development consequences (and causes) of hiv/aids by prof. alan whiteside director, heard institue...
TRANSCRIPT
Development Consequences (and Causes) of HIV/AIDS
By
Prof. Alan Whiteside
Director, HEARD
Institue of Public Policy Research
London,
5th November, 2004
• Why has the development community failed to take cognisance of HIV/AIDS?
• Why have governments failed to respond to the crisis?
Presentation Outline
• Scale and future trends
• Impacts
– Demographic
– Political
– Economic
• Conclusions
Freedom!
2nd Democratic
Election
0
5
10
15
20
25
30
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
% H
IV P
osit
ive
HIV Prevalence South AfricaWomen Attending Public Antenatal Clinics
FREEDOM!
2nd General Election
National trends in HIV prevalenceWomen attending Public Antenatal Clinics
0
5
10
15
20
25
30
35
40
45
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
% H
IV p
os
itiv
e
Botswana Namibia South Africa Swaziland
Epidemic Curve: HIV
27Aug01 -Report I: Epidem’gy& Lit. p. 27
T1 T2 Time
Numbers
A1
A2
HIV prevalence
A
B
Epidemic Curves: HIV and AIDS
Epidemic Curve: HIV, AIDS and Impact
27Aug01 -Report I: Epidem’gy & Lit. p. 27
T1 T2 Time
Numbers
A1
A2
HIV prevalence
B1
A
B
AIDS - cumulative
Impact
A model of futureAIDS and non-AIDS Deaths
0
200000
400000
600000
800000
1000000
1200000
1995 2000 2005 2010 2015
year
num
ber o
f dea
ths
Other deaths AIDS Deaths
All orphans & orphans due to AIDS by HIV prevalence Uganda
1985 1990 1995 2000 2005 20100
0.5 million
1 million
1.5 million
2 million
Total Number
0
6%
12%
HIV Prevalence
Total Orphans
AIDS Orphans
HIV Prevalence
Impact of HIV/AIDS
• Demographic
• Political
• Economic
Changing life expectancy in African countries with high and low HIV prevalence: 1950-2005
Source: UNAIDS, 2002. Report on the global HIV/AIDS epidemic
Population Structure, South Africa2000 and 2010
3,000,000.00 2,000,000.00 1,000,000.00 0.00 1,000,000.00 2,000,000.00 3,000,000.00
0-4
10-14
20-24
30-34
40-44
50-54
60-64
70-74
80-84
Age
MALE : FEMALE
2000 2000 2010 2010
Source: Actuarial Society of South Africa
By-Elections in Zambia
0
20
40
60
80
100
120
1964-1984 1985 - 2003
total due to deathresignation/expulsion
Source: IDASA
Non-registration
HIV prevalence_
_
+
+
Pearson’s r = .7
Level of analysis: the nine provinces
Non-participation by young women in South Africa
Estimates of the impact of AIDS Estimates of the impact of AIDS on economic growth, 1992on economic growth, 1992−−20002000
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)
By 2010 orphans will account for 15-25% of all children in 12 countries in SAA
Source: UNICEF
Conclusions 1
• Prevention
• Care and treatment
• Mitigation
World HIV Chart World HIV Chart 20012001
Perc
en
t ad
ult
s liv
ing
wit
h H
IV
(log
)
0.1
Annual income per person in US dollar (ppp & log)
300 40 0001
0005
00010
00020
0002
000500
0.5
1
5
10
30
20
7
3
2
Alg
eria
Angola
Argentina
Armenia
Aus
tral
ia
Austria
Aze
rbai
jan
Bahrain
Ban
glad
esh
Barbados
Belarus
Belgium
Belize
Benin
Bhu
tan
Bol
ivia
Botswana
Brazil
Bul
garia
Burundi
Cambodia
Cameroon
Canada
Central African Rep.
Chad
Chile
Chi
na
Colombia
Costa Rica
Côte d'Ivoire
Cro
atia
Cub
a
Cyprus
Cze
ch R
epub
lic
Denmark
Dominican Rep.
