HIV and AIDS Epidemic: Potential Contribution from

DSS sites

Nyovani Madise, PhD

Centre for Global Health, Population, Poverty & Policy

What Do We Already Know?

• 39 million infected with virus

• 4 million new infections per year

• Globally, HIV infections are unevenly spread- 29 million of those infected living in Africa

Geography of HIV and AIDSPrevalence in adults, 2005

Number of people living with HIV

% HIV prevalence, adult (15-49)

1985 1990 1995 2000 2005

0

5

10

15

20

25

30

0.0

2.5

5.0

7.5

12.5

15.0

% HIV prevalence, adult (15‒49)

HIV epidemic in sub-Saharan Africa, 1985‒2005*

Number of peopleliving with HIV (millions)

This bar indicates the range around the estimate

*

10.0

2.2

Source: UNAIDS 2006 Report on Global AIDS Epidemic

Increasing Mortality

Male adult mortality (15 - 49 years) 1992 & 2000 Malawi DHS

0

5

10

15

20

25

15-19 20-24 25-29 30-34 25-39 40-44 45-49

Age in years

Death

s p

er

1000

1992

2000

Population by age and sex, South Africa, 2020 (under “no AIDS” scenario)

Source: United Nations, World Population Prospects: The 2004 Revision, CD-ROM Edition, Extended Dataset (2005).

South Africa in 2020 Without AIDS:

Source: United Nations, World Population Prospects: The 2004 Revision, CD-ROM Edition, Extended Dataset (2005).

South Africa in 2020 With AIDS (Medium AIDS Scenario)

Stagnation or Increase in Childhood Mortality

Changes in infant mortality in selected African countries with high HIV prevalence

0

20

40

60

80

100

120

140

160

Malawi Coted'Ivoire

Kenya Uganda Zambia Zimbabwe

De

ath

s p

er

10

00

live

bir

ths

Early 90s

Late 90s-2000

Social and Economics Aspects

National Wealth & HIV Prevalence

1000 $

2000 $

3000 $

Per capita 1999

Adult HIV prevalence end 1999

Botswana

South Africa

Namibia

Swaziland

ZimbabweUganda

Cote d’Ivoire

Zambia10

10 20 30

Household Wealth and HIV Prevalence

Malawi

0

5

10

15

20

Lowest Second Middle Fourth Highest

Wealth Quintiles

HIV

prev

alen

ce (%

)

Women Men

Kenya

0

2

4

6

8

10

12

14

Lowest Second Middle Fourth Highest

Wealth Quintiles

HIV

prev

alenc

e (%

)

HIV Prevalence by Age at First Sexual intercourse

0

2

4

6

8

10

12

14

16

18

20

Kenya Malawi Uganda

Ad

ult

HIV

pre

val

ence

(%) <15 years

15-17

18-19

20+

Sources: DHS surveys

Women

Gender Differences in HIV Prevalence

What We Know and Don’t Know…

BIOCHEMISTRY

POTENTIAL IMPACTS

TREATMENT

BEHAVIOURALSTUDIES

DSS Sites Can Advance Knowledge

A Population-based Longitudinal Assessment of ART Rollout:

Effects on Individuals, Populations, and, Health Systems

Proposal by INDEPTH Network

5-year evaluation of the antiretroviral therapy (ART) roll-out programmes at INDEPTH sites in West, East and Southern Africa

Collaborating Sites

• Agincourt (South Africa)

• Nairobi  (Kenya)

• Bandim  (Guinea Bissau)

• Ifakara (Tanzania)

• Kisumu (Kenya) 

Overall Objectives

Effect of ART roll-out on

• Individuals under treatment & families

• The population

• Health systems

Effect on Individuals and Their Families

• Survival after starting ART

• Quality-of-life on ART

• Sexual behaviour of individuals taking ART

• Economic impact on households with member taking ART

Effect of ART on the Population

• Trends in mortality, morbidity, and survival in DSS communities

• Household structure and childcare

• Sexual behaviour in the population

• Stigma at population level

• Access to ART- what % of those who need it are receiving it?

Effect of ART and the Health System

• Understanding ART roll-out national policies, how they are developed/revised

• Interpretation and application of policies at district level

• Equity in provision of ART

• ART impacts on other health services

• Improving effectiveness of ART roll-out programmes

Proposed Activities

Existing DSS activities• Verbal autopsies on cause of death• Population and household structure• Socio-economic status

Additional activities• Population-based HIV testing• Morbidity, sexual behaviour studies• Closer linkage with health service provider

Thank You