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HIV AIDS Pandemic

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Information about HIV AIDS Pandemic
News-Reports

Published on August 6, 2007

Author: Pravez

Source: authorstream.com

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Please be aware that…:  Please be aware that… Most of the hard work represented in this talk was done by others—if you do decide to 'borrow' slides then please try to acknowledge that when you give the presentation. I apologize in advance for not giving sources or photo credits…Most of the info is out there on the web if you care to document it and make it more rigorous—have fun surfing! Slide2:  Slide3:  The HIV/AIDS pandemic:a barometer of our times:  The HIV/AIDS pandemic: a barometer of our times Reuben Granich, MD, MPH Doctors for Global Health Meeting, August 1st, 2004 We will cover…:  We will cover… HIV/AIDS pandemic Global response Actions Some numbers to consider…:  Some numbers to consider… 571 342 25,000,000+ AIDS pandemic:  AIDS pandemic Adults and children estimated to be living with HIV as of end 2003:  Adults and children estimated to be living with HIV as of end 2003 Total: 37.8 (34.6 – 42.3) million 4.8 million new infections annually Western Europe 580 000 [460 000 – 730 000] North Africa andamp; Middle East 480 000 [200 000 – 1.4 million] Sub-Saharan Africa 25.0 million [23.1 – 27.9 million] Eastern Europe andamp; Central Asia 1.3 million [860 000 – 1.9 million] South andamp; South-East Asia 6.5 million [4.1 – 9.6 million] Oceania 32 000 [21 000 – 46 000] North America 1.0 million [520 000 – 1.6 million] Caribbean 430 000 [270 000 – 760 000] Latin America 1.6 million [1.2 – 2.1 million] East Asia 900 000 [450 000 – 1.5 million] Estimated adult and child deaths from AIDS during 2003:  Estimated adult and child deaths from AIDS during 2003 Total: 2.9 (2.6 – 3.3) million Western Europe 6 000 [andlt;8 000] North Africa andamp; Middle East 24 000 [9 900 – 62 000] Sub-Saharan Africa 2.2 million [2.0 – 2.5 million] Eastern Europe andamp; Central Asia 49 000 [32 000 – 71 000] East Asia 44 000 [22 000 – 75 000] South andamp; South-East Asia 460 000 [290 000 – 700 000] Oceania 700 [andlt;1 300] North America 16 000 [8 300 – 25 000] Caribbean 35 000 [23 000 – 59 000] Latin America 84 000 [65 000 – 110 000] About 14 000 new HIV infections a day in 2003:  About 14 000 new HIV infections a day in 2003 More than 95% are in low and middle income countries Almost 2000 are in children under 15 years of age About 6,000 are in persons aged 15 to 24 years Almost 50% of all new infections are in women Women are heavily impacted…:  Women are heavily impacted… Percent of Pregnant Women 15-24 Years Old who are HIV-Infected, 2000-3:  Percent of Pregnant Women 15-24 Years Old who are HIV-Infected, 2000-3 AFRICA Botswana South Africa Zambia Namibia Kenya Mozambique Ethiopia Uganda Nigeria Tanzania Cote d'Ivoire Rwanda CARIBBEAN Haiti Guyana Percent HIV-infected HIV prevalence among pregnant women in South Africa, 1990 to 1999:  HIV prevalence among pregnant women in South Africa, 1990 to 1999 Source: Department of Health, South Africa 0.7 1.7 2.1 4 7.6 10.4 14.2 17 22.8 22.4 0 5 10 15 20 25 90 91 92 93 94 95 96 97 98 99 HIV prevalence (%) Slide14:  Changes in Life Expectancy in Selected African Countries with High HIV Prevalence 1950 to 2000 Source: United Nations Population Division, 1998 35 40 45 50 55 60 65 1950-55 55-60 60-65 65-70 70-75 75-80 80-85 85-90 90-95 95-2000 Life expectancy at birth, in years Botswana Uganda South-Africa Zambia Zimbabwe Years United States: Invisible epidemic?:  United States: Invisible epidemic? Slide16:  Estimated Incidence of AIDS, Deaths, Prevalence by Year of Diagnosis/Death US, 1981 – 2002 *Adjusted for reporting delays 81 83 16 87 89 91 93 95 97 99 82 84 86 88 90 92 94 96 98 00 01 02 Incidence Deaths Prevalence Number of Cases/Deaths (Thousands) Prevalence (Thousands) Year Slide17:  Percent of Cases Year of Report Proportion of AIDS Cases, by Race/Ethnicity and Year of Report, 1985 – 2002, US White, not Hispanic Black, not Hispanic Hispanic Asian/Pacific Islander American Indian/ Alaska Native 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 HIV/AIDS in African Americans:  HIV/AIDS in African Americans African Americans are only 13% of US population but are half of the new