EcuadorEg
ypt
El Salvado
r
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finl
and
France
Geo
rgia
Ger
man
y
Ghana
Greece
Guatemala
Guinea-Bissau
Guyana
Haiti
Honduras
Hun
gary
Iceland
Indo
nesi
a
Irel
and
Isra
el
Italy
Jamaica
Japa
n
Jord
an
Kenya
Rep
ublic
of K
orea
Latvia
Lesotho
Lith
uani
a
Luxembourg
Madagascar
Malawi
Malaysia
Mal
dive
s
Mali
Mal
ta
Mau
ritius
Mexico
Mon
golia
Mor
occo
Mozambique
Namibia
Nepal
Netherlands
New
Zea
land
Nicaragua
Nigeria
Nor
way
Paki
sta
n
Panama
Papua New Guinea
PeruPh
ilipp
ines
Portugal
Rom
ania
Russia
Rwanda
Senegal
Sierra Leone
Singapore
Slov
enia
South Africa
Spain
Sri L
anka
Sudan
Suriname
Swaziland
Sw
eden
Switzerland
Tajik
ista
n
Thailand
Togo
Trinidad & Tobago
Turk
ey
Turk
men
ista
n
Uganda
Ukraine
Uni
ted
King
dom
United Statesof America
Uruguay
Uzb
ekis
tan
Venezuela
Yem
en
Zambia
Zimbabwe
BurkinaFaso
India
AIDS deaths per year
300 000100 00010 000
1 000
Africa
Americas
Arab countries
Asia
Europe
Continents
0.2
0.3
World HIV Chart World HIV Chart 20012001
Perc
en
t ad
ult
s liv
ing
wit
h H
IV
(log
)
0.1
Annual income per person in US dollar (ppp & log)300 40 000
1 000
5 000
10 000
20 000
2 000
500
0.5
1
5
10
30
20
7
3
2
Alg
eria
Angola
Argentina
Armenia
Aus
tral
ia
Austria
Aze
rbai
jan
Bahrain
Ban
glad
esh
Barbados
Belarus
Belgium
Belize
Benin
Bhu
tan
Bol
ivia
Botswana
Brazil
Bul
garia
Burundi
Cambodia
Cameroon
Canada
Central African Rep.
Chad
Chile
Chi
na
Colombia
Costa Rica
Côte d'Ivoire
Cro
atia
Cub
a
Cyprus
Cze
ch R
epub
lic
Denmark
Dominican Rep.
EcuadorEg
ypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finl
and
France
Geo
rgia
Ger
man
y
Ghana
Greece
Guatemala
Guinea-Bissau
Guyana
Haiti
Honduras
Hun
gary
Iceland
Indo
nesi
a
Irel
and
Isra
el
Italy
Jamaica
Japa
n
Jord
an
Kenya
Rep
ublic
of K
orea
Latvia
Lesotho
Lith
uani
a
Luxembourg
Madagascar
Malawi
Malaysia
Mal
dive
s
Mali
Mal
ta
Mau
ritiu
s
Mexico
Mon
golia
Mor
occo
Mozambique
Namibia
Nepal
Netherlands
New
Zea
land
Nicaragua
Nigeria
Nor
way
Paki
sta
n
Panama
Papua New Guinea
Peru
Phili
ppin
es
Portugal
Rom
ania
Russia
Rwanda
Senegal
Sierra Leone
Singapore
Slov
enia
South Africa
Spain
Sri L
anka
Sudan
Suriname
Swaziland
Swed
en
Switzerland
Tajik
ista
n
Thailand
Togo
Trinidadand Tobago
Turk
ey
Turk
men
ista
n
Uganda
Ukraine
Uni
ted
King
dom
United Statesof America
Uruguay
Uzb
ekis
tan
Venezuela
Yem
en
Zambia
Zimbabwe
BurkinaFaso
India
AIDS deaths per year
300 000100 00010 000
1 000
Africa
Americas
Arab countries
Asia
Europe
Continents
0.2
0.3
X200?
