Transcript Slide 1

Development Consequences
(and Causes) of HIV/AIDS
By
Prof. Alan Whiteside
Director, HEARD
Institue of Public Policy Research
London,
5th November, 2004
• Why has the development community
failed to take cognisance of HIV/AIDS?
• Why have governments failed to
respond to the crisis?
Presentation Outline
• Scale and future trends
• Impacts
– Demographic
– Political
– Economic
• Conclusions
HIV Prevalence South Africa
Women Attending Public Antenatal Clinics
30
% HIV Positive
25
2nd
General
Democratic
Election
Election
2nd
20
15
10
Freedom!
FREEDOM!
5
0
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
National trends in HIV prevalence
Women attending Public Antenatal Clinics
45
40
35
% HIV positive
30
25
20
15
10
5
0
1990
1991
1992
1993
Botswana
1994
1995
1996
Namibia
1997
1998
1999
South Africa
2000
2001
2002
Swaziland
2003
Epidemic Curve: HIV
Numbers
HIV prevalence
A
A1
A2
B
T1
T2
Time
27Aug01-Report I:Epidem’gy& Lit. p. 27
Epidemic Curves: HIV and AIDS
Numbers
HIV prevalence
A
A2
A1
AIDS - cumulative
B
B1
T1
T2
Time
27Aug01 -Report I: Epidem’gy & Lit. p. 27
Epidemic Curve: HIV, AIDS and
Impact
Numbers
HIV prevalence
A
Impact
A2
A1
AIDS - cumulative
B
B1
T1
T2
Time
27Aug01 -Report I: Epidem’gy & Lit. p. 27
A model of future
AIDS and non-AIDS Deaths
1200000
number of deaths
Other deaths
AIDS Deaths
1000000
800000
600000
400000
200000
0
1995
2000
2005
year
2010
2015
All orphans & orphans due to AIDS
by HIV prevalence Uganda
Total Number
HIV Prevalence
2 million
12%
1.5 million
Total Orphans
AIDS Orphans
HIV Prevalence
1 million
6%
0.5 million
0
1985
0
1990
1995
2000
2005
2010
Impact of HIV/AIDS
• Demographic
• Political
• Economic
Changing life expectancy in African countries
with high and low HIV prevalence: 1950-2005
Source: UNAIDS, 2002. Report on the global HIV/AIDS epidemic
Population Structure, South Africa
2000 and 2010
80-84
70-74
60-64
50-54
Age
40-44
30-34
20-24
10-14
0-4
3,000,000.00
2,000,000.00
1,000,000.00
0.00
1,000,000.00
MALE : FEMALE
2000
2000
2010
2010
Source: Actuarial Society of South Africa
2,000,000.00
3,000,000.00
By-Elections in Zambia
120
100
80
total
due to death
resignation/expulsion
60
40
20
0
1964-1984
1985 - 2003
Source: IDASA
Non-participation by young women
in South Africa
+
Pearson’s r = .7
Non-registration
_
_
HIV prevalence
Level of analysis: the nine provinces
+
Estimates of the impact of AIDS
on economic growth, 1992−2000
0.00%
-0.50%
-1.00%
-1.50%
-2.00%
Botswana,
Lesotho,
Namibia*
South Africa**
Botswana***
30 Countries*
Cameroon**
Methodology:
* Demographic and economic modelling
** CGE Simulations
*** Economic
Source: (1) Botswana, Lesotho, Namibia data: Sackey and Raparla, 2000. (2) South Africa data: Arndt
and Lewis 2000. (3) Botswana data: Greener, Jefferis and Siphambe, 2000. (4) 30 Countries data:
Over, 1992. (5) Cameroon data: Kambou et al, 1992.
2004 Report on the Global AIDS Epidemic (Fig 14)
By 2010 orphans will account for 15-25% of all
children in 12 countries in SAA
Non-AIDS
South Africa
AIDS
Namibia
Zambia
Mozambique
Zimbabwe
Botswana
Swaziland
Lesotho
0
5
10
15
Source: UNICEF
20
25
Conclusions 1
• Prevention
• Care and treatment
• Mitigation
Percent adults living with HIV (log)
World HIV Chart 2001
30
20
Zimbabwe
Lesotho
Swaziland
Zambia
Kenya
Malawi
Central African Rep.
AIDS deaths
per year
Botswana
300 000
Namibia
South Africa
100 000
Mozambique Cameroon
10 000
10
Burundi
Côte d'Ivoire
Rwanda
Sierra
1 000
7 Leone
Haiti
Angola
Ethiopia Nigeria Togo
Equatorial
5
Uganda
Continents
Guinea
Burkina GuineaGhana
Bissau Chad Benin
Dominican Rep.
3
Faso
Eritrea Cambodia Sudan Guyana
Africa
Trinidad & Tobago
2
Honduras
Belize
Thailand
Mali
Americas
Barbados
Suriname Jamaica
Panama
Estonia
Ukraine
1
United States
Guatemala
Papua New Guinea
Brazil Russia
Asia
of America
El
Argentina
Nepal
Portugal
Rica
India SalvadorVenezuela CostaMalaysia
0.5
Spain
Switzerland Europe
Senegal
Peru
Latvia
Italy
Belarus
Chile
France
Madagascar
Colombia
Bahrain
0.3
Ecuador
Mexico
Nicaragua
0.2
Uruguay
Armenia
500
1 000
2 000
Canada
Singapore
Iceland
Arab
countries
Greece
Luxembourg
Netherlands
Denmark
Austria Belgium
0.1
300
Cyprus
5 000
10 000
20 000
40 000
Annual income per person in US dollar (ppp & log)
Percent adults living with HIV (log)
World HIV Chart 2001
30
20
Zimbabwe
Lesotho
Swaziland
Zambia
Kenya
Malawi
Central African Rep.
