the political geography of aids

The Political Geography of AIDS

Alan WhitesideDirector,HEARD, University of

KwaZulu-Natal and Leverhulme Visiting Professor,

Centre for AIDS Research Southampton University

Outline of presentation• Physical geography• Economic geography• Human geography

–Demography –Development

HIV prevalence in adults in sub-Saharan Africa, 1986-

2001

20 – 39%10 – 20% 5 – 10% 1 – 5% 0 – 1%

trend data unavailableoutside region

1986 1991

1996 2001

HIV prevalence in adults in sub-Saharan Africa, end

200120 – 39%10 – 20% 5 – 10% 1 – 5% 0 – 1%

trend data unavailableoutside region

2001

HIV Prevalence

1 - 3%

3 - 6%

6 - 9%

9 - 12%

12 - 15%

15 - 18%

18 - 21%

21 - 24%

24 - 27%

27 - 30%

30 - 33%

33 - 36.2%

Provinces

Northern Cape

Eastern Cape

Free State

North West

Western Cape

Northern Province

KwaZulu-Natal

MpumalangaGauteng

1997Northern Cape

Eastern Cape

Free State

North West

Western Cape

Northern Province

KwaZulu-Natal

MpumalangaGauteng

1998

Northern Cape

Eastern Cape

Free State

North West

Western Cape

Northern Province

KwaZulu-Natal

MpumalangaGauteng

1999

Northern Cape

Eastern Cape

Free State

North West

Western Cape

Northern Province

KwaZulu-Natal

MpumalangaGauteng

2000

Northern Cape

Eastern Cape

Free State

North West

Western Cape

Northern Province

KwaZulu-Natal

MpumalangaGauteng

1994

Northern Cape

Eastern Cape

Free State

North West

Western Cape

Northern Province

KwaZulu-Natal

MpumalangaGauteng

1995

Northern Cape

Eastern Cape

Free State

North West

Western Cape

Northern Province

KwaZulu-Natal

MpumalangaGauteng

1996

Progression of HIV Prevalence in South AfricaTrends Amongst Provincial AnteNatal Clinic Attendees, 1994-2000

Source: National HIV and Syphilis Sero-PrevalenceSurvey of Women Attending Public AnteNatalClinics in South Africa, 1994 - 2000.

The Health Economics & HIV/AIDS Research DivisionUniversity of NatalKing George V AvenueDurban, 4041Tel: +27 31 260 2592Fax: +27 31 260 2587Email: [email protected]: www.und.ac.za/und/heard

Developed by Susan Erskine & Lucinda Franklin

We wish to acknowledge the assistance of staff atEduAction in the development of this output.In particular, we wish to thank Daniel Wilson for hisinvaluable guidance, time and provision of resources.

Legend

Intro.

Wealth and HIV

1000 $

2000 $

3000 $

Per capita 1999

Adult HIV prevalence end 1999

Botswana

South Africa

Namibia

Swaziland

ZimbabweUganda

Cote d’Ivoire

Zambia10

10 20 30

Debswana Diamond Company (Pty) Ltd

HIV Prevalence by Job Band

30.9% 30.7%27.6%

19.3% 18.8%

0

5

10

15

20

25

30

35

A Band B Band C Band D Band F Band

% H

IV p

ositi

ve e

mpl

oyee

s in

eac

h jo

b ba

nd

World HIV Chart World HIV Chart 20012001

Perc

ent

adul

ts li

ving

wit

h H

IV

(log

)

0.1

Annual income per person in US dollar (ppp & log)300 40 0001

0005

00010

00020

0002

000500

0.5

1

5

10

3020

7

32

Alger

ia

Angola

Argentina

Armenia

Austr

alia

Austria

Azer

baija

nBahrain

Bang

lades

hBarbados

Belarus

Belgium

Belize

Benin

Bhut

an

Boliv

ia

Botswana

Brazil

Bulga

ria

Burundi

Cambodia

Cameroon

Canada

Central African Rep.

Chad

Chile

Chin

a

Colombia

Costa Rica

Côte d'Ivoire

Croa

tia

Cuba

Cyprus

Czec

h Rep

ublic

Denmark

Dominican Rep.

