"HIV/AIDS in Southern Africa: A Dispatch from the Battlelines" By Prof. Alan Whiteside Director, HEARD Southampton January, 2005

Headlines HIV/AIDS prevalence rises Impact becoming apparent Response picks up momentum -Governments -International agencies -NGOs -CHGA Treatment slow

Presentation Outline Prevalence Impacts –Demographic –Political –Economic Response Treatment

Freedom! 2 nd Democratic Election HIV Prevalence South Africa Women Attending Public Antenatal Clinics FREEDOM! 2 nd General Election

National trends in HIV prevalence Women attending Public Antenatal Clinics

Epidemic Curve: HIV 27Aug01-Report I:Epidem’gy& Lit.p.27 T 1 T 2 Time Numbers A 1 A 2 HIV prevalence A B

Epidemic Curves: HIV and AIDS

Epidemic Curve: HIV, AIDS and Impact 27Aug01 -Report I:Epidem’gy & Lit. p.27 T 1 T 2 Time Numbers A 1 A 2 HIV prevalence B 1 A B AIDS - cumulative Impact

YearProvinceGroupN% 1985KwaZulu NatalRural community TransvaalMiners TransvaalSex workers KwaZulu NatalAntenatal women Outpatient Source: Abdool Karim SS. S Afr Med J, 1999; 89: Dusheiko GM. Am J Epidemiol. 1989; 129(1): HIV infection in selected groups from

Source: Wilkinson D, Abdool Karim SS, Williams B, Gouws E. JAIDS 2000; 23: Age Group %21.1%39.3%50.8% %18.8%36.4%47.2% %15.0%23.4%38.4% %3.4%23.0%36.4% Temporal trends in the age-specific prevalence of HIV infection in antenatal clinic attendees in Hlabisa

A model of future AIDS and non-AIDS Deaths

All orphans & orphans due to AIDS by HIV prevalence Uganda million 1 million 1.5 million 2 million Total Number 0 6% 12% HIV Prevalence Total Orphans AIDS Orphans HIV Prevalence

Impact of HIV/AIDS Demographic Political Economic

Changing life expectancy in African countries with high and low HIV prevalence: Source: UNAIDS, Report on the global HIV/AIDS epidemic

By-Elections in Zambia Source: IDASA

Non-registration HIV prevalence _ _ + + Pearson’s r =.7 Level of analysis: the nine provinces Non-participation by young women in South Africa

Estimates of the impact of AIDS on economic growth, 1992−2000 Source: (1) Botswana, Lesotho, Namibia data: Sackey and Raparla, (2) South Africa data: Arndt and Lewis (3) Botswana data: Greener, Jefferis and Siphambe, (4) 30 Countries data: Over, (5) Cameroon data: Kambou et al, % -1.50% -1.00% -0.50% 0.00% Cameroon**30 Countries*Botswana***South Africa**Botswana, Lesotho, Namibia* Methodology: * Demographic and economic modelling ** CGE Simulations *** Economic 2004 Report on the Global AIDS Epidemic (Fig 14)

By 2010 orphans will account for 15-25% of all children in 12 countries in SAA Source: UNICEF

Conclusions 1 Prevention Care and treatment Mitigation

World HIV Chart 2001 Percent adults living with HIV (log) 0.1 Annual income per person in US dollar (ppp & log) Algeria Angola Argentina Armenia Australia Austria Azerbaijan Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Botswana Brazil Bulgaria Burundi Cambodia Cameroon Canada Central African Rep. Chad Chile China Colombia Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Dominican Rep. Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Georgia Germany Ghana Greece Guatemala Guinea- Bissau Guyana Haiti Honduras Hungary Iceland Indonesia Ireland Israel Italy Jamaica Japan Jordan Kenya Republic of Korea Latvia Lesotho Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Mauritius Mexico Mongolia Morocco Mozambique Namibia Nepal Netherlands New Zealand Nicaragua Nigeria Norway Pakistan Panama Papua New Guinea Peru Philippines Portugal Romania Russia Rwanda Senegal Sierra Leone Singapore Slovenia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Tajikistan Thailand Togo Trinidad & Tobago Turkey Turkmenistan Uganda Ukraine United Kingdom United States of America Uruguay Uzbekistan Venezuela Yemen Zambia Zimbabwe Burkina Faso India AIDS deaths per year Africa Americas Arab countries Asia Europe Continents