AIDS cases and AIDS deaths in 2002 By the end of 2002, more than 185,000 African Americans had died with AIDS Poorest survival rates of all racial and ethnic groups late diagnosis poor access HIV therapy Slide19:  Leading Causes of Death Among Black Americans, 25- to 44-Years-Old, United States, 2001* * Preliminary death-certificate data for 2001 Deaths Slide20:  The widening treatment gap Source: Adapted from WHO/UNAIDS Statistics, andamp; HIV/AIDS Surveillance in Europe, End- year report 2001, No. 66, CESES 0.0 0.5 1.0 1.5 2.0 2.5 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Yearly deaths as a proportion of 1995 values HAART AIDS deaths in Africa AIDS deaths in Western Europe Global response has had devastating consequences::  Global response has had devastating consequences: Some advances but many delays over last 20 years…. Insert favorite golfer here… Why have we failed to stop the HIV/AIDS epidemic?An outbreak of “Isms” and a lack of human rights…:  Why have we failed to stop the HIV/AIDS epidemic? An outbreak of 'Isms' and a lack of human rights… Racism, prejudice and discrimination Sexism--lack of womens rights Beliefs regarding drug use World Poverty Debt Greed Corruption Economic colonialism Structural adjustment/health sector reform Insufficient development aid Military industrial complex/war Complex biology Individual vs. Community rights Religion Pharmaceutical industry Ignorance--lack of education Values regarding sex and commercial sex work Fear of Death Public health obstacles Tribalism Nationalism Lack of women’s rights:  Lack of women’s rights HIV/AIDS epidemic has highlighted the lack of basic rights for women discrimination economic oppression legal oppression denial of equal opportunity to education domestic violence rape Religion:  Religion Religious views have sometimes been an obstacle to confronting the epidemic Same sex relations Sex before marriage Condom use vs. abstinence Sexism/gender oppression Science vs. religious dogma HIV/AIDS and Poverty:  HIV/AIDS and Poverty Low economic status is a predictor of increased mortality from HIV disease even after controlling for confounders such as age, disease stage, and access to care Economics influence risk of infection and the spread of HIV Urban centers Trade routes Commercial sex workers Migrant workers Low income is associated with greater risk of HIV infection:  Low income is associated with greater risk of HIV infection A greater exposure to higher risk sexual experiences Diminished access to health information Higher frequency of sexually transmitted infections Absent or delayed diagnosis Less concern about one’s health and the future given harshness of present World Poverty/structural violence:  World Poverty/structural violence 6 billion people 2 billion have no power 2 billion live on less than 1$ a day 1,5 billion lack access to safe water 125 million children have no school 28 million disease-related deaths per year Increasing inequity Vast majority of people with HIV are living in 'resource-poor' countries The share of the world’s wealth among the poor is diminishing…:  The share of the world’s wealth among the poor is diminishing… Percentage of global income of world’s poorest 20% % Obscene economic disparity:1990’s “Decade of Despair”:  Obscene economic disparity: 1990’s 'Decade of Despair' United Nations Development Programme’s 2003 Human Development Report 54 countries becoming even poorer than before. Life expectancy has fallen in 34 nations The income of the richest 10% of the US population is now equal to that of the poorest 43% of the world In Brazil less than 3% of the population own two-thirds of the country’s arable land World Economic System::  World Economic System: World Trade Organization GATT, GATTS, TRIPS…etc. Multi-lateral trade agreements NAFTA, CAFTA, FTAA…..etc. World Bank and IMF US has veto power over WB and IMF Structural adjustment programs control developing country economies Structural Adjustment Programs:  Structural Adjustment Programs Conditions for Structural Adjustment Loans Reduce govt. spending (cut health/education programs) Devalue local currency (make exports cheaper for North) Cut wages (become more 'competitive') Change to export economy (e.g. grow coffee not corn) Remove restrictions on foreign corps. (allow multinationals to operate freely) Privatize state companies (sell