildren under 15 years 3.2 millionTotal 42 million
PEOPLE NEWLY INFECTED WITH HIV in 2002 Adults 4.2 millionWomen 2 millionChildren under 15 year 800 000Total 5 million
Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO). AIDS epidemic update Dec 2002
Latin America
1 500 000
East Asia & Pacific
1 200 000
Eastern Europe & Central \Asia
1 200 000
Sub Saharan Africa
29 400 000
Australia & New Zealand
15 000
Caribbean
440 000
North America
980 000North Africa &
Middle East
550 000
Western Europe
570 000
South & South-East Asia
6 000 000
Total: 42 million
Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO). AIDS epidemic update Dec 2002
Source: Department of Health
0
10
20
30
40
1988 1990 1992 1994 1996 1998 2000 2002
HIV
pre
vale
nce
(%)
Source: Williams BG, Gouws E, Wilkinson D, Abdool Karim SS. Estimating HIV from Age Prevalence data e epidemic situation. Statistic in Medicine 2000.Gouws E, Williams BG, Sheppard HW, Enge B, Abdool Karim SS. High incidence of HIV-1 in South Africa using a standardized algorithm for recent HIV seroconversion. J AIDS 2002; 29: 531-535.
Source: Williams BG, Gouws E, Wilkinson D, Abdool Karim SS. Estimating HIV from Age Prevalence data e epidemic situation. Statistic in Medicine 2000.Gouws E, Williams BG, Sheppard HW, Enge B, Abdool Karim SS. High incidence of HIV-1 in South Africa using a standardized algorithm for recent HIV seroconversion. J AIDS 2002; 29: 531-535.
Year N Prev(%)(95% CI) Incidence %
1992 884 4.2 (3.0-5.7) 2.0
1993 709 7.9 (6.0-10.1) 3.3
1995 314 14.0 (10.4-18.4) 7.1
1997 4731 27.2 (25.9-28.5) 10.2
1998 3166 29.9 (28.4-31.6) 10.5
1999 3001 34.0 (32.5-35.7) 10.3
2001 906 36.1 (32.9-39.2) 10.2
00
<9<9 10-1410-14
JUN/JUL 1992JUN/JUL 1992
Pre
vale
nce (
%)
Pre
vale
nce (
%)
15-1915-19 20-2420-24 25-2925-29 30-3930-39 40-4940-49
22
44
66
88
1010
FemaleFemaleMaleMale
Source: Abdool Karim Q, Abdool Karim SS, Singh B, Short R, Ngxongo S. Prevalence of HIV infection in Rural South Africa. AIDS 1992; 6: 1535 - 1539
Source: Wilkinson D, Abdool Karim SS, Williams B, Gouws E. High HIV incidence and prevalence among young women in rural South Africa: developing a cohort for Intervention Trials. J Acquir Immune Defic Syndr 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%
0246
810
1214
16
15-19 20-24 25-29 30-34 35-39 40-44 Total
Age
Inci
den
ce (
%)
1998
2001
YearPerson-months
of follow-upIncidence Rate (%);
95% CI
1996/97 996 16.8 (8.0-26.0)
1998 1644 18.2 (11.0-25.0)
1999 780 20.0 (9.0-31.0)
Overall (1996-99) 3420 18.2 (13.0-23.0)
Source: Abdool Karim SS, Ramjee G and Gouws E – Data from COL-1492 trial
STD Prevalence (95% CI)(n=472)
Incidence (95% CI)(n=198)
T.Vaginalis 36.1% (31.6; 40.6) 114.0% (102; 126)
N.Gonorrhoeae 11.3% (8.4; 14.3) 42.0% (34.8; 49.2
C.Trachomatis 12.7% 9.4; 36.2) 43.2% (34.8; 50.4)
Syphilis 31.9% (27.6; 36.2) -
HIV 51.3% (46.7; 55.8) 18.2% (13.0; 23.0)
Source: Ramjee G, Abdool Karim SS, Morar NS, Gwamanda Z, Xulu G, Ximba T, Gouws E. Acceptability of a vaginal microbicide among female sex workers. S Afr Med J 1999; 89: 673-676.
