1. HIV / AIDS a global emergency A development education resource from World Vision New Zealand Education Version 1.0 April 2003 click to continue

2. end show skip slide click to continue What is HIV / AIDS? uman mmuno-deficiency irus The HIV virus attacks the cells that fight disease, damaging the immune system. People who have the virus are known as HIV-Positive. Many people who are HIV-positive don't get sick for many years, but the virus slowly wears down the immune system, until the body can no longer fight disease. Once the immune system is damaged, HIV-positive people develop a group of diseases that are known as AIDS. Slide 2 H I V Image copyright Russell Kightley MediaRussell Kightley Media

3. end show skip slide click to continue A set of diseases that people get once their immune system is damaged by the HIV virus. a pattern of signs or symptoms that indicate the presence of a disease = weakness of the immune system = What is HIV / AIDS? People with HIV usually develop some or all of: Tuberculosis Herpes (cold sores, genital herpes) Septicaemia Pneumonia Recurring fungal infections of the skin, mouth and throat Other skin diseases Unexplained fever Meningitis Cancers such as Kaposi sarcoma Chronic diarrhoea with weight loss ("slim disease") Slide 3 A I D S cquired mmuno - eficiency yndrome “caught” not inherited=

4. end show skip slide click to continue How do people get HIV / AIDS? The HIV virus is spread through human body fluids, especially blood and sexual fluids. The most common way to get the HIV virus is: Other common ways: - mother to child transmission - dirty medical equipment especially poorly equipped hospitals in developing countries - drug users sharing needles especially in Eastern Europe - unprotected heterosexual sex - blood products if not screened What is HIV / AIDS? - unprotected male-to-male sex especially in developed countries like New Zealand, but world-wide, only 5% of those who have died from AIDS were gay men. Slide 4

5. end show skip slide click to continue 1980 81 82 83 84 85 86 87 88 89 1990 91 92 93 94 95 96 97 98 99 2000 01 02 Number of people living with HIV / AIDS (Millions) 40 35 30 25 20 15 10 5 Source: Based on UNAIDS 20 Years of HIV / AIDS HIV / AIDS epidemic discovered among heterosexuals in Africa HIV virus identified as the cause of AIDS HIV screening of blood products starts in US 1st unusual cases of weak immune systems among gay men in USA AIDS defined for the first time First AIDS drug therapy approved for use in US HIV prevalence begins to fall in Uganda - first time in a developing country First treatment to reduce mother-to-child transmission developed First development of Highly Active Anti-retroviral Therapy (AIDS drugs) Global Fund for AIDS, TB and Malaria created Brazil becomes first developing country to provide anti-retroviral therapy through its public health system Outbreak in Eastern Europe among injecting drug users UNAIDS is created What is HIV / AIDS? Slide 5

6. end show skip slide click to continue The HIV / AIDS pandemic Source: UNAIDS AIDS Epidemic Update, December 2002 HIV / AIDS: global impact Number of people living with HIV/AIDS in December 2002 People newly infected with HIV in 2002 AIDS deaths in 2002 Total42 million Adults38.6 million Women19.2 million Children under 15 years3.2 million Total5 million Adults4.2 million Women2 million Children under 15 years800 000 Total3.1 million Adults2.5 million Women1.2 million Children under 15 years610 000 Slide 6

7. end show skip slide click to continue People living with HIV / AIDS (end of 2001) Total: 42 million Sub-Saharan Africa 29.4 million North America 980 000 Caribbean 440 000 Latin America 1.5 million Australia & New Zealand 15 000 North Africa & Middle East 550 000 Western Europe 570 000 Eastern Europe & Central Asia 1.2 million South & South- East Asia & Pacific 1.2 million 6 million Source: UNAIDS, AIDS Epidemic update, December 2002 HIV / AIDS: global impact Slide 7

