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 Germany  First world country  Legalised prostitution in 2002 – prostitutes have legal rights, entitled to receive social benefits and health insurance  Expected 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

Total: 33.2 (30.6 – 36.1) million Western & Central Europe [ – 1.1 million] Middle East & North Africa [ – ] Sub-Saharan Africa 22.5 million [20.9 – 24.3 million] Eastern Europe & Central Asia 1.6 million [1.2 – 2.1 million] South & South-East Asia 4.0 million [3.3 – 5.1 million] Oceania [ – ] North America 1.3 million [ – 1.9 million] Latin America 1.6 million [1.4 – 1.9 million] East Asia [ – ] Caribbean [ – ] Adults and children estimated to be living with HIV, 2007

Estimated number of adults and children newly infected with HIV, 2007 Western & Central Europe [ – ] Middle East & North Africa [ – ] Sub-Saharan Africa 1.7 million [1.4 – 2.4 million] Eastern Europe & Central Asia [ – ] South & South-East Asia [ – ] Oceania [ – ] North America [ – ] Latin America [ – ] East Asia [ – ] Caribbean [ – ] Total: 2.5 (1.8 – 4.1) million

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− % − 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