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Centre for AIDS Research. World AIDS Day 2004 Some viewpoints and perspectives. Professor Mike Clark School of Geography Director – Centre for AIDS Research. University of

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centre for aids research

Centre for AIDS Research

World AIDS Day 2004

Some viewpoints and perspectives

Professor Mike Clark School of GeographyDirector – Centre for AIDS Research

University of

Southampton

the centre for aids research

The Centre for AIDS Research

The vision which fuelled our struggle for freedom; the development of energies and resources; the unity and commitment of common goals – all these are needed if we are to bring AIDS under control. Future generations will judge us on the adequacy of our response.

Nelson Mandela

a distinctive mission

Focus on impacts – social, economic, political, environmental & bio-medical

Research and policy-orientated engagement

Centre for AIDS Research

Founded on strategic partnerships with institutions, stakeholders, governments and agencies

A holistic approach – cross-disciplinary and cross-sectoral

A distinctive mission

World AIDS Day: viewpoints and perspectives

slide4

The roots of health and welfare

Development . . .

& underdevelopment?

Soshanguve Township 10 miles from Pretoria

Pretoria - South Africa

But watch for challenges:

AIDS and poverty?

Two pandemics or one?

More than a disease?

World AIDS Day: viewpoints and perspectives

slide5

AIDS

The health of the individual

The welfare and income of the family

Supported children – not orphans

Functional communities and services

National economic stability

A stable society

Development founded on Health

World AIDS Day: viewpoints and perspectives

slide6

Global summary December 2003

People living with HIV/AIDS ………….. 40 million (34 - 46 million)

New HIV infections in 2003 ………….... 5 million (4.2 - 5.8 million)

Deaths due to HIV/AIDS in 2003 ……… 3 million (2.5 – 3.5 million)

The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information. These ranges are more precise than those of previous years.

World AIDS Day: viewpoints and perspectives

slide7

14 million AIDS orphans already

40 million by 2010!

40 million people are living with AIDS worldwide

20-25 million people have already died of AIDS

68 million more will die of AIDS by 2020

14000 people become newly infected every day

World AIDS Day: viewpoints and perspectives

hiv cases precede aids cases
HIV Cases Precede AIDS Cases

Numbers - AIDS

Numbers - HIV

HIV prevalence

A2

A1

A

AIDS - cumulative

B

B1

Death rises later

T1

T2

Time

Source: Whiteside & Sunter AIDS: The Challenge for South Africa, 2000, p. 27

World AIDS Day: viewpoints and perspectives

slide9
HIV and AIDS diagnoses and deaths in HIV-infected individuals by year of diagnosis, United Kingdom, 1994-2003

Slide Source: UK Collaborative Group

for HIV and STI Surveillance

1

1

1 Numbers will rise, for recent years, as further reports are received.

Data Source: HIV/AIDS reports. Reports received by the end of June 2004.

World AIDS Day: viewpoints and perspectives

slide10
Rates of diagnosed HIV-infected adults seen for care, United Kingdom, 1998 and 2003 by residence, 1998 and 2003

Data source: SOPHID and CD4

monitoring scheme for Scotland.

Slide Source: UK Collaborative Group for HIV and STI Surveillance

World AIDS Day: viewpoints and perspectives

slide11

Steps towards a response

Introducing HIV/AIDS

Understanding HIV/AIDS

Towards a Geography of HIV/AIDS

Responding to HIV/AIDS

World AIDS Day: viewpoints and perspectives

propensity aids factors

A 15-year old in Zambia has a 60% chance of dying of AIDS

Propensity - AIDS factors
  • Gender (girls more vulnerable)
  • Age (sexually-active years)
  • Poverty (directly and indirectly create propensity to infection)
  • Sexually-transmitted diseases (STDs)

World AIDS Day: viewpoints and perspectives

vulnerability aids triggers
Vulnerability - AIDS triggers
  • Unsafe sex, mother-to-baby, drug injection, blood contact
  • LACK OF SOCIAL COHESION
      • Migration (to work) - multiple partners
      • Military service (war/terrorism)
      • Refugees
      • Prostitution
      • Child abuse and rape
      • Fatalism and traditional medicine

Poverty?

