AIDS in Africa: Past and Future
Peter Piot
Souleymane Mboup
Meskerem Grunitzky Bekele
Spread of HIV in Africa
1985 1990 1995
2001 2007
Incidence by Modes of Transmission
Sources: Draft results from Know your Epidemic project
Uganda0
20
40
60
80
100
Kenya Mozambique
Percentnew infections
Clients of female sex workers
Injecting drug users
Men having sex with men
Casual heterosexual sex
Fishing community
Partners (Casual heterosexual sex)
Low risk heterosexual
Other
Partners of clients of female sex workers
HIV prevalence (%) among 15-24-year-olds, by gender, selected sub-Saharan African countries, 2005‒2007
SwazilandSouth Africa
ZimbabweCentral African Republic
Côte d'Ivoire
Sierra Leone
Rwanda
Guinea
Ethiopia
Benin
DR Congo
NigerSenegal
Uganda
Chad
Mali
0 5 10 15 20 25% HIV prevalence
Female
Male
Southern Africa
Central Africa
Eastern Africa
Western Africa
10 top causes of death in Africa
1. AIDS2. Malaria3. Lower respiratory infections4. Diarrhoeal diseases5. Perinatal conditions6. Cerebrovascular disease7. Tuberculosis8. Ischaemic heart disease9. Measles10. Road traffic accidentsExtrapolated from WHO data
Research – the early years
Projet Sida, 1984
Research
Heterosexual transmission
SIV and SIV cpz
HIV2
TB and HIV
PMTCT, breastfeeding and HIV transmission
Genetic diversity of HIV
Risk factors for sexual transmission
Intervention research
1980s HIV prevention among sex workers
1990s Impact of STI treatment on HIV infection
1999 Nevirapine for PMTCT
2000 Cotrimoxazole to prevent opportunistic infections
2007 Male circumcision for HIV prevention
Social Science Research
1980s Sex and sexual behaviour1990s Sex work, STIs and HIV
Socio-economic impact Counselling and testing
2000s Orphans Political science Sexual networking & behaviour patterns Stigma Establishment of SAHARA
Political Leadership
Ab
OAU, Abuja, 2001
Community mobilization
TASO, 1987
Activism
Tipping point: 2000-2001
• African Development Forum, Addis• International AIDS Conference, Durban• UN Security Council session on AIDS in Africa• G8 Okinawa Declaration• World Bank Multi-Country AIDS Programme for Africa• Millennium Development Summit• World Trade Organisation Agreement on TRIPS• UN General Assembly Special Session on HIV/AIDS• OAU Summit, Abuja
Drug Access Initiative
Drug prices fall
International expenditure on AIDS and STIs in sub-Saharan Africa, 2002-6
2000
2002 2003 2004 2005 2006
1000
500
0
1500
220
554
1093
16121688
0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
2007 2008 2009 2010 2011 2012 2013 2014 2015
Projected Financial Resources Required in sub-Saharan Africa if current scale-up trends continue
(US$ Millions)
Expansion of HIV treatment in Sub-Saharan Africa
Mill
ions
Year
0.5
2.0
1.0
1.5
2.5
0.0end-2001
end-2002
end-2005
end-2006
end-2003
end-2004
end-2007
1997
HIV Prevalence among pregnant women attending Antenatal clinics in Sub Saharan Africa
1997-2006
HIV Prevalence among pregnant women attending Antenatal clinics in Sub Saharan Africa
1997-2006
0
5
10
15
20
25
30
35
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Years
HIV
%
Cote d'Ivoire
Ethiopia
Kenya
Burkina Faso
Zimbabwe
The next 25 years
Add long-term approach to crisis management:
• aids 2031 project
• scenarios for Africa
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