EcuadorEg

ypt

El Salvado

r

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Fiji

Finlan

d

France

Geor

gia

Germ

any

Ghana

Greece

Guatemala

Guinea-Bissau

Guyana

Haiti

Honduras

Hung

ary

Iceland

Indon

esia

Irelan

dIsrae

l

Italy

Jamaica

JapanJorda

n

Kenya

Repu

blic o

f Kor

ea

Latvia

Lesotho

Lithu

ania

Luxembourg

Madagascar

Malawi

Malaysia

Maldi

ves

Mali

Malta

Maur

itius

Mexico

Mong

olia

Moro

cco

Mozambique

Namibia

Nepal

Netherlands

New

Zeala

nd

Nicaragua

Nigeria

Norw

ay

Pakis

tan

PanamaPapua New Guinea

PeruPh

ilippin

es

Portugal

Roma

nia

Russia

Rwanda

Senegal

Sierra Leone

Singapore

Slove

nia

South Africa

SpainSr

i Lan

ka

Sudan

Suriname

Swaziland

Swed

en

Switzerland

Tajik

istan

Thailand

Togo

Trinidad & Tobago

Turk

ey

Turk

menis

tan

Uganda

Ukraine

Unite

d King

dom

United Statesof America

Uruguay

Uzbe

kista

nVenezuela

Yemen

Zambia

Zimbabwe

BurkinaFaso

India

AIDS deaths per year

300 000100 00010 000

1 000

AfricaAmericas

Arab countries

AsiaEurope

Continents

0.20.3


Perc

ent

adul

ts li

ving

wit

h H

IV

(log

)

0.1

Annual income per person in US dollar (ppp & log)300 40 0001

0005

00010

00020

0002

000500

0.5

1

5

10

3020

7

32

Alger

ia

Angola

Argentina

Armenia

Austr

alia

Austria

Azer

baija

nBahrain

Bang

lades

hBarbados

Belarus

Belgium

Belize

Benin

Bhut

an

Boliv

ia

Botswana

Brazil

Bulga

ria

Burundi

Cambodia

Cameroon

Canada


Chad

Chile

China

Colombia

Costa Rica

Côte d'Ivoire

Croa

tia

Cuba

Cyprus

Czec

h Rep

ublic

Denmark

Dominican Rep.

EcuadorEg

ypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Fiji

Finlan

d

France

Geor

gia

Germ

any

Ghana

Greece

Guatemala

Guinea-Bissau

Guyana

Haiti

Honduras

Hung

ary

Iceland

Indon

esia

Irelan

dIsrae

l

Italy

Jamaica

JapanJorda

n

Kenya

Repu

blic o

f Kor

ea

Latvia

Lesotho

Lithu

ania

Luxembourg

Madagascar

Malawi

Malaysia

Maldi

ves

Mali

Malta

Maur

itius

Mexico

Mong

olia

Moro

cco

Mozambique

Namibia

Nepal

Netherlands

New

Zeala

nd

Nicaragua

Nigeria

Norw

ay

Pakis

tan

Panama

Papua New Guinea

PeruPh

ilippin

es

Portugal

Roma

nia

Russia

Rwanda

Senegal

Sierra Leone

Singapore

Slove

nia

South Africa

SpainSr

i Lan

ka

Sudan

Suriname

Swaziland

Swed

en

Switzerland

Tajik

istan

Thailand

Togo

Trinidadand Tobago

Turk

ey

Turk

menis

tan

Uganda

Ukraine

Unite

d King

dom


Uruguay

Uzbe

kista

nVenezuela

Yemen

Zambia

Zimbabwe

BurkinaFaso

India


300 000100 00010 000

1 000

AfricaAmericas

Arab countries

AsiaEurope

Continents

0.20.3

X200?


