AIDS impact Wim Van Damme Department of Public Health ITM, November 2006

AIDS = political issue Why?

People living with HIV/AIDS (estimation end 2003) Total: 34 – 46 million Western Europe – North Africa & Middle East – Sub-Saharan Africa 25.0 – 28.2 million Eastern Europe & Central Asia 1.2 – 1.8 million South & South-East Asia 4.6 – 8.2 million Australia & New Zealand – North America – 1.2 million Caribbean – Latin America 1.3 – 1.9 million East Asia & Pacific – 1.3 million

A global view of HIV infection 38.6 million people [33.4 ‒ 46.0 million] living with HIV,

HIV prevalence in adults in sub-Saharan Africa, – 39% 10 – 20% 5 – 10% 1 – 5% 0 – 1% trend data unavailable outside region

HIV prevalence (%) in adults in Africa,

People living with HIV/AIDS in sub-Saharan Africa, Millions Source: UNAIDS, 2002

People who died from HIV/AIDS in sub-Saharan Africa, ,000 1,500 2,000 2, Thousands Source: UNAIDS, 2002

HIV prevalence rate, adults (%), end 2003 Selected countries in Southern Africa Swaziland37-40% Botswana36-39% Zimbabwe22-28% Namibia18-25% South-Africa19-25% Zambia14-20% Malawi11-18% Mozambique 9-16% 9-16%

Deaths in South-Africa (a model for of future AIDS and non-AIDS Deaths)

Deaths at ages South Africa: (Estimated and projected ) ,200 1,600 2,000 Deaths (thousands) Without AIDS With AIDS

Population Structure in 2020 (Projected) Thousands MalesFemales With AIDSWithout AIDS Age AIDS’ Toll on Population Structure, Botswana Source: U.S. Census Bureau demographic estimates and projections, 2002.

Millions South Africa’s Population With and Without AIDS Source: U.S. Census Bureau demographic estimates and projections, 2002.

Changes in life expectancy in selected African countries with high and low HIV prevalence: with high HIV prevalence: Zimbabwe South Africa Botswana with low HIV prevalence: Madagascar Senegal Mali Life expectancy (years) 1950–

Lifetime risk of AIDS death for 15-year-old boys, (assuming unchanged or halved risk of becoming infected with HIV) Source: Zaba B, 2000 (unpublished data) Current adult HIV prevalence rate Burkina Faso Cambodia Côte d’Ivoire Kenya South Africa Zambia Zimbabwe Botswana Burkina Faso Cambodia Côte d’Ivoire Kenya South Africa Zambia Zimbabwe Botswana 0% 20% 40% 60% 80% 100% 0%5%10%15%20%25%30%35% 40% Risk of dying of AIDS risk halved over next 15 yearscurrent level of risk maintained

Reduction in production in a household with an AIDS death, Zimbabwe Source: Stover & Bollinger, 1999 CropsReduction in output Maize Cotton Vegetables Groundnuts Cattle owned 49% 37% 29% 47% 61%

AIDS  famine?? Lancet article: October 2003

AIDS orphans in South Africa

Disease

Dead

Orphans

Malawi 2004

Malawi 2006