state resources to private corps. - assisted thru devalued currency) Bello International Forum on Globalization Effects of Structural Adjustment Programs:  Effects of Structural Adjustment Programs Diminished economic growth Latin America GNP: Increased 73% 1960-80 Increased only 7% 1980-02 Accruing interest has led to a cycle of dependency Tremendous rising debt in the Global South 1980 was $609 billion / 2001 was $2.4 trillion For example: Nigeria took $5B loan, has paid $16B, and owes $32B International Forum on Globalization Center for Economic Justice Debt Servicing=AIDS Program Costs:  Debt Servicing=AIDS Program Costs Source: UNAIDS, 2001, World Bank 'Financial Impact of the HIPC Initiative: first 22 country cases.' 1st March 2001. Figures do not include related costs of infrastructure, capacity building, and impact mitigation.  Economic Solution?:  Economic Solution? New global economic system that is grounded in human rights and environmental justice Debt cancellation would be part of the new level playing field HIV/AIDS assistance: are we doing enough?:  HIV/AIDS assistance: are we doing enough? Very slow out of the blocks… Fewer than one in five persons at risk for HIV infection has access to even the most basic services; standard services could prevent 29 million infections by 2010 2001 established Global Fund 2002 1.2 billion dollars spent on HIV/AIDS 2003 WHO 3x5 initiative 2004 President’s AIDS Initiative Slide36:  1998 HIV/AIDS ODA in US$ million HIV/AIDS ODA in US$ per US$ million 1998 GNP HIV/AIDS ODA in 1998: Total amount obligated, in US$ million and per US$ million of donor country’s GNP Slide37:  Haiti Guyana Côte d’Ivoire Nigeria Ethiopia Kenya Uganda Rwanda Tanzania Mozambique Zambia South Africa Botswana Namibia President’s Emergency Plan for AIDS Relief 15 Focus Countries FY 2004 Budget for Global AIDS: $2.2 Billion“Sense of Congress” for Distribution of Funds:  FY 2004 Budget for Global AIDS: $2.2 Billion 'Sense of Congress' for Distribution of Funds *33% of prevention funds should be for abstinence-until-marriage programs **75% of treatment funds should be for purchase and distribution of ARVs Source: Public Law 108-25 Net Official Aid (Billion US$) by rich country donors to poor countries:  Net Official Aid (Billion US$) by rich country donors to poor countries Goal is 0.7% of GNP Military Industrial Complex:  Military Industrial Complex 'Every gun that is made, every warship launched, every rocket fired, signifies in the final sense a theft from those who hunger and are not fed, those who are cold and are not clothed.' President Dwight D. Eisenhower April 16, 1953 Military spending:  Military spending Big Pharma and HIV/AIDS:  Big Pharma and HIV/AIDS Issues surrounding access to treatment have called into question profit motive and corporate responsibility Used enormous resources and clout to fight access to treatment/use of generics Profit motive vs. humanitarian or human rights concerns 500 million drug development costs What about Government contribution to ARV development costs? NGO/activists and developing country producers have won the first round WTO/TRIPS? Competition is good for prices…:  Competition is good for prices… Slide44:  During the last 60 minutes…:  During the last 60 minutes… 571 People infected with HIV 342 deaths from AIDS Insert webcounter here Since the beginning of the epidemic…. 25,000,000+ AIDS deaths Slide46:  HIV prevalence rate among 13 to 19-year-olds, Masaka, Uganda, 1989 to 1997 0 1 2 3 4 5 1989/90 1990/91 1991/92 1992/93 1993/94 1994/95 1995/96 1996/97 girls boys Source: Kamali et al. AIDS 2000, 14: 427-434 HIV prevalence (%) Slide47:  Trend in HIV prevalence in 21 year old military conscripts in Thailand Source: Armed Forces Research Institute of Medical Sciences, Thailand Slide48:  Activists and generic drugs force lower prices for treatment… Positive lessons from AIDS Epidemic:  Positive lessons from AIDS Epidemic People are heroic and often exhibit unimaginable dignity Epidemic is not inexorable Prevention works Uganda, Senegal, Thailand Effective prevention and care efforts involve Governments, communities, individuals Prevention and care efforts must involve and reach out to the marginalized Prevention and care work together Top down and bottom up are both needed Top down:  Top down Global commitment to confront the epidemic Government