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HIV/AIDS & MDG Micronesia Region & MDG-Consistent HIV/AIDS Costing. Kazuyuki Uji HIV/AIDS Practice Team UNDP Regional Centre in Colombo. Outline. What is HIV / AIDS? Linkage between HIV and MDGs Overview of the epidemic in the North Pacific
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HIV/AIDS & MDGMicronesia Region&MDG-Consistent HIV/AIDS Costing Kazuyuki Uji HIV/AIDS Practice Team UNDP Regional Centre in Colombo
Outline • What is HIV / AIDS? • Linkage between HIV and MDGs • Overview of the epidemic in the North Pacific • Overview of the MDG-Consistent HIV/AIDS Costing model
What is HIV? • HIV • Human Immunodeficiency Virus • The virus that causes AIDS • Transmitted by: • (1) blood and blood products • (2) genital fluids (semen and virginal fluid) and • (3) breast milk
What is AIDS? • AIDS • Acquired Immuno-Deficiency Syndrome • Not a disease • The physical state in which the body’s immune system becomes too weak to defend against a range of diseases (opportunistic infections)
AIDS DISEASES How does HIV cause AIDS? HIV White Blood Cells (CD4) [coordinate body’s defence system against diseases]
HIV and MDGs “Halting the spread of HIV is not only an MDG in itself, it is a pre-requisite for reachingmost of the others. ” - Kofi Annan
Estimated number of people impoverished by HIV/AIDS in Cambodia, India, Thailand, and Viet Nam (5.6 mil / year) MDG 1:HIV/AIDS drives people deeper into poverty million 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5 0 2003 2005 2007 2009 2011 2013 2015 Source: ADB (2004) “Asia Pacific’s Opportunity: Investing to Avert an HIV/AIDS Crisis”
17.5 7.3 MDG 1:Large economic loss in Asia Pacific due to HIV/AIDS US billion 18 16 Annual losses 14 12 10 8 6 4 2 0 2001 2010 Source: ADB (2004) “Asia Pacific’s Opportunity: Investing to Avert an HIV/AIDS Crisis”
MDG1: HIV could put enormous financial burdens on government PNG Source: ADB
MDG 1:Already high health cost in the North Pacific could increase due to HIV/AIDS Total health expenditure as % GDP (2004) Source: WHO
Women (34,000) Men (23,000) MDG 3: HIV disempowers women 40000 35000 30000 25000 20000 15000 10000 5000 0 Number of people living with HIV in PNG Source: UNAIDS
MDG 3: Particularly girls and young women are vulnerable Distribution of HIV cases by sex and age in PNG Source: PNG NACS &DoH (2004)
MDG4: HIV worsens under-five child mortality Source: Lancet (2002)
MDG 5: HIV worsens maternal mortality Maternal deaths Source: Khan M et al. (2001)
MDG6: HIV increases TB incidence 160 35 TB 140 30 HIV-national 120 25 HIV-Kampala 100 20 (%) HIV prevalence adults TB incidence/100,000 80 Uganda 15 60 10 40 5 20 0 0 1975 1980 1985 1990 1995 2000 Source: WHO (2002)
HIV and MDGs “Halting the spread of HIV is not only an MDG in itself, it is a pre-requisite for reachingmost of the others. ” - Kofi Annan
HIV in the Pacific (1):Low number except for PNG HIV Cases Source: SPC (2004)
Micronesia HIV in the Pacific (2):But the impact is visible Cumulative HIV cases per 100,000 people Source: SPC (2004)
HIV in the Micronesia Region • Still low prevalence • But presence of vulnerability factors
Foreign migrant workers as % of total population 20% 30% Naura Palau Factor 1: High Mobility • Outward migration to Guam • Large number of seafarers • Large inflow mobility Sources: UNAIDS/ UNFPA/ Palau census (2000)
33% 33% 32% 21% 15% 9% 4% 2% Mobile men can be vulnerable to HIV Percentage of non-mobile/mobile men paying for sex in the past 12 months 0 China Cambodia Indonesia Viet Nam FHI, 2006
58.8% of Kiribati population = Ages 0-24 Factor 2: Young population Source: US Census Bureau
Factor 3: Low contraceptive use Contraceptive prevalence rate (modern methods) % (2000) Source: UNFPA
Factor 4: High prevalence of sexually-transmitted infections (STI) Prevalence of Chlamydia among antenatal women Source: WHO (2001)
Other factors: • Strong stigma and discrimination • Geographical difficulty in accessing services
4.5 years Low to high prevalence doesn’t take too long HIV prevalence among pregnant women in Thailand Source: Science magazine (2003)
The MDG-consistent HIV/AIDS Costing Model (MHM): An Overview Resource Needs Model (Futures Group) Cape Town Model (U of Cape Town) (ARV treatment) UNDP RCC, MDG-S(UNMP), UNAIDS Improvements New functions New interventions MDG-consistent HIV/AIDS Costing Model (part of integrated health model or independent)
What does the model do? Designed to calculate the total cost of HIV/AIDS responses NOT designed to: • Assess the impact of a response on the future course of the epidemic • Assist in priority-setting
MDG-consistent HIV Costing Model (MHM): Key characteristics Compared with existing HIV costing models, MHM is: • Simpler and more transparent • More