1. The State of the Epidemic in 2010
DFID HIV Leaders Meeting
The State of the Epidemic in 2010 by
Professor Alan Whiteside
HEARD
House of Lords
9th March 2010

2. ‘Three Threes’ Three exceptional epidemics Three challenges
Russia and Ukraine
Poor countries with low health spends and mid-range HIV burdens
Hyper-endemic countries of Southern Africa
Three challenges
Prevention
Care and treatment (in light of new guidelines)
Impact mitigation and looking to the next generation
Three critical responses
What works
Who pays
How can it be sustained

3. The global picture in 2007
Source: UNAIDS Global Report Geneva: UNAIDS. (2007 data)

4. Exceptional epidemics: Eastern Europe
Low prevalence ; climbing incidence; falling populations; lack of political will
Sources: HIV/AIDS Surveillance in Europe. EuroHIV 2007, and World Population Prospects: The 2008 Revision Population database. UN Population Division.

5. HIV Prevalence in Africa 2007(Adults 15–49)
Source: UNAIDS Global Report Geneva: UNAIDS (2007 data)

6. Mid-level prevalence in low resourced countries
Malawi
Tanzania
Uganda
Government Health Expenditure Per Capita
$62
$72
$71
Average Cost of treatment per person/per year *
$257
$850
People living with HIV **
930,000
1,400,000
940,000
People receiving ARV treatment ***
100, 649
373, 265
111, 232
GDP per capita
$800
$1,300
$1,100
Sources: *Rosen, S. and Long, L. ‘How Much Does it Cost to Provide Antiretroviral Therapy for HIV/AIDS in Africa?’ 2006, **UNAIDS Global Report 2008 and ***UNGASS Country Reports 2008.

7. Exceptional epidemics: the Hyper-endemic Countries
Source: Epidemiological Updates. Geneva: UNAIDS 2009.

8. HIV and AIDS Country Population
Numbers living with HIV/AIDS at a 18.8% prevalence rate
Swaziland
1,200,000
225,600 UK
60,776,000
11,425,888 EU
492,964,000
92,677,000

9. Three Challenges: Three Waves
Numbers
HIV Prevalence
AIDS cases
Impacts
Time
Source: Barnett, T. & Whiteside, A. (2006) AIDS in the Twenty-First Century. Palgrave MacMillan

10. Three Challenges Prevention Impacts Care & Treatment Numbers A A A B B2 A A 1
Care & Treatment B B 1 T T
Time 1 2
Source: Barnett, T. & Whiteside, A. (2006) AIDS in the Twenty-First Century. Palgrave MacMillan

11. AIDS Treatment without prevention is mopping the floor while the tap is running

12. AIDS Impacts
Sources: Swaziland HIV Estimates and Projections. NERCHA and UNIAIDS Workshop report and US Census Bureau International Database

13. Three Critical Responses
What works?
Who pays? (and for what)
Sustainability

14. What Works Prevention of Vertical Transmission Combination prevention
Male circumcision
Social change
Leadership
Changing Gender Relations
Economic Empowerment
Community Mobilisation
Treatment

15. Combination HIV Prevention
Source: Coates et al. (2008) Behavioural Strategies to Reduce HIV Transmission: How to make them work better. Lancet, 372:

16. Adherence to HIV Prevention Technologies
Source: Coates et al. (2008) Behavioural Strategies to Reduce HIV Transmission: How to make them work better. Lancet, 372:

17. Who Pays?
Source: UNAIDS (2009) What Countries Need, Investments Needed for 2010 Targets. Geneva: UNAIDS

18. Global Resource Needs
Source: Estimating the Long-term Global Resource Needs for AIDS through Draft Working Paper AIDS 2031

19. Sustainability
Do we agree on importance of AIDS in the global development context and in global health
The rich world needs to keep promises
Africa needs to honour the Abuja Declaration (Only Botswana and Gambia have achieved this)
Treatment is not sustainable without prevention and international commitment
Political and financial commitment are both needed

20. Conclusions Targets set in 2005 much has been done
MDG targets in Southern Africa not sure?
Should we change targets (treatment)?
Keeping ‘exceptional’ epidemics on the agenda?
Moving forward? Who makes decisions?
Partnerships?