World HIV Chart 2001 Percent adults living with HIV (log) 0.1 Annual income per person in US dollar (ppp & log) Algeria Angola Argentina Armenia Australia Austria Azerbaijan Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Botswana Brazil Bulgaria Burundi Cambodia Cameroon Canada Central African Rep. Chad Chile China Colombia Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Dominican Rep. Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Georgia Germany Ghana Greece Guatemala Guinea- Bissau Guyana Haiti Honduras Hungary Iceland Indonesia Ireland Israel Italy Jamaica Japan Jordan Kenya Republic of Korea Latvia Lesotho Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Mauritius Mexico Mongolia Morocco Mozambique Namibia Nepal Netherlands New Zealand Nicaragua Nigeria Norway Pakistan Panama Papua New Guinea Peru Philippines Portugal Romania Russia Rwanda Senegal Sierra Leone Singapore Slovenia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Tajikistan Thailand Togo Trinidad and Tobago Turkey Turkmenistan Uganda Ukraine United Kingdom United States of America Uruguay Uzbekistan Venezuela Yemen Zambia Zimbabwe Burkina Faso India AIDS deaths per year Africa Americas Arab countries Asia Europe Continents X 200 ?

World HIV Chart 2001 Percent adults living with HIV (log) 0.1 Annual income per person in US dollar (purchasing power) Log Algeria Angola Argentina Armenia Australia Austria Azerbaijan Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Botswana Brazil Bulgaria Burundi Cambodia Cameroon Canada Central African Rep. Chad Chile China Colombia Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Georgia Germany Ghana Greece Guatemala Guinea- Bissau Guyana Haiti Honduras Hungary Iceland Indonesia Ireland Israel Italy Jamaica Japan Jordan Kenya Republic of Korea Latvia Lesotho Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Mauritius Mexico Mongolia Morocco Mozambique Namibia Nepal Netherlands New Zealand Nicaragua Nigeria Norway Pakistan Panama Papua New Guinea Peru Philippines Portugal Romania Russia Rwanda Senegal Sierra Leone Singapore Slovenia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Tajikistan Thailand Togo Trinidad and Tobago Turkey Turkmenistan Uganda Ukraine United Kingdom United States of America Uruguay Uzbekistan Venezuela Yemen Zambia Zimbabwe Burkina Faso India AIDS deaths per year Africa Americas Arab countries Asia Europe Continents X 20 =200

HEARD Research Educator reported Orphan Incidence in Amabuja District, Newcastle, KwaZulu-Natal GIS (with Southampton)

Projected Number of schools with learners experiencing new parent death between April-July 2004 Amajuba District, Newcastle, April-July 2004 N = 43 Schools Source: HEARD, 2004

Number of new orphans reported in schools Amabuja District, Newcastle, April-July 2004 N = 43 Schools Source: HEARD, 2004

A Spatial Framework for the Management & Support of Orphans and Vulnerable Children in KwaZulu-Natal “The care and protection of children is a practice and ethic rooted deep in the wisdom and culture of all societies” – James Grant Daniel Wilson, Su Erskine, Peter Badcock-Walters, HEARD/MTT (Study supported by Rockefeller Brothers Fund)

Aims and Objectives Define, identify and geolocate OVC and service organisations; Establish relationships between OVC & service providers; Develop adaptive management tools & share accessible data.

The Geographic Information System Approach (GIS) Analyse & visualise layers of information Tools for data exploration Outputs tables, graphs & maps

State Social Service Delivery Source: EduAction

Access to Magistrates Courts

Distribution of All NGO OVC Services

Targets SA ARV treatment target announced in Cabinet Statement on 19th November Operational target of 53,000 people on ARV treatment by March 2004, (extended March 2005). The Medical Research Council says people fulfil criteria for treatment already

Achievements (?) In September 2004, close to 8000 people were on ARV treatment at public health facilities nationally. At end of November 2004, approx. 18,500 people on treatment. Most in Gauteng, the Western Cape and KwaZulu-Natal.

Current patient numbers by province ProvinceOperational Plan March 2004 (05) Total patients (Adults and Children) % on Western Cape Eastern Cape Northern Cape 790[150]19 Gauteng 10, KZN 24,902[3004] Limpopo 6965[300]4 North West Free State Mpumalanga 1934[500]26 TOTAL (53,000)Approx 18,50034 Source: Treatment Action Campaign ( [ ] denotes unsure of accuracy *A site usually means a hospital plus several feeder clinicswww.tac.org.za

Aluta continua Leadership Prevention Treatment Social development