Perc

ent a

dults

livi

ng w

ith H

IV (l

og)

0.1

Annual income per person in US dollar (purchasing power) Log

300 40 0001 000

5 000

10 000

20 000

2 000500

0.5

1

5

10

3020

7

32

Alger

ia

Angola

Argentina

Armenia

Austr

alia

Austria

Azer

baija

nBahrain

Bang

lades

hBarbados

Belarus

Belgium

Belize

Benin

Bhut

an

Boliv

ia

Botswana

Brazil

Bulga

ria

Burundi

Cambodia

Cameroon

Canada


Chad

Chile

China

Colombia

Costa Rica

Côte d'Ivoire

Croa

tia

Cuba

Cyprus

Czec

h Rep

ublic

Denmark

Dominican Republic

EcuadorEg

ypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Fiji

Finlan

d

France

Geor

gia

Germ

any

Ghana

Greece

Guatemala

Guinea-Bissau

Guyana

Haiti

Honduras

Hung

ary

Iceland

Indon

esia

Irelan

dIsrae

l

Italy

Jamaica

JapanJorda

n

Kenya

Repu

blic o

f Kor

ea

Latvia

Lesotho

Lithu

ania

Luxembourg

Madagascar

Malawi

Malaysia

Maldi

ves

Mali

Malta

Maur

itius

Mexico

Mong

olia

Moro

cco

Mozambique

Namibia

Nepal

Netherlands

New

Zeala

nd

Nicaragua

Nigeria

Norw

ay

Pakis

tan

Panama

PapuaNew Guinea

PeruPh

ilippin

es

Portugal

Roma

nia

Russia

Rwanda

Senegal

Sierra Leone

Singapore

Slove

nia

South Africa

SpainSr

i Lan

ka

Sudan

Suriname

Swaziland

Swed

en

Switzerland

Tajik

istan

Thailand

Togo

Trinidadand Tobago

Turk

ey

Turk

menis

tan

Uganda

Ukraine

Unite

d King

dom


Uruguay

Uzbe

kista

nVenezuela

Yemen

Zambia

Zimbabwe

BurkinaFaso

India


300 000100 00010 000

1 000

AfricaAmericas

Arab countries

AsiaEurope

Continents

0.20.3

10 X20=200

0

10

20

30

40

50

6019

8519

8719

8919

9119

9319

9519

9719

9920

0120

0320

0520

0720

09

Mill

ions

Tota

l pop

ulat

ion

0

1

2

3

4

5

6

7

8

9

Mill

ions

Num

bers

HIV

, AID

S si

ck a

nd H

IV d

eath

s

Totalpopulation

Total HIV

TotalnumberAIDS sick

CumulativeHIVdeaths

Numbers infected, sick & dead ASSA2000

All orphans & orphans due to AIDS by HIV prevalence Uganda

1985 1990 1995 2000 2005 2010 Year0

0.5 million

1 million

1.5 million

2 million

Total Number

0

6%

12%

HIV Prevalence

Total OrphansAIDS OrphansHIV Prevalence

Estimated and projected deaths 15-34, with and without AIDS in South Africa: 1980-2025

Source: UN Department of Economic and Social Affairs (2002) World Population Prospects, the 2000 Revision

0

400

800

1,200

1,600

2,000

Dea

ths

(tho

usan

ds)

1980-19851985-1990

1990-1995

1995-20002000-2005

2005-2010

2010-20152015-2020

2020-2025

Without AIDS With AIDS

0 10 20 30 40 50 60 70CambodiaHaiti

MozambiqueRwandaCôte d'IvoireZambiaKenyaSouth AfricaZimbabweBotswana

Life expectancy at birth (years)

Predicted life expectancy Loss in life expectancy due to HIV/AIDS

Predicted loss in life expectancy Predicted loss in life expectancy due to HIV/AIDS in children born in due to HIV/AIDS in children born in

20002000

Source: U.S. Census Bureau, 2000

Estimated increase in adult death rates relative to the 1985 rates

Women

0.000

0.500

1.000

1.500

2.000

2.500

3.000

3.500

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

Age

Ratio

1994

1996

1997/8

1998/99

1999/2000

Changing life expectancy in African countries with high and low HIV prevalence: 1950-2005

Source: UNAIDS, 2002. Report on the global HIV/AIDS epidemic

Projected Population Structure: Botswana 20202020

80757065605550454035302520151050

020406080100120140 0 20 40 60 80 100 120 140

Males Females

Deficits due to AIDS

Projected population structure in 2020

Population (thousands)

Age

in y

ears

Source: US Census Bureau, World Population Profile 2000

the political geography of aids

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