01 July 2002 slide number SSA-1 HIV/AIDS in sub-Saharan Africa July 2002

01 July 2002 slide number SSA-2 Trends in the HIV/AIDS Epidemic Different Sectors of the Population HIV/AIDS and Youth Impact of HIV/AIDS Knowledge and Behavior Success Stories

01 July 2002 slide number SSA-3 Trends in the HIV/AIDS Epidemic

01 July 2002 slide number SSA-4 HIV prevalence in adults in sub-Saharan Africa, end – 39% 10 – 20% 5 – 10% 1 – 5% 0 – 1% trend data unavailable outside region 2001

01 July 2002 slide number SSA-5 HIV prevalence in adults in sub-Saharan Africa, – 39% 10 – 20% 5 – 10% 1 – 5% 0 – 1% trend data unavailable outside region

01 July 2002 slide number SSA-6 Number of people living with HIV/AIDS in sub-Saharan Africa, Millions Source: UNAIDS, 2002

01 July 2002 slide number SSA-7 Number of people who died from HIV/AIDS in sub-Saharan Africa, ,000 1,500 2,000 2, Thousands Source: UNAIDS, 2002

01 July 2002 slide number SSA ‘91‘92‘93‘94‘95‘96‘97‘98‘99‘01 Source: Department of Health, Republic of South Africa HIV prevalence among pregnant women in South Africa, 1990 to 2001 HIV prevalence (%)

01 July 2002 slide number SSA-9 Estimated adult HIV prevalence in Kenya, Source: National AIDS and STD Control Programme, 1999 and UNAIDS HIV prevalence (%)

01 July 2002 slide number SSA-10 Kenya: HIV prevalence for adults and pregnant women Major urban and outside major urban areas Year HIV prevalence (%) Source: 1 UNAIDS/WHO Epi Country Fact Sheets U.S. Census Bureau Database

01 July 2002 slide number SSA-11 Senegal: HIV prevalence for pregnant women Major urban and outside major urban areas Year Urban Outside Urban Median (Urban) Median (Outside Urban) UNAIDS adult prevalence HIV Prevalence, (%) Source: 1 UNAIDS/WHO Epi Country Fact Sheets U.S. Census Bureau Database. 3 Conseil National de Lutte Contre le SIDA, Republique du Senegal

01 July 2002 slide number SSA-12 HIV prevalence rates among pregnant women attending antenatal clinics in urban sites in Cameroon: Bamenda Limbe Yaounde Garoua % HIV-positive Source: National AIDS Programme, Cameroon ( ). Data compiled by the US Census Bureau

01 July 2002 slide number SSA-13 Launch of AAI Negotiation with R&D Pharma within the AAI Cipla offer of price reduction to Uganda Further price reductions by BMS and Merck Further discussion with Cipla 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 Price US$ Jun 1998 Jul 1998 Aug 1998 Apr 2000 Nov 2000 Dec 2000 Jan 2001 Feb 2001 Mar 2001 Apr 2001 May 2001 Jun 2001 Jul 2001 Aug 2001 Oct 2000 Source: WHO/UNAIDS, 2002 Prices (US$/year) of a first-line antiretroviral regimen in Uganda:

01 July 2002 slide number SSA-14 Different Sectors of the Population

01 July 2002 slide number SSA-15 HIV prevalence among people consuming alcohol and among non-drinkers, Carletonville, South Africa, menwomenwomen in commercial sex areas drinkers non-drinkers Source: Campbell et al. (unpublished data) HIV prevalence (%)

01 July 2002 slide number SSA-16 HIV prevalence rate and frequency of sexually transmitted infection (STI) episodes, Carletonville miners, South Africa, Number of STI episodes Source: Ballard R, 2000 (unpublished data). HIV prevalence (%)

