“Are you unaware that vast numbers of your fellow men

1. “Are you unaware that vast numbers of your fellow men suffer or perish from need of the things that you have to excess, and that you required the explicit and unanimous consent of the whole human race for you to appropriate from the common subsistence anything besides that required for your own?” Jean-Jacques Rousseau, 1775

2. As you now know, in the developing world treatable infectious diseases remain big killers Leading causes of death in Sub-Saharan Africa, South Asia, and Southeast Asia for persons age 0-44 (World Health Organization)

3. HIV/AIDS and AIDS related illnesses are among the largest killers Leading causes of death in Sub-Saharan Africa, South Asia, and Southeast Asia for persons age 0-44 (World Health Organization)

4. Untreated AIDS is a devastating disease that inevitably leads to an early death “Tropical Medicine and Parasitiology” 1997

5. The virus kills people indirectly, by destroying the immune system

6. The virus kills people indirectly, by destroying the immune system

7. With a disabled immune system, other infections take off

8. As you already know…

9. HIV and AIDS by the numbers 33 million people worldwide living with HIV 2.1 million people died of AIDS in 2004 --this dropped to 1.8 million in 2009 2.5 million new infections in 2009 UN AIDS press release 11/20/2010

10. Once again, AIDS and the deaths it causes are not evenly distributed around the world It is estimated that 5 million individuals were newly infected with HIV during 2001.

11. Sub-Saharan Africa is the epicentre 68% of HIV-infected people live there 1/3 in just 8 countries UN AIDS press release 11/20/2007

12. This has had dramatic effects on the life expectancy of those in sub-Saharan Africa 2005 Economic report to the US President, Council of Economic Advisors

13. What is your picture of the average HIV positive person?

14. In the developing world, HIV is becoming a disease of children! New HIV Infections in 2002 by Age Group

15. In the developing world, HIV is becoming an infection of children! UN AIDS press release 11/20/2010 Global Trends

16. We can also see these differences when we return to our comparison of the US and Haiti

18. HIV prevalence in the Caribbean ranges from 0.1% in Cuba to > 3% in the Bahamas and Haiti UNAIDS 2006 Report on the Global AIDS Epidemic And BBC November 2003

19. HIV prevalence in the Caribbean ranges from 0.1% in Cuba to > 3% in the Bahamas and Haiti One in 20 Haitians has the disease, and it is the main cause of death among women of reproductive age. UNAIDS 2006 Report on the Global AIDS Epidemic And BBC November 2003

20. HIV prevalence in the Caribbean ranges from 0.1% in Cuba to > 3% in the Bahamas and Haiti One in 20 Haitians has the disease, and it is the main cause of death among women of reproductive age. Region-wide, fewer than one in four people needing antiretroviral drugs received them UNAIDS 2006 Report on the Global AIDS Epidemic And BBC November 2003

21. In contrast, in the US…. AIDS is not on this list!

22. The development of effective treatments turned the tide in the US

23. This becomes even clearerif we focus in on the key years Mortality vs. ART utilization 100 40 Percentage of Patient-days on HAART 35 USE OF ART 30 75 25 DEATHS Percentage of patient-days on ART 20 50 Deaths per 100 person-years 15 10 25 Deaths per 100 Person-Years 5 0 0 1995 1996 1997 1998 1999 2000 2001 Palella F et al. 8th CROI 2001; abstract 268b.

24. However major disparities in AIDS incidence occur even within our nation

25. Top 10 States by AIDS Case Rate per 100,000 Population, 2004 U.S. Rate = 15.0 Source: CDC, HIV/AIDS Surveillance Report, Vol. 16, 2005.

26. There are also major disparitiesalong ethnic lines (largely but not entirely reflecting poverty) Percent of AIDS Diagnoses White, non-Hispanic African American Latino American Indian/ Alaska Native Asian/Pacific Islander 2004 Note: Data are estimates. Source: CDC, Data Request, 2006.

27. AIDS Diagnoses Disparities, 2004 AIDS Cases U.S. Population 42,514 293,655,404 White, non-Hispanic 28% 69% African American 49% 13% Latino 14% 4% 20% Asian/Pacific Islander 1% 1% <1% AI/AN Notes: U.S. Population estimates do not include U.S. dependencies, possessions, and associated nations; persons who reported more than one race were included in multiple categories.May not total 100% due to rounding. Total AIDS diagnoses in 2004 include persons of unknown race or multiple races. AI/AN = American Indian/Alaskan NativeSources: CDC, HIV/AIDS Surveillance Report, Vol. 16, 2005; U.S. Census Bureau, Population Estimates Program, 2004 Population Estimates.