commitment—ensure prevention and care services Establish basic treatment approach for everyone Guarantee regular supply of medicines for everyone Involve stakeholders in key decisions Slide51:  Field officers, who carry drugs, forms, and supplies for specimen collection, visit each patient weekly and can visit up to 10 patients per day. Drug Distribution Network and Field-Based Monitoring, Uganda Bottom-up:  Bottom-up Community must organize to demand rights from their governments Meaningfully involve people with HIV/AIDS Broad coalitions/common grounds Enlist allies in dominant countries Work to re-define the paradigm so that it is people-centered and has a focus on achieving equity as soon as possible Community mobilization is essential….:  Community mobilization is essential…. Thanks….:  Thanks…. People living and working with HIV/AIDS Slide55:  HIV, Health and Your Community: A Guide for Action Information Gap:  Information Gap Rwanda 1992—no materials Fewer than five percent of people infected with HIV live in industrialized countries Most information regarding HIV/AIDS is written for people in these countries More than 100,000 scientific articles on HIV and AIDS Most have little relevance for most people living with HIV Little usefulness for most health care providers Comprehensive guide to prevention is needed Commercial sex work :  Commercial sex work Economic exchange of sex interdiction approach moral judgement denial hypocrisy (e.g., international sex tourism) HIV/AIDS forces us to confront death:  HIV/AIDS forces us to confront death Tough death Denial—HIV/AIDS is uniformly fatal Irrational fear of contagion Prolonged suffering without the basic medical care Human rights vs. Public Health:  Human rights vs. Public Health Does human rights emphasis hamper public health efforts? Human rights minimally conflict with public health restrictions as long as the objectives and processes used to make the decision to restrict the rights are clear SIRACUSA (1985) Proposed restriction has to provided for and in accordance with the law Restriction must be directed toward a legitimate objective of general interest (e.g., prevention of HIV transmission) Restriction must be strictly necessary to achieve objective No less intrusive means should be available to reach objective Cannot be unreasonable or discriminatory—burden of proof falls on those who want to restrict the rights and concrete public health evidence is needed to respond to questions regarding the last three criteria Human rights should be used a criteria for public health success Lessons from AIDS Epidemic:  Lessons from AIDS Epidemic Epidemic is not inexorable Prevention works Uganda, Senegal, Thailand Effective prevention efforts involve Governments, communities, individuals Prevention efforts must involve and reach out to the marginalized Prevention and care work together Human rights and health issues:  Human rights and health issues Human rights and health issues:  Human rights and health issues Article 25 of the Universal Declaration of Human Rights (1949): 'everyone has the right to a standard of living adequate for the health of himself and his family including food, clothing, housing, and medical care and necessary social services' Article 12 of the International Covenant on Economic, Social and Cultural Rights (US has not ratified) 'Right of everyone to the enjoyment of the highest attainable standard of physical and mental health' Equity is a major issue Liberation Theology and Health:  Liberation Theology and Health Observe Analysis Judge Structural violence Act Not just report one’s findings but struggle for the less fortunate’s liberation (read survival) Evolution of an epidemic:  Evolution of an epidemic 1986 1991 2001 Americans’ Perceptions of Urgent Health Problems of the World:  Americans’ Perceptions of Urgent Health Problems of the World Q2. What would you say is the most urgent health problem facing the world at the present time? Copyright © 2002 The Gallup Organization, Princeton, NJ. All rights reserved. Based on interviews with 800 adults ≥18 years old done in October and November 2002 AIDS is caused by HIV:  AIDS is caused by HIV Sexual transmission Blood borne—transfusion, injection drug use Perinatal--during and after birth Massive HIV/AIDS case load:  Massive HIV/AIDS case load Impact on health care workers: Increasing demand for care and support in health facilities and communities Overburdened in-patient and out-patient services Increased need for knowledge and skills on HIV/AIDS Increased need for voluntary confidential counselling and HIV testing Fear and discrimination Burn out Slide68:  Tuberculosis is a major global killer…. 