Transcript HIV & AIDS Programme

2010 FIFA World Cup and
HIV/AIDS
“Football and sex belong
together”
Risks
Intuitively assume that
“football and sex” go
together
Link between staging a FIFA
world cup and risky sexual
activity
Possible increase in HIV
infection
World Cup 2006 - Germany
 First world country
 Legalised prostitution in 2002 – prostitutes have legal rights,
entitled to receive social benefits and health insurance
 Expected 40 000 extra commercial sex workers to be trafficked
into Germany
 Research – no huge increase in demand documented. Why?
 Planning and coordination started more than a year before the
event
 Increased law enforcement during the cup
 Fan-base – many families and children; many low-budget
tourists who did not have extra money for sex
 Fan parks also decreased demand
 Not profitable enough event for traffickers
 National hotlines set up
South Africa 2010
Third world country – high levels
of unemployment and poverty
Surrounded by countries who
are poor
Region has highest rates of HIV
infection in the world
Adults and children estimated to be living with HIV, 2007
Western & Eastern Europe
Central Europe & Central Asia
760 000
North America
1.3 million
[480 000 – 1.9 million]
Caribbean
230 000
1.6 million
[600 000 – 1.1 million] [1.2 – 2.1 million] East Asia
Middle East & North
Africa
[210 000 – 270 000]
380 000
[270 000 – 500 000]
Sub-Saharan Africa
Latin America
1.6 million
[1.4 – 1.9 million]
22.5 million
[20.9 – 24.3 million]
800 000
[620 000 – 960 000]
South & South-East
Asia
4.0 million
[3.3Oceania
– 5.1 million]
75 000
[53 000 – 120 000]
Total: 33.2 (30.6 – 36.1) million
Estimated number of adults and children
newly infected with HIV, 2007
Western & Eastern Europe
Central Europe & Central Asia
31 000
North America
46 000
[38 000 – 68 000]
Caribbean
17 000
[19 000 – 86 000]
150 000
[70 000 – 290 000] East Asia
Middle East & North
Africa
[15 000 – 23 000]
35 000
[16 000 – 65 000]
Sub-Saharan Africa
Latin America
100 000
[47 000 – 220 000]
1.7 million
[1.4 – 2.4 million]
92 000
[21 000 – 220 000]
South & South-East
Asia
340 000
[180 000
– 740 000]
Oceania
14 000
[11 000 – 26 000]
Total: 2.5 (1.8 – 4.1) million
Percent of adults (15+) living with HIV who are
female, 1990–2007
70
Sub-Saharan Africa
GLOBAL
Caribbean
Asia
E Europe & C Asia
Latin America
60
50
Percent
40
female
(%)
30
20
10
0
5
1990‘91‘92 ‘93‘94‘95 ‘96 ‘97‘98 ‘99 ‘00‘01 ‘02‘03‘04 ‘05‘062007
Year
The tipping point
Epidemics:
Takes smallest of changes to shatter an
epidemic’s equilibrium
Different ways of tipping an epidemic –
depends on different agents of change
tiny % of people do the majority of the work
Change happens in a hurry
1% = tipping point
E.g. SA – took 5 years for prevalence rates to
move from 0.5% - 1%; then only 7 years to
jump from 1% to 20%.
HIV prevalence in adults
in sub-Saharan Africa, 1988−2003
20% − 39%
10% − 20%
5%
− 10%
1%
− 5%
0%
− 1%
trend data unavailable
outside region
Size matters: the number of prostitutes
and the global HIV/AIDS pandemic
 Infection rates among CSWs (commercial sex workers) higher
than the general population (Study of data available from 77
countries)
 On average, Africa = 4X as many CSWs as rest of world (as % of
pop) & CSW community in Africa more than 4X as likely to be HIV
infected as rest of world
 “To visualise the potential power of CSWs in spreading the virus,
one need only assume that in a country with 4% of its adult
females working as CSWs, if each CSW has sex with 10 new
male clients in a week, assuming no repeat customers in the
week, this leads to contact with 40% of the adult male population
in just one week”.
 Male clients = spread HIV into general population –
back to their mother countries.
 Many illegal immigrants seeking means to survive –
world cup = income generating event
 Attract sex workers from neighbouring countries and
from all over SA
 Possibility that commercial sex work and public
drinking will be legalised over world cup period –
condom use?
So what are the risks?
 2010 likely to increase risk of HIV infection
 Spread of infection from area with one of the highest
prevalence rates back to countries of origin of fans
(bring them nearer to the tipping point)
 Fan base? Two scenarios – ‘rich’ fans from first world
countries – mainly men? Fans from neighbouring
countries – poorer, also mainly men? Will this equate
with unprotected casual sex?
So what are the risks?
 Worst case scenario: Further spread and reinfection in
SA – particularly if we have an influx of sex workers from
high prevalence neighbouring countries
 Unlikely that people will plan to have safe sex- unlikely
that fans will know about risk (unless aggressively
educated and informed)
 Unlikely that sufficient condoms will be freely available
 Likely that there will be lots of unprotected casual sex to
‘celebrate’ & ‘drown sorrows’
Opportunities
 Deliver effective preventive education – particularly targeting
young people
 Generate income – eg Alive and Kicking in Kenya
 Use celebrity sports stars and coaches as role models
 Use sports to break down stigma and discrimination
 Use events as a point of access to VCT and other health service
 Use sports media profile to communicate and promote AIDS
messages to a wider audience
What now?
Early and sound situation assessment –
regional experts (police & NGOs)
Need co-ordinated advocacy and
effective public awareness campaigns
(also targeting arriving fans)
Condom availability
Hotlines
Information kiosks
Training of key staff