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

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

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

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

5. National trends in HIV prevalence Women attending Public Antenatal Clinics

6. 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

7. Epidemic Curves: HIV and AIDS

8. 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

9. YearProvinceGroupN% 1985KwaZulu NatalRural community4410.00 1986TransvaalMiners17 0210.01 TransvaalSex workers1 2000.00 1987KwaZulu NatalAntenatal women5000.00 Outpatient2680.00 Source: Abdool Karim SS. S Afr Med J, 1999; 89: 609-611 Dusheiko GM. Am J Epidemiol. 1989; 129(1):138-45. HIV infection in selected groups from 1985 - 1987

10. Source: Wilkinson D, Abdool Karim SS, Williams B, Gouws E. JAIDS 2000; 23: 405-409 Age Group1992199519982001 20-246.9%21.1%39.3%50.8% 25-292.7%18.8%36.4%47.2% 30-341.4%15.0%23.4%38.4% 35-390.0%3.4%23.0%36.4% Temporal trends in the age-specific prevalence of HIV infection in antenatal clinic attendees in Hlabisa

11. A model of future AIDS and non-AIDS Deaths

12. All orphans & orphans due to AIDS by HIV prevalence Uganda 198519901995200020052010 0 0.5 million 1 million 1.5 million 2 million Total Number 0 6% 12% HIV Prevalence Total Orphans AIDS Orphans HIV Prevalence

13. Impact of HIV/AIDS Demographic Political Economic

14. Changing life expectancy in African countries with high and low HIV prevalence: 1950-2005 Source: UNAIDS, 2002. Report on the global HIV/AIDS epidemic

15. By-Elections in Zambia Source: IDASA

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

17. Estimates of the impact of AIDS on economic growth, 1992−2000 Source: (1) Botswana, Lesotho, Namibia data: Sackey and Raparla, 2000. (2) South Africa data: Arndt and Lewis 2000. (3) Botswana data: Greener, Jefferis and Siphambe, 2000. (4) 30 Countries data: Over, 1992. (5) Cameroon data: Kambou et al, 1992. -2.00% -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)

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

19. Conclusions 1 Prevention Care and treatment Mitigation

20. World HIV Chart 2001 Percent adults living with HIV (log) 0.1 Annual income per person in US dollar (ppp & log) 300 40 000 1 0005 00010 000 20 000 2 000 500 0.5 1 5 10 30 20 7 3 2 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 300 000 100 000 10 000 1 000 Africa Americas Arab countries Asia Europe Continents 0.2 0.3

21. World HIV Chart 2001 Percent adults living with HIV (log) 0.1 Annual income per person in US dollar (ppp & log) 300 40 000 1 0005 00010 000 20 000 2 000 500 0.5 1 5 10 30 20 7 3 2 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 300 000 100 000 10 000 1 000 Africa Americas Arab countries Asia Europe Continents 0.2 0.3 X 200 ?

22. World HIV Chart 2001 Percent adults living with HIV (log) 0.1 Annual income per person in US dollar (purchasing power) Log 300 40 000 1 0005 00010 000 20 000 2 000 500 0.5 1 5 10 30 20 7 3 2 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 300 000 100 000 10 000 1 000 Africa Americas Arab countries Asia Europe Continents 0.2 0.3 10 X 20 =200

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

24. 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

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

26. 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)

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

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

29. State Social Service Delivery Source: EduAction

30. Access to Magistrates Courts

31. Distribution of All NGO OVC Services

32. Targets SA ARV treatment target announced in Cabinet Statement on 19th November 2003. Operational target of 53,000 people on ARV treatment by March 2004, (extended March 2005). The Medical Research Council says 400 000 people fulfil criteria for treatment already

33. 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.

34. Current patient numbers by province ProvinceOperational Plan March 2004 (05) Total patients (Adults and Children) % on Western Cape 27285137188 Eastern Cape 2750152555 Northern Cape 790[150]19 Gauteng 10,0005588178 KZN 24,902[3004] 250012 Limpopo 6965[300]4 North West 1808112462 Free State 212760228 Mpumalanga 1934[500]26 TOTAL 54004 (53,000)Approx 18,50034 Source: Treatment Action Campaign (www.tac.org.za) [ ] denotes unsure of accuracy *A site usually means a hospital plus several feeder clinicswww.tac.org.za

35. Aluta continua Leadership Prevention Treatment Social development