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Africa, the West, and the Fight against AIDS

Africa, the West, and the Fight against AIDS. By Helen Epstein June 6, 2007 UCLA School of Public Health. The countries in Africa most affected by AIDS. Adult HIV Prevalence Worldwide. Source: UNAIDS 2004: 2004 Report on the Global AIDS Epidemic

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Africa, the West, and the Fight against AIDS

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  1. Africa, the West, and the Fight against AIDS By Helen Epstein June 6, 2007 UCLA School of Public Health

  2. The countries in Africa most affected by AIDS

  3. Adult HIV Prevalence Worldwide Source: UNAIDS 2004: 2004 Report on the Global AIDS Epidemic This map does not reflect a position by the UN on the legal status of any country or territory or the delimitations of any frontiers.

  4. Adult Prevalence Projections, to 2030

  5. “HIGH RISK GROUP” MODEL • ACCORDING TO “HRG” MODEL, THE EXTENT OF SPREAD OF HIV IN A POPULATION WILL DEPEND ON: • FRACTION OF PEOPLE IN “HRG”s (CSWs, MIGRANT LABORERS, ETC) AND • THE DEGREE OF “MIXING” BETWEEN HIGH AND LOWER RISK GROUPS.

  6. Who has HIV? (Zambia)

  7. Frequency of concurrent and suspected concurrent relationships.Redrawn from Carael M. “Sexual Behavior” Chapter 4 in Cleland and Ferry 1995

  8. Concurrency Slides By Stewart Parkinson

  9. HIV Negative Male Effects of Concurrency HIV Positive Viremic Male HIV Positive Non-Viremic Male HIV Negative Female HIV Positive Viremic Female HIV Positive Non-Viremic Female

  10. Concurrency December

  11. Concurrency January

  12. Concurrency February

  13. Concurrency March

  14. Concurrency April

  15. Concurrency May

  16. Concurrency June

  17. Concurrency July

  18. Concurrency August

  19. Serial Monogamy December

  20. Serial Monogamy January

  21. Serial Monogamy February

  22. Serial Monogamy March

  23. Serial Monogamy April

  24. Serial Monogamy May

  25. Serial Monogamy June

  26. Serial Monogamy July

  27. Serial Monogamy August

  28. WHERE DID MARTINA MORRIS GET THE IDEA THAT LONG TERM CONCURRENCY WAS DRIVING THE HIV EPIDEMIC IN AFRICA? • UGANDAN DOCTORS……

  29. Premarital sex: % of never married women 15-24 years old who had sex in the past year Early 90s/late 80s Mid 90s Late 90s/early 2000s 48 52 33 35 32 39 34 26 35 22 27 18 13 15 Cameroon Zimbabwe Uganda Zambia Kenya ORC Macro

  30. Reported condom use last higher-risk sex for ages 15-24 (UNAIDS, 2001 & BAIS 2001) Percent Given that Botswana has for some time featured some of the highest rates of (self-reported) condom use in the world, why isn’t Botswana hailed alongside of Uganda as a major success story? Condoms? Since the beginning of the HIV/AIDS epidemic, a considerable amount of programmatic effort has focused on condom promotion…

  31. HIV Prevalence Condom sales The condom quandary

  32. Uganda: Botswana: C is for condomize “Ever” use of condoms among adults increased from 15 to 30 percent in men, and from 7 to 20 percent for women, from 1989 to 19951 Botswana may have the highest levels of reported condom use in Sub-Saharan Africa 1Shelton, et al (2004)

  33. “CONSISTENT” CONDOM USE PROTECTS, BUT NOT TOTALLY….(PROBABLY BECAUSE THE USE IS NOT AS CONSISTENT AS IT SHOULD BE.)

  34. Consistent condom use by type of partner, Zambia 2003

  35. Uganda: Botswana: B is for be faithful Uganda1: Uganda coined (from agricultural tradition) the “zero-grazing” approach to prevention 1Shelton, et al (in press) 3BAIS (2001) 2UNAIDS (2002)

  36. Early successes: Uganda and “zero grazing”

  37. From Warren Winkelstein Jr et al, “The San Francisco Men’s Health Study: Continued Decline in HIV Seroconversion Rates among Homosexual/Bisexual Men.” AJPH November 1988 vol 78, pp. 1472-4

  38. Early successes: Thailand and “100% condoms”

  39. The HIV rate is beginning to decline in several African countries, including Kenya, Zimbabwe and I think maybe Malawi and Zambia. But—why did it take so long? And why is the HIV rate still so high in southern Africa?

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