AIDS deaths
per year
Botswana
300 000
Namibia
South Africa
Mozambique Cameroon
10
Burundi
Côte d'Ivoire
Rwanda
Sierra
7 Leone
Haiti
Angola
Equatorial
Ethiopia Nigeria Togo
5
Uganda
Guinea
Burkina GuineaGhana
Bissau Chad Benin
Dominican Rep.
3
Faso
Guyana
Sudan
Eritrea
Trinidad
Cambodia
and Tobago
2
Belize
200?
X
Mali
Suriname
1
Papua New Guinea
Nepal
Senegal
0.5
0.3
Honduras
Madagascar
0.2
Panama
Jamaica
Ukraine
Thailand
Estonia
India
Costa Rica
El Salvador
Venezuela
Peru
Ecuador
Barbados
Brazil Russia
Guatemala
Colombia
Nicaragua
Argentina
Portugal
Chile
Mexico
Bahrain
Uruguay
Armenia
500
1 000
2 000
Africa
Americas
Asia
Europe
Switzerland
Italy
France
Cyprus
Canada
Singapore
Iceland
Arab
countries
Greece
Luxembourg
Netherlands
Denmark
Austria Belgium
0.1
300
Continents
United States
of America
Spain
Malaysia
Latvia
Belarus
100 000
10 000
1 000
5 000
10 000
20 000
40 000
Annual income per person in US dollar (ppp & log)
World HIV Chart 2001
Percent adults living with HIV (log)
30
20
Zimbabwe
Lesotho
Swaziland
Zambia
Kenya
Malawi
Honduras
Suriname
1
Papua
New Guinea
Nepal
Thailand
Americas
Estonia
Barbados
Brazil Russia
India
Costa Rica
Venezuela
Peru
Colombia
Nicaragua
0.2
Africa
Trinidad
and Tobago
Panama
Jamaica
Ukraine
Guatemala
Ecuador
Continents
Dominican Republic
El Salvador
Madagascar
Argentina
Portugal
Chile
Mexico
Bahrain
Uruguay
Armenia
500
1 000
2 000
United States
of America
Spain
Malaysia
Latvia
Belarus
Asia
Europe
Switzerland
Italy
France
Cyprus
Canada
Singapore
Iceland
Arab
countries
Greece
Luxembourg
Netherlands
Denmark
Austria Belgium
0.1
300
100 000
10 000
1 000
Equatorial Guinea
Senegal
0.3
300 000
Namibia
South Africa
Belize
Mali
0.5
Botswana
10 X 20 =200
Central African Rep.
Mozambique Cameroon
10
Burundi
Côte d'Ivoire
Rwanda
Sierra
7 Leone
Haiti
Angola
Ethiopia Nigeria Togo
5
Uganda
Burkina GuineaGhana
Bissau Chad Benin
3
Faso
Guyana
Eritrea Cambodia Sudan
2
AIDS deaths
per year
5 000
10 000
20 000
40 000
Annual income per person in US dollar (purchasing power) Log
Public expenditure on
health as percent of
general government
expenditure in African
countries, 1998
Conclusions 2
• The role of policy and development
practitioners
Economics
Social
Political commitment
The
‘Free By Five’
Declaration
www.heard.org.za
HIV Epidemic – Determinants and Responses – A Medical View
Determinants
Biomedical
Virus sub-types
Stage of infection
HIV Infection
Presence of
other STDs
Gender
Circumcision
Other
Aids
HIV Epidemic – Determinants and Responses – Sexual Behaviour
Determinants
Sexual behaviour
Biomedical
Rate of partner change
Virus sub-types
Concurrent partners
Stage of infection
Sexual mixing patterns
Presence of other STDs
Sexual practices
Gender
Condom use
Circumcision
Other
Other
HIV Infection
Aids
HIV Epidemic – Determinants and Responses – Upstream Causes
Determinants
Macroenvironment
Microenvironment
Wealth
Mobility
Income distribution
Urbanisation
Culture
Access to health
care
Religion
Governance
Other
Levels of
violence
Women’s rights
and status
Other
Sexual behaviour
Biomedical
Rate of partner
Virus sub-types
change
Stage of
infection
Concurrent
partners
Sexual mixing
Presence of
other STDs
patterns
Gender
Sexual practices
Circumcision
Condom use
Other
Other
HIV Infection
Aids
HIV Epidemic – Where we responded
Determinants Macroenvironment
Microenvironment
Sexual behaviour
Biomedical
Behaviour change
STD treatment
Interventions
communication
Condom
Blood safety
Promotion and
marketing
Anti-retroviral
therapy during
pregnancy
Provision of
condoms
HIV Epidemic – Where we should respond
Determinants
Macroenvironment
Microenvironment
Sexual behaviour
Interventions
Social policy –
redistribution
Social Policy
Behaviour change
communication
Legal Reform
Economic
Policy
Human Rights
Legal Reform
Taxation
Employment
legislation
Debt relief
Terms of Trade
Biomedical
STD treatment
Blood safety
Condom promotion
and marketing
Anti-retroviral
therapy during
pregnancy
Provision of
condoms