World HIV Chart World HIV Chart 20012001
Perc
en
t ad
ult
s liv
ing
wit
h H
IV (
log
)
0.1
Annual income per person in US dollar (purchasing power) Log
300 40 0001
0005
00010
00020
0002
000500
0.5
1
5
10
30
20
7
3
2
Alg
eria
Angola
Argentina
Armenia
Aus
tral
ia
Austria
Aze
rbai
jan
Bahrain
Ban
glad
esh
Barbados
Belarus
Belgium
Belize
Benin
Bhu
tan
Bol
ivia
Botswana
Brazil
Bul
garia
Burundi
Cambodia
Cameroon
Canada
Central African Rep.
Chad
Chile
Chi
na
Colombia
Costa Rica
Côte d'Ivoire
Cro
atia
Cub
a
Cyprus
Cze
ch R
epub
lic
Denmark
Dominican Republic
EcuadorEg
ypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finl
and
France
Geo
rgia
Ger
man
y
Ghana
Greece
Guatemala
Guinea-Bissau
Guyana
Haiti
Honduras
Hun
gary
Iceland
Indo
nesi
a
Irel
and
Isra
el
Italy
Jamaica
Japa
n
Jord
an
Kenya
Rep
ublic
of K
orea
Latvia
Lesotho
Lith
uani
a
Luxembourg
Madagascar
Malawi
Malaysia
Mal
dive
s
Mali
Mal
ta
Mau
ritiu
s
Mexico
Mon
golia
Mor
occo
Mozambique
Namibia
Nepal
Netherlands
New
Zea
land
Nicaragua
Nigeria
Nor
way
Paki
sta
n
Panama
PapuaNew Guinea
Peru
Phili
ppin
es
Portugal
Rom
ania
Russia
Rwanda
Senegal
Sierra Leone
Singapore
Slov
enia
South Africa
Spain
Sri L
anka
Sudan
Suriname
Swaziland
Swed
en
Switzerland
Tajik
ista
n
Thailand
Togo
Trinidadand Tobago
Turk
ey
Turk
men
ista
n
Uganda
Ukraine
Uni
ted
King
dom
United Statesof America
Uruguay
Uzb
ekis
tan
Venezuela
Yem
en
Zambia
Zimbabwe
BurkinaFaso
India
AIDS deaths per year
300 000100 00010 000
1 000
Africa
Americas
Arab countries
Asia
Europe
Continents
0.2
0.3
10 X20=200
Public expenditure on health as
percent of general government
expenditure in African countries,
1998
Conclusions 2
• The role of policy and development practitioners
Economics
Social
Political commitment
HIV Epidemic – Determinants and Responses – A Medical View
DeterminantsBiomedical
Virus sub-types
Stage of infection
Presence of
other STDs
Gender
Circumcision
Other
HIV Infection
Aids
HIV Epidemic – Determinants and Responses – Sexual Behaviour
Determinants Biomedical
Virus sub-types
Stage of infection
Presence of other STDs
Gender
Circumcision
Other
HIV Infection
Aids
Sexual behaviour
Rate of partner change
Concurrent partners
Sexual mixing patterns
Sexual practices
Condom use
Other
HIV Epidemic – Determinants and Responses – Upstream Causes
Determinants
Biomedical
Virus sub-types
Stage of infection
Presence of other STDs
Gender
Circumcision
Other
HIV Infection
Aids
Sexual behaviour
Rate of partner
change
Concurrent partners
Sexual mixing
patterns
Sexual practices
Condom use
Other
Micro-environment
Mobility
Urbanisation
Access to health care
Levels of violence
Women’s rights and status
Other
Macro-environment
Wealth
Income distribution
Culture
Religion
Governance
Other
HIV Epidemic – Where we responded
Determinants
Biomedical
STD treatment
Blood safety
Anti-retroviral therapy during pregnancy
Provision of condoms
Sexual behaviour
Behaviour change
communication
Condom
Promotion and marketing
Micro-environment
Macro-environment
Interventions
HIV Epidemic – Where we should respond
Determinants
STD treatment
Blood safety
Anti-retroviral therapy during pregnancy
Provision of condoms
Behaviour change communication
Condom promotion and marketing
Micro-environment
Social Policy
Economic Policy
Legal Reform
Employment legislation
Macro-environment
Social policy – redistribution
Legal Reform
Human Rights
Taxation
Debt relief
Terms of Trade
Interventions
Sexual behaviour
Biomedical