Case Study 4 AIDS in Africa : Serial Killer at Large

1
Case Study 4 AIDS in Africa Serial Killer at
Large

• 1 The AIDS Epidemic
• 2 AIDS in Africa
• 3 Consequences

2
The AIDS Epidemic
1

• Chronology
• 1930s Mutation and transmission of HIV (human
  immunodeficiency virus) from a chimpanzee to a
  human.
• 1950s First likely cases and deaths in Africa.
• 1981-83 First cases of an unknown disease that
  destroys the immune system are detected in the
  United States.
• Mainly prevalent among homosexuals and drug
  users.
• 1984 The HIV virus is first identified.
• Virus is identified as spreading through blood.
• 1985 First World AIDS conference held in
  Atlanta.
• Blood screening test introduced in North America
  and Europe.
• 1987 First possible treatment (AZT Zidovudine)
  launched.

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The AIDS Epidemic
1

• 1992 Women are recognized to be as risky as men
  to catch HIV.
• 1993 First estimates of HIV infected reach 13
  million.
• 1996 Efficient HIV inhibitors introduced
  (cocktails).
• 1997 Drug resistant forms of HIV start to
  appear, notably in new-born children.
• 1998 Sharp decline of new cases in the developed
  world due to access to new treatments.
• AIDS continues to be rampant in the developing
  world.
• 2000 AIDS officially recognized by the US as a
  threat to national security.

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The AIDS Epidemic
1

• 2001 First UN special session on AIDS.
• All 189 member nations agreed on a set strategies
  for comprehensive prevention and treatment
  programs.
• Issues of womens rights, AIDS orphans and HIV
  discrimination.

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The AIDS Epidemic
1

• Strains
• Destroys white blood cells.
• HIV 1
• A similar virus found in some sub-species of
  chimpanzees.
• Only present in West Central Africa.
• Most prevalent among adults aged 15-49.
• Greater effect on population rates.
• Most prevalent form of HIV in Africa.
• HIV 2
• A mutation of HIV 1.
• Occurs primarily in older age cohorts.
• People under 30 account for only 10 of
  infections.

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The AIDS Epidemic
1

• Global Context
• More than 40 million people were HIV positive in
  2000.
• One person every six second contracts the
  disease.
• By the end of 2000, 21.8 million people have died
  of AIDS.
• About 5 million contracted the virus in 2001.
• 14,000 people a day contracted HIV.
• 95 in developing countries.
• 5.6 million in 1999.
• 3.0 million died, of which 2.4 million in Africa.
• 70 of all HIV positive population.
• 80 of all deaths.
• 47 HIV positive persons are women.
• 13.2 million children (-14) have been orphaned
  (end of 1999).

7
Global Estimates of Cumulative HIV/AIDS
Infections and Deaths Worldwide, 1980-2001 (in
millions)
1
8
The AIDS Epidemic
1

• Epidemiology
• Pattern 1
• Homosexual/bisexual activity and intravenous drug
  use.
• Most prevalent in the developed world.
• Pattern 2
• Heterosexual activity.
• Mainly prevalent in the developing world.
• Especially the case of Africa.

9
Adults and children estimated to be living with
HIV/AIDS as of end 1999-2001 (in millions)
1
10
Estimated deaths due to HIV/AIDS from the
beginning of the epidemic to end 1999 (in
millions)
1
11
Estimated number of adults and childrennewly
infected with HIV during 2000 (in millions)
1
12
HIV Prevalence and Percentage of Infected Women,
2000
1
13
AIDS in Africa
2

• African Context
• AIDS is reaching epidemic proportions.
• About 25 million infected.
• Most will die within 8 years.
• One new HIV positive case every 25 seconds.
• The transmission is mainly heterosexual.
• 55 of infected people are women.
• In several large cities, 33 of pregnant women
  are infected.
• Death rates are rising.
• Infant mortality rates are rising.
• Life expectancy is declining.
• Most of the population will die around 30.
• Back 100 years in time.
• The population of some countries is expected to
  drop.
• First time since the Black Death of the 14th
  century.

