[PPT] - HIV and development challenges for Africa Catherine Hankins, PowerPoint Presentation

SLIDE 1

25 October, 2007 UNAIDS

‘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

10th Anniversary of the Centre for the Study of Globalisation and Regionalisation Centre at Warwick University

Warwick, September 17, 2007 Hankins

SLIDE 2

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

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

SLIDE 3

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

Global HIV epidemic, 1990‒2005* HIV epidemic in sub-Saharan Africa, 1985‒2005*

Number of people living with HIV % HIV prevalence, adult (15-49)

% HIV prevalence, adult (15‒49) Number of people living with HIV (millions)

10 20 30 40 50 1990 1995 2000 2005 0.0 1.0 2.0 3.0 4.0 5.0 1985 1990 1995 2000 2005 5 10 15 20 25 30 0.0 2.5 5.0 7.5 12.5 15.0

% HIV prevalence, adult (15‒49) Number of people living with HIV (millions)

Estimated number of people living with HIV and adult HIV Estimated number of people living with HIV and adult HIV prevalence prevalence

This bar indicates the range around the estimate

*Even though the HIV prevalence rates have stabilized in sub-Saharan Africa, the actual number of people infected continues to grow because of population growth. Applying the same prevalence rate to a growing population will result in increasing numbers of people living with HIV.

10.0

2.2

SLIDE 4

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

1990 1992 1994 1996 1998 2000 2002 2004 2006

Sub-Saharan Africa Caribbean GLOBAL Latin America Asia E Europe and C Asia

Percent Female (%) 70 60 50 40 30 20 10

Percent of adults (15+) living with HIV who are female, 1990‒2006

Figure 1

SLIDE 5

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

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

2.5

SLIDE 6

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

HIV prevalence (%) by gender and urban/rural residence, HIV prevalence (%) by gender and urban/rural residence, selected sub selected sub-

Saharan African countries, 2001

Saharan African countries, 2001‒ ‒2005 2005

10 20 30 %

15‒49 years old, by gender

Lesotho South Africa Zambia Kenya Uganda UR Tanzania Burkina Faso Ghana Guinea Senegal Urban Rural Women Men Women Men

10 20 30 %

15‒24 years old, by gender

10 20 30 %

15‒49 years old, by urban/ rural residence

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 AIDS (UR Tanzania) (2005).

2.7

SLIDE 7

Illustrative Results

Resources Needed for Prevention

2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 2006 2010 2015 Millions of US$

Univ Precautions Male circumcision Safe injections PEP Blood safety PMTCT STI treatment Condoms Social marketing Other vuln. pops. Prevention for PLHA Workplace IDU MSM CSW Youth out of school Youth in school VCT

Comm. Mobilization

Mass media

Targets reached in 2010

SLIDE 8

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

SLIDE 9

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

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

SLIDE 10

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

HIV & Poverty - Africa

0% 5% 10% 15% 20% 25% 10 20 30 40 50 60 70 80 Percentage below $1 per day HIV Prevalence

Botswana Lesotho Namibia Zimbabwe Zambia Malawi Mozambique Sierra Leone Tanzania Central African Republic Ethiopia Côte d'Ivoire Uganda Kenya Rwanda South Africa Mali Nigeria Cameroon Niger Madagascar Gambia Burundi Ghana Burkina Faso Senegal Mauritania

SLIDE 11

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

HIV & Income Inequality - Africa

R2 = 0.4881 p=0.005% 0% 5% 10% 15% 20% 25% 30% 35% 0.25 0.35 0.45 0.55 0.65 0.75 GINI Coefficient HIV Prevalence

Botswana Lesotho Namibia Zimbabwe Zambia Malawi Mozambique Tanzania Central African Republic Ethiopia Côte d'Ivoire Uganda Kenya Rwanda South Africa Mali Nigeria Cameroon Niger Burundi Ghana Senegal Swaziland

SLIDE 12

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

LE at birth (healthy years), total

Log 25 75

GDP per capita in 1995 international dollars

Log 308 53 500 1 000 5 000 10 000 20 000 7 000 3 000 2 000 800 600 50 70 60 40 30 Armenia Azerbaijan Bangladesh Bhutan Bolivia Cuba Finland Georgia

Ghana Haiti

Iceland Italy Japan Luxembourg Madagascar Maldives

Mali

Mongolia Nicaragua Pakistan Papua New Guinea Russia

Senegal

Spain

Sudan

Tajikistan Turkmenistan Uzbekistan Yemen

Africa Americas Arab countries Asia Europe

size = HIV prevalence (age 15–49)

