2010 FIFA World Cup and HIV/AIDS

1. 2010 FIFA World Cup and HIV/AIDS “Football and sex belong together”

2. Risks • Intuitively assume that “football and sex” go together • Link between staging a FIFA world cup and risky sexual activity • Possible increase in HIV infection

3. World Cup 2006 - Germany • First world country • Legalised prostitution in 2002 – prostitutes have legal rights, entitled to receive social benefits and health insurance • Expected 40 000 extra commercial sex workers to be trafficked into Germany • Research – no huge increase in demand documented. Why? • Planning and coordination started more than a year before the event • Increased law enforcement during the cup • Fan-base – many families and children; many low-budget tourists who did not have extra money for sex • Fan parks also decreased demand • Not profitable enough event for traffickers • National hotlines set up

4. South Africa 2010 • Third world country – high levels of unemployment and poverty • Surrounded by countries who are poor • Region has highest rates of HIV infection in the world

5. Eastern Europe & Central Asia 1.6 million [1.2 – 2.1 million] Western & Central Europe 760 000 [600 000 – 1.1 million] North America 1.3 million [480 000 – 1.9 million] East Asia 800 000 [620 000 – 960 000] Middle East&North Africa 380 000 [270 000 – 500 000] Caribbean 230 000 [210 000 – 270 000] South & South-East Asia 4.0 million [3.3 – 5.1 million] Sub-Saharan Africa 22.5 million [20.9 – 24.3 million] Latin America 1.6 million [1.4 – 1.9 million] Oceania 75 000 [53 000 – 120 000] Adults and children estimated to be living with HIV, 2007 Total: 33.2 (30.6 – 36.1) million

6. Eastern Europe & Central Asia 150 000 [70 000 – 290 000] Western & Central Europe 31 000 [19 000 – 86 000] North America 46 000 [38 000 – 68 000] East Asia 92 000 [21 000 – 220 000] Middle East&North Africa 35 000 [16 000 – 65 000] Caribbean 17 000 [15 000 – 23 000] South & South-East Asia 340 000 [180 000 – 740 000] Sub-Saharan Africa 1.7 million [1.4 – 2.4 million] Latin America 100 000 [47 000 – 220 000] Oceania 14 000 [11 000 – 26 000] Estimated number of adults and children newly infected with HIV, 2007 Total: 2.5 (1.8 – 4.1) million

7. Percent of adults (15+) living with HIV who are female, 1990–2007 70 Sub-Saharan Africa 60 GLOBAL 50 Percent female (%) Caribbean 40 Asia 30 E Europe & C Asia 20 Latin America 10 0 1990 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 ‘00 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 2007 Year 5

8. The tipping point Epidemics: • Takes smallest of changes to shatter an epidemic’s equilibrium • Different ways of tipping an epidemic – depends on different agents of change • tiny % of people do the majority of the work • Change happens in a hurry • 1% = tipping point • E.g. SA – took 5 years for prevalence rates to move from 0.5% - 1%; then only 7 years to jump from 1% to 20%.

9. HIV prevalence in adults in sub-Saharan Africa, 1988−2003 20% − 39% 10% − 20% 5% − 10% 1% − 5% 0% − 1% trend data unavailable outside region

10. Size matters: the number of prostitutes and the global HIV/AIDS pandemic • Infection rates among CSWs (commercial sex workers) higher than the general population (Study of data available from 77 countries) • On average, Africa = 4X as many CSWs as rest of world (as % of pop) & CSW community in Africa more than 4X as likely to be HIV infected as rest of world • “To visualise the potential power of CSWs in spreading the virus, one need only assume that in a country with 4% of its adult females working as CSWs, if each CSW has sex with 10 new male clients in a week, assuming no repeat customers in the week, this leads to contact with 40% of the adult male population in just one week”.

11. Male clients = spread HIV into general population – back to their mother countries. • Many illegal immigrants seeking means to survive – world cup = income generating event • Attract sex workers from neighbouring countries and from all over SA • Possibility that commercial sex work and public drinking will be legalised over world cup period – condom use?

12. So what are the risks? • 2010 likely to increase risk of HIV infection • Spread of infection from area with one of the highest prevalence rates back to countries of origin of fans (bring them nearer to the tipping point) • Fan base? Two scenarios – ‘rich’ fans from first world countries – mainly men? Fans from neighbouring countries – poorer, also mainly men? Will this equate with unprotected casual sex?

13. So what are the risks? • Worst case scenario: Further spread and reinfection in SA – particularly if we have an influx of sex workers from high prevalence neighbouring countries • Unlikely that people will plan to have safe sex- unlikely that fans will know about risk (unless aggressively educated and informed) • Unlikely that sufficient condoms will be freely available • Likely that there will be lots of unprotected casual sex to ‘celebrate’ & ‘drown sorrows’

14. Opportunities • Deliver effective preventive education – particularly targeting young people • Generate income – eg Alive and Kicking in Kenya • Use celebrity sports stars and coaches as role models • Use sports to break down stigma and discrimination • Use events as a point of access to VCT and other health service • Use sports media profile to communicate and promote AIDS messages to a wider audience

15. What now? • Early and sound situation assessment – regional experts (police & NGOs) • Need co-ordinated advocacy and effective public awareness campaigns (also targeting arriving fans) • Condom availability • Hotlines • Information kiosks • Training of key staff