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Centre for AIDS Research

Centre for AIDS Research. World AIDS Day 2004 Some viewpoints and perspectives. Professor Mike Clark School of Geography Director – Centre for AIDS Research. University of

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Centre for AIDS Research

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  1. Centre for AIDS Research World AIDS Day 2004 Some viewpoints and perspectives Professor Mike Clark School of GeographyDirector – Centre for AIDS Research University of Southampton

  2. The Centre for AIDS Research The vision which fuelled our struggle for freedom; the development of energies and resources; the unity and commitment of common goals – all these are needed if we are to bring AIDS under control. Future generations will judge us on the adequacy of our response. Nelson Mandela

  3. Focus on impacts – social, economic, political, environmental & bio-medical Research and policy-orientated engagement Centre for AIDS Research Founded on strategic partnerships with institutions, stakeholders, governments and agencies A holistic approach – cross-disciplinary and cross-sectoral A distinctive mission World AIDS Day: viewpoints and perspectives

  4. The roots of health and welfare Development . . . & underdevelopment? Soshanguve Township 10 miles from Pretoria Pretoria - South Africa But watch for challenges: AIDS and poverty? Two pandemics or one? More than a disease? World AIDS Day: viewpoints and perspectives

  5. AIDS The health of the individual The welfare and income of the family Supported children – not orphans Functional communities and services National economic stability A stable society Development founded on Health World AIDS Day: viewpoints and perspectives

  6. Global summary December 2003 People living with HIV/AIDS ………….. 40 million (34 - 46 million) New HIV infections in 2003 ………….... 5 million (4.2 - 5.8 million) Deaths due to HIV/AIDS in 2003 ……… 3 million (2.5 – 3.5 million) The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information. These ranges are more precise than those of previous years. World AIDS Day: viewpoints and perspectives

  7. 14 million AIDS orphans already 40 million by 2010! 40 million people are living with AIDS worldwide 20-25 million people have already died of AIDS 68 million more will die of AIDS by 2020 14000 people become newly infected every day World AIDS Day: viewpoints and perspectives

  8. HIV Cases Precede AIDS Cases Numbers - AIDS Numbers - HIV HIV prevalence A2 A1 A AIDS - cumulative B B1 Death rises later T1 T2 Time Source: Whiteside & Sunter AIDS: The Challenge for South Africa, 2000, p. 27 World AIDS Day: viewpoints and perspectives

  9. HIV and AIDS diagnoses and deaths in HIV-infected individuals by year of diagnosis, United Kingdom, 1994-2003 Slide Source: UK Collaborative Group for HIV and STI Surveillance 1 1 1 Numbers will rise, for recent years, as further reports are received. Data Source: HIV/AIDS reports. Reports received by the end of June 2004. World AIDS Day: viewpoints and perspectives

  10. Rates of diagnosed HIV-infected adults seen for care, United Kingdom, 1998 and 2003 by residence, 1998 and 2003 Data source: SOPHID and CD4 monitoring scheme for Scotland. Slide Source: UK Collaborative Group for HIV and STI Surveillance World AIDS Day: viewpoints and perspectives

  11. Steps towards a response Introducing HIV/AIDS Understanding HIV/AIDS Towards a Geography of HIV/AIDS Responding to HIV/AIDS World AIDS Day: viewpoints and perspectives

  12. A 15-year old in Zambia has a 60% chance of dying of AIDS Propensity - AIDS factors • Gender (girls more vulnerable) • Age (sexually-active years) • Poverty (directly and indirectly create propensity to infection) • Sexually-transmitted diseases (STDs) World AIDS Day: viewpoints and perspectives

  13. Vulnerability - AIDS triggers • Unsafe sex, mother-to-baby, drug injection, blood contact • LACK OF SOCIAL COHESION • Migration (to work) - multiple partners • Military service (war/terrorism) • Refugees • Prostitution • Child abuse and rape • Fatalism and traditional medicine Poverty? High wealth + high social cohesion = no epidemic Low wealth + low social cohesion = high epidemic Low wealth + high social cohesion = slow epidemic World AIDS Day: viewpoints and perspectives

