1. EG3244 Development Geographies The AIDS crisis Dr Mark Cresswell

2. TOPICS Background to STDs HIV: Introduction HIV: Aetiology & History Global and Regional Analysis Treatments Online resources

3. Sexually Transmitted Diseases STDs are one of the few emerging diseases that are not strictly related to economic wealth (love is free!!!!) Most STDs are really lifestyle diseases rather than emerging diseases – many STDs were caught and spread by amorous sailors from European colonial powers visiting islands and previously unchartered lands

4. Sexually Transmitted Diseases What we might term as “emerging diseases” are those STDs which are relatively new and for which there is no cure – principally HIV Human Immunodeficiency Virus (HIV) is a retrovirus HIV leads to a clinical condition known as Acquired Immune Deficiency Syndrome (AIDS) which may take a decade to develop

5. HIV: Introduction HIV was isolated in 1983 and was often linked to mainly homosexual activity – paticularly in the Los Angeles and San Francisco regions of the US It has claimed a number of high profile people (actors and scientists) who have been active in raising public awareness

6. HIV: Aetiology & History In fact, HIV is known to be transmitted through unprotected heterosexual activity, blood transfusions and medical procedures and drug use where hygiene rules are ignored Once HIV develops into AIDS the result is a progressive decline in immune status. Cause of death may be a common cold or septicaemia from cut

7. HIV: Aetiology & History HIV is believed to have resulted from a “crossing over” from a known animal disease affecting chimpanzees – Simian Immunodeficiency Virus (SIV) Two main types of HIV –HIV-1 most prevalent in western societies –HIV-1 & HIV-2 found mainly in Africa –HIV-2 is less aggressive form

8. HIV: Aetiology & History HIV-1 sub-types (known as “clades”) are very strongly associated with geography and vary from country to country Epidemiology of all STDs in human society is usually a direct result of: –Social and moral beliefs –Urbanisation and household occupancy patterns –Religious belief

9. Statistical Measures - Incidence This is the number of new cases in a particular time period: I = Incidence N = Number of new cases in a given time period P = Person years at risk during same time period Note that person years at risk means the total amount of time (in years) that each member of the population being studied (the study population) is at risk of the disease during the period of interest.

10. Statistical Measures - Prevalence This is the proportion of current cases in a population at a given point in time: P = Prevalence Nc = Number of cases in the population at a given point in time P = Total population at the same point in time

12. 2006 Report on the global AIDS epidemic Fig 06/06 e

13. 2006 Report on the global AIDS epidemic Fig 06/06 e

14. 2006 Report on the global AIDS epidemic Fig 06/06 e A global view of HIV infection 38.6 million people [33.4 ‒ 46.0 million] living with HIV, 2005 2.4

15. 2006 Report on the global AIDS epidemic Fig 06/06 e HIV prevalence (%) in adults in Africa, 2005 2.5

16. 2006 Report on the global AIDS epidemic Fig 06/06 e Comprehensive knowledge about HIV and AIDS among young males aged 15–24, by level of education, in 11 sub-Saharan African countries, 2000–2004 Sources: Demographic and Health Surveys; HIV/AIDS Indicator Surveys (2000–2004). 0 10 20 30 40 50 60 70 80 Burkina Faso Cameroon Ghana Kenya Mali Mozambique Namibia Nigeria Rwanda Uganda Zambia % No educationPrimary educationSecondary education and beyond 3.4

17. 2006 Report on the global AIDS epidemic Fig 06/06 e Comprehensive knowledge about HIV and AIDS among young females aged 15–24, by level of education, in 11 sub-Saharan African countries, 2000–2004 Sources: Demographic and Health Surveys; HIV/AIDS Indicator Surveys (2000–2004). 0 10 20 30 40 50 60 70 80 Burkina Faso Cameroon Ghana Kenya Mali Mozambique Namibia Nigeria Rwanda Uganda Zambia % No educationPrimary educationSecondary education and beyond : 3.5

18. 2006 Report on the global AIDS epidemic Fig 06/06 e Percentage of young people aged 15–24 reporting the use of a condom during sexual intercourse with a non-regular partner, Sub-Saharan Africa, 2001–2005 Male Female Countries with date of survey indicated 1000102030405060708090 % Benin 2001 Botswana 2001 Burkina Faso 2003 Cameroon 2004 Chad 2004 Ghana 2003 Guinea 2005 Kenya 2003 Lesotho 2004 Madagascar 2003 Malawi 2004 Mali 2001 Mozambique 2003 Nigeria 2003 Rwanda 2004 Senegal 2005 United Republic of Tanzania 2003 Uganda 2004 Zambia 2003 Sources: Demographic Health Surveys; HIV/AIDS Indicator Surveys (2001-2005). 3.6

19. 2006 Report on the global AIDS epidemic Fig 06/06 e Estimated total annual resources available for AIDS, 1996 ‒ 2005 292 1623 8297* 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 1996199719981999200020012002200320042005 US$ million Signing of Declaration of Commitment on HIV/AIDS Data include: International donors, domestic spending (including public spending and out-of-pocket expenditures) International Foundations and Global Fund included from 2003 onwards, PEPFAR included from 2004 onwards * Projections based on previous pledges and commitments (range of the estimation: US$7.5 to US$8.5 billion). 3.8

20. 2006 Report on the global AIDS epidemic Fig 06/06 e

21. 2006 Report on the global AIDS epidemic Fig 06/06 e Impact of three scenarios on HIV infection in sub-Saharan Africa, 2003–2020 0.0 1.0 2.0 3.0 4.0 5.0 20032005201020152020 Year Treatment-centered Prevention-centered Baseline Comprehensive response Number of new HIV infections (millions) Source: Salomon JA et al. (2005). Integrating HIV prevention and treatment: from slogans to impact 6.1

22. 2006 Report on the global AIDS epidemic Fig 06/06 e

23. 2006 Report on the global AIDS epidemic Fig 06/06 e Distribution by region of the funding required for prevention Latin America/Caribbean: 9% Eastern Europe: 12% North Africa/Middle East: 3% Africa: 29% South/South-East Asia: 21% East Asia/Pacific: 26% Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries. 10.3

24. 2006 Report on the global AIDS epidemic Fig 06/06 e Distribution by region of the funding required for treatment and care Latin America/Caribbean: 17% Eastern Europe: 7% North Africa/Middle East: 1% Africa: 55% South/South-East Asia: 4% East Asia/Pacific: 16% Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries. 10.6

25. Treatments There is currently no cure for HIV/AIDS Current treatments are therapies which attempt to slow down the virus (combination therapy) Lifestyle changes to boost natural immune system can extend life Antiretrovirals are used. Typical combinations include two drugs from the NRTI group (nucleoside reverse transcriptase inhibitors, also known as 'nukes') plus an NNRTI ('non-nuke') or a protease inhibitor A vaccine is some way off

26. Reading UNAIDS: http://www.unaids.org/en/ CDC: http://www.cdc.gov/hiv/default.htm AIDS portal: http://www.aidsportal.org/ UK Development: http://www.aidsconsortium.org.uk/ TH Trust: http://www.tht.org.uk/ Check papers with Science Direct/Web of Knowledge and library texts

27. Any Questions ?