HIV AND AIDS IN AFRICA Public Policy Issues and Foreign Roles Joel Samoff Slide Number 2Slide Number 3Slide Number 4Slide Number 5Slide Number 6Slide Number 7Slide Number 8Slide Number 9Slide Number 10Slide Number 11Slide Number 12Slide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Slide Number 18Slide Number 19Slide Number 20Spread of HIV in sub-Saharan Africa, 1987Spread of HIV in sub-Saharan Africa, 1997Slide Number 23Spread of HIV in AfricaSlide Number 25Slide Number 26Slide Number 27Slide Number 28Slide Number 29Slide Number 30Slide Number 31Slide Number 32Slide Number 33Slide Number 34Slide Number 35Slide Number 36Differences in HIV among countries in AfricaSlide Number 38Slide Number 39Slide Number 40Slide Number 41Slide Number 42Slide Number 43Slide Number 44Slide Number 45Slide Number 46Slide Number 47Slide Number 48Slide Number 49Slide Number 50Slide Number 51Slide Number 52Slide Number 53Slide Number 54Slide Number 55Slide Number 56Slide Number 57Drug prices fallSlide Number 59From Health Issue to Development CrisisSlide Number 61Notwithstanding the image of crisis, there have been some successes—  Uganda  Sénégal Notwithstanding the image of crisis, there have been some successes—  Uganda • public recognition of HIV/AIDS, public discussion Notwithstanding the image of crisis, there have been some successes—  Uganda • public recognition of HIV/AIDS, public discussion • HIV/AIDS as a family or community, rather than individual, issue Notwithstanding the image of crisis, there have been some successes—  Uganda • public recognition of HIV/AIDS, public discussion • HIV/AIDS as a family or community, rather than individual, issue  Sénégal • registration of prostitutes  free regular medical care  reduction in STDs  reduced transmission of HIV/AIDS Notwithstanding the image of crisis, there have been some successes—  Uganda • public recognition of HIV/AIDS, public discussion • HIV/AIDS as a family or community, rather than individual, issue  Sénégal • registration of prostitutes  free regular medical care  reduction in STDs  reduced transmission of HIV/AIDS  For both Uganda and Sénégal • type and strain of HIVSlide Number 67Is there an AIDS crisis in Africa? A pandemic? • There is no AIDS • HIV does not cause AIDS Is there an AIDS crisis in Africa? A pandemic?  Skepticism about measurement, data, assumptions • There is no AIDS • HIV does not cause AIDS Is there an AIDS crisis in Africa? A pandemic?  Skepticism about measurement, data, assumptions  Critics: • There is no AIDS Is there an AIDS crisis in Africa? A pandemic?  Skepticism about measurement, data, assumptions  Critics: • There is no AIDS • HIV does not cause AIDS Slide Number 72How to decide which treatment(s) to use? How to decide which treatment(s) to use?  Double-blind tests • There is no AIDS • HIV does not cause AIDS How to decide which treatment(s) to use?  Double-blind tests • On whom? • There is no AIDS • HIV does not cause AIDS How to decide which treatment(s) to use?  Double-blind tests • On whom? • Under what circumstances? • There is no AIDS • HIV does not cause AIDS How to decide which treatment(s) to use?  Double-blind tests • On whom? • Under what circumstances?  Ethics of medical testing • There is no AIDS • HIV does not cause AIDS Slide Number 78Policy Challenges 1. Government role Policy Challenges 1. Government role 2. Access to medical care, both preventive and curative, including drugs Policy Challenges 1. Government role 2. Access to medical care, both preventive and curative, including drugs 3. Data gathering: what? by whom? how? accessible to whom? Policy Challenges 1. Government role 2. Access to medical care, both preventive and curative, including drugs 3. Data gathering: what? by whom? how? accessible to whom? 4. Whatever is government policy, who is responsible for implementing it? Policy Challenges 1. Government role 2. Access to medical care, both preventive and curative, including drugs 3. Data gathering: what? by whom? how? accessible to whom? 4. Whatever is government policy, who is responsible for implementing it? HIV AND AIDS IN AFRICA Public Policy Issues and Foreign Roles Joel SamoffHIV AND AIDS IN AFRICAHIV AND AIDS IN AFRICA Public Policy IssuesPublic Policy Issues and Foreign Rolesand Foreign Roles Joel SamoffJoel SamoffThe broader context: the HIV/AIDS crisis globally—Global summary of the AIDS epidemic, December 2007Total 33 million [30 – 36 million] Adults 30.8 million [28.2 – 34.0 million] Women 15.5 million [14.2 – 16.9 million] Children under 15 years 2.0 million [1.9 – 2.3 million]Total 2.7 million [2.2 – 3.2 million] Adults 2.3 million [1.9 – 2.8 million] Children under 15 years 370 000 [330 000 – 410 000]Total 2.0 million [1.8 – 2.3 million] Adults 1.8 million [1.6 – 2.1 million] Children under 15 years 270 000 [250 000 – 290 000]Number of people living with HIV in 2007People newly infected with HIV in 2007 AIDS deaths in 2007Global estimates for adults and children, 2007• People living with HIV 33 million [30 – 36 million]• New HIV infections in 2007 2.7 million [2.2 – 3.2 million]• Deaths due to AIDS in 2007 2.0 million [1.8 – 2.3 million]• Children living with HIV 2.0 million [1.9 – 2.3 million]• New HIV infections in 2007 370 000 [330 000 – 410 000]• Deaths due to AIDS in 2007 270 000 [250 000 – 290 000]2007 global HIV and AIDS estimatesChildren (<15 years)Over 7400 new HIV infections a day in 2007• More than 96% are in low and middle income countries• About 1000 are in children under 15 years of age• About 6300 are in adults aged 15 years and older of whom:— almost 50% are among women— about 45% are among young people (15-24)HIV/AIDS in the World / in Africa—A global view of HIV infectionA global view of HIV infection38.6 million people [33.4‒46.0 million] living with HIV, 20052.4A global view of HIV infection33 million people [30–36 million] living with HIV, 20072.2Total: 33 million (30 – 36 million)Western & Central Europe730 000730 000[580 000 [580 000 –– 1.0 million]1.0 million]Middle East & North