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DFID HIV Leaders Meeting . The State of the Epidemic in 2010 by Professor Alan Whiteside HEARD House of Lords 9 th March 2010. ‘Three Threes’ . Three exceptional epidemics Russia and Ukraine Poor countries with low health spends and mid-range HIV burdens

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The State of the Epidemic in 2010 by Professor Alan Whiteside HEARD House of Lords

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The state of the epidemic in 2010 by professor alan whiteside heard house of lords

DFID HIV Leaders Meeting

The State of the Epidemic in 2010

by

Professor Alan Whiteside

HEARD

House of Lords

9th March 2010


Three threes

‘Three Threes’

  • Three exceptional epidemics

    • Russia and Ukraine

    • Poor countries with low health spends and mid-range HIV burdens

    • Hyper-endemic countries of Southern Africa

  • Three challenges

    • Prevention

    • Care and treatment (in light of new guidelines)

    • Impact mitigation and looking to the next generation

  • Three critical responses

    • What works

    • Who pays

    • How can it be sustained


The global picture in 2007

The global picture in 2007

Source: UNAIDS Global Report 2008. Geneva: UNAIDS. (2007 data)


Exceptional epidemics eastern europe

Exceptional epidemics: Eastern Europe

Sources: HIV/AIDS Surveillance in Europe. EuroHIV 2007, and World Population Prospects: The 2008 Revision Population database. UN Population Division.


Hiv prevalence in africa 2007 adults 15 49

HIV Prevalence in Africa 2007(Adults 15–49)

Source: UNAIDS Global Report 2008. Geneva: UNAIDS (2007 data)


Mid level prevalence in low resourced countries

Mid-level prevalence in low resourced countries

Sources: *Rosen, S. and Long, L. ‘How Much Does it Cost to Provide Antiretroviral Therapy for HIV/AIDS in Africa?’ 2006, **UNAIDS Global Report 2008 and ***UNGASS Country Reports 2008.


Exceptional epidemics the hyper endemic countries

Exceptional epidemics: the Hyper-endemic Countries

Source: Epidemiological Updates. Geneva: UNAIDS 2009.


Hiv and aids

HIV and AIDS


Three challenges three waves

Three Challenges: Three Waves

Numbers

HIV Prevalence

AIDS cases

Impacts

Time

Source: Barnett, T. & Whiteside, A. (2006) AIDS in the Twenty-First Century. Palgrave MacMillan


Three challenges

Three Challenges

Numbers

Prevention

Impacts

A

2

A

1

A

Care & Treatment

B

B

1

T

T

Time

1

2

Source: Barnett, T. & Whiteside, A. (2006) AIDS in the Twenty-First Century. Palgrave MacMillan


Aids treatment without prevention is mopping the floor while the tap is running

AIDS Treatment without prevention is mopping the floor while the tap is running


Aids impacts

AIDS Impacts

Sources: Swaziland HIV Estimates and Projections. NERCHA and UNIAIDS Workshop report. 2007 and US Census Bureau International Database


Three critical responses

Three Critical Responses

  • What works?

  • Who pays? (and for what)

  • Sustainability


The state of the epidemic in 2010 by professor alan whiteside heard house of lords

What Works

Prevention of Vertical Transmission

Combination prevention

Male circumcision

Social change

Leadership

Changing Gender Relations

Economic Empowerment

Community Mobilisation

Treatment


The state of the epidemic in 2010 by professor alan whiteside heard house of lords

Combination HIV Prevention

Source: Coates et al. (2008) Behavioural Strategies to Reduce HIV Transmission: How to make them work better. Lancet, 372: 669-684


The state of the epidemic in 2010 by professor alan whiteside heard house of lords

Adherence to HIV Prevention Technologies

Source: Coates et al. (2008) Behavioural Strategies to Reduce HIV Transmission: How to make them work better. Lancet, 372: 669-684


The state of the epidemic in 2010 by professor alan whiteside heard house of lords

Who Pays?

Source: UNAIDS (2009) What Countries Need, Investments Needed for 2010 Targets. Geneva: UNAIDS


Global resource needs

Global Resource Needs

Source: Estimating the Long-term Global Resource Needs for AIDS through 2031. Draft Working Paper. 2009. AIDS 2031


The state of the epidemic in 2010 by professor alan whiteside heard house of lords

Sustainability

Do we agree on importance of AIDS in the global development context and in global health

The rich world needs to keep promises

Africa needs to honour the Abuja Declaration (Only Botswana and Gambia have achieved this)

Treatment is not sustainable without prevention and international commitment

Political and financial commitment are both needed


Conclusions

Targets set in 2005 much has been done

MDG targets in Southern Africa not sure?

Should we change targets (treatment)?

Keeping ‘exceptional’ epidemics on the agenda?

Moving forward? Who makes decisions?

Partnerships?

Conclusions


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