Title - What is going on HIV and AIDS in 2013 and beyond Presented at the HIV Capacity Summit. view program here - http://www.hivcapacityforum.org/index.php?sid=12

1. WHAT IS GOING ON IN HIV AND AIDS IN
2013 AND BEYOND
Prof Alan Whiteside
RATN MEETING
JOHANNESBURG
March 2013

2. Outline
1. Context: Epidemiology
• Where the epidemic is
• Hyper-epidemic countries
2. What does this mean
• For development (and MDGs)
• Economic growth
• Donors
3. Responding
• Prevention (first prize)
• Treatment
• Impact mitigation
4. Conclusion
• Understand your epidemic
• Prioritize

3. 2009 Global HIV Infection
33.3 million people [31.4–35.3 million] living with HIV
2.2

4. Exceptional Epidemics: Prevalence in Africa
2009 (Adults 15–49)
Source: UNAIDS Global Report 2010 Geneva: UNAIDS (2009data)

5. HIV prevalence & no of HIV+ people countries
with >1% of SSA HIV+ population.
HIV prevalence and number of HIV positive
people in countries with 1% or more of the
total Sub-Saharan African HIV positive
population. Data from: UNAIDS
(http://www.unaids.org/en/dataanalysis/epi
demiology/

6. DHS HIV Prevalence Swaziland 2006

7. HIV and AIDS
Country Number of adults HIV/AIDS
living with HIV Prevalence rate
Swaziland 190,000 26.1%
South Africa 5,700,000 18.1%
Botswana 300,000 23.9%

8. Comparison of Epidemics
•Scale of the epidemic: Southern Africa unbelievably
high over 15%,
•Numbers
•Mode of transmission: SA - unprotected
heterosexual intercourse
•Ability to respond: a function of wealth and political
commitment

9. What does this mean
(more)
• For development (and
MDGs)
• Economic growth
• Donors

10. Demographics: Population Growth Rate

11. Beyond the
MDGs

12. Responding
• Prevention (first prize)
• Treatment
• Impact mitigation

13. Epidemic Curves: HIV, AIDS and Impact
Numbers
HIV prevalence
Impact
A2
A1
A
AIDS - cumulative
B B1
T1 T2 Time
Epidem’gy& Lit. p. 27
27Aug01 -Report I:

14. Logic for Prevention
1. Growing case load
• For every two people put on treatment there are
five new infections
2. Stretched health systems
• Lack of buy-in, time for adequate training,
intervention that ‘speak to’ individuals
3. Strained human resources
• 13 providers per 100,000 people in SSA
• 5,100 new doctors per year in Africa
(compared to 173,800 in Europe)
4. Money

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

16. What Works in Prevention?
Currently:
PMTCT
Male circumcision
Male and female condoms
Potentially:
Microbicides PREP
Vaccine
Cure
Behaviour change that works

17. What Should Work in Prevention
Behaviour change
Fewer partners
Less concurrency
Later sexual debut
What Needs to be Addressed…
• Poverty/ economic inequalities
• Gender inequalities
• Leadership and policy
• Etc.

18. Total annual resources available for AIDS in low
and middle income countries
Domestic
contribution
Source: UNAIDS analysis based on (1) Kaiser Family Foundation and UNAIDS , financing the Response to AIDS in low and
middle income countries from the G8, European Commission and other Donor Governments in 2009, July 2010; (2)
UNAIDSOECD/DAC online database (last visited on January 05, 2011); (3) Funders Concerned About AIDS (FCAA), 2010; (4)
European HIV/AIDS Funders Group (EFG, 2010; (5) UNAIDS Unified Budget of Work (UBW) for 2010 & 2011); (6) Disbursements
reports and pledges and contributions reports from the GFATM (last visited on Jan 06 2011(7) budget review from Donor
governments and multilateral organizations.

19. Donor funding for Africa flattened, domestic
funding increasing (UNAIDS)

20. African Treatment Programmes aid dependent!

21. Fiscal Space for Health Spending
Health expenditure per capita is predicted by GDP
Source: International
AIDS Society
presentation by van
der Gaag, McGreevey
& Stimac

22. National Health Expenditures

23. Global Positioning 2012
The United States:
Terra Nova: How to achieve a successful PEPFAR
Transition in South Africa, A report of the CSIS Global
Health Policy Centre, December 2011
The Global Fund:
Round 11 Cancelled Pledges not met
UNAIDS:
AIDS Dependency Crisis Sourcing African Solutions

24. AIDS Dependency Crisis: Sourcing
African Solutions (UNAIDS)
1. Strengthen African ownership, exploit & diversifysources
• Negotiate long-term predicable money from donors
• Grow African investments
• Compact for shared differentiated responsibilities
• Explore sustainable innovative financing
2. Quality Assured Medicines sooner to those in need
3. Establish centres of excellent for local production of
medicines in Africa

25. 2007 DHS and 2011 SHIMS
HIV Prevalence in Swaziland
(ages 18-49)
Men: Prevalence by Age Women: Prevalence by Age

26. Conclusion
• The HIV epidemic is no longer on
the top of the agenda – it is being
overtaken and mainstreamed
• Understand your epidemic
• Prioritize
• Be realistic

27. THANK YOU