centre for aids research world aids day 2004 some viewpoints and perspectives professor mike clark...

Centre for AIDS Research

World AIDS Day 2004Some viewpoints and perspectives

Professor Mike Clark School of Geography

Director – Centre for AIDS Research

University ofSouthampton

The Centre for AIDS Research

The vision which fuelled our struggle for freedom; the development of energies and resources; the unity and commitment of common goals – all these are needed if we are to bring AIDS under control. Future generations will judge us on the adequacy of our response. Nelson Mandela

World AIDS Day: viewpoints and perspectivesUniversity ofSouthampton

Research and policy-orientated engagement

Focus on impacts – social, economic, political,

environmental & bio-medical

Founded on strategic partnerships with

institutions, stakeholders, governments and agencies

A holistic approach – cross-disciplinary and

cross-sectoral

A distinctive mission

Centre for AIDS Research


The roots of health and welfare

Development . . .

But watch for challenges:

Pretoria - South Africa

AIDS and poverty?

Two pandemics or one?

More than a disease?

Soshanguve Township 10 miles from Pretoria

& underdevelopment?


Development founded on Health

The health of the individual

The welfare and income of the family

Supported children – not orphans

Functional communities and services

National economic stability

A stable society

AIDS


Global summary December 2003

The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information. These ranges are more precise than those of previous years.

People living with HIV/AIDS ………….. 40 million (34 - 46 million)

New HIV infections in 2003 ………….... 5 million (4.2 - 5.8 million)

Deaths due to HIV/AIDS in 2003 ……… 3 million (2.5 – 3.5 million)


40 million people are living with AIDS worldwide

20-25 million people have already died of AIDS

68 million more will die of AIDS by 2020

14000 people become newly infected every day

14 million AIDS orphans already

40 million by 2010!


HIV Cases Precede AIDS Cases

T1 T2 Time

Numbers - HIV

A1

A2

HIV prevalence

AIDS - cumulative

B1

A

B

Source: Whiteside & Sunter AIDS: The Challenge for South Africa, 2000, p. 27

Numbers - AIDS

Death rises later


HIV and AIDS diagnoses and deaths in HIV-infected individuals by year of diagnosis, United Kingdom, 1994-

2003

0

1000

2000

3000

4000

5000

6000

7000

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Year

Num

ber o

f dia

gnos

es

HIV diagnoses

AIDS diagnoses

Deaths

1 1

1 Numbers will rise, for recent years, as further reports are received.Data Source: HIV/AIDS reports. Reports received by the end of June 2004.

Slide Source: UK Collaborative Groupfor HIV and STI Surveillance


Rates of diagnosed HIV-infected adults seen for care, United Kingdom, 1998 and 2003 by residence, 1998 and

2003

Data source: SOPHID and CD4

monitoring scheme for Scotland.

Slide Source: UK Collaborative Group for HIV and STI Surveillance


Introducing HIV/AIDS

Understanding HIV/AIDS

Towards a Geography of HIV/AIDS

Responding to HIV/AIDS

Steps towards a response


Propensity - AIDS factors

Gender (girls more vulnerable)Age (sexually-active years)Poverty (directly and indirectly create propensity to infection)Sexually-transmitted diseases (STDs)

A 15-year old in Zambia has a 60% chance of dying of

AIDS


Vulnerability - AIDS triggers

Unsafe sex, mother-to-baby, drug injection, blood contactLACK OF SOCIAL COHESION

Migration (to work) - multiple partnersMilitary service (war/terrorism)RefugeesProstitutionChild abuse and rapeFatalism and traditional medicine

High wealth + high social cohesion = no epidemicLow wealth + low social cohesion = high epidemicLow wealth + high social cohesion = slow epidemic


INCIDENCE - the human dimension

The School Choir

SA prevalence of HIV/AIDS = 4.5 million

Women’s deaths peak at 24 years: men 29

One third HIV infections in school years

Population polarising <15 and >50 years

Perhaps 30% SA school children HIV+

Up to 40% at some SA universities






Looking beyond the maps


1. Policy-influencing & attitudinal


Western Europe520 000 – 680 520 000 – 680

000000North 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 1.2 – 1.8 millionmillion