01 July 2002 slide number SSA-17 Percentage of workforce lost to AIDS by 2005 and 2020 in selected African countries % Botswana Cameroon Central African Republic Cote d’Ivoire Ethiopia Guinea-Bissau Mozambique Nigeria South Africa Togo United Rep. of Tanzania Zimbabwe Sources: ILO (2000) POPILO population and labour force projection; UN Department of Economic and Social Affairs, Population Division (1998) World Population Prospects: the 1998 Revision

01 July 2002 slide number SSA-18 HIV prevalence in military personnel in Africa l Nigeria: 11% among peacekeepers returning from Sierra Leone and Liberia vs 5% in adult population l South Africa: 60-70% in military vs 20% in adult population Source: Nigeria AIDS bulletin No 15, May 20, 2000; The Mail & Guardian, Pretoria, March 31, 2000; UNAIDS/WHO 1999 estimate

01 July 2002 slide number SSA-19 HIV prevalence by self-reported urban/rural residence among ANC attendees aged 15-24, Zimbabwe 2000 p = 0.8 Source: Ministry of Health and Child Welfare, Zimbabwe Rural (n=1753) Urban (n=1544) Place of Usual Residence Percent

01 July 2002 slide number SSA-20 Newly diagnosed AIDS cases and medical expenditure on an agricultural estate in Kenya, 1989 to Number of newly diagnosed AIDS cases Medical expenditure (KSh millions) new AIDS cases medical spending Source: Rugalema et al. HIV/AIDS and the commercial agricultural sector of Ken UNDP/FAO, 1999

01 July 2002 slide number SSA-21 Condom use among men with non-regular partners over time in selected sub-Saharan African countries: Malawi Tanzania Uganda Zambia % Source: Macro International ( ) Demographic Health Surveys; Measure Evaluation

01 July 2002 slide number SSA-22 HIV prevalence by educational level among ANC attendees aged 15-44, Zimbabwe, 2000 p<0.01 Source: Ministry of Health and Child Welfare, Zimbabwe None (n=154) Primary (n=1769) Secondary (n=3718) Tertiary (n=9) Education Level Percent

01 July 2002 slide number SSA-23 HIV/AIDS and Youth

01 July 2002 slide number SSA-24 Prevalence among pregnant women in major urban areas, Uganda Source: Uganda National AIDS Programme Prevalence

01 July 2002 slide number SSA-25 HIV prevalence by age among ANC attendees, Zimbabwe 2000 Source: Ministry of Health and Child Welfare, Zimbabwe n= n= n= n= n= n=96 Age Group Percent

01 July 2002 slide number SSA-26 HIV prevalence rate among teenagers by age in Kisumu, Kenya Age in years HIV prevalence (%) boys girls Source: National AIDS Programme, Kenya, and Population Council, 1999

01 July 2002 slide number SSA-27 Percentage of women who are mothers or pregnant by the end of their teens, Source: Demographic and Health Surveys, various countries Benin Cameroon CAR Comoros Côte d'Ivoire Ghana Kenya Madagascar Mali Mozambique Namibia Niger Nigeria Rwanda Senegal Togo Uganda Zambia Zimbabwe Percentage of women

01 July 2002 slide number SSA-28 The Impact of HIV/AIDS

01 July 2002 slide number SSA-29 Projected population structure with and without the AIDS epidemic, Botswana, MalesFemales Deficits due to AIDS Projected population structure in 2020 Population (thousands) Age in years Source: US Census Bureau, World Population Profile 2000

01 July 2002 slide number SSA-30 Increase in mortality among men between 15 and 60, selected African countries, Tanzania 1996 Malawi 1992 Zimbabwe 1994 Uganda 1995 Zambia Probability of dying from all causes estimated for 6 years before survey estimated for year of survey Source: Timaeus I, AIDS 1998, 12 (suppl): S15-S27

01 July 2002 slide number SSA-31 Adult mortality attributable to HIV, community-based studies in Africa, Source: Boerma JT et al, AIDS 1998, 12 (suppl 1): S3-S Rakai, Uganda (21% HIV) Masaka, Uganda (8% HIV) Kisesa, Tanzania (7% HIV) Mwanza, Tanzania (4% HIV) Mortality per 1,000 person - years Mortality among HIV-negatives Excess mortality due to HIV

