1. Analysis of national responses to HIV/AIDS and non-communicable diseases in Brazil, Russia, India, China and South Africa (BRICS) Geoffrey Setswe DrPH, MPH Human Sciences Research Council (HSRC), BRICS Research Unit & HAST Research Program ICBM Satellite Workshop Forum on Dissemination and Implementation Science 20 August 2014

2. Introduction BRICS represent almost half the world's population. It is threatened by HIV/AIDS and NCDs; They recognised that NCDs are now a global priority that affects them and acknowledged that NCDs are preventable and impact on development BRICS countries committed to work together to address HIV/AIDS & NCDs as part of development and health; An analysis of national responses to HIV/AIDS and NCDs in BRICS countries will inform response programs. We move from research to reality and share lessons from dissemination and implementation research on HIV/AIDS & NCDs in BRICS Kulik, (2013); BRICS, (2013)

3. Social science that makes a difference HIV/AIDS Since the beginning of the HIV/AIDS epidemic, about 70m people have been infected and 35m have died. At the end of 2012, 34m people were living with HIV. About 0.8% of adults aged 15-49 years are living with the virus. 1.7 million people died of AIDS-related illnesses worldwide in 2011. Sub-Saharan Africa accounts 69% of people living with HIV worldwide. 1 in 20 adults in Sub-Saharan Africa (4.9%) are living with the virus. Haregu et al., (2013); UNAIDS, (2013)

4. Social science that makes a difference NCDs NCDs are now the major cause of death and disability across the world 4 common NCDs (CV diseases, cancers, chronic respiratory diseases and diabetes) account for 80% of all NCD related deaths. NCDs kill >36m people every year and 80% of NCD related deaths (29m) occur in LMICs. > 9m NCD related deaths occur before 60 years of age and 90% of premature NCD deaths occur in LMICs. The common NCDs are associated with 4 common behavioural and lifestyle risk factors (unhealthy diet, insufficient physical activity, tobacco use & harmful use of alcohol) 2010 Global Burden of Disease study

5. Methods Analysed the national (strategic) level response to HIV/AIDS and NCDs A comparative case study on how the 5 BRICS countries respond to HIV/AIDS & NCDs. Used multiple sources of data on a data abstraction template Themes used to analyse data: Magnitude of the problem Policy response Programmatic response Comparative qualitative content analysis was used Conceptual framework of the study Source: Haregu, Setswe, Elliot & Oldenburg (2013)

6. Magnitude of HIV/AIDS in BRICS countries, 2013 CountryHIV prevalence %# People Living with HIV Brazil0.5%490 000 Russia1.1%1 300 000 India0.27%2 088 642 China0.1%780 000 South Africa12.2%6 400 000 Average/Total 2.8%11 058 000

7. Policy response to HIV/AIDS HIV/AIDS is included in the health sector policies in all the BRICS countries. All the BRICS countries have stand-alone HIV/AIDS related policies and/or strategies. BRICS countries also have HIV policies specific to some population groups (IDU, SW, MSM, migrants, minorities) and specific technical areas. BRICS countries are dedicating higher levels of political leadership and resources to combating their epidemics (Morrison and Kates, 2006) Global AIDS Report (2013)

8. Social science that makes a difference Programmatic response to HIV/AIDS Programmatic responses to HIV/AIDS in BRICS are comprised of prevention, treatment, care and support and cross-cutting interventions. All the BRICS countries have implemented fiscal interventions to influence behaviour change. Individual, community-based & institution-based approaches are used in the prevention approaches of HIV/AIDS. Most of the stakeholders (actors) in HIV/AIDS are outside the healthcare system - government sectors, NGOs, CBOs, FBOs etc

9. Social science that makes a difference Programmatic response to HIV/AIDS Brazil's National AIDS Programme (NAP) contains four essential elements: universal access, integral care, social control and public funding (Berkman et al. 2005). Brazil has a well-known, successful universal access to HIV/AIDS treatment program India has strengthened its pharmaceutical industry to provide low-cost access to medicines (Chan 2011) In China, more than 136,000 AIDS patients had received anti- retroviral treatment by 2011 S. Africa tested more than 15m people for HIV & has the largest ART program in the world with 2.4m people by 2013.

10. Social science that makes a difference Magnitude of NCDs in BRICS, 2010 In 2011, 72% of all deaths in Brazil were caused by NCDs. CV disease and cancer are the leading causes of death. 37% have a cardio-metabolic condition (eg diabetes or HBP); 27% officially diagnosed & 5.4m adults have diabetes (Schmidt et al. 2011) 44% of adults in Russia report metabolic diseases – including diabetes, HBP; 2% have some form of cancer. 1.3m deaths each year are due to CV disease (Eberstadt 2011) In 2010, India had >41 m diabetic patients – the largest in the world! 800,000 new cases of cancer diagnosed every year (Reddy et al. 2005) 350m smokers in China. 85% of deaths are due to NCDs and among the largest population of people living with diabetes (Huang 2011). Around 160m cases of HBP aged 18-59. 253.2m cancer cases. In S Africa, prevalence of chronic NCDs was 51.8% in 2013. NCDs accounted for 29% of all deaths in 2008 (Phaswana-Mafuya et al., 2013),

11. Social science that makes a difference Magnitude of Diabetes in BRICS Country Diabetes prevalence Diabetes cases, (20-79) Deaths attributable to diabetes Brazil9.2%11.9 million124 687 Russia8.3%10.9 million197 299 India9.1%65.0 million1 065 053 China9.0%98.4 million1 272 004 South Africa9.3%2.6 million83 114 Total/Average 9.0%188.8 million2 742 157 Source: Diabetes atlas. Brussels: International Diabetes Federation; 2010

12. Social science that makes a difference All BRICS countries have a responsible authority in the Ministry of Health responsible for NCDs NCDs are included in the health sector policies in all the BRICS countries All BRICS countries have ratified the WHO Framework Convention on Tobacco Control (FCTC) Policy response to NCDs

13. Social science that makes a difference Integrated NCD programs are not well instituted NCD interventions are mainly biomedical while prevention strategies are on behavioural, life style, structural and policy/regulatory dimensions. The priorities of NCD treatment strategies are to increase availability of drugs and improve accessibility of treatment services; BRICS countries have >4/5 of the drugs included in the list for the assessment Brazil's NAP has 4 essential elements: universal access, integral care, social control, and public funding (Berkman et al. 2005) S Africa provide Human Papiloma Virus (HPV) vaccine to girls aged 9-10 to reduce cervical cancer Programmatic response to NCD

14. Social science that makes a difference Conclusions The five BRICS countries have produced innovative solutions and strategies for responding to HIV/AIDS and NCDs. These have led to decreased mortality from HIV/AIDS but morbidity and mortality due to NCDs is a serious concern. The parallels between the national responses between HIV/AIDS and NCDs in BRICS are largely in process characteristics and the differences are in content characteristics. The findings of this study have important implications for policy and practice in BRICS countries. The main implication is the coordination of national responses to reduce duplication and overlap and maximize synergy and efficiency.