  14.        The School Choir INCIDENCE - the human dimension SA prevalence of HIV/AIDS = 4.5 million Women’s deaths peak at 24 years: men 29 One third HIV infections in school years Population polarising <15 and >50 years Perhaps 30% SA school children HIV+ Up to 40% at some SA universities World AIDS Day: viewpoints and perspectives

  15. Looking beyond the maps Introducing HIV/AIDS Understanding HIV/AIDS Towards a Geography of HIV/AIDS Responding to HIV/AIDS World AIDS Day: viewpoints and perspectives

  16. 1. Policy-influencing & attitudinal World AIDS Day: viewpoints and perspectives

  17. Eastern Europe & Central Asia 1.2 – 1.8 million Western Europe 520 000 – 680 000 North America 790 000 – 1.2 million East Asia & Pacific 700 000 – 1.3 million North Africa & Middle East 470 000 – 730 000 Caribbean 350 000 – 590 000 South & South-East Asia 4.6 – 8.2 million Sub-Saharan Africa 25.0 – 28.2 million Latin America 1.3 – 1.9 million Australia & New Zealand 12 000 – 18 000 People living with AIDS: end 2003 World AIDS Day: viewpoints and perspectives

  18. 2. Strategic (targets & monitoring) World AIDS Day: viewpoints and perspectives

  19. Mapping – The Valley Trust 3. Operational (support & supervision) World AIDS Day: viewpoints and perspectives

  20. P Johnstone & J Ranken (1994) 4. Community participation World AIDS Day: viewpoints and perspectives

  21. Engagement Empowering Equity Elitism Exclusion The intellectual/moral challenge World AIDS Day: viewpoints and perspectives

  22. Steps towards a response Introducing HIV/AIDS Understanding HIV/AIDS Towards a Geography of HIV/AIDS Responding to HIV/AIDS World AIDS Day: viewpoints and perspectives

  23. “If you do that, this is what will happen to you” • “OK, in that case I won’t do it” As simple as ABC! Abstain Be faithful Condom World AIDS Day: viewpoints and perspectives

  24. (after The Theory of Reasoned Action: Ajzen & Fishbein, 1975) Making the message more realistic  Harare, Zimbabwe ABC World AIDS Day: viewpoints and perspectives

  25. Drug therapy/Lifestyle TREAT AIDS RESPONSE COPE PREVENT Vaccine?? Modify behaviour? Tackle poverty! Locate impact Assess impact Manage impact World AIDS Day: viewpoints and perspectives

  26. Don’t expect too much! <1% of 28.5 million people with HIV/AIDS in Africa have access to drugs Global spending on AIDS prevention and care in developing countries about $2 billion a year – about the same as the UK floods in 2000! World AIDS Day: viewpoints and perspectives

  27. CLINICS diagnosis treatment advice World AIDS Day: viewpoints and perspectives

  28. Training . . . Counselling . . . Destigmatising World AIDS Day: viewpoints and perspectives

  29. Peer advice - Making the message cool World AIDS Day: viewpoints and perspectives

  30. An image from the sexual health information campaign, England Slide Source: UK Collaborative Group for HIV and STI Surveillance (Department of Health) World AIDS Day: viewpoints and perspectives

  31. Drug therapy/Lifestyle TREAT AIDS RESPONSE COPE PREVENT Vaccine?? Modify behaviour? Tackle poverty! Locate impact Assess impact Manage impact World AIDS Day: viewpoints and perspectives

  32. The World Bank TAP World AIDS Day: viewpoints and perspectives

  33. ORGANISATIONAL STRUCTURE SPATIAL STRUCTURE Community Health Workers “governance” “spatial structure” World AIDS Day: viewpoints and perspectives

  34. World AIDS Day: viewpoints and perspectives

  35. Confront the disease and plan the response Tackle the underlying poverty/politics Acknowledge the problem of HIV/AIDS FIRST STEP COMMITMENT THE STRATEGY World AIDS Day: viewpoints and perspectives

  36. The Centre for AIDS Research The geography of HIV/AIDS: looking beyond the maps I live in hope I hope I live

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