AIDSAIDSimpactimpact

Wim Van DammeWim Van Damme

Department of Public HealthDepartment of Public Health

ITM, November 2006ITM, November 2006

AIDS = political issueAIDS = political issue

Why?Why?

People living with HIV/AIDS(estimation end 2003)

Total: 34 – 46 million

Western Europe520 000 – 680 000520 000 – 680 000

North Africa & Middle East470 000 – 730 000470 000 – 730 000

Sub-Saharan Africa25.0 – 28.2 25.0 – 28.2

millionmillion

Eastern Europe & Central Asia1.2 – 1.8 million1.2 – 1.8 million

South & South-East Asia

4.6 – 8.2 million4.6 – 8.2 million

Australia & New Zealand

12 000 – 18 00012 000 – 18 000

North America790 000 – 1.2 million790 000 – 1.2 million

Caribbean350 000 – 590 000350 000 – 590 000

Latin America1.3 – 1.9 million1.3 – 1.9 million

East Asia & Pacific700 000 – 1.3 million700 000 – 1.3 million

A global view of HIV infectionA global view of HIV infection38.6 million people [33.4‒46.0 million] living with HIV, 2005

2.4

HIV prevalence in adults in sub-Saharan Africa, 1986-

2001

20 – 39%

10 – 20%

5 – 10%

1 – 5%

0 – 1%

trend data unavailable

outside region

1986 1991

1996 2001

HIV prevalence (%) in adults in Africa, 2005HIV prevalence (%) in adults in Africa, 2005

2.5

People living with HIV/AIDS in sub-Saharan Africa, 1980-2001

0

5

10

15

20

25

30

1980 1983 1986 1989 1992 1995 1998 2001

Mill

ion

s

Source: UNAIDS, 2002

People who died from HIV/AIDSin sub-Saharan Africa, 1980-2001

0

500

1,000

1,500

2,000

2,500

1980 1983 1986 1989 1992 1995 1998 2001

Th

ou

san

ds

Source: UNAIDS, 2002

HIV prevalence rate,HIV prevalence rate,adults 15-49 (%), end 2003adults 15-49 (%), end 2003

Selected countries in Southern AfricaSelected countries in Southern Africa

SwazilandSwaziland 37-40%37-40%

BotswanaBotswana 36-39%36-39%

ZimbabweZimbabwe 22-28%22-28%

NamibiaNamibia 18-25%18-25%

South-AfricaSouth-Africa 19-25%19-25%

ZambiaZambia 14-20%14-20%

MalawiMalawi 11-18%11-18%

MozambiqueMozambique 9-16%9-16%

Deaths in South-AfricaDeaths in South-Africa(a model for of future AIDS and non-AIDS Deaths)(a model for of future AIDS 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

Deaths at ages 15-34Deaths at ages 15-34South Africa: 1980-2025South Africa: 1980-2025

(Estimated and projected )(Estimated and projected )

0

400

800

1,200

1,600

2,000

Dea

ths

(th

ou

san

ds)

Without AIDS

With AIDS

1980-1985 1985-1990 1990-1995 1995-2000 2000-2005 2005-2010 2010-2015 2015-2020 2020-2025

Population Structure in 2020 (Projected)Thousands

150 100 50 0 50 100 150

Males Females

With AIDS Without AIDS

Age80+757065605550454035302520151050

AIDS’ Toll on Population Structure, BotswanaAIDS’ Toll on Population Structure, Botswana

Source: U.S. Census Bureau demographic estimates and projections, 2002.

Millions

South Africa’s Population With and Without AIDSSouth Africa’s Population With and Without AIDS

0

10

20

30

40

50

60

70

1985 2000 2010 2020 2030 2040 2050

With AIDS Without AIDS

Source: U.S. Census Bureau demographic estimates and projections, 2002.

Changes in life expectancyChanges in life expectancyin selected African countries in selected African countries

with high and low HIV prevalence: 1950-2005with high and low HIV prevalence: 1950-2005

with high HIV prevalence:ZimbabweSouth AfricaBotswana

with low HIV prevalence:MadagascarSenegalMali

30

35

40

45

50

55

60

65

Lif

e e

xp

ecta

ncy

(y

ears

)

1950– 1955

1955- 1960

1960-1965

1965-1970

1970-1975

1975-1980

1980-1985

1985-1990

1990-1995

1995-2000

2000-2005

Lifetime risk of AIDS death for 15-year-old Lifetime risk of AIDS death for 15-year-old boys, boys,

(assuming unchanged or halved risk of becoming infected with (assuming unchanged or halved risk of becoming infected with HIV)HIV)

Source: Zaba B, 2000 (unpublished data)

Current adult HIV prevalence rate

Burkina Faso

Cambodia

Côte d’Ivoire

Kenya

South Africa

Zambia

Zimbabwe

Botswana

Burkina FasoCambodia

Côte d’Ivoire

Kenya

South AfricaZambia

Zimbabwe

Botswana

0%

20%

40%

60%

80%

100%

0% 5% 10% 15% 20% 25% 30% 35% 40%

Ris

k o

f d

yin

g o

f A

IDS

risk halved over next 15 years current level of risk maintained

Reduction in production in a Reduction in production in a household household

with an AIDS death, Zimbabwewith an AIDS death, Zimbabwe

Source: Stover & Bollinger, 1999

•

•

•

•

•

Crops Reduction in output

Maize

Cotton

Vegetables

Groundnuts

Cattle owned

49%

37%

29%

47%

61%

AIDS AIDS famine?? famine??Lancet article: October 2003Lancet article: October 2003

AIDS orphans in South Africa

Disease

Dead

Orphans

Malawi 2004Malawi 2004

Malawi 2006Malawi 2006