HIV prevalence & Life expectancy at birth 2000

Botswana

Angola

Burundi Cameroon Central African Republic

Chad Equatorial Guinea

Ethiopia

Guinea-Bissau

Kenya

Lesotho

Malawi Mozambique

Namibia

Nigeria

Sierra Leone

South Africa Swaziland

Togo Uganda

Zambia Zimbabwe

Burkina Faso

Côte d'Ivoire Rwanda

Cambodia Benin Eritrea

Nepal India

Honduras Guyana

China Ecuador Egypt El Salvador Indonesia Jordan Morocco Peru Philippines Sri Lanka

Suriname Ukraine Guatemala

Algeria

Argentina

Australia Austria Bahrain

Barbados

Belarus Belgium

Belize

Brazil Bulgaria Canada Chile Colombia Costa Rica Croatia Cyprus Czech Republic Denmark

Dominican Republic

Fiji France Germany Greece Hungary Ireland Israel South Korea Latvia Lithuania Malaysia Malta Mauritius Mexico Netherlands New Zealand Norway

Panama

Poland Portugal Romania Singapore Slovenia Sweden Switzerland

Thailand Trinidad and Tobago

Turkey United Kingdom

United States of America

Uruguay

Jamaica

Estonia

SLIDE 13

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

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

SLIDE 14

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

Epidemic Curves, HIV, AIDS & Impact

T1 T2 Time Numbers A1 A2

HIV prevalence

B1 A B

AIDS - cumulative SOCIAL AND ECONOMIC IMPACT

SLIDE 15

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

Impact of AIDS on life expectancy in five African countries Impact of AIDS on life expectancy in five African countries 1970 1970– –2010 2010

Life expectancy at birth (years)

Source: United Nations Population Division (2004). World Population Prospects: The 2004 Revision, database.

Botswana South Africa Swaziland Zambia Zimbabwe

1970–1975 1975–1980 1980–1985 1985–1990 1990–1995 1995–2000 2000–2005 2005–2010 70 65 60 55 50 45 40 35 30 25 20

4.1

SLIDE 16

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

Percentage of distribution of deaths by age in southern Africa, Percentage of distribution of deaths by age in southern Africa, 1985 1985– –1990 and 2000 1990 and 2000– –2005 2005

0–4 5–19 20–29 30–39 40–49 50–59 60+ 40 35 30 25 20 15 10 5 1985-1990 2000-2005 Percentage

f total deaths

Age-groups

:

Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat (2005). World Population Prospects: The 2004 Revision. Highlights. New York: United Nations.

4.2

SLIDE 17

Lifetime risk of AIDS death for 15 Lifetime risk of AIDS death for 15-

year

year-

old boys,
ld boys,

assuming unchanged or halved risk of becoming assuming unchanged or halved risk of becoming infected with HIV, selected countries infected with HIV, selected countries

Source: Zaba B, 2000 (unpublished data)

Current adult HIV prevalence rate

Burkina Faso Cambodia Côte d’Ivoire Kenya South Africa Zambia Zimbabwe Botswana Burkina Faso Cambodia Côte d’Ivoire Kenya South Africa Zambia Zimbabwe Botswana 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0% 5% 10% 15% 20% 25% 30% 35% 40%

Risk of dying of AIDS

current level of risk maintained risk halved over next 15 years

SLIDE 18

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

Projected reduction in African agricultural Projected reduction in African agricultural labour labour force force due to HIV and AIDS by 2020 due to HIV and AIDS by 2020

Sources: ILO (2004). HIV/AIDS and work: global estimates, impact and responses

Projected labor force loss (%) by year Namibia Botswana Zimbabwe Mozambique South Africa Kenya Malawi Uganda UR Tanzania Central African Republic Côte d’Ivoire Cameroon 5 10 15 20 25 30 2020 2000

4.8

SLIDE 19

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

Human capital

Rising morbidity & mortality leading to decreased

productivity in public and private sector

investment declines at family, community, public

sector and private sector levels

Private sector: loss of skilled workforce, increased

training needs, reduced management expertise

Public sector: reduced tax revenues at a time of

increased demand for health care and social support, reduced investment in child education, effects on workforce, potential for eroded governance capacity

GDP effects: reduction of 0.5% to 1.5% in GDP

growth rate over a 10 to 20 year period in high HIV prevalence countries

SLIDE 20

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

Between 1990 and 2003, sub-Saharan Africa’s population of children orphaned by AIDS increased from less than 1 million to more than 12 million

4 8 12 16 20 1990 1995 2000 2003 2010

Source: Children on the Brink 2004. A Joint Report of New Orphan Estimates and a Framework for Action. Fig. 6.

