1. Salim S Abdool Karim Pro Vice-Chancellor (Research), University of KwaZulu-Natal Director: CAPRISA - Centre for the AIDS Programme of Research in South Africa Professor in Clinical Epidemiology, Columbia University Adjunct Professor in Medicine, Cornell University Presented at: 11 th World Congress on Public Health Rio de Janeiro– 22 August 2006 Demographic impact of AIDS in Africa

2. Scale of global HIV epidemic - 2004 Number HIV infected* Estimated % due to heterosexual transmission Persons living with HIV 39.4 million 87% New infections 4.9 million 86% Estimated deaths 3.1 million 88% Source: Joint UNAIDS and WHO AIDS epidemic update December 2004 *(conservative estimate) C APRISA

3. The evolving HIV epidemic in Africa Ghana Benin Data unavailable 0 - 0.99% 1 - 4.9% 5 - 9.9% 10 - 19.9% ≥20% 2003 1984 1994 Algeria Mauritania Morocco Senegal Mali Niger Burkina Faso Cote D’Ivoire Togo Liberia Sierra Leone Guinea Bissau Guinea Chad Cameroon Nigeria Central Afr Rep Libya Egypt Sudan Ethiopia Somalia Kenya Uganda Zaire Tanzania Angola Zambia Mozambique Malawi Zimbabwe Botswana Namibia South Africa Lesotho Swaziland Gabon Congo Western Sahara C APRISA Source: adapted from Abdool Karim SS. The African Experience. In: Kenneth Mayer and HF Pizer (eds) The AIDS Pandemic: Impact on science and society. 2005

4. Source: Bradshaw et al. South African Medical Journal 2005; 95: 496-503 Impact of HIV/AIDS on mortality in South Africa - 2000 (% years of life lost) 39.0 7.5 4.3 4.2 4.1 3.9 2.7 2.5 1.7 1.5 HIV/AIDS Homicide/violence Tuberculosis Diarrhoeal disease Road traffic accidents Lower respiratory infections Stroke Ischaemic heart disease Low birth weight Protein-energy malnutrition C APRISA

5. 15-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-69 1996-1998 1999-2000 AGE 0 50 100 150 200 250 300 350 PERCENTAGE OF 1985-1990 AVERAGE Source: Dorrington R, Bourne D, Bradshaw D, Laubscher R, Timæus IM. The Impact of HIV/AIDS on Adult Mortality in South Africa. MRC Technical Report. 2001 Impact of AIDS in South Africa: Mortality in Men

6. 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 15-1920-2425-2930-3435-3940-4445-4950-5455-5960-64 Age Ratio 1994 1996 1997/8 1998/99 1999/2000 Source: Dorrington R, Bourne D, Bradshaw D, Laubscher R, Timæus IM. The Impact of HIV/AIDS on Adult Mortality in South Africa. MRC Technical Report. 2001 Impact of AIDS in South Africa: Mortality in Women

7. Impact of Antiretroviral Treatment on mortality in the USA C APRISA Trends in annual rates of death due to leading causes of death among persons 25-44 years, USA, 1987-2000 Unintentional injury Cancer Heart Disease Suicide HIV infection Homicide Stroke 87 88 89 90 91 92 93 94 95 96 97 98 99 00 Year Deaths per 100,000 population 45 40 35 30 25 20 15 10 5 0 Source: Adapted from lecture series by the University of South Carolina School of Medicine: http://pathmicro.med.sc.edu/lecture/hiv-USfigs.htm

8. HIV Infection scenarios of the impact of ART in South Africa 0 10 20 30 40 19881990199219941996199820002002 Year HIV prevalence (%) 200420062008 Scenario A Scenario B Scenario C Actual HIV prevalence rates in South African pregnant women Projection scenarios. Scenario A = No ART Scenario B = ART without improvements in prevention, and Scenario C = ART accompanied by improved prevention Source: Abdool Karim SS, Abdool Karim Q, Baxter C. Lancet 2003; 362: 1499. C APRISA

9. Projected HIV infections and AIDS deaths averted, 2002 to 2015 Source: Johnson and Dorrington, 2002 Johnson/Dorrington simulation model: Impact of ART on prevention and mortality Number of people (millions) 4321043210 Prevention only scenario Treatment and prevention scenario HIV infections Averted AIDS deaths averted Treatment and Prevention scenarios C APRISA

10. 40 30 20 10 Baseline Treatment-centred (mixed) Prevention centred Combined response (optimistic) New HIV infections (millions) Solomon simulation model: Impact of ART on new HIV infections Source: Solomon et al. PLOS Medicine 2005; 2(1): 50-6. C APRISA HIV incidence in sub-Saharan Africa, 2003-2020: various intervention scenarios

11. Conclusion  AIDS is one of the global public health community’s greatest challenges  The demographic impact:  Deaths of children & young adults  Higher mortality in women than men  Orphan and vulnerable children  Negative impact on dependency ratio  AIDS prevention and treatment can alter the future course of the epidemic C APRISA