All Women aged
15-49 years
(N=55 974)
All Women aged
15-49 years
(N=55 974)
Women with
an STI
Women with
an STI
Symptoms
Recognized
Symptoms
Recognized
TreatmentTreatmentInadequate
88 35%Adequate
164 65%
No6 994 98%
Yes252 2%
Asymptomatic6 697 48%
Symptomatic7 246 52%
No STI42 031 75%
At Least One STI13 943 25%
Source: Wilkinson D, Abdool Karim SS, Harrison A, Lurie M, Colvin M, Connolly C, Sturm AW. Unrecognised Sexually Transmitted Infections in Rural South Africa African Women - The Hidden Epidemic. Bull WHO 1999; 77: 22-28
Source: Wilkinson D, Abdool Karim SS, Harrison A, Lurie M, Colvin M, Connolly C, Sturm AW. Unrecognised Sexually Transmitted Infections in Rural South Africa African Women - The Hidden Epidemic. Bull WHO 1999; 77: 22-28
Source: Wilson J, N DOH Logistics
300300
200200
FY2000FY2000 FY2001FY2001 FY2002 FY2002
400400
R61,4m@R0,23c
Fiscal Year Distribution / CostFiscal Year Distribution / Cost
Co
nd
om
P
iece
s /
Mil
lio
ns
of
Ran
ds
Co
nd
om
P
iece
s /
Mil
lio
ns
of
Ran
ds
250Million
100100
267Million
R103,8m@R0,29c
Distribution inDistribution inmillions of piecesmillions of pieces
Investment in Investment in millions of Randmillions of Rand
Projected costProjected cost
Projected Projected distribution pieces distribution pieces
358 Million
2.5Mil2.5MilPiecesPieces
R18,5R18,[email protected]@R7.50
600 000600 000PiecesPieces
1.3 Mil1.3 MilPiecesPieces
Distribution inDistribution inmillions of piecesmillions of pieces
Investment in Investment in millions of Randmillions of Rand
Projected costProjected cost
Projected Projected distribution pieces distribution pieces
FY2000FY2000 FY2001FY2001 FY2002 FY2002
Fiscal Year Distribution / CostFiscal Year Distribution / Cost
Co
nd
om
P
iece
s /
Mil
lio
ns
of
Ran
ds
Co
nd
om
P
iece
s /
Mil
lio
ns
of
Ran
ds
5
10
15
20
Source: Wilson J, N DOH Logistics
• 384 sequential condom recipients and their 5528 384 sequential condom recipients and their 5528 condoms condoms
• Condoms after 5 weeks:Condoms after 5 weeks:- 43.7% had been used- 43.7% had been used- 21.8% had been given away- 21.8% had been given away- 8.5% had been lost or discarded- 8.5% had been lost or discarded- 26.0% were still available for use- 26.0% were still available for use
• Wastage at 5 weeks is less than 10%. Wastage at 5 weeks is less than 10%.
• Extrapolating these data: at least 87 million condoms were Extrapolating these data: at least 87 million condoms were used in sex in 2000used in sex in 2000
Source: Myer L, Mathews C, Little F, Abdool Karim SS. The fate of free male condoms distributed to the public in South Africa. AIDS 2001;15: 789-793.
Microbicides
WhenWhen
PreventionPrevention
fails…fails…
Source: Hlabisa Hospital Records
0
500
1000
1500
2000
2500
3000
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
Year
Nu
mb
er o
f T
B c
ases
0
5
10
15
20
25
30
35
40
HIV
Pre
vale
nce
(%
)
• 54% of Medical in-patients were HIV+54% of Medical in-patients were HIV+
• 84% of HIV+ met WHO AIDS case criteria84% of HIV+ met WHO AIDS case criteria
• More women than men admittedMore women than men admitted
• 56% HIV+ co-infected with tuberculosis56% HIV+ co-infected with tuberculosis
• Case fatality rates: HIV+ = 22% vs HIV- = 9%Case fatality rates: HIV+ = 22% vs HIV- = 9%
Source: Colvin M, Dawood S, Kleinschmidt I, Mullick S, Lalloo U. Int J STD AIDS 2001, 386-389
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69
1996-1998
1999-2000
AGE
0
50
100
150
200
250
300
350
PE
RC
EN
TA
GE
OF
19
85-1
990
AV
ER
AG
E
Source: Dorrington R, Bourne D, Bradshaw D, Laubscher R, Timæus IM. The Impact of HIV/AIDS on Adult Mortality in South Africa. MRC Technical Report. 2001
0.000
0.500
1.000
1.500
2.000
2.500
3.000
3.500
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
Age
Rat
io
1994
1996
1997/8
1998/99
1999/2000
Source: Dorrington R, Bourne D, Bradshaw D, Laubscher R, Timæus IM. The Impact of HIV/AIDS on Adult Mortality in South Africa. MRC Technical Report. 2001
• Current epidemic in most of sub-Saharan Africa Current epidemic in most of sub-Saharan Africa has 5 parallel effects:has 5 parallel effects:
- - Continuing large numbers of new HIV infectionsContinuing large numbers of new HIV infections
- Ongoing high mother-to-child transmission rates- Ongoing high mother-to-child transmission rates
- Rising morbidity and its impact on health - Rising morbidity and its impact on health servicesservices
- Rapid rise in the number of deaths- Rapid rise in the number of deaths
- Increase in numbers of orphans- Increase in numbers of orphans
• Both prevention and treatment needed, preferably Both prevention and treatment needed, preferably in integrated deliveryin integrated delivery
• In sub-Saharan Africa, women are more severely affected by the HIV In sub-Saharan Africa, women are more severely affected by the HIV
epidemicepidemic
• Condom uptake & use – continues to increaseCondom uptake & use – continues to increase but there is a clear & but there is a clear &
urgent need for a woman controlled methodurgent need for a woman controlled method
• Microbicides have real potential to influence the course of the HIV Microbicides have real potential to influence the course of the HIV
epidemicepidemic