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Causes of deaths, globally and in Africa, 1999
(in )
2
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AIDS in Africa
2

• Botswana
• The worlds hardest hit country.
• 33 of the reproductive-age population is
  infected.
• Life expectancy expected to decline from 61 years
  in 1990 to 29 years in 2010.
• Zimbabwe
• Second-highest infection rate for HIV.
• 25 of people between 25 and 45 are HIV
  positive.
• 220 deaths a day were attributed to AIDS (1998).
• Government spent 70 million a month for the war
  with the Democratic Republic of Congo.
• 1 million a month for the prevention of AIDS.

16
Projected population structure with and without
the AIDS epidemic, Botswana, 2020
2
Projected population structure in 2020
Deficits due to AIDS
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AIDS in Africa
2

• Other countries
• Tanzania and Uganda 50 of the population that
  is currently 18 is expected to die before 65.
• South Africa has the highest absolute number of
  infected people in the world, with 4.2 million
  people infected (out of 40 million).
• 25 South African women between the ages of 20
  and 29 are HIV positive.
• Over 70 of hospital beds in Burundi are taken by
  AIDS patients.
• Over 40 in Kenya.

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Spread of HIV in sub-Saharan Africa, 1987, 1997
2
1987
1997
16.0 32.0 8.0 16.0 2.0 8.0
0.5 2.0 0 0.5 trend data
unavailable outside region
Estimated percentage of adults (1549) infected
with HIV
19
Life Expectancy in Selected African Countries,
1955-2000
2
20
Life Expectancy at Birth in 29 African Countries
With and Without AIDS Between 1985-1990 and
2010-2015
2
21
Population Projections for the 29 Most-affected
Sub-Saharan African Countries, 1980-2050 (in
millions)
2
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Consequences
2

• Social costs
• Places the most infected are the least able to
  fight the disease.
• Widespread poverty.
• Poor educational system.
• Limited employment opportunities.
• Limited health facilities.
• Foreign debt.
• Changed African family structures.
• Instead of grown children looking after aging
  parents, these parents have to look after their
  orphaned grandchildren.
• One of the main obstacles to fighting AIDS in
  Africa is patriarchy.
• Societies (and government) are male dominated.

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Consequences
3

• AIDS orphans.
• Most HIV positive themselves.
• Lost the support of their parents.
• Perceived as taboo.
• There are over 12.1 million AIDS orphans in
  Africa.
• Economic costs
• People dying of AIDS are mostly between 25 and
  35.
• Most productive years.
• Four out of five deaths of the age group are
  attributed to AIDS.
• Less attractive context for investment.
• Recruiting problems.

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Consequences
3

• Is the health system coping?
• Governments have other priorities such as
  repairing the road system and paying civil
  servants salaries.
• Proper control of AIDS require proper healthcare
  system.
• Medication
• Medication to prolong life and to prevent the
  transmission to the fetus is available in the
  developed world.
• Cost about 10,000 to 15,000 per person per
  year.
• Most African countries spend less than 50 per
  person on health per year.
• UN says it will take 3 billion a year in
  spending on AIDS prevention programs in Africa to
  make a difference.
• The US pharmaceutical market represents 126
  billion a year.
• US spends 52 billion a year coping with the
  costs of the medical consequences caused by
  obesity.

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AIDS Related Skin Infection, Tanzania, 1998
3
26
Children Watching their Mother Dying of AIDS,
Tanzania, 1998
3
27
AIDS Orphan, Addis Ababa, Ethiopia, 1999
3
28
AIDS Prevention Advertising, Botswana, 2000
3
29
AIDS Victim in Final Stages, Harare, Zimbabwe,
2000
3
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Not Knowing What They're Talking About
3