‘ HIV and development challenges for Africa ’ Catherine Hankins, Associate Director & Chief Scientific Adviser to UNAIDS Session: Challenges of globalisation, regional integration and development of Africa 10 th Anniversary of the Centre for the Study of Globalisation and Regionalisation Centre at Warwick University Warwick, September 17, 2007 Hankins UNAIDS 25 October, 2007
HIV and development challenges for Africa • There is no one African epidemic: know your epidemic and act on it • Upstream effects: structural drivers in Africa: poverty versus income equality: which is more powerful? • Downstream impact: long wave impacts on poverty, GDP, human capital, social capital • Responding to the interaction between HIV and poverty Warwick Univ. Hankins HIV and development challenges for Africa Sept 17 10 th Anniversary, Centre for the Study of Globalisation and Regionalisation UNAIDS 2007
Estimated number of people living with HIV and adult HIV Estimated number of people living with HIV and adult HIV prevalence prevalence Global HIV epidemic, 1990 ‒ 2005* HIV epidemic in sub-Saharan Africa, 1985 ‒ 2005* Number of people % HIV prevalence, Number of people % HIV prevalence, adult (15 ‒ 49) adult (15 ‒ 49) living with HIV (millions) living with HIV (millions) 50 5.0 30 15.0 25 12.5 40 4.0 20 10.0 30 3.0 15 7.5 20 2.0 10 5.0 10 1.0 5 2.5 0 0.0 0 0.0 1990 1995 2000 2005 1985 1990 1995 2000 2005 *Even though the HIV prevalence rates have Number of people living with HIV stabilized in sub-Saharan Africa, the actual number of people infected continues to grow % HIV prevalence, adult (15-49) because of population growth. Applying the same prevalence rate to a growing population This bar indicates the range around the estimate will result in increasing numbers of people living with HIV. Warwick Univ. Hankins HIV and development challenges for Africa Sept 17 10 th Anniversary, Centre for the Study of Globalisation and Regionalisation UNAIDS 2007 2.2
Percent of adults (15+) living with HIV who are female, 1990 ‒ 2006 70 Sub-Saharan Africa 60 Caribbean 50 GLOBAL 40 Percent Latin America Female 30 (%) E Europe and C Asia 20 Asia 10 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 Warwick Univ. Hankins HIV and development challenges for Africa Sept 17 10 th Anniversary, Centre for the Study of Globalisation and Regionalisation UNAIDS 2007 Figure 1
HIV prevalence (%) in adults in Africa, 2005 HIV prevalence (%) in adults in Africa, 2005 Warwick Univ. Hankins HIV and development challenges for Africa Sept 17 10 th Anniversary, Centre for the Study of Globalisation and Regionalisation UNAIDS 2007 2.5
HIV prevalence (%) by gender and urban/rural residence, HIV prevalence (%) by gender and urban/rural residence, ‒ 2005 Saharan African countries, 2001 ‒ selected sub- -Saharan African countries, 2001 2005 selected sub 30 15 ‒ 49 20 Women Men years old, % by 10 gender 0 30 15 ‒ 24 20 Women Men years old, % by gender 10 0 15 ‒ 49 30 years old, 20 Urban Rural by urban/ % rural 10 residence 0 South UR Burkina Lesotho Zambia Kenya Uganda Ghana Guinea Senegal Africa Tanzania Faso South East West Sources: Demographic and Health Survey reports (Lesotho, Zambia, Kenya, Burkina Faso, Ghana, Guinea and Senegal) (2001–2005). Nelson Mandela Foundation (South Africa) (2005). Ministry of Health (Uganda). Tanzania Commission for 2.7 AIDS (UR Tanzania) (2005). Warwick Univ. Hankins HIV and development challenges for Africa Sept 17 10 th Anniversary, Centre for the Study of Globalisation and Regionalisation UNAIDS 2007
Illustrative Results Univ Precautions Resources Needed for Prevention Male circumcision Safe injections PEP 16,000 Blood safety PMTCT 14,000 STI treatment Millions of US$ 12,000 Condoms Social marketing 10,000 Other vuln. pops. 8,000 Prevention for PLHA Workplace 6,000 IDU 4,000 MSM CSW 2,000 Youth out of school Youth in school 0 VCT 2006 2010 2015 Comm. Mobilization Mass media Targets reached in 2010
Disconnect between dynamics of the epidemic and action: example from a West African country � General population prevalence 1.8%; antenatal clinic data stable 10 years � Peak age is 35-39 years (low prevalence in youth) � Sex worker HIV prevalence 78% and 82% in 2 largest cities � 75% of new infections in men in the capital city are clients of sex workers � Strategic plan presupposes a highly generalised epidemic with widest possible engagement of society and a broad range of interventions � Only 0.8% of AIDS investments are focused on sex work