01 July 2002 slide number SSA-32 Trends in mortality among children under five years old and end-1999 adult HIV prevalence rate, selected African countries, Source: Demographic and Health Surveys, Macro International, USA Kenya HIV prevalence 14.1% Zambia HIV prevalence 19.9% Cameroon HIV prevalence 7.7% 80 % 85 % 90 % 95 % 100 % 105 % 110 % Relative under-5 mortality (1981 = 100 %)

01 July 2002 slide number SSA-33 Probability of a Zimbabwean boy aged 15 dying before age 50, trends over time, various national surveys Source: Feeney G, 1999 (unpublished data) Probability of dying before age 50 (%) reports from surviving siblings death registration household reports of death

01 July 2002 slide number SSA-34 Estimated impact of AIDS on under-5 child mortality rates, selected African countries, 2010 Botswana Kenya Malawi Tanzania Zambia Zimbabwe Deaths per 1,000 live births Without AIDS With AIDS Source: US Census Bureau

01 July 2002 slide number SSA-35 Changes in life expectancy in selected African countries with high and low HIV prevalence: with high HIV prevalence: Zimbabwe South Africa Botswana with low HIV prevalence: Madagascar Senegal Mali Source: UN Department of Economic and Social Affairs (2001) World Population Prospects, the 2000 Revision Life expectancy (years) 1950–

01 July 2002 slide number SSA Cambodia Haiti Mozambique Rwanda Côte d'Ivoire Zambia Kenya South Africa Zimbabwe Botswana Life expectancy at birth (years) Predicted life expectancyLoss in life expectancy due to HIV/AIDS Source: U.S. Census Bureau, 2000 Predicted loss in life expectancy due to HIV/AIDS in children born in 2000

01 July 2002 slide number SSA-37 Lifetime risk of AIDS death for 15-year-old boys, assuming unchanged or halved risk of becoming infected with HIV, selected countries Source: Zaba B, 2000 (unpublished data) Current adult HIV prevalence rate Burkina Faso Cambodia Côte d’Ivoire Kenya South Africa Zambia Zimbabwe Botswana Burkina Faso Cambodia Côte d’Ivoire Kenya South Africa Zambia Zimbabwe Botswana 0% 20% 40% 60% 80% 100% 0%5%10%15%20%25%30%35% 40% Risk of dying of AIDS risk halved over next 15 yearscurrent level of risk maintained

01 July 2002 slide number SSA-38 Leading causes of death in Africa, 2000 Source: The World Health Report 2001, WHO HIV/AIDSMalariaPerinatal conditions Tuber culosis Cerebro vascular disease Diarrhoeal disease Lower respiratory infections Measles Ischaemic Heart disease Maternal conditions % of Total

01 July 2002 slide number SSA-39 Leading causes of disease burden in Africa, 2000 Source: The World Health Report 2001, WHO * Unintentional injuries aside from traffic accidents, poisoning, falls, fires and drowning HIV/AIDS Malaria Lower respiratory infections Perinatal conditions Diarrhoeal diseases Measles Maternal conditions Tuberculosis Other unintentional injuries* Pertussis % of Total

01 July 2002 slide number SSA-40 Impact of HIV/AIDS on urban households, Côte d’Ivoire Source: Simulation-based on data from Bechu, Delcroix and Guillaume, 1997 General population Families living with AIDS Monthly income per capita Monthly income per capita Monthly consumption per capita Monthly consumption per capita – Francs CFA Savings/Disavings

01 July 2002 slide number SSA-41 Reduction in production in a household with an AIDS death, Zimbabwe Source: Stover & Bollinger, 1999 CropsReduction in output Maize Cotton Vegetables Groundnuts Cattle owned 49% 37% 29% 47% 61%

01 July 2002 slide number SSA-42 Estimated and projected deaths at ages 15-34, with and without AIDS in South Africa: ,200 1,600 2,000 Deaths (Thousands) Without AIDS With AIDS Source: UN Department of Economic and Social Affairs (2001) World Population Prospects, the 2000 Revision.

