EG3244 Development Geographies The AIDS crisis Dr Mark Cresswell.
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Transcript of EG3244 Development Geographies The AIDS crisis Dr Mark Cresswell.
EG3244Development Geographies
The AIDS crisis
Dr Mark Cresswell
TOPICS
• Background to STDs
• HIV: Introduction
• HIV: Aetiology & History
• Global and Regional Analysis
• Treatments
• Online resources
Sexually Transmitted Diseases
• STDs are one of the few emerging diseases that are not strictly related to economic wealth (love is free!!!!)
• Most STDs are really lifestyle diseases rather than emerging diseases – many STDs were caught and spread by amorous sailors from European colonial powers visiting islands and previously unchartered lands
Sexually Transmitted Diseases
• What we might term as “emerging diseases” are those STDs which are relatively new and for which there is no cure – principally HIV
• Human Immunodeficiency Virus (HIV) is a retrovirus• HIV leads to a clinical condition known as Acquired
Immune Deficiency Syndrome (AIDS) which may take a decade to develop
HIV: Introduction
• HIV was isolated in 1983 and was often linked to mainly homosexual activity – paticularly in the Los Angeles and San Francisco regions of the US
• It has claimed a number of high profile people (actors and scientists) who have been active in raising public awareness
HIV: Aetiology & History
• In fact, HIV is known to be transmitted through unprotected heterosexual activity, blood transfusions and medical procedures and drug use where hygiene rules are ignored
• Once HIV develops into AIDS the result is a progressive decline in immune status. Cause of death may be a common cold or septicaemia from cut
HIV: Aetiology & History
• HIV is believed to have resulted from a “crossing over” from a known animal disease affecting chimpanzees – Simian Immunodeficiency Virus (SIV)
• Two main types of HIV– HIV-1 most prevalent in western societies– HIV-1 & HIV-2 found mainly in Africa– HIV-2 is less aggressive form
HIV: Aetiology & History
• HIV-1 sub-types (known as “clades”) are very strongly associated with geography and vary from country to country
• Epidemiology of all STDs in human society is usually a direct result of:– Social and moral beliefs– Urbanisation and household occupancy patterns– Religious belief
Statistical Measures - Incidence
This is the number of new cases in a particular time period:
P
NI
I = IncidenceN = Number of new cases in a given time periodP = Person years at risk during same time period
Note that person years at risk means the total amount of time (in years) that each member of the population being studied (the study population) is at risk of the disease during the period of interest.
Statistical Measures - Prevalence
This is the proportion of current cases in a population at a given point in time:
P = PrevalenceNc = Number of cases in the population at a given point in timeP = Total population at the same point in time
P
NcP
06/06 e 2006 Report on the
global AIDS epidemicFig
25 years of AIDS25 years of AIDS
9 In 1991-1993, HIV prevalence in young pregnant women in Uganda and in young men in Thailand begins to decrease, the first major downturns in the epidemic in developing countries
10 Highly Active Antiretroviral Treatment launched
11 Scientists develop the first treatment regimen to reduce mother-to-child transmission of HIV
12 UNAIDS is created
13 Brazil becomes the first developing country to provide antiretroviral therapy through its public health system
14 The UN General Assembly Special Session on HIV/AIDS. Global Fund to fight AIDS, Tuberculosis and Malaria launched
15 WHO and UNAIDS launch the "3 x 5" initiative with the goal of reaching 3 million people in developing world with ART by 2005
16 Global Coalition on Women and AIDS launched
40
30
20
10
0
50
35
25
15
5
45
Mill
ion
1980 1985 1990 1995 2000 2005
1 2 3 45 6
8
9
11
12
13
14
1516
7
10
1 First cases of unusual immune deficiency are identified among gay men in USA, and a new deadly disease noticed
2 Acquired Immune Deficiency Syndrome (AIDS) is defined for the first time
3 The Human Immune Deficiency Virus (HIV) is identified as the cause of AIDS
4 In Africa, a heterosexual AIDS epidemic is revealed
5 The first HIV antibody test becomes available
