centre for aids research world aids day 2004 some viewpoints and perspectives professor mike clark...
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Centre for AIDS Research
World AIDS Day 2004Some viewpoints and perspectives
Professor Mike Clark School of Geography
Director – Centre for AIDS Research
University ofSouthampton
The Centre for AIDS Research
The vision which fuelled our struggle for freedom; the development of energies and resources; the unity and commitment of common goals – all these are needed if we are to bring AIDS under control. Future generations will judge us on the adequacy of our response. Nelson Mandela
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
Research and policy-orientated engagement
Focus on impacts – social, economic, political,
environmental & bio-medical
Founded on strategic partnerships with
institutions, stakeholders, governments and agencies
A holistic approach – cross-disciplinary and
cross-sectoral
A distinctive mission
Centre for AIDS Research
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
The roots of health and welfare
Development . . .
But watch for challenges:
Pretoria - South Africa
AIDS and poverty?
Two pandemics or one?
More than a disease?
Soshanguve Township 10 miles from Pretoria
& underdevelopment?
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
Development founded on Health
The health of the individual
The welfare and income of the family
Supported children – not orphans
Functional communities and services
National economic stability
A stable society
AIDS
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
Global summary December 2003
The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information. These ranges are more precise than those of previous years.
People living with HIV/AIDS ………….. 40 million (34 - 46 million)
New HIV infections in 2003 ………….... 5 million (4.2 - 5.8 million)
Deaths due to HIV/AIDS in 2003 ……… 3 million (2.5 – 3.5 million)
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
40 million people are living with AIDS worldwide
20-25 million people have already died of AIDS
68 million more will die of AIDS by 2020
14000 people become newly infected every day
14 million AIDS orphans already
40 million by 2010!
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
HIV Cases Precede AIDS Cases
T1 T2 Time
Numbers - HIV
A1
A2
HIV prevalence
AIDS - cumulative
B1
A
B
Source: Whiteside & Sunter AIDS: The Challenge for South Africa, 2000, p. 27
Numbers - AIDS
Death rises later
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
HIV and AIDS diagnoses and deaths in HIV-infected individuals by year of diagnosis, United Kingdom, 1994-
2003
0
1000
2000
3000
4000
5000
6000
7000
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Year
Num
ber o
f dia
gnos
es
HIV diagnoses
AIDS diagnoses
Deaths
1 1
1 Numbers will rise, for recent years, as further reports are received.Data Source: HIV/AIDS reports. Reports received by the end of June 2004.
Slide Source: UK Collaborative Groupfor HIV and STI Surveillance
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
Rates of diagnosed HIV-infected adults seen for care, United Kingdom, 1998 and 2003 by residence, 1998 and
2003
Data source: SOPHID and CD4
monitoring scheme for Scotland.
Slide Source: UK Collaborative Group for HIV and STI Surveillance
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
Introducing HIV/AIDS
Understanding HIV/AIDS
Towards a Geography of HIV/AIDS
Responding to HIV/AIDS
Steps towards a response
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
Propensity - AIDS factors
Gender (girls more vulnerable)Age (sexually-active years)Poverty (directly and indirectly create propensity to infection)Sexually-transmitted diseases (STDs)
A 15-year old in Zambia has a 60% chance of dying of
AIDS
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
Vulnerability - AIDS triggers
Unsafe sex, mother-to-baby, drug injection, blood contactLACK OF SOCIAL COHESION
Migration (to work) - multiple partnersMilitary service (war/terrorism)RefugeesProstitutionChild abuse and rapeFatalism and traditional medicine
High wealth + high social cohesion = no epidemicLow wealth + low social cohesion = high epidemicLow wealth + high social cohesion = slow epidemic
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
INCIDENCE - the human dimension
The School Choir
SA prevalence of HIV/AIDS = 4.5 million
Women’s deaths peak at 24 years: men 29
One third HIV infections in school years
Population polarising <15 and >50 years
Perhaps 30% SA school children HIV+
Up to 40% at some SA universities
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
Introducing HIV/AIDS
Understanding HIV/AIDS
Towards a Geography of HIV/AIDS
Responding to HIV/AIDS
Looking beyond the maps
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
1. Policy-influencing & attitudinal