01 July 2002 slide number SSA-43 Reduction in size of primary- school-age population by 2010, in selected African countries ZimbabweZambiaKenyaUganda % reduction Source: World Bank, 2000

01 July 2002 slide number SSA-44 Reduction in life expectancy compared to the ‘no AIDS’ scenario in selected countries: Number of years Thailand Myanmar Angola Dominican Rep. Cambodia Bahamas Guyana Haiti Burkina Faso Cameroon Côte d'Ivoire Mozambique Kenya South Africa Swaziland Zimbabwe Botswana Source: UN Department of Economic and Social Affairs (2001) World Population Prospects, the 2000 Revision.

01 July 2002 slide number SSA-45 Knowledge and Behavior

01 July 2002 slide number SSA-46 Percentage of girls who do not know that a HIV-infected person may look healthy, Sources: UNICEF, DHS surveys and other nationwide surveys, Benin Dominican Republic Cameroon Chad Comoros Côte d'Ivoire Brazil Kenya Madagascar Malawi Mali Mozambique Haiti Niger Tanzania Uganda Zambia Zimbabwe Nepal Lesotho Bangladesh Cambodia Guatemala Papua New Guinea Mongolia South Africa Viet Nam Cape Verde Central African Republic Eritrea Romania Turkey Togo Peru Percentage who do not know

01 July 2002 slide number SSA-47 Knowledge of condoms among adolescent boys Sources: UNICEF, DHS surveys, % 25% 50% 75% 100%Brazil Dominican Republic Haiti Peru Bolivia Malawi Nicaragua Zambia Zimbabwe Tanzania Kenya Uganda Mali Niger Mozambique Chad Do not know condoms Know condoms but not where to get them Know condoms and where to get them Percentage of year old boys

01 July 2002 slide number SSA-48 Percentage of year old women who are aware that HIV can be transmitted from a mother to her child, Sources: UNICEF, DHS and other nationwide surveys, Madagascar Niger Chad Mali Benin Cameroon Cote d'Ivoire CAR Tanzania Haiti Peru South Africa Kenya Uganda Zambia Zimbabwe Dominican Rep. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

01 July 2002 slide number SSA-49 Risk perception percentage of sexually active women (15-19) that perceive not to be at risk at all of getting AIDS Sources: UNICEF, DHS surveys, *HIV prevalence in women attending antenatal care clinics in major urban areas Zimbabwe Zambia Uganda Kenya CAR Haiti Togo Cameroon Mali Chad Benin Niger Dominican Rep. Brazil Guatemala Bolivia Colombia Nepal Nicaragua 0% 10% 20%30% 40%50% 60% 70%80% 90% 100% HIV Prevalence (at time of survey *) Percentage of year old girls who think they are not at risk of AIDS

01 July 2002 slide number SSA-50 Number of reported rapes and convictions in Botswana, 1984 to 1997 Source: Emang Basadi Women’s Association, Botswana, reported rapes convictions Number

01 July 2002 slide number SSA-51 Percentage of sexually experienced girls in South Africa who say … No 61% Yes 39% “I have been forced to have sex.” Agree 33% Disagree 60% 7% “I am afraid of saying no to sex.” Agree 55% Disagree 39% 6% “There are times I don't want to have sex but I do because my boyfriend Insists on having sex.” Source: Kaiser Family Foundation/KLA (2000) South African National Youth Survey

01 July 2002 slide number SSA-52 Condom gap in sub-Saharan African countries in 1999 Source: Shelton JD, Johnston B (2001) Condom gap in Africa: evidence from donor agencies and key infromants, British Medical Journal

01 July 2002 slide number SSA-53 Knowledge and beliefs concerning AIDS among AIDS orphans, Rusinga Island, Kenya Source: Johnston T et al. Population Communication Africa, Kenya, 1999 Believe parents died of AIDS Know about AIDS Believe people in extended family died of AIDS Orphans holding the belief (%) Believe many people in their community have died of AIDS

