1. Unit 1: The Global HIV/AIDS Situation #1-1-1

2. Warm Up Questions: Instructions v Take five minutes now to try the Unit 1 warm up questions in your manual. v Please do not compare answers with other participants. v Your answers will not be collected or graded. v We will review your answers at the end of the unit. #1-1-2

3. What You Will Learn v By the end of this unit you should be able to: © describe the overall HIV/AIDS situation in the world © describe the HIV/AIDS situation in sub- Saharan Africa #1-1-3

4. Table 1.1. Worldwide Epidemic #1-1-4 CategoryNumber Worldwide Sub-Saharan Africa (% of world total) Adults and children living with HIV/AIDS in 2004 39.4 million25.4 million (64%) Adults and children newly infected with HIV in 2004 4.9 million3.1 million (63%) Adult and child deaths due to AIDS in 2004 3.1 million2.3 million (74%) Children <15 years old living with HIV in 2004 2.2 million1.9 million (90%) Children <15 years old newly infected with HIV in 2004 640,000560,000 (88%) Deaths in children <15 years old due to AIDS in 2004 510,000450,000 (88%) Source: UNAIDS, 2004

5. Figure 1.1. HIV Prevalence among Adults in Africa, 2003 #1-1-5 Source: UNAIDS, 2003

6. Success in Uganda v HIV prevalence rates have been falling at major urban surveillance sites. © HIV prevalence rates have declined by 50% in Kampala ANC attendees since early 1990s. © Median HIV prevalence outside major urban areas has been cut in half. v Behaviour change has been an important part of the reported decline. © Condom use among women aged 15-24 has reportedly almost doubled. © These women also delayed or abstained entirely from sexual intercourse. #1-1-6

7. Table 1.2. Comparing 1994 and 1997 Prevalence Rates #1-1-7 19941997Most recent West Africa Accra, Ghana1.7%2.2%4.2% (2003) Cotonou, Benin0.9%4.4%3.9% (2003) Southern Africa Francistown, Botswana29.7%42.9%45.6% (2003) KwaZulu-Natal, South Africa13.5%26.9%37.5% (2003) Harare, Zimbabwe25.8%30.4%20.3% (2002) East Africa Addis Ababa, Ethiopia20.3%16.7%11% (2003) Kampala, Uganda22.3%14.3%10% (2002) Central Africa Yaounde, Cameroon----5.6%7.2% (2002) Source: WHO-AFRO, 2003

8. Some Increase, Some Decrease v In southern Africa, HIV prevalence at ANCs in major urban areas has dramatically increased since the early 1990s, although rates appear to be levelling off now. v In some West African urban areas prevalence rates have remained low and stable (< 5%). v Uganda and a few other areas have experienced declines. #1-1-8

9. Figure 1.2. Trends in HIV Prevalence Among ANC Attendees #1-1-9 Source: WHO-AFRO, 2003

10. Figure 1.3. Urban versus Rural HIV Prevalence #1-1-10 Source: WHO-AFRO, 2003

11. High Prevalence Factors v High prevalence of other STIs increase the risk of acquiring and transmitting HIV v Limited access to STI management v Limited access to, or social non-acceptance of, condoms #1-1-11

12. High Prevalence Factors, Cont. v War or civil disturbance v Cultural or ethnic practices, such as polygamy and wife inheritance v Women’s low status and inability to influence their partner’s behaviour #1-1-12

13. High Prevalence Factors, Cont. v Low literacy rates v Increasing urbanisation, migration, mobilisation and separation of families as a result of poverty or other social circumstances v Low level of political commitment to the prevention and control of HIV/AIDS v Exposure to blood from unsafe medical practices and traditional practices #1-1-13

14. In Summary v By the end of 2004, there were almost 40 million people living with HIV/AIDS worldwide, including more than 2 million children. v The situation is especially serious in sub- Saharan Africa, which accounts for 64% of these infections. #1-1-14

15. Warm Up Review v Take a few minutes now to look back at your answers to the warm up questions at the beginning of the unit. v Make any changes you want to. v We will discuss the questions and answers in a few minutes. #1-1-15

16. Answers to Warm Up Questions 1. True or false? Almost 40 million people are infected with HIV worldwide. #1-1-16

17. Answers to Warm Up Questions, Cont. 1. True or false? Almost 40 million people are infected with HIV worldwide. True #1-1-17

18. Answers to Warm Up Questions, Cont. 2. What region of the world has been affected the most by HIV/AIDS, with an infection prevalence rate of over 40% in some countries? #1-1-18

19. Answers to Warm Up Questions, Cont. 2. What region of the world has been affected the most by HIV/AIDS, with an infection prevalence rate of over 40% in some countries? Sub-Saharan Africa #1-1-19

20. Answers to Warm Up Questions, Cont. 3. What region of Africa has been the most affected by HIV/AIDS? #1-1-20

21. Answers to Warm Up Questions, Cont. 3. What region of Africa has been the most affected by HIV/AIDS? Southern Africa #1-1-21

22. Answers to Warm Up Questions, Cont. 4. Some of the factors that account for the high prevalence of HIV/AIDS in sub-Saharan Africa include a.extensive population mobility b.women’s status and inability to influence partner’s behavior c.war and civil disturbance d.blood exposure from unsafe medical practices e.all of the above #1-1-22

23. Answers to Warm Up Questions, Cont. 4. Some of the factors that account for the high prevalence of HIV/AIDS in sub-Saharan Africa include a.extensive population mobility b.women’s status and inability to influence partner’s behavior c.war and civil disturbance d.blood exposure from unsafe medical practices e.all of the above #1-1-23

24. Small Group Discussion: Instructions v Get into small groups to discuss these questions. v Choose a speaker for your group who will report back to the class. #1-1-24

25. Small Group Reports v Select one member from your group to present your answers. v Discuss with the rest of the class. #1-1-25

26. Case Study: Instructions v Try this case study individually. v We’ll discuss the answers in class. #1-1-26

27. Case Study Review v Follow along as we go over the case study in class. v Discuss your answers with the rest of the class. #1-1-27

28. Questions, Process Check v Do you have any questions on the information we just covered? v Are you happy with how we worked on Unit 1? v Do you want to try something different that will help the group? #1-1-28