High wealth + high social cohesion = no epidemic

Low wealth + low social cohesion = high epidemic

Low wealth + high social cohesion = slow epidemic

World AIDS Day: viewpoints and perspectives

incidence the human dimension

The School Choir

INCIDENCE - the human dimension

SA prevalence of HIV/AIDS = 4.5 million

Women’s deaths peak at 24 years: men 29

One third HIV infections in school years

Population polarising <15 and >50 years

Perhaps 30% SA school children HIV+

Up to 40% at some SA universities

World AIDS Day: viewpoints and perspectives

slide15

Looking beyond the maps

Introducing HIV/AIDS

Understanding HIV/AIDS

Towards a Geography of HIV/AIDS

Responding to HIV/AIDS

World AIDS Day: viewpoints and perspectives

1 policy influencing attitudinal
1. Policy-influencing & attitudinal

World AIDS Day: viewpoints and perspectives

slide17

Eastern Europe & Central Asia

1.2 – 1.8 million

Western Europe

520 000 – 680 000

North America

790 000 – 1.2 million

East Asia & Pacific

700 000 – 1.3 million

North Africa & Middle East

470 000 – 730 000

Caribbean

350 000 – 590 000

South

& South-East Asia

4.6 – 8.2 million

Sub-Saharan Africa

25.0 – 28.2 million

Latin America

1.3 – 1.9 million

Australia

& New Zealand

12 000 – 18 000

People living with AIDS: end 2003

World AIDS Day: viewpoints and perspectives

2 strategic targets monitoring
2. Strategic (targets & monitoring)

World AIDS Day: viewpoints and perspectives

3 operational support supervision

Mapping – The Valley Trust

3. Operational (support & supervision)

World AIDS Day: viewpoints and perspectives

4 community participation

P Johnstone & J Ranken (1994)

4. Community participation

World AIDS Day: viewpoints and perspectives

slide21

Engagement

Empowering

Equity

Elitism

Exclusion

The intellectual/moral challenge

World AIDS Day: viewpoints and perspectives

slide22

Steps towards a response

Introducing HIV/AIDS

Understanding HIV/AIDS

Towards a Geography of HIV/AIDS

Responding to HIV/AIDS

World AIDS Day: viewpoints and perspectives

as simple as abc

“If you do that, this is what will happen to you”

  • “OK, in that case I won’t do it”
As simple as ABC!

Abstain Be faithful Condom

World AIDS Day: viewpoints and perspectives

making the message more realistic

(after The Theory of Reasoned Action: Ajzen & Fishbein, 1975)

Making the message more realistic

Harare, Zimbabwe

ABC

World AIDS Day: viewpoints and perspectives

slide25

Drug therapy/Lifestyle

TREAT

AIDS

RESPONSE

COPE

PREVENT

Vaccine??

Modify behaviour?

Tackle poverty!

Locate impact

Assess impact Manage impact

World AIDS Day: viewpoints and perspectives

slide26

Don’t expect too much!

<1% of 28.5 million people with HIV/AIDS in Africa have access to drugs

Global spending on AIDS prevention and care in developing countries about $2 billion a year – about the same as the UK floods in 2000!

World AIDS Day: viewpoints and perspectives

slide27

CLINICS diagnosis treatment advice

World AIDS Day: viewpoints and perspectives

slide28

Training . . . Counselling . . . Destigmatising

World AIDS Day: viewpoints and perspectives

slide29

Peer advice -

Making the message cool

World AIDS Day: viewpoints and perspectives

an image from the sexual health information campaign england
An image from the sexual health information campaign, England

Slide Source: UK Collaborative Group

for HIV and STI Surveillance

(Department of Health)

World AIDS Day: viewpoints and perspectives

slide31

Drug therapy/Lifestyle

TREAT

AIDS

RESPONSE

COPE

PREVENT

Vaccine??

Modify behaviour?

Tackle poverty!

Locate impact

Assess impact Manage impact

World AIDS Day: viewpoints and perspectives

the world bank tap
The World Bank TAP

World AIDS Day: viewpoints and perspectives

community health workers

ORGANISATIONAL STRUCTURE

SPATIAL STRUCTURE

Community Health Workers

“governance”

“spatial structure”

World AIDS Day: viewpoints and perspectives

slide35

Confront the disease and plan the response

Tackle the underlying poverty/politics

Acknowledge the problem of HIV/AIDS

FIRST STEP

COMMITMENT

THE STRATEGY

World AIDS Day: viewpoints and perspectives

the centre for aids research36

The Centre for AIDS Research

The geography of HIV/AIDS: looking beyond the maps

I live in hope

I hope I live