01 July 2002 slide number SSA-54 Casual sex and condom use by educational status, Mozambique Number of years respondent spent in school Respondents reporting the behaviour (%) casual sex in the past year condom use at last casual sex Source: Agha S, et al. The promotion of safer sex among high-risk individuals in Mozambique, Population Services International, USA, 1999

01 July 2002 slide number SSA-55 Success Stories

01 July 2002 slide number SSA-56 HIV prevalence rate among 13 to 19-year-olds Masaka, Uganda, 1989 to 1997 Source: Kamali et al. AIDS 2000, 14: /901990/911991/921992/931993/941994/951995/961996/97 Girls Boys HIV prevalence (%)

01 July 2002 slide number SSA-57 HIV prevalence rate among pregnant 15 to 19-year-olds, Lusaka, Zambia, 1993 to 1998 Source: Ministry of Health, Zambia, ChelstoneChilenjeKalingalingaMatero Clinic HIV prevalence (%)

01 July 2002 slide number SSA-58 Prevalence among pregnant women, outside major urban areas, Uganda Source: Uganda National AIDS Programme HIV Prevalence (%)

01 July 2002 slide number SSA-59 Prevalence in years old first time testers Kampala, Uganda Source: Uganda National AIDS Programme Males Females HIV Prevalence (%)

01 July 2002 slide number SSA-60 Behavioural Indicators Uganda, Source: Uganda National AIDS Programme Reported non-regular sexual partners Percentage Reported condom use with non- regular partners Reported incidence of Urethritis (men) Condom use at last sex with regular partner Age at first sex

01 July 2002 slide number SSA-61 Knowledge about HIV/AIDS Uganda, Source: Uganda National AIDS Programme Knowledge of preventive practices Knowledge of condom source Knows a friend, colleague with AIDS Percentage

01 July 2002 slide number SSA-62 % HIV seropositive HIV prevalence and reported consistent condom use among female sex workers, Abidjan, Côte d'Ivoire, % consistent condom use HIV prevalence Reported consistent condom use Source: Ghys PD et al. (2002) AIDS

01 July 2002 slide number SSA-63 Prevalence of sexually transmitted diseases among sex workers Dakar, Senegal, 1991 and 1996 Source: National AIDS Programme, Senegal Trichomonas vaginalis Chlamydia trachomatis Neisseria gonorrhoeae Syphilis STD prevalence (%)

01 July 2002 slide number SSA-64 Increase in reported condom use with non-regular partners in selected districts in Uganda: % condom use Source: STD/AIDS Control Programme, Uganda (2001) HIV/AIDS Surveillance Report MbaraMpigiMasindiPallisa

01 July 2002 slide number SSA-65 Trends in HIV prevalence among pregnant women in Kampala, Uganda: % Source: STD/AIDS Control Programme, Uganda (2001) HIV/AIDS Surveillance Report

01 July 2002 slide number SSA-66 Public expenditure on health as percentage of general government expenditure in African countries: 1998 Source: WHO, World Health Report 2001 Sao Tome and Principe* Burundi Morocco Cape Verde Congo Togo Egypt Sudan Eritrea Somalia NigeriaBotswana Niger* Cameroon* Cote d'Ivoire Benin* Gabon Tunisia Madagascar* Kenya* Seychelles Swaziland Mali* Ghana* Uganda* Comoros Ethiopia* Rwanda* Mauritania* Burkina Faso Lesotho Mozambique* Gambia Namibia Chad* Zambia* Guinea* Senegal* DR Congo* Malawi* UR Tanzania Zimbabwe Libyan Arab Jamahiriya Djibouti Angola Mauritius Sierra Leone* Liberia Equatorial Guinea South Africa Algeria * Heavily indebted, poor countries % Expenditure on health Guinea-Bissau* Central African Republic* Abuja Target = 15.0%