HIV and development challenges for Africa • There is no one African epidemic: know your epidemic and act on it • Upstream effects: structural drivers in Upstream effects: structural drivers in • Africa: poverty versus income equality: Africa: poverty versus income equality: which is more powerful? which is more powerful? • Downstream impact: long wave impacts on poverty, GDP, human capital, social capital • Responding to the interaction between HIV and poverty Warwick Univ. Hankins HIV and development challenges for Africa Sept 17 10 th Anniversary, Centre for the Study of Globalisation and Regionalisation UNAIDS 2007
HIV & Poverty - Africa 25% Botswana Lesotho Zimbabwe 20% Namibia South Africa Zambia Mozambique HIV Prevalence 15% Malawi Central African Republic 10% Côte d'Ivoire Tanzania Uganda Kenya 5% Cameroon Nigeria Rwanda Burundi Ghana Gambia Ethiopia Mali Burkina Faso Niger Senegal Sierra Leone Mauritania Madagascar 0% 0 10 20 30 40 50 60 70 80 Percentage below $1 per day Warwick Univ. Hankins HIV and development challenges for Africa Sept 17 10 th Anniversary, Centre for the Study of Globalisation and Regionalisation UNAIDS 2007
HIV & Income Inequality - Africa 35% Swaziland 30% R 2 = 0.4881 p=0.005% 25% Botswana Lesotho HIV Prevalence Zimbabwe Namibia 20% South Africa Zambia Mozambique 15% Malawi Central African Republic 10% Tanzania Uganda Côte d'Ivoire Kenya Cameroon 5% Rwanda Nigeria Burundi Ghana Mali Ethiopia Senegal Niger 0% 0.25 0.35 0.45 0.55 0.65 0.75 GINI Coefficient Warwick Univ. Hankins HIV and development challenges for Africa Sept 17 10 th Anniversary, Centre for the Study of Globalisation and Regionalisation UNAIDS 2007
HIV prevalence & Life expectancy Switzerland Norway Iceland 75 Spain Chile Japan at birth 2000 New Zealand Costa Rica Uruguay Israel Czech Jordan Poland Greece Republic Sri Lanka Log 70 Mexico Ukraine Malta Luxembourg Slovenia Egypt Malaysia Morocco Cuba Portugal Panama Cyprus United States of America Jamaica China Argentina Barbados Suriname Estonia Croatia Bulgaria Georgia Bahrain South Korea Hungary Armenia Belize Ecuador 60 Trinidad and Tobago Fiji Thailand Nicaragua Mauritius Indonesia Peru Sweden Honduras El Salvador Russia Lithuania Brazil Australia Mongolia Romania Dominican Uzbekistan Ireland Guatemala Latvia Bangladesh Republic Guyana Belgium Turkey India Bhutan Azerbaijan Canada Belarus Philippines LE at birth (healthy years), total Colombia Maldives Tajikistan Bolivia Pakistan Denmark 50 Turkmenistan Finland Yemen Nepal Algeria Netherlands Papua New Africa Ghana Italy Guinea Cambodia France Madagascar Equatorial Guinea Haiti Sudan Germany United Kingdom Americas Senegal Togo South Africa Singapore Guinea-Bissau Benin Austria Nigeria Cameroon Kenya 40 Namibia Arab Chad countries Ethiopia Uganda Côte d'Ivoire Eritrea Mozambique Swaziland Asia Mali Burkina Faso Lesotho Central Burundi Botswana Rwanda Europe African Republic Zimbabwe Zambia 30 Malawi Angola Sierra Leone size = HIV prevalence (age 15–49) 25 308 600 800 1 000 2 000 3 000 7 000 10 000 20 000 53 500 5 000 GDP per capita in 1995 international dollars Log Warwick Univ. Hankins HIV and development challenges for Africa Sept 17 10 th Anniversary, Centre for the Study of Globalisation and Regionalisation UNAIDS 2007
HIV and development challenges for Africa • There is no one African epidemic: know your epidemic and act on it • Upstream effects: structural drivers in Africa: poverty versus income equality: which is more powerful? • Downstream impact: long wave impacts on Downstream impact: long wave impacts on • poverty, GDP, human capital, social capital poverty, GDP, human capital, social capital • Responding to the interaction between HIV and poverty Warwick Univ. Hankins HIV and development challenges for Africa Sept 17 10 th Anniversary, Centre for the Study of Globalisation and Regionalisation UNAIDS 2007
Epidemic Curves, HIV, AIDS & Impact Numbers HIV prevalence SOCIAL AND A 2 ECONOMIC A 1 IMPACT A AIDS - cumulative B B 1 T 1 T 2 Time Warwick Univ. Hankins HIV and development challenges for Africa Sept 17 10 th Anniversary, Centre for the Study of Globalisation and Regionalisation UNAIDS 2007
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