Number

f Orphans

due to AIDS

(millions)

SLIDE 21

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

Intergenerational effects

Orphans: 13% less likely to attend school than

non-orphans (maternal orphans, double

rphans, girls)
Orphans overwhelming capacity of social

networks and traditional patterns of intergenerational dependency, creating an uneducated, unsocialized and uncared for generation

Lost transmission of knowledge and skills

between generations (cf Bell and Deverajan): cumulative weakening from generation to generation of human and social capital

SLIDE 22

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

People in sub People in sub-

Saharan Africa on antiretroviral treatment

Saharan Africa on antiretroviral treatment as percentage of those in need, 2002 as percentage of those in need, 2002– –2005 2005

2002 2003 2004 2005

7.2

Source: WHO/UNAIDS (2005). Progress on global access to HIV antiretroviral therapy: An update on “3 by 5.”

SLIDE 23

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

Women as a percentage of all adults receiving antiretroviral the Women as a percentage of all adults receiving antiretroviral therapy rapy in 30 countries: actual versus expected percentages, 2005 in 30 countries: actual versus expected percentages, 2005a

a

Latin America and Caribbean Latin America and Caribbean

Guyana Argentina Brazil El Salvador Haiti Honduras Panama Peru Venezuela 0% 20% 40% 60% 80% 0% 20% 40% 60% 80% Cambodia China India Viet Nam

Asia Asia Sub Sub-

Saharan Africa

Saharan Africa

Kenya 0% 20% 40% 60% 80% Malawi Mozambique Namibia Nigeria Rwanda South Africa UR Tanzania Uganda Zambia Zimbabwe Côte d'Ivoire Ethiopia Ghana Botswana Burundi Central African Republic

Expected percentage of women receiving ARV therapy

7.4

Source: WHO/UNAIDS (2006). Progress on global access to HIV antiretroviral therapy. A report on “3 by 5” and beyond.

a The expected percentage of

women receiving ARV therapy is based on the percentage of people living with HIV/AIDS who are women

SLIDE 24

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

Coverage of HIV-infected mothers who received antiretroviral prophylaxis

Comparison of 2003 and 2005 data on the expansion of antiretrovi Comparison of 2003 and 2005 data on the expansion of antiretroviral ral therapy therapy and coverage of HIV and coverage of HIV-

infected mothers who received antiretroviral

infected mothers who received antiretroviral prophylaxis in three sub prophylaxis in three sub-

Saharan African countries

Saharan African countries

Coverage of antiretroviral therapy

30 40 50 60 % 20 10 Kenya Uganda Namibia

1.0 7.0 4.6 9.3 25.0 12.0

30 40 50 60 % 20 10 Kenya Uganda Namibia

3.0 0.0 6.3 19.7 35.0 56.0

2003 2005

3.3

Sources: Individual country reports (2005).

SLIDE 25

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

Impact of three scenarios on HIV infection Impact of three scenarios on HIV infection in sub in sub-

Saharan Africa, 2003

Saharan Africa, 2003– –2020 2020

0.0 1.0 2.0 3.0 4.0 5.0 2003 2005 2010 2015 2020 Year Treatment-centered Prevention-centered Baseline Comprehensive response Number

f new HIV

infections (millions)

Source: Salomon JA et al. (2005). Integrating HIV prevention and treatment: from slogans to impact

6.1

SLIDE 26

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

Impact of AIDS Impact of AIDS-

related deaths in sub

related deaths in sub-

Saharan Africa, 2003

Saharan Africa, 2003– –2020 2020

2003 2005 2010 2015 2020 Year Treatment-centered Prevention-centered Baseline Comprehensive response 0.0 0.5 1.0 1.5 2.0 2.5 3.0 Number

f AIDS-

related deaths (millions)

Source: Salomon JA et al. (2005). Integrating HIV prevention and treatment: from slogans to impact

6.2

SLIDE 27

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

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

Responding to the interaction between HIV and poverty and poverty

SLIDE 28

Targets and timelines

UNGASS young people HIV-infected

– 25% reduction in most affected countries 2005; 25% globally 2010

UNGASS MTCT: % HIV + infants born to HIV-infected mothers

– 20% reduction by 2005; 50% reduction by 2010

3 by 5 Initiative: 3 million on ART by end 2005

– Setting of next target?

