hiv and aids epidemic: potential contribution from dss sites
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HIV and AIDS Epidemic: Potential Contribution from DSS sites. Nyovani Madise, PhD Centre for Global Health, Population, Poverty & Policy. What Do We Already Know?. 39 million infected with virus 4 million new infections per year - PowerPoint PPT PresentationTRANSCRIPT
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HIV and AIDS Epidemic: Potential Contribution from
DSS sites
Nyovani Madise, PhD
Centre for Global Health, Population, Poverty & Policy
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What Do We Already Know?
• 39 million infected with virus
• 4 million new infections per year
• Globally, HIV infections are unevenly spread- 29 million of those infected living in Africa
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Geography of HIV and AIDSPrevalence in adults, 2005
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Number of people living with HIV
% HIV prevalence, adult (15-49)
1985 1990 1995 2000 2005
0
5
10
15
20
25
30
0.0
2.5
5.0
7.5
12.5
15.0
% HIV prevalence, adult (15‒49)
HIV epidemic in sub-Saharan Africa, 1985‒2005*
Number of peopleliving with HIV (millions)
This bar indicates the range around the estimate
*
10.0
2.2
Source: UNAIDS 2006 Report on Global AIDS Epidemic
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Increasing Mortality
Male adult mortality (15 - 49 years) 1992 & 2000 Malawi DHS
0
5
10
15
20
25
15-19 20-24 25-29 30-34 25-39 40-44 45-49
Age in years
Death
s p
er
1000
1992
2000
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Population by age and sex, South Africa, 2020 (under “no AIDS” scenario)
Source: United Nations, World Population Prospects: The 2004 Revision, CD-ROM Edition, Extended Dataset (2005).
South Africa in 2020 Without AIDS:
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Source: United Nations, World Population Prospects: The 2004 Revision, CD-ROM Edition, Extended Dataset (2005).
South Africa in 2020 With AIDS (Medium AIDS Scenario)
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Stagnation or Increase in Childhood Mortality
Changes in infant mortality in selected African countries with high HIV prevalence
0
20
40
60
80
100
120
140
160
Malawi Coted'Ivoire
Kenya Uganda Zambia Zimbabwe
De
ath
s p
er
10
00
live
bir
ths
Early 90s
Late 90s-2000
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Social and Economics Aspects
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National Wealth & HIV Prevalence
1000 $
2000 $
3000 $
Per capita 1999
Adult HIV prevalence end 1999
Botswana
South Africa
Namibia
Swaziland
ZimbabweUganda
Cote d’Ivoire
Zambia10
10 20 30
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Household Wealth and HIV Prevalence
Malawi
0
5
10
15
20
Lowest Second Middle Fourth Highest
Wealth Quintiles
HIV
prev
alen
ce (%
)
Women Men
Kenya
0
2
4
6
8
10
12
14
Lowest Second Middle Fourth Highest
Wealth Quintiles
HIV
prev
alenc
e (%
)
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HIV Prevalence by Age at First Sexual intercourse
0
2
4
6
8
10
12
14
16
18
20
Kenya Malawi Uganda
Ad
ult
HIV
pre
val
ence
(%) <15 years
15-17
18-19
20+
Sources: DHS surveys
Women
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Gender Differences in HIV Prevalence
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What We Know and Don’t Know…
BIOCHEMISTRY
POTENTIAL IMPACTS
TREATMENT
BEHAVIOURALSTUDIES
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DSS Sites Can Advance Knowledge
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A Population-based Longitudinal Assessment of ART Rollout:
Effects on Individuals, Populations, and, Health Systems
Proposal by INDEPTH Network
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5-year evaluation of the antiretroviral therapy (ART) roll-out programmes at INDEPTH sites in West, East and Southern Africa
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Collaborating Sites
• Agincourt (South Africa)
• Nairobi (Kenya)
• Bandim (Guinea Bissau)
• Ifakara (Tanzania)
• Kisumu (Kenya)
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Overall Objectives
Effect of ART roll-out on
• Individuals under treatment & families
• The population
• Health systems
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Effect on Individuals and Their Families
• Survival after starting ART
• Quality-of-life on ART
• Sexual behaviour of individuals taking ART
• Economic impact on households with member taking ART
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Effect of ART on the Population
• Trends in mortality, morbidity, and survival in DSS communities
• Household structure and childcare
• Sexual behaviour in the population
• Stigma at population level
• Access to ART- what % of those who need it are receiving it?
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Effect of ART and the Health System
• Understanding ART roll-out national policies, how they are developed/revised
• Interpretation and application of policies at district level
• Equity in provision of ART
• ART impacts on other health services
• Improving effectiveness of ART roll-out programmes
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Proposed Activities
Existing DSS activities• Verbal autopsies on cause of death• Population and household structure• Socio-economic status
Additional activities• Population-based HIV testing• Morbidity, sexual behaviour studies• Closer linkage with health service provider
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Thank You