6 Global Network of People living with HIV/AIDS (GNP+) (then International Steering Committee of People Living with HIV/AIDS) founded
7 The World Health Organisation launches the Global Programme on AIDS
8 The first therapy for AIDS – zidovudine, or AZT -- is approved for use in the USA
People People living living with HIVwith HIV
Children Children orphaned orphaned by AIDS in by AIDS in sub-Saharan sub-Saharan AfricaAfrica
1.1
06/06 e 2006 Report on the
global AIDS epidemicFig
Global HIV epidemic, 1990‒2005* HIV epidemic in sub-Saharan Africa, 1985‒2005*
Number of people living with HIV
% HIV prevalence, adult (15-49)
% HIV prevalence, adult (15‒49)
Number of peopleliving with HIV (millions)
0
10
20
30
40
50
1990 1995 2000 2005
0.0
1.0
2.0
3.0
4.0
5.0
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)
Number of peopleliving with HIV (millions)
Estimated number of people living with HIV and adult HIV prevalenceEstimated number of people living with HIV and adult HIV prevalence
This bar indicates the range around the estimate
*Even though the HIV prevalence rates have stabilized in sub-Saharan Africa, the actual number of people infected continues to grow because of population growth. Applying the same prevalence rate to a growing population will result in increasing numbers of people living with HIV.
10.0
2.2
06/06 e 2006 Report on the
global AIDS epidemicFig
A global view of HIV infectionA global view of HIV infection38.6 million people [33.4‒46.0 million] living with HIV, 2005
2.4
06/06 e 2006 Report on the
global AIDS epidemicFig
HIV prevalence (%) in adults in Africa, 2005HIV prevalence (%) in adults in Africa, 2005
2.5
06/06 e 2006 Report on the
global AIDS epidemicFig
Comprehensive knowledge about HIV and AIDS Comprehensive knowledge about HIV and AIDS among young males aged 15–24, by level of education, among young males aged 15–24, by level of education,
in 11 sub-Saharan African countries, 2000–2004in 11 sub-Saharan African countries, 2000–2004
Sources: Demographic and Health Surveys; HIV/AIDS Indicator Surveys (2000–2004).
0
10
20
30
40
50
60
70
80
BurkinaFaso Cameroon
GhanaKenya
MaliMozambique
NamibiaNigeria
RwandaUganda
Zambia
%
No education Primary education Secondary education and beyond
3.4
06/06 e 2006 Report on the
global AIDS epidemicFig
Comprehensive knowledge about HIV and AIDS Comprehensive knowledge about HIV and AIDS among young females aged 15–24, by level of education, among young females aged 15–24, by level of education,
in 11 sub-Saharan African countries, 2000–2004in 11 sub-Saharan African countries, 2000–2004
Sources: Demographic and Health Surveys; HIV/AIDS Indicator Surveys (2000–2004).
0
10
20
30
40
50
60
70
80
BurkinaFaso Cameroon
GhanaKenya
MaliMozambique
NamibiaNigeria
RwandaUganda
Zambia
%
No education Primary education Secondary education and beyond
:
3.5
06/06 e 2006 Report on the
global AIDS epidemicFig
Percentage of young people aged 15–24 reporting the use of a condom during Percentage of young people aged 15–24 reporting the use of a condom during sexual intercourse with a non-regular partnersexual intercourse with a non-regular partner, , Sub-Saharan Africa, 2001–2005Sub-Saharan Africa, 2001–2005
Male
Female
Countries with date of survey indicated
1000 10 20 30 40 50 60 70 80 90
%
Benin 2001
Botswana 2001
Burkina Faso 2003
Cameroon 2004
Chad 2004
Ghana 2003
Guinea 2005
Kenya 2003
Lesotho 2004
Madagascar 2003
Malawi 2004
Mali 2001
Mozambique 2003
Nigeria 2003
Rwanda 2004
Senegal 2005
United Republic of Tanzania 2003
Uganda 2004
Zambia 2003
Sources: Demographic Health Surveys; HIV/AIDS Indicator Surveys (2001-2005).3.6
06/06 e 2006 Report on the
global AIDS epidemicFig
Estimated total annual resources available for AIDS, 1996‒2005Estimated total annual resources available for AIDS, 1996‒2005
292
1623
8297*
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
US
$ m
illi
on
Signing of Declaration of Commitment on HIV/AIDS
Data include:
• International donors, domestic spending (including public spending and out-of-pocket expenditures)
• International Foundations and Global Fund included from 2003 onwards, PEPFAR included from 2004 onwards
* Projections based on previous pledges and commitments (range of the estimation: US$7.5 to US$8.5 billion).