16–20 million people with active TB globally 11 million people are currently infected with TB and HIV 8 million new TB cases annually 2 million TB deaths annually (including TB-HIV) TB is the biggest killer of people with HIV/AIDS TB is the largest cause of death among women of reproductive age Slide69:  Estimated HIV-MTB co-infection prevalence, 2000 Source: Corbett EL, Watt CJ, Walker N, Maher D, Raviglione MC, Williams B, Dye C. (submitted for publication). Slide70:  Africa: HIV is driving the TB Epidemic TB Notification Rates, 1980-1999 World Health Organization Slide71:  Percent of Cases MSM andamp; IDU Men who have sex with men (MSM) Injection drug use (IDU) Heterosexual contact Year of Diagnosis Estimated Adult/Adolescent AIDS Cases by Exposure Category and Year of Diagnosis, 1985 – 2002 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 Racism, prejudice and discrimination:  Racism, prejudice and discrimination There continues to be an outbreak of prejudice and discrimination… In the United States…. 'Haitian disease' 'GRID' Rock Hudson was a major breakthrough in US 'Self-inflicted disease' 'God’s wrath' Health care workers refused to work with people with HIV or who they thought had HIV Kids not allowed to attend school—Ryan White Current HIV epidemic among minorities Disease and poverty:GNP per capita and TB incidence:  Disease and poverty: GNP per capita and TB incidence TB Incidence GNP per capita in thousands of US Dollars . India . Bangladesh China . . Indonesia . Canada . US Current WB/IMF debt relief programs are inadequate :  Current WB/IMF debt relief programs are inadequate In 2002 Malawi received initial debt service cut of $28 million, or 30% per cent. Money used for a 45% rise in total 2001 social expenditure The breakdown of the $28 million for spending in the 2001 budget is:  $7.3 million more on critical drugs for hospitals and health centers  $2.7 million for extra staff and support in primary health centers  $1.1 million for training more nurses  $3.8 million for training new teachers  $6.1 million for repairs to schools and new teaching materials  $4.2 million for borehole construction and maintenance  $2.7 million for agriculture expansion  Source: Malawi's decision point document, 2000 Debt:  Debt In Zambia, where primary school rates are falling and one in five adults is HIV positive, has to find $176 million a year for debt repayments, compared to the $76 million currently spent on health and $70 million on education……. Net official aid (billion US$) by rich country donors to poor countries:  Net official aid (billion US$) by rich country donors to poor countries Aid in terms of billion US$ Commonly heard arguments against using ARVs in the resource poor settings…:  Commonly heard arguments against using ARVs in the resource poor settings… Unsustainable Inappropriate technology Not cost effective Not a priority in light of other demands Too difficult to administer Prevention is more important Too expensive Drug resistance Corruption, thievery and sale Stigma Comparison of Apparel Manufacturing Wages in 1998:  Comparison of Apparel Manufacturing Wages in 1998 By Kurt Salmon Associates “Race to the Bottom” supported by World Bank / IMF policies:  'Race to the Bottom' supported by World Bank / IMF policies World Bank plans to loan $23 million for a new free trade zone in Haiti The zone will build clothes factories for Tommy Hilfiger and Levis Haitian workers make 30 cents / hour Mexican and Jamaican workers make 75-85 cents / hour In July 2003, the management in Mexican factories that produce Tommy Hilfiger and Levis products fired and assaulted union workers Need for Holistic Public Health Perspective:  Need for Holistic Public Health Perspective Current focus on behavioral theory/interventions and biomedical model Improve individual 'self-efficacy' Provide treatment for individuals Too little emphasis on changing global and societal structural violence Customs Laws Policies Unfair economic system

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