1. 1 What are the factors influencing HIV transmission/spreading?

2. 2 Some factors that influence HIV transmission 1. Lack of information and services for adolescent girls 2. Violence against women 3. Lack of treatment and prevention options for women. 4. Cultural and social expectations for boys

3. 3 Some factors that influence HIV transmission … 5. HIV transmission is not a random event -The spread of the virus is profoundly influenced by the surrounding social, economic and political environment. -Wherever people are struggling against adverse conditions, such as poverty, discrimination and illiteracy, they are especially vulnerable -Efforts to prevent the spread of HIV need to focus both on individual risk behaviour, and on the broad structural factors underlying exposure to HIV—so as to help people control the risks they take and thereby protect themselves.

4. 4 Some factors that influence HIV transmission… 6. Vulnerability, risk and the impact of AIDS coexist in a vicious circle. Vulnerability can be reduced by providing young people with schooling, supporting protective family environments and extending access to health and support services population-wide. Addressing vulnerability at the structural level includes reforming discriminatory laws and policies, monitoring practices and providing legal protections for people living with HIV.

5. 5 Some factors that influence HIV transmission… 7. Challenges in scaling up antiretroviral treatment. 8. AIDS-related stigma hampers the response and accelerates transmission. In many countries stigma and discrimination remain important barriers to understanding how marginalized groups of society are coping with the epidemic.

6. 6 Some factors that influence HIV transmission… 9. Risk behaviour on the rise In South Asia, behavioural information suggests that conditions are ripe for HIV to spread. For example, in Bangladesh, national adult prevalence is less than 0.1%, but there are significant levels of risky behaviour. Large numbers of men continue to buy sex in greater proportions than elsewhere in the region. Moreover, most of these men do not use condoms in their commercial sex encounters and female sex workers report the lowest condom use in the region.

7. 7 Some factors that influence HIV transmission… 10. Mobility and the spread of HIV Human mobility has always been a major driving force in epidemics of infectious disease. Two recent studies have examined its role in the spread of HIV.

8. 8 In Yaoundé, Cameroon. One study on the relationship between mobility, sexual behaviour and HIV infection in an urban population interviewed a representative sample of 1913 men and women in Yaoundé, Cameroon. It found HIV prevalence of 7.6% among men who had been away from home for periods longer than 31 days.

9. 9 Prevalence among those who had been away for less than 31 days in the year was 3.4%, while prevalence among those who had not been away from home in the previous 12 months was 1.4%. The association between men’s mobility and HIV was apparently related to risky sexual behaviour and remained significant after controlling for other important variables. There was no association between women’s mobility and HIV infection (Lydié et al., 2004).

10. 10 KwaZulu-Natal, South Africa Across Southern Africa, the phenomenon of men migrating to urban centres in search of work and leaving their partners and children at home in rural areas is widespread and has complex historical roots. Researchers interested in the role migration plays in spreading HIV in South Africa studied the pattern of infection in couples in Hlabisa, a rural district of KwaZulu-Natal, in which nearly two-thirds of adult men spent most nights away from home. The study confirmed that migration does play an important role in spreading HIV but revealed a more complex picture than had been expected, which challenged some basic assumptions.

11. 11 Looking at discordant couples (that is, couples in which just one partner is HIV-positive), the study found that, in nearly 30% of cases, the infected person was the female partner who stayed home in the rural area, while her migrant partner was HIV- negative. In other words, migration may create vulnerability to HIV exposure at both ends of the trail, and the virus may be spread in both directions (Lurie et al., 2003).

12. 12 The association of mobility with HIV infection may also affect the findings of household surveys. Mobile men, who generally have higher levels of HIV infection, are less likely to be found at home for these surveys. This is especially important in countries with high levels of mobility or migration, and for surveys with a high proportion of absentees.

13. 13 HIV/AIDS and Conflicts Factors in conflicts that may lead to the spread of HIV Armed conflict can increase the likelihood of exposure to HIV infection in several of the following ways: –Population displacement –Breakdown of traditional sexual norms –Women and girls become more vulnerable –Rape as a ‘weapon of war’ –Collapse of health systems –Increased substance use

14. 14 HIV/AIDS and Conflicts… For example, in Rwanda, the 1994 genocide is believed to have contributed to the epidemic expanding to rural areas, which had previously been less affected. This came about because urban and rural populations were mixed together in refugee camps in neighbouring countries.

15. 15 HIV/AIDS and Conflicts …

16. 16 Challenges of A Pandemic: HIV/AIDS Widows ???

17. 17 AIDS and orphans: a tragedy unfolding ???

18. 18 AIDS and orphans: a tragedy unfolding …

19. 19 AIDS and orphans: a tragedy unfolding

20. 20 AIDS and orphans: a tragedy unfolding …

21. 21 AIDS and orphans: a tragedy unfolding … Mobilizing community-based responses Communities are capable of responding effectively to the plight of orphans and children whose parents are dying of AIDS?

22. 22 The impact of AIDS on people and societies The impact on population and population structure The impact of AIDS on poverty and hunger Impact on agriculture and rural development Impact on the supply, demand and quality of education Impact on the health sector Impact on public-sector capacity Impact on workers and the workplace Macroeconomic impact Denial of women’s property and inheritance rights

23. 23 The impact of AIDS on people and societies The impact on population and population structure Sub-Saharan Africa has the world’s highest HIV prevalence and faces the greatest demographic impact. In the worst-affected countries of Eastern and Southern Africa, the probability of a 15-year-old dying before reaching age 60 has risen dramatically. HIV’s impact on adult mortality is greatest on people in their twenties and thirties, and is proportionately larger for women than men.

24. 24 The impact of AIDS on people and societies

25. 25 The impact of AIDS on people and societies

26. 26 Reducing HIV transmission Forthright national leadership Widespread public awareness Intensive prevention efforts have enabled entire nations to reduce HIV transmission.

27. 27 Challenges of the ‘Next Agenda’ - UNAIDS, 2004 The epidemic has placed multiple challenges before the international community, cutting across every sector. These challenges include:

28. 28 Challenges of the ‘Next Agenda’ - UNAIDS, 2004 Embedding the message that AIDS is both a global emergency and a long-term development crisis that requires an exceptional and sustained response, far beyond the scale of what we have seen to date. Ensuring there is universal recognition that AIDS is reversing decades of development progress in the most-affected countries. Therefore, strengthening the response to AIDS must be a central part of development programming and practice.

29. 29 Challenges of the ‘Next Agenda’ - UNAIDS, 2004 Reorienting situation assessment and early warning systems to a ‘people focus’ with greater attention to household impacts. Developing new strategies to deal with the disproportionate impact of the epidemic on women, girls and orphans, including microcredit, school support and food assisstance programmes.

30. 30 Challenges of the ‘Next Agenda’ - UNAIDS, 2004 Developing strategies for radical and innovative approaches to restoring human capacity in the worst- affected countries; for example, massive antiretroviral therapy programmes Developing long-term strategies to replace the short- term ‘Band-Aid’ approaches which have dominated the response up until now.