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
Western Europe520 000 – 680 520 000 – 680
000000North Africa & Middle
East470 000 – 730 000470 000 – 730 000
Sub-Saharan Africa25.0 – 28.2 25.0 – 28.2
millionmillion
Eastern Europe & Central Asia1.2 – 1.8 1.2 – 1.8 millionmillion
South & South-East Asia
4.6 – 8.2 million4.6 – 8.2 million
Australia & New Zealand
12 000 – 18 00012 000 – 18 000
North America790 000 – 1.2 million790 000 – 1.2 million
Caribbean350 000 – 590 000350 000 – 590 000
Latin America1.3 – 1.9 million1.3 – 1.9 million
East Asia & Pacific700 000 – 1.3 million700 000 – 1.3 million
People living with AIDS: end 2003
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
2. Strategic (targets & monitoring)
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
3. Operational (support & supervision)
Waterfall
Molweni
Msunduzi
Ngcolosi
Fredville
MpumalangaPeaceville
Hally Stott
Ntshongweni
Hlengisizwe
Qadi
Injabula
Zwelibomvu
Wyebank
Legend^ No clinic/mobile entered(15)
#* Bhekisisa Mobile Point_HS M1&2(3)
#* Botha's Hill Mobile Point_HS M1&2(1)
Fredville Clinic(9)
#* Gigaba Mobile Point_HS M1&2(6)
Halley Stott(2)
#* Halley Stott Mobiles 1&2(3)
Hlengisizwe Clinic(7)
") Injabulo Clinic_attached to Edendale Hospital(1)
#* Khayelihle Mobile Point_HS M1&2(4)
#* Mathebethu Mobile Point_HS M1&2(1)
#* Mgoqozi Mobile Point_HS M1&2(2)
#* Mhlabunzima Mobile Point_HS M1&2(12)
XWMobile(?) & Waterfall Clinic(1)
XWMobile(?) & Wyebank Clinic(2)
Molweni Clinic(16)
#* Molweni Clinic & Umgababa Mobile(1)
XWMpumalanga & Hlengisizwe(8)
XWMpumalanga & Peaceville(10)
Mpumalanga Clinic(14)
Msunduzi Clinic(23)
Ngcolosi Clinic(15)
Ntshongweni Clinic(9)
Peaceville Clinic(1)
") Qadi Building_KwaMashu Polyclinic(7)
#* Siyathuthuka Point_HS M1&2(1)
#* Smangenduku Point_HS M1&2(2)
#* Vulindlela Store Mobile Point_HS M1&2(2)
XWVulingqondo Pre-School(2)
kj Waterfall clinic(1)
kj Wyebank Clinic(7)
") Zwelibomvu Building_Prince Mshiyeni Polyclinic(3)Local Council
G Other Clinics in Outer West
G TVT related Clinics
Buffer of 5km around Msunduzi ClinicInner West CHW (106)South CHW (85 with 20 mistakes)Planning Units
Community Health Workers homesteads captured for the Outer West .Illustrating the clinics or mobiles their respective communities visit.Although most CHW seem to be within 5km of the clinictheir community uses, it does not confirm their communities fall within this radius.
Mapping – The Valley Trust
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
4. Community participation
P Johnstone & J Ranken (1994)
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
ElitismExclusion
EngagementEmpowering
Equity
The intellectual/moral challenge
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
Introducing HIV/AIDS
Understanding HIV/AIDS
Towards a Geography of HIV/AIDS
Responding to HIV/AIDS
Steps towards a response
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
As simple as ABC!
“If you do that, this is
what will happen to
you”
“OK, in that
case I won’t
do it”
Abstain Be faithful Condom
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
Making the message more realistic
ABCHarare, Zimbabwe
(after The Theory of Reasoned Action: Ajzen & Fishbein, 1975)
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
TREAT
COPEPREVENT
AIDSRESPONSE
Drug therapy/Lifestyle
Vaccine??Modify behaviour?
Tackle poverty!
Locate impact Assess impact Manage impact
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
Global spending on AIDS prevention and care in developing countries about $2 billion a year – about
the same as the UK floods in 2000!
<1% of 28.5 million people with HIV/AIDS in Africa have access to drugs
Don’t expect too much!
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
CLINICS diagnosis
treatment advice
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
Training . . . Counselling . . . Destigmatising
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
Peer advice -Making the message cool
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
An image from the sexual health information campaign, England
(Department of Health)
Slide Source: UK Collaborative Groupfor HIV and STI Surveillance
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
TREAT
COPEPREVENT
AIDSRESPONSE
Drug therapy/Lifestyle
Vaccine??Modify behaviour?
Tackle poverty!
Locate impact Assess impact Manage impact
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
The World Bank TAP
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
Community Health Workers
ORGANISATIONAL STRUCTURESPATIAL STRUCTURE
“governance”
“spatial structure”
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton
Acknowledge the problem of
HIV/AIDSFIRST STEP COMMITMENT
Tackle the underlying
poverty/politicsTHE STRATEGY
Confront the disease and plan
the response
The Centre for AIDS Research
The geography of HIV/AIDS: looking beyond the maps
I live in hopeI hope I live