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

People living with AIDS: end 2003


2. Strategic (targets & monitoring)


3. Operational (support & supervision)

Waterfall

Molweni

Msunduzi

Ngcolosi

Fredville

MpumalangaPeaceville

Hally Stott

Ntshongweni

Hlengisizwe

Qadi

Injabula

Zwelibomvu

Wyebank

Legend^ No clinic/mobile entered(15)

#* Bhekisisa Mobile Point_HS M1&2(3)

#* Botha's Hill Mobile Point_HS M1&2(1)

Fredville Clinic(9)

#* Gigaba Mobile Point_HS M1&2(6)

Halley Stott(2)

#* Halley Stott Mobiles 1&2(3)

Hlengisizwe Clinic(7)

") Injabulo Clinic_attached to Edendale Hospital(1)

#* Khayelihle Mobile Point_HS M1&2(4)

#* Mathebethu Mobile Point_HS M1&2(1)

#* Mgoqozi Mobile Point_HS M1&2(2)

#* Mhlabunzima Mobile Point_HS M1&2(12)

XWMobile(?) & Waterfall Clinic(1)

XWMobile(?) & Wyebank Clinic(2)

Molweni Clinic(16)

#* Molweni Clinic & Umgababa Mobile(1)

XWMpumalanga & Hlengisizwe(8)

XWMpumalanga & Peaceville(10)

Mpumalanga Clinic(14)

Msunduzi Clinic(23)

Ngcolosi Clinic(15)

Ntshongweni Clinic(9)

Peaceville Clinic(1)

") Qadi Building_KwaMashu Polyclinic(7)

#* Siyathuthuka Point_HS M1&2(1)

#* Smangenduku Point_HS M1&2(2)

#* Vulindlela Store Mobile Point_HS M1&2(2)

XWVulingqondo Pre-School(2)

kj Waterfall clinic(1)

kj Wyebank Clinic(7)

") Zwelibomvu Building_Prince Mshiyeni Polyclinic(3)Local Council

G Other Clinics in Outer West

G TVT related Clinics

Buffer of 5km around Msunduzi ClinicInner West CHW (106)South CHW (85 with 20 mistakes)Planning Units

Community Health Workers homesteads captured for the Outer West .Illustrating the clinics or mobiles their respective communities visit.Although most CHW seem to be within 5km of the clinictheir community uses, it does not confirm their communities fall within this radius.

Mapping – The Valley Trust


4. Community participation

P Johnstone & J Ranken (1994)


ElitismExclusion

EngagementEmpowering

Equity

The intellectual/moral challenge






Steps towards a response


As simple as ABC!

“If you do that, this is

what will happen to

you”

“OK, in that

case I won’t

do it”

Abstain Be faithful Condom


Making the message more realistic

ABCHarare, Zimbabwe

(after The Theory of Reasoned Action: Ajzen & Fishbein, 1975)


TREAT

COPEPREVENT

AIDSRESPONSE

Drug therapy/Lifestyle

Vaccine??Modify behaviour?

Tackle poverty!

Locate impact Assess impact Manage impact


Global spending on AIDS prevention and care in developing countries about $2 billion a year – about

the same as the UK floods in 2000!

<1% of 28.5 million people with HIV/AIDS in Africa have access to drugs

Don’t expect too much!


CLINICS diagnosis

treatment advice


Training . . . Counselling . . . Destigmatising


Peer advice -Making the message cool


An image from the sexual health information campaign, England

(Department of Health)

Slide Source: UK Collaborative Groupfor HIV and STI Surveillance


TREAT

COPEPREVENT

AIDSRESPONSE

Drug therapy/Lifestyle

Vaccine??Modify behaviour?

Tackle poverty!

Locate impact Assess impact Manage impact


The World Bank TAP


Community Health Workers

ORGANISATIONAL STRUCTURESPATIAL STRUCTURE

“governance”

“spatial structure”


Acknowledge the problem of

HIV/AIDSFIRST STEP COMMITMENT

Tackle the underlying

poverty/politicsTHE STRATEGY

Confront the disease and plan

the response

The Centre for AIDS Research

The geography of HIV/AIDS: looking beyond the maps

I live in hopeI hope I live

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