City epidemics matter! The urban HIV & AIDS epidemic in Eastern and Southern Africa: Need for better KYE/KYR to inform adequate city responses Dedicated to Dr Mark Colvin (deceased 31/01/2012) Van Renterghem H. 1, Colvin M. 2, De Beer I. 3, Gunthorp J. 4, Odiit M. 1, Thomas L. 5, Jackson H. 1, Getahun M. 6 1 UNAIDS, Namibia 2 Maromi Health Research, South Africa 3 PharmAccess Foundation, Namibia 4 Southern African AIDS Trust, South Africa 5 Wits University, South Africa 6 UNDP, Africa Regional Office, South Africa Acknowledgements: SEARCH-network, Ghys P, Mahy M, Gouws E, Daher J

2 Background Source: United Nations, Department of Economic and Social Affairs, Population Division: World Urbanization Prospects, the 2009 Revision. New York 2010 Urban Agglomerations in 2025 (proportion urban of the world: 56.6%) The proportion of PLHIV living in urban areas in SSA has been rising due to higher urban prevalence & continued urbanization Source: unpublished estimates, UNAIDS 2012

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Conclusions & Recommendations Conclusions – Large City epidemics matter & provide opportunities to mobilise resources and to make a significant contribution to scaling up and sustaining national responses to AIDS - Addressing large city epidemics requires a mindshift and attention to the urban vulnerable - We need better city specific data & KYE/KYR Recommendations for large and generalized city HIV epidemics a) Strategic Information –Improve data collection –Conduct city specific KYE/KYR and synthesis exercises to inform planning & delivery of services b) Leadership and coordination: –Promote leadership & ownership by city authorities and partnerships c) Planning & Service delivery –Ensure National AIDS strategies address the urban dimension of the epidemic and prioritise large city epidemics. –Enhance synergy & integration of HIV services in cities with other urban development and health programmes. –Pay particular attention to targeted and equitable services for urban women, key populations and slum populations.