28. As with TB, the impact of AIDS Is not limited to illness and death

29. As with TB, the impact of AIDS Is not limited to illness and death Worldwide >16 million children have been orphaned by AIDS Lesotho Swaziland UN AIDS press release 11/20/2010 Global Trends Rwanda

30. More than 11 million Of these children are in Sub-Saharan Africa Newsweek, Vol. CXXXV, No. 3, 17 January 2000

31. More than 11 million Of these children are in Sub-Saharan Africa UNICEF 2006

32. There is some good news to which we’ll return later UN AIDS press release 11/20/2007 and UNAIDS/WHO/UNICEF report 4/17/2007

33. There is some good news to which we’ll return later Global HIV prevalence=% of people living with HIV leveled off in 2007 and and number of new infections has fallen In part as a result of the impact of HIV programs. UN AIDS press release 11/20/2007 and UNAIDS/WHO/UNICEF report 4/17/2007

34. There is some good news to which we’ll return later Global HIV prevalence=% of people living with HIV leveled off in 2007 and and number of new infections has fallen In part as a result of the impact of HIV programs. Access to retroviral therapy increased sharply in 2006 From 1.3 million to 2 million, a 54% increase in one year However, this is still only 28% of those in need of treatment UN AIDS press release 11/20/2007 and UNAIDS/WHO/UNICEF report 4/17/2007

35. Let’s return to the impact of AIDS on Haiti the US and Haiti

36. AIDS and the fear of AIDS have had a major effect on Haiti since the dawn of the epidemic

37. Let’s go back in time and see how things began

38. The first H: Homosexuals Doctors in California and New York note increase in cases of Kaposi’s sarcoma and Pneumocystis carinii pneumonia in gay men

39. A remarkable tribute to epidemiology! They first noticed the disease based on: a handful of cases of Pneumocystis pneumonia And 8 cases of Kaposi’s sarcoma and Why did they suspect a new disease? Kaposi’s sarcoma lesions

40. A remarkable tribute to epidemiology! Because you NEVER see these diseases in patients who are not immune-compromised. Their hypothesis: A new sexually transmitted disease.

41. In July 1981 Dr Jim Curran of the CDC summarized what we knew: "Dr. Curran said there was no apparent danger to non homosexuals from contagion. 'The best evidence against contagion', he said, 'is that no cases have been reported to date outside the homosexual community or in women'" - The New York Times http://www.avert.org/his81_86.htm

42. Then came the first reports of similar outbreaks In those injecting illegal drugs

43. Then came the first reports of similar outbreaks In those injecting illegal drugs The second H = heroin-users

44. By mid 1982 the third and fourth H’s were added:

45. By mid 1982 the third and fourth H’s were added: Haitians and hemophiliacs

46. In March 1983 this was formalized by the CDC "persons who may be considered at increased risk of AIDS include those with symptoms and signs suggestive of AIDS; sexual partners of AIDS patients; sexually active homosexual or bisexual men with multiple partners; Haitian entrants to the United States; present or past abusers of IV drugs[heroin]; patients with hemophilia; and sexual partners of individuals at increased risk for AIDS”.

47. As AIDS emerged into the public view discrimination against the 4H’s skyrocketed

48. Our nation’s leaders did not help "It is true that some medical sources had said that (AIDS) cannot be communicated in any way other than the ones we already know and which would not involve a child being in the school. And yet medicine has not come forth unequivocally and said, 'This we know for a fact, that it is safe.' And until they do, I think we just have to do the best we can with this problem. I can understand both sides of it." - Ronald W. Reagan Sept. 17, 1985 http://www.avert.org/his81_86.htm

49. This was despite strong scientific evidence to the contrary "The cause of AIDS is unknown, but it seems most likely to be caused by an agent transmitted by intimate sexual contact, through contaminated needles, or, less commonly, by percutaneous inoculation of infectious blood or blood products. No evidence suggests transmission of AIDS by airborne spread. The failure to identify cases among friends relatives, and co-workers of AIDS patients provides further evidence that casual contact offers little or no risk” MMWR Weekly (1983) 'Current Trends Acquired Immunodeficiency Syndrome (AIDS) Update - United States', June 24, 32 (24); 309-11 http://www.avert.org/his81_86.htm

50. This sort of fear devastated the Haitian economy