Joint United Nations Programme on HIV/AIDS (UNAIDS)

1. Joint United Nations Programme on HIV/AIDS (UNAIDS) UN Theme Group on HIV/AIDS Intercountry Team for Eastern and Southern Africa Policy Recommendations “2005 and Beyond” Megan Casey Tracy Chavis Eric Kennedy Dwayne Kirk Erin Lyons Wendy Resnik

2. AIDS Crisis in South Africa • 4,700,000 – 5,300,000 million infected with HIV • HIV prevalence of 20 - 25% • Avg. life expectancy dropped from 60 yrs to 50 yrs over last decade • 1 in 4 pregnant women are HIV+ • 600 die every DAY from AIDS/HIV-related complications • 130,000 children contract HIV from parents every year • 660,000 orphans, estimate 2,000,000 by 2010 • 2/3 AIDS patients have HIV + TB (TB kills 1 in 3 HIV/AIDS patients worldwide)

3. AIDS Crisis in South Africa • Issues • Apartheid only recently ended • Govt. slow to act on AIDS (denial of HIV link) • Mobility of population • High incidence of rape/Risky sexual behavior • Social/political stigma of AIDS/HIV

4. AIDS Crisis in South Africa ANC elected in post-apartheid elections; National AIDS plan is drafted HIV / AIDS Strategic Plan for South Africa: 2000-2005 Govt. commits to rolling out ARVs for all Court orders Govt. to provide ARVs; Govt. lodges appeal 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Govt. loses court appeal, but blocks $72M in provincial support for ARVs Medicines and Related Substances Amendment Act 10% ARV coverage in those requiring treatment NGO Defies Govt.; imports generic drugs from Thailand

5. Overview of Recommendations • Recommendations for the Immediate • Education • Prevention • Recommendations for the Intermediate • Treatment • Recommendations for the Long Term • Support Services

6. Focus on Education • Gugu Dlamini was beaten to death for having AIDS. • 30% of young African women believe healthy looking men can’t have AIDS. • Some believe you can be cured by having sex with a virgin. • Goals • Promote open discussion of sexual practices • Promote voluntary testing and counseling services • Emphasize health care and social service rights • Disseminate information on treatment availability • Focus on safe sex education

7. Focus on Education • Where to Begin • Primary and secondary schools • Trade unions • Trucking industry • Government workers • Policy Recommendations • 1. Train peer educators, doctors, nurses, and lab technicians • 2. Systematically visit and revisit locations • 3. Target high-risk groups • 4. Produce AIDS/STD pamphlets • 5. Condom / Information distribution • 6. Provide mobile testing facilities or info about nearest testing

8. Focus on Prevention “The internationally agreed upon approach to preventing MTCT includes: (1) primary prevention of HIV among prospective parents; (2) prevention of unwanted pregnancies among HIV-positive women; (3) prevention of transmission of HIV from mother to child; (4) the care and treatment of HIV-positive mothers in the context of mother-to-child transmission.”* • *Treating 3 million by 2005 : Making it happen, the WHO strategy : the WHO and UNAIDS global initiative to provide antiretroviral therapy to 3 million people with HIV/AIDS in developing countries by the end of 2005. 1/12/2003.

9. Focus on Prevention “Microbicides are a form of ‘chemical condom’ that can be self-administered and that can protect from HIV infection during sexual intercourse.”* *Treating 3 million by 2005 : Making it happen, the WHO strategy : the WHO and UNAIDS global initiative to provide antiretroviral therapy to 3 million people with HIV/AIDS in developing countries by the end of 2005. 1/12/2003.

10. Health and Medicine - Prevention Issues: • Vaccine development is highly expensive and occurs predominantly in US/Europe • Phase III clinical trials to date have shown little promise for an effective vaccine • Physiological correlates of protection are not known • HIV has nine known clades, with ability to recombine in-vivo to form mosaic genomes • Rate of increasing serotypes is an extreme challenge for vaccine developers • Sub-types are geographically distinct; different to clinical trials in US and Asia • Limited infrastructure in Africa has made other continents preferred targets for clinical trials • Eventual vaccine is likely to be expensive compared to other vaccines, drugs Policy Recommendations: • Engage pharmaceutical research agencies to focus on disease strains which • are most dominant in South Africa. 2. Encourage SA government to provide clinical trial infrastructure for existing and emerging vaccine candidates

11. Health and Medicine - Treatment Issues: • Anti-retrovirals (ARVs) are effective in reducing transmission and extending life • Access to ARVs is limited to approximately 1% (50,000) of those infected • Political environment has not been supportive of widespread use of ARVs • There are no alternative treatments which perform better than ARVs • Use of ARVs is a chronic dependency (CD4 below 200); risk of drug resistance • One year supply of individual ARV treatment ($250) exceeds average annual income • Continued pharmaceutical development is critical, hence protection of the industry • ARVs are treated as “controlled substances” (scarcity, combinatorial regimen) Policy Recommendations: • Prioritize distribution of ARVs to achieve 50% coverage within 2 years ($60M) 2. Escalate UNAIDS negotiations with pharmaceutical developers for cost effective options for new ARVs, and generic manufacturers 3. Communicate with SA government to prioritize allocation of resources for infrastructure necessary to fully distribute ARVs

12. Support Services Issues: • Estimated 2,000,000 orphaned children by 2010. • Family unit consists of the elderly and children. • AIDS victim is often the main breadwinner. Policy Recommendations: 1. Use the education/treatment infrastructure to distribute water, food and other basic necessities to the affected population. 2. Initiate a program to provide financial help, in the form of funeral assistance, welfare benefits, life insurance, etc. 3. Subsidize the adoption of AIDS orphans

13. Conclusions • Issues: • Poverty/Hunger • Racial/Gender Inequity • Hope: • Prevention/Education • Treatment • “It is morally, ethically, politically and even economically unsustainable for the majority of the world’s people living with HIV to have no access to the treatments that can save their lives.” • -Peter Pilot, Executive Director, UNAIDS

14. Making a Difference Students for International Change 21 students (including 5 from ASU) are traveling to Africa to promote education, testing and treatment for HIV and AIDS. “ASU, UA students plan to battle AIDS in Africa” By Jessica Wanke The Arizona Republic Mar. 23, 2004

15. Any Questions? An AIDS awareness notice erected by the health department on a busy street in Nazareth, Ethiopia

16. For More Information UNAIDS http://www.unaids.org/EN/Geographical+Area/by+country/south+africa.asphttp://www.unaids.org/html/pub/publications/irc-pub05/paper3_en_html.htm http://www.unaids.org/html/pub/publications/irc-pub06/jc951 steppingback_en_pdf.pdf South African Govt. http://www.gov.za/documents/2000/aidsplan2000.pdf NGO http://www.africaaction.org/action/access.htm http://www.tac.org.za News http://www.cnn.com/SPECIALS/2000/aids/stories/overview/ http://www.cnn.com/SPECIALS/2000/aids/stories/economic.impact/ http://www.irinnews.org/report.asp?ReportID=33826&SelectRegion=Southern _Africa