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AIDS in Africa: Past and Future

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  1. AIDS in Africa: Past and Future Peter Piot Souleymane Mboup Meskerem Grunitzky Bekele

  2. Spread of HIV in Africa 1985 1990 1995 2001 2007

  3. Swaziland South Africa Southern Africa Zimbabwe Central African Republic Chad Central Africa Female DR Congo Male Ethiopia Eastern Africa Rwanda Uganda Benin Côte d'Ivoire Western Africa Guinea Mali Niger Senegal Sierra Leone 0 5 10 15 20 25 % HIV prevalence HIV prevalence (%) among 15-24-year-olds, by gender, selected sub-Saharan African countries, 2005‒2007

  4. 10 top causes of death in Africa • AIDS • Malaria • Lower respiratory infections • Diarrhoeal diseases • Perinatal conditions • Cerebrovascular disease • Tuberculosis • Ischaemic heart disease • Measles • Road traffic accidents Extrapolated from WHO data

  5. Research – the early years

  6. Projet Sida, 1984

  7. Research Heterosexual transmission SIV and SIV cpz HIV2 TB and HIV PMTCT, breastfeeding and HIV transmission Genetic diversity of HIV Risk factors for sexual transmission

  8. Intervention research 1980s HIV prevention among sex workers 1990s Impact of STI treatment on HIV infection 1999 Nevirapine for PMTCT 2000 Cotrimoxazole to prevent opportunistic infections 2007 Male circumcision for HIV prevention

  9. Social Science Research 1980s Sex and sexual behaviour 1990s Sex work, STIs and HIV Socio-economic impact Counselling and testing 2000s Orphans Political science Sexual networking & behaviour patterns Stigma Establishment of SAHARA

  10. Political Leadership OAU, Abuja, 2001 Ab

  11. Community mobilization TASO, 1987

  12. Activism

  13. Tipping point: 2000-2001 • African Development Forum, Addis • International AIDS Conference, Durban • UN Security Council session on AIDS in Africa • G8 Okinawa Declaration • World Bank Multi-Country AIDS Programme for Africa • Millennium Development Summit • World Trade Organisation Agreement on TRIPS • UN General Assembly Special Session on HIV/AIDS • OAU Summit, Abuja

  14. Drug Access Initiative

  15. Drug prices fall

  16. 2000 1688 1612 1500 1093 1000 554 500 220 0 2002 2003 2004 2005 2006 International expenditure on AIDS and STIs in sub-Saharan Africa, 2002-6

  17. $14,000 $12,000 $10,000 $8,000 $6,000 $4,000 $2,000 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 Projected Financial Resources Required in sub-Saharan Africa if current scale-up trends continue (US$ Millions)

  18. 2.5 2.0 1.5 1.0 0.5 0.0 Expansion of HIV treatment in Sub-Saharan Africa Millions end- 2001 end- 2002 end- 2003 end- 2004 end- 2005 end- 2006 end- 2007 1997 Year

  19. HIV Prevalence among pregnant women attending Antenatal clinics in Sub Saharan Africa 1997-2006 35 30 Cote d'Ivoire 25 Ethiopia Kenya 20 Burkina Faso HIV % Zimbabwe 15 10 5 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Years

  20. The next 25 years Add long-term approach to crisis management: • aids 2031 project • scenarios for Africa