3.8
06/06 e 2006 Report on the
global AIDS epidemicFig
Impact of AIDS on life expectancy in five African countries, 1970–2010Impact of AIDS on life expectancy in five African countries, 1970–2010
Life expectancy at birth (years)
Source: United Nations Population Division (2004). World Population Prospects: The 2004 Revision, database.
Botswana
South Africa
Swaziland
Zambia
Zimbabwe
1970–1975 1975–1980
1980–19851985–1990
1990–19951995–2000
2000–20052005–2010
70
65
60
55
50
45
40
35
30
25
20
4.1
06/06 e 2006 Report on the
global AIDS epidemicFig
Impact of three scenarios on HIV infection Impact of three scenarios on HIV infection in sub-Saharan Africa, 2003–2020in sub-Saharan Africa, 2003–2020
0.0
1.0
2.0
3.0
4.0
5.0
2003 2005 2010 2015 2020
Year
Treatment-centered
Prevention-centered
Baseline
Comprehensive response
Number of new HIV infections (millions)
Source: Salomon JA et al. (2005). Integrating HIV prevention and treatment: from slogans to impact6.1
06/06 e 2006 Report on the
global AIDS epidemicFig
Percentage of people on treatment who are children, Percentage of people on treatment who are children, by country, 2005by country, 2005
Zambia
0% 2% 4% 6% 8% 10% 12% 14% 16%
AfricaAfrica [Median: 7%] UR Tanzania
UgandaCentral African Republic
South AfricaKenya
ZimbabweNamibiaRwanda
MozambiqueMalawi
Côte d'IvoireNigeriaGhana
Haiti
Latin America and CaribbeanLatin America and Caribbean [Median: 8%] Panama
HondurasArgentina
GuyanaBrazil
El SalvadorVenezuela
Peru
0% 2% 4% 6% 8% 10% 12% 14% 16%
0% 2% 4% 6% 8% 10% 12% 14% 16%
CambodiaViet Nam
IndiaChina
AsiaAsia [Median: 4%]
Source: WHO/UNAIDS (2005). Progress on global access to HIV antiretroviral therapy: An update on “3 by 5.”7.3
06/06 e 2006 Report on the
global AIDS epidemicFig
Distribution by region of the funding required for preventionDistribution by region of the funding required for prevention
Latin America/Caribbean: 9%
Eastern Europe: 12%
North Africa/Middle East: 3%
Africa: 29%
South/South-East Asia: 21%
East Asia/Pacific: 26%
Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.10.3
06/06 e 2006 Report on the
global AIDS epidemicFig
Distribution by region of the funding required for treatment and careDistribution by region of the funding required for treatment and care
Latin America/Caribbean: 17%
Eastern Europe: 7%
North Africa/Middle East: 1%
Africa: 55%
South/South-East Asia: 4%
East Asia/Pacific: 16%
Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.10.6
Treatments
• There is currently no cure for HIV/AIDS• Current treatments are therapies which attempt to slow
down the virus (combination therapy)• Lifestyle changes to boost natural immune system can
extend life• Antiretrovirals are used. Typical combinations include
two drugs from the NRTI group (nucleoside reverse transcriptase inhibitors, also known as 'nukes') plus an NNRTI ('non-nuke') or a protease inhibitor
• A vaccine is some way off
Reading
• UNAIDS: http://www.unaids.org/en/• CDC: http://www.cdc.gov/hiv/default.htm• AIDS portal: http://www.aidsportal.org/• UK Development: http://www.aidsconsortium.org.uk/• TH Trust: http://www.tht.org.uk/
• Check papers with Science Direct/Web of Knowledge and library texts
Any Questions?