8. end show skip slide click to continue Tanzania: 7.8% Kenya: 15% Uganda: 5.0% Mozambique: 13.0% Malawi: 15% Zambia: 21.5% Zimbabwe: 33.7% South Africa: 20.1% Swaziland: 33.7% Lesotho: 33.4% Namibia: 22.5% Botswana: 38.8% Angola: 5% D.R. Congo: 4.9% Percentage of adults aged 15-49 living with HIV Burundi: 8.3% Rwanda: 8.9% Source: UNAIDS Barcelona Report HIV / AIDS: local impact Slide 8

9. end show skip slide click to continue 40 45 50 55 60 65 1965-19701970-19751975-19801980-19851985-19901990-19951995-2000 Bangladesh: low HIV rate Botswana Kenya Zimbabwe Zambia Uganda Malawi HIV / AIDS is reversing gains in life expectancy Life expectancy Source: UN Population Division HIV / AIDS: local impact Slide 9

10. end show skip slide click to continue 25% of Africa’s agricultural workers will be sick or dead from AIDS by 2020 Botswana: 25% of families will lose an income earner by 2010 Tanzania: women become caregivers for the sick – a woman with a sick husband spends 60 % less time doing agricultural work Sources: NORAD, Socio-economic effects of HIV/AIDS in African countries, 2002; World Vision, HIV / AIDS and Human Development in Africa, 1999. HIV / AIDS: local impact HIV / AIDS impacts on... family income social services Rwanda: families with an AIDS patient spend 20 times more on health care Uganda: one study showed up to 47% of households with orphans can’t afford to send children to school HIV / AIDS will account for 60-70% of Zimbabwe’s public health budget by 2005 In Malawi and Zambia, more than 30% of school teachers are HIV positive. In the Central African Republic, 100 schools have closed because so many teachers have died. Agriculture and food production Slide 10

11. end show skip slide click to continue Source: UNAIDS Socio-Economic Impact of HIV/AIDS in Africa HIV / AIDS is overwhelming health and social services 2000 % hospital beds occupied by AIDS patients in Zambia AIDS patientsNon-AIDS patients 1990 HIV / AIDS: local impact The cost of treating one AIDS patient is equivalent to putting ten children through primary school Source: World Bank (Africa) 1999 Slide 11

12. end show skip slide click to continue Children aged 0-14 living with HIV / AIDS 0 10,000 20,000 30,000 40,000 50,000 60,000 70,000 Botswana 28,000 Malawi 65,000 Zambia 22,000 Uganda 19,000 HIV / AIDS impacts on children and young people 3.2 million children (under 15) live with HIV / AIDS 2200 are infected with the HIV virus everyday 1700 die of AIDS everyday 14 million have been orphaned by AIDS World-wide... HIV / AIDS: local impact Source: UNAIDS Barcelona Report; UNAIDS AIDS Epidemic Update, December 2002. Slide 12

13. end show skip slide click to continue 0 2 4 6 8 10 12 14 16 18 20 % of all children who are orphans AIDS Orphans HIV / AIDS: local impact Source: UNAIDS ‘Children on the Brink 2002’ Slide 13 1990 Malawi Other orphans AIDS orphans 1990 Botswana 1990 Zambia 1990 Uganda 1995 2000

14. end show skip slide click to continue My son Pirirani is four. He has been ill with diarrhoea, stomach pains, weight loss, a cough and fever for more than three years. My baby Davis is 13 months old, and he is wasting away. I also am unwell, and my wife Celina. And I look after my parents, who are old, and two orphans. I had a lot of pigs, but I would sell anything to save the life of my children. I always thought I would live a happy life with my beautiful wife, working hard on my land for my children’s future. I thought we would own cattle and I would have a pleasant home. But the story has come out differently to my dreams because of this sickness. We have no cash, but I need 400 kwacha (NZ$13) for the next round of medicine for the children. A chicken sells for 150 kwacha. Slide 14 Vincent - Malawi

