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HIV and AIDS Epidemic: Potential Contribution from DSS sites

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

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HIV and AIDS Epidemic: Potential Contribution from DSS sites

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  1. HIV and AIDS Epidemic: Potential Contribution from DSS sites Nyovani Madise, PhD Centre for Global Health, Population, Poverty & Policy

  2. 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

  3. Geography of HIV and AIDS Prevalence in adults, 2005

  4. HIV epidemic in sub-Saharan Africa, 1985‒2005* Number of people living with HIV (millions) % HIV prevalence, adult (15‒49) 30 15.0 12.5 25 20 10.0 7.5 15 5.0 10 2.5 5 0 0.0 1985 1990 1995 2000 2005 * Number of people living with HIV % HIV prevalence, adult (15-49) This bar indicates the range around the estimate 2.2 Source: UNAIDS 2006 Report on Global AIDS Epidemic

  5. Increasing Mortality

  6. South Africa in 2020 Without AIDS: 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).

  7. South Africa in 2020 With AIDS (Medium AIDS Scenario) Source: United Nations, World Population Prospects: The 2004 Revision, CD-ROM Edition, Extended Dataset (2005).

  8. Stagnation or Increase in Childhood Mortality

  9. Social and Economics Aspects

  10. National Wealth & HIV Prevalence Botswana South Africa 3000 $ Namibia 2000 $ Swaziland 1000 $ Cote d’Ivoire Zimbabwe Uganda Zambia Per capita 1999 10 10 20 30 Adult HIV prevalence end 1999

  11. Household Wealth and HIV Prevalence

  12. HIV Prevalence by Age at First Sexual intercourse Women Sources: DHS surveys

  13. Gender Differences in HIV Prevalence

  14. What We Know and Don’t Know…

  15. DSS Sites Can Advance Knowledge

  16. A Population-based Longitudinal Assessment of ART Rollout:Effects on Individuals, Populations, and, Health SystemsProposal byINDEPTH Network

  17. 5-year evaluation of the antiretroviral therapy (ART) roll-out programmes at INDEPTH sites in West, East and Southern Africa

  18. Collaborating Sites • Agincourt (South Africa) • Nairobi  (Kenya) • Bandim  (Guinea Bissau) • Ifakara (Tanzania) • Kisumu (Kenya) 

  19. Overall Objectives Effect of ART roll-out on • Individuals under treatment & families • The population • Health systems

  20. 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

  21. 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?

  22. 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

  23. 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

  24. Thank You

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