Alan whitside - HEARD

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Title - What is going on HIV and AIDS in 2013 and beyond Presented at the HIV Capacity Summit. view program here - http://www.hivcapacityforum.org/index.php?sid=12

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<ul><li>1.WHAT IS GOING ON IN HIV AND AIDS IN 2013 AND BEYONDProf Alan WhitesideRATN MEETING JOHANNESBURG March 2013</li></ul> <p>2. Outline 1. Context: Epidemiology Where the epidemic is Hyper-epidemic countries 2. What does this mean For development (and MDGs) Economic growth Donors 3. Responding Prevention (first prize) Treatment Impact mitigation 4. Conclusion Understand your epidemic Prioritize 3. 2009 Global HIV Infection33.3 million people [31.435.3 million] living with HIV2.2 4. Exceptional Epidemics: Prevalence in Africa2009 (Adults 1549) Source: UNAIDS Global Report 2010 Geneva: UNAIDS (2009data) 5. HIV prevalence &amp; no of HIV+ people countries with &gt;1% of SSA HIV+ population. HIV prevalence and number of HIV positive people in countries with 1% or more of the total Sub-Saharan African HIV positive population. Data from: UNAIDS (http://www.unaids.org/en/dataanalysis/epi demiology/ 6. DHS HIV Prevalence Swaziland 2006 7. HIV and AIDSCountry Number of adults HIV/AIDSliving with HIVPrevalence rateSwaziland 190,00026.1%South Africa5,700,00018.1%Botswana300,00023.9% 8. Comparison of EpidemicsScale of the epidemic: Southern Africa unbelievablyhigh over 15%,NumbersMode of transmission: SA - unprotectedheterosexual intercourseAbility to respond: a function of wealth and politicalcommitment 9. What does this mean (more) For development (andMDGs) Economic growth Donors 10. Demographics: Population Growth Rate 11. Beyond theMDGs 12. Responding Prevention (first prize) Treatment Impact mitigation 13. Epidemic Curves: HIV, AIDS and Impact Numbers HIV prevalenceImpact A2 A1 A AIDS - cumulative BB1 T1 T2Time Epidemgy&amp; Lit. p. 2727Aug01 -Report I: 14. Logic for Prevention1. Growing case load For every two people put on treatment there arefive new infections2. Stretched health systems Lack of buy-in, time for adequate training,intervention that speak to individuals3. Strained human resources 13 providers per 100,000 people in SSA 5,100 new doctors per year in Africa(compared to 173,800 in Europe)4. Money 15. AIDS Treatment without prevention is moppingthe floor while the tap is running 16. What Works in Prevention? Currently:PMTCTMale circumcisionMale and female condoms Potentially:Microbicides PREPVaccineCureBehaviour change that works 17. What Should Work in Prevention Behaviour change Fewer partners Less concurrency Later sexual debut What Needs to be Addressed Poverty/ economic inequalities Gender inequalities Leadership and policy Etc. 18. Total annual resources available for AIDS in lowand middle income countries DomesticcontributionSource: UNAIDS analysis based on (1) Kaiser Family Foundation and UNAIDS , financing the Response to AIDS in low andmiddle income countries from the G8, European Commission and other Donor Governments in 2009, July 2010; (2)UNAIDSOECD/DAC online database (last visited on January 05, 2011); (3) Funders Concerned About AIDS (FCAA), 2010; (4)European HIV/AIDS Funders Group (EFG, 2010; (5) UNAIDS Unified Budget of Work (UBW) for 2010 &amp; 2011); (6) Disbursementsreports and pledges and contributions reports from the GFATM (last visited on Jan 06 2011(7) budget review from Donorgovernments and multilateral organizations. 19. Donor funding for Africa flattened, domesticfunding increasing (UNAIDS) 20. African Treatment Programmes aid dependent! 21. Fiscal Space for Health SpendingHealth expenditure per capita is predicted by GDPSource: InternationalAIDS Societypresentation by vander Gaag, McGreevey&amp; Stimac 22. National Health Expenditures 23. Global Positioning 2012The United States:Terra Nova: How to achieve a successful PEPFARTransition in South Africa, A report of the CSIS GlobalHealth Policy Centre, December 2011The Global Fund:Round 11 Cancelled Pledges not metUNAIDS:AIDS Dependency Crisis Sourcing African Solutions 24. AIDS Dependency Crisis: Sourcing African Solutions (UNAIDS)1. Strengthen African ownership, exploit &amp; diversifysources Negotiate long-term predicable money from donors Grow African investments Compact for shared differentiated responsibilities Explore sustainable innovative financing2. Quality Assured Medicines sooner to those in need3. Establish centres of excellent for local production of medicines in Africa 25. 2007 DHS and 2011 SHIMSHIV Prevalence in Swaziland (ages 18-49)Men: Prevalence by AgeWomen: Prevalence by Age 26. Conclusion The HIV epidemic is no longer onthe top of the agenda it is beingovertaken and mainstreamed Understand your epidemic Prioritize Be realistic 27. THANK YOU </p>