HIV and AIDS Epidemic: Potential Contribution from DSS sites Nyovani Madise, PhD Centre for Global Health, Population, Poverty & Policy

What Do We Already Know? 39 million infected with virus 4 million new infections per year Globally, HIV infections are unevenly spread- 29 million of those infected living in Africa

Geography of HIV and AIDS Prevalence in adults, 2005

Source: UNAIDS 2006 Report on Global AIDS Epidemic

Increasing Mortality

Population by age and sex, South Africa, 2020 (under “no AIDS” scenario) Source: United Nations, World Population Prospects: The 2004 Revision, CD-ROM Edition, Extended Dataset (2005). South Africa in 2020 Without AIDS:

Source: United Nations, World Population Prospects: The 2004 Revision, CD-ROM Edition, Extended Dataset (2005). South Africa in 2020 With AIDS (Medium AIDS Scenario)

Stagnation or Increase in Childhood Mortality

Social and Economics Aspects

National Wealth & HIV Prevalence 1000 $ 2000 $ 3000 $ Per capita 1999 Adult HIV prevalence end 1999 Botswana South Africa Namibia Swaziland Zimbabwe Uganda Cote d’Ivoire Zambia

Household Wealth and HIV Prevalence

HIV Prevalence by Age at First Sexual intercourse Sources: DHS surveys Women

Gender Differences in HIV Prevalence

What We Know and Don’t Know… BIOCHEMISTRY POTENTIAL IMPACTS TREATMENT BEHAVIOURAL STUDIES

DSS Sites Can Advance Knowledge

A Population-based Longitudinal Assessment of ART Rollout: Effects on Individuals, Populations, and, Health Systems Proposal by INDEPTH Network

5-year evaluation of the antiretroviral therapy (ART) roll-out programmes at INDEPTH sites in West, East and Southern Africa

Collaborating Sites Agincourt (South Africa) Nairobi (Kenya) Bandim (Guinea Bissau) Ifakara (Tanzania) Kisumu (Kenya)

Overall Objectives Effect of ART roll-out on Individuals under treatment & families The population Health systems

Effect on Individuals and Their Families Survival after starting ART Quality-of-life on ART Sexual behaviour of individuals taking ART Economic impact on households with member taking ART

Effect of ART on the Population Trends in mortality, morbidity, and survival in DSS communities Household structure and childcare Sexual behaviour in the population Stigma at population level Access to ART- what % of those who need it are receiving it?

Effect of ART and the Health System Understanding ART roll-out national policies, how they are developed/revised Interpretation and application of policies at district level Equity in provision of ART ART impacts on other health services Improving effectiveness of ART roll-out programmes

Proposed Activities Existing DSS activities Verbal autopsies on cause of death Population and household structure Socio-economic status Additional activities Population-based HIV testing Morbidity, sexual behaviour studies Closer linkage with health service provider

Thank You