1. Prevention Relative To Treatment and Management of Disease Case Study HIV/AIDS in South Africa

2. Day 1

3. Objective The syllabus says... Discuss the geographic factors that determine the relative emphasis placed by policy-makers, in one country or region, on prevention as opposed to treatment of disease and evaluate the management strategies that have been applied in any one country or region for one disease.

4. Lets “unpack” these exam questions Referring to one or more diseases, discuss the factors that determine the relative importance of policies of disease prevention as opposed to policies of treatment. Evaluate the management strategies that have been applied in any one country or region for one disease.

5. Let’s Deconstruct or “Unpack” the first question together You are asked to “discuss the factors that determine the relative importance”. What does it mean to “Discuss”? This means looking at the factors that determine medical policies and explaining why treatment is more commonly adopted than prevention (and vice versa) with some diseases.

6. With your partner, unpack the second question together… Evaluate the management strategies that have been applied in any one country or region for one disease.

7. Prevention Versus Treatment If prevention measures are not used, illness can become established in an area. It is often more expensive to treat an illness or condition that has developed, rather than prevent it's establishment in the first place.

8. What is HIV/AIDS? HIV stands for Human Immunodeficiency Virus. –It is a disease which reduces the ability of the body to fight off other diseases. It reduces the efficiency of the body’s immune system. AIDS stands for Acquired Immune Deficiency Syndrome. –HIV and AIDS are related, but not the same. –A person only has AIDS in the final stages of HIV- after their immune system can no longer defend itself.

9. How do you become infected with HIV? HIV is spread through human-to-human contact through direct contact with bodily fluids: –Blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, breast milk HIV is NOT spread by: –Air, water, insects, saliva, tears, sweat, casual contact (shaking hands, hugging, sharing drinking glasses), drinking fountains, toilet seat, kissing (unless person with HIV has open sores in mouth or bleeding gums)

10. 2/3 of all people infected with HIV/AIDS live in Sub-Saharan Africa: over a million adults a year die from the disease, despite improvements in treatments including antiretroviral drugs (ART). Access to these drugs is not equal, and millions of people who would benefit from these treatments don’t receive them. One in four schoolchildren in South Africa lives with the impact of HIV/AIDS.

13. Case Study: HIV in South Africa

16. HIV Prevalence by age/sex 2012

17. HIV Positive South Africans A projection Source: Metropolitan Life

18. Demographic Impact

19. A model of future AIDS and non-AIDS Deaths in South Africa

20. Forecast Mortality South Africa Source: Metropolitan Life

21. Projected AIDS Orphans in South Africa Source: Metropolitan Life

22. Economic Impact

23. Pathways to Economic Impact MORTALITY MORBIDITY Smaller population Change in age structure INDIVIDUAL FIRM/SECTOR GOVERNMENT MACRO-ECONOMY HOUSEHOLD LABOUR MARKET AIDSHIV Productivity

24. Individual level Incubation period –5-8 years from infection until the onset of AIDS –very little economic impact during this time AIDS –Period of escalating illness –Ability to work is reduced –The cost of care increases

25. Household level Due to the sexual nature of transmission often more than one household member is infected. Infections are concentrated among the primary carers and earners Double impact of reduced income and increased costs of care

26. Labor Market AIDS related illness leads to: –reduced productivity due to absenteeism, high turnover etc AIDS related death leads to: –change in labor force and labour participation –change in age structure of labour force –change in available skills and experience

27. Government Finance Increased demand on government services –Health –Welfare –Poverty reduction Although demand will increase, the level of spending on services will be determined by policy decisions

28. Social Impacts

29. Systems Health care –Increased demand –Decreased ability to offer services as a result of staff loss –Similar impact on Welfare services Education –Reduction in demand –Greater reduction in ability to offer services

30. HIV and Poverty Poverty can lead to behavior which results in increased risk of infection (unable to purchase condoms, can’t afford basic medical care to treat STDs, poverty may drive women to prostitution) HIV increases poverty due to costs of care, lower earnings because of inability to work. Thus…Poverty is a cause and a consequence of HIV!!!

31. Treatment/Management of Diseases Poor people generally: –Have less access to health services –Are more vulnerable to diseases Treatment of diseases in many developing countries is therefore difficult once an illness is established. A more effective and much less costly way of containing disease is to prevent its occurrence and present barriers to its spread.

32. Prevention Improvements in domestic hygiene Providing health education Public awareness Better food Safe water

33. Day 2

34. Let’s go back to the questions Referring to one or more diseases, discuss the factors that determine the relative importance of policies of disease prevention as opposed to policies of treatment. Evaluate the management strategies that have been applied in any one country or region for one disease.

35. How will this Case Study work? Materials You’ll Need: –These notes (especially for background information) –All Videos/Articles-Textual Evidence –Video Analysis Guide –Essay Planning Tools: one for each question

36. Articles/Textual Evidence “History of HIV/AIDS in South Africa” from AVERT “Key Facts on HIV Epidemic and Progress in Sub-Saharan Africa” from the World Health Organization “Risky Sexual Behavior Threatens to Derail AIDS Progress, UN Report Says” from the Guardian

37. Video 1 Title: “A Woman with AIDS filmed every day for 90 days” http://www.youtube.com/watch?v=IExRHL7D_NI http://www.youtube.com/watch?v=IExRHL7D_NI

38. Video 2 Title: “AIDS denial in South Africa” http://www.youtube.com/watch?v=N98xMJ Wy9tQhttp://www.youtube.com/watch?v=N98xMJ Wy9tQ (20 minutes)

39. Day 3

40. Video 3 Title: “AIDS in South Africa Documentary Trailer” http://www.youtube.com/watch?v=vyGYrw LJNkI&playnext=1&lis t=PL68CA76D0DC81DB34http://www.youtube.com/watch?v=vyGYrw LJNkI&playnext=1&lis t=PL68CA76D0DC81DB34 (10 minutes)

41. Video 4 Title: “South Africa AIDS Legacy” http://www.youtube.com/watch?v=KAh1Ny ueyW0 http://www.youtube.com/watch?v=KAh1Ny ueyW0 2 minutes

42. Video 5 Title: “HIV/AIDS in South Africa: A Personal Story” http://www.youtube.com/watch?feature=pl ayer_embedded&v=XUVtpozb9qI#!http://www.youtube.com/watch?feature=pl ayer_embedded&v=XUVtpozb9qI# 4 minutes

43. Video 6 Hans Rosling on HIV: New Facts and Stunning Data Visuals http://www.youtube.com/watch?v=3qRtDn snSwk#t=27http://www.youtube.com/watch?v=3qRtDn snSwk#t=27 (10 minutes)

44. Video 7 UNICEF: “Working to prevent HIV/AIDS infection in South Africa” https://www.youtube.com/watch?v=xVWG sKjjTcAhttps://www.youtube.com/watch?v=xVWG sKjjTcA (4minutes)