15. end show skip slide click to continue And my staff are not safe. If you stick yourself with a needle – and that’s a common thing – there is no chance of getting anti- retroviral treatment if you get HIV. So you find you don’t always want to know, and most staff don’t get tested after a needle-stick. In most cases we strongly suspect AIDS based on the symptoms, but we don’t always carry out tests because of the lack of resources and the workload. You should counsel people before and after the test, and we don’t have enough staff for that. It’s desperate if you really look at it. We have 240 beds in this hospital, and we have more than 300 patients, with people sleeping on the floor. The overcrowding is very definitely related to HIV. AIDS is making the related problem of tuberculosis very serious and complicated. Frankly, sometimes you give a treatment and you just pray that it will work. Slide 15 Ntcheu Hospital - Malawi

16. end show skip slide click to continue Sophy is often kicked out of children's groups when she tries to play with them. The shame and the pain inside Sophy have completely changed her. She is quiet and rarely laughs. This is my great- grandniece, Sophy. She is three years old. First her father and then her mother died of AIDS. When Sophy’s mother started to get sick she and her three children came to live with my sister and I. My name is Eng. I am 79 years old. Sophy has HIV from her mother. She has a skin infection on her head. Wherever she goes, she wears this hat to protect her head from flies and to hide her infection from other children. Most children don’t like Sophy much because of her infection and the bad smell from her body. Slide 16 Sophy - Cambodia

17. end show skip slide click to continue I know that men my age are the ones getting HIV. With this killer disease that is affecting our country, I try and keep myself safe. Zione too, she is not safe. She is too young to date, to go out with boys. I’m doing my best to help her and look after her. I work at anything I can, for 50 kwacha a day to buy enough food (about NZ$1.20). Sometimes we have two meals a day and sometimes only one. I have gone as far as I can with free education. I did well in school, and I would like to continue. My English is very strong, and I would like to be a mechanic. But I can't afford my school fees if I am to look after my sister. Our mother died a year ago, she was sick for a long time. I left school right away to look after Zione. She is 13 and she wants to be a nurse. If she continues at school, and she wants to, she could start nursing training after she finishes Form 4. Slide 17 Muziona and Zione - Malawi

18. end show skip slide click to continue HIV / AIDS: strategies Slide 18 Blantyre Urban Project Malawi Strategies for tackling HIV / AIDS 1. Prevention Education and behaviour change ‘Breaking the silence’ - tackling the stigma that prevents people talking openly about HIV / AIDS Education on how HIV is spread and avoiding high-risk behaviours (ABC) Addressing barriers to behaviour change: gender relations,economic barriers, cultural practices Focus on high risk groups, like truck drivers, migrant workers and sex workers Focus on pregnant & breast-feeding mothers Education on prevention strategies Health care during and after pregnancy Mother-to-child transmission Breaking the silence, educating a whole new generation about the dangers of HIV/AIDS Training school teachers to teach children about AIDS prevention Anti-AIDS clubs, dramas, events

19. end show skip slide click to continue Kagera HIV / AIDS counselling and orphans support project – Tanzania Training and equipping volunteers for home-based care and counselling. These volunteers cook, wash clothes and bed-clothes, and distribute basics like flour, oil, blankets and sheets. 2. Care for the sick HIV / AIDS: strategies HIV testing Counselling and emotional support Education about living with HIV Advocating for wider availability of drug treatments Preventing other infections through healthcare, clean water, and sanitation Providing practical support such as food, blankets, sheets Training and support for care-givers Home-based care and counselling, especially where hospital beds are scarce Slide 19

20. end show skip slide click to continue HIV / AIDS: strategies Slide 20 Rakai-Kooki Orphans on their own project – Uganda 3. Care for those left behind Meeting the immediate and long term needs of orphans and elderly caregivers in the absence of Mums and Dads. Counselling and support for children who have lost their parents Helping orphans or elderly guardians to strengthen their income and food supply Making sure orphans have access to education Improving living conditions With hardly any income, these orphans had no chance of replacing their unsafe, crumbling mud hut without help from World Vision. There are many thousands of other children who still need help.