US President's Emergency Plan 2008

– 2 million on treatment, 7 million infections prevented, 10 million people, including orphans, provided with care

Millennium Development Goals 2015

– Halt and begin to reverse the spread of HIV/AIDS

Global Fund rolling targets over 5 years (replenishment 2006, 2007)

– 1.6 million on treatment, 52 million reached by VCT; 1 million orphans

SLIDE 29

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

AIDS funding requirements for low AIDS funding requirements for low-

and middle

and middle-

income

income countries countries

Prevention

8.4 10.0 11.4 29.8

Care and treatment

3.0 4.0 5.3 12.3 Support for orphans and vulnerable children 1.6 2.1 2.7 6.4

Programme costs

1.5 1.4 1.8 4.6

Human resources

0.4 0.6 0.9 1.9

TOTAL 14.9 22.1 55.1 18.1

2006 2007 2008 2006‒2008 US$ billion

Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.

10.1

SLIDE 30

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

Sources of the estimated and projected funding Sources of the estimated and projected funding for the AIDS response from 2005 to 2007* for the AIDS response from 2005 to 2007*

* Assuming there are no new commitments

Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.

Domestic Bilateral Multilateral Private Sector 2005 2006 2007 US$ billion 2 4 6 8 10 12

10.10

SLIDE 31

Impact of external grants on the macro- economy at country level

If small share in GDP, no problem If grants used to purchase imports (e.g. drugs), not much of a problem— this is similar to receiving commodities If grants used to purchase nontradeables (goods or services that you can’t import) then it creates demand for local goods and services; in large amounts, it pushes up their prices which disproportionately affects poor people It also pushes up demand for local currency, appreciating the exchange rate which can have a potentially adverse effect on exporters. Can you use grants to improve supply-side of economy—reduce key bottlenecks? Adverse impact on revenue mobilization? Creates dependency? Advantages of debt relief

SLIDE 32

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

Progress towards achieving the Progress towards achieving the “ “Three Ones Three Ones” ”: : Percentage of countries with one national coordinating body, one Percentage of countries with one national coordinating body, one national national HIV/AIDS strategy or framework and one national monitoring and HIV/AIDS strategy or framework and one national monitoring and evaluation plan evaluation plan

50 90 85

20 40 60 80 100 National body National frameworkNational monitoring and evaluation plan %

3.10

SLIDE 33

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

Stakeholder participation in development Stakeholder participation in development

f national AIDS plans in 79 countries, 2004
f national AIDS plans in 79 countries, 2004

full participation insufficient but increasing participation insufficient participation with no signs of improvement no participation

Source: (UNAIDS 2006) From advocacy to action: A progress report on UNAIDS at country-level, UNAIDS.

UN agencies Civil society/NGOs People living with HIV Donors Line ministries Media District and local authorities Faith-based organizations Private sector Women’s groups 0% 20% 40% 60% 80% 100%

11.1

SLIDE 34

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

Addressing AIDS in the poorest communities and countries

AIDS money has most impact when strategies are based on the concept
f “know and act on your epidemic”.
Combine HIV programmes with poverty reduction initiatives. e.g. NGOs

integrating HIV prevention into village/community banking programmes/microfinance (Malawi) for women, and combine AIDS education with the provision of microfinance to groups of women: need to shift from small shift from small-

scale projects to large

scale projects to large-

scale programmes

scale programmes.

Provision of HIV treatment can help prevent poverty, delay orphaning –

and indirectly contribute to HIV prevention as well.

Development plans (whether they concern the development of

productive sectors or the provision of social safety nets) must “pass the AIDS test”. e.g. World Bank-supported Chad/Cameroon Pipeline Project, supports HIV workplace interventions along the pipeline route – both for workers and for affected communities

Poverty reduction programmes and AIDS strategies must both reduce

vulnerability – particularly of women and young people: protecting human rights and tackling issues around social marginalization and stigma.

Increased and sustained international support, driven by high-level

political commitment and anchored in country ownership.

SLIDE 35

Warwick Univ. Sept 17 2007

Hankins UNAIDS

HIV and development challenges for Africa

10th Anniversary, Centre for the Study of Globalisation and Regionalisation

Acknowledgements

Peter Piot
Michel Sidibe
Robert Greener
Efren Fadriquela
Mihika Acharya
Constance Kponvi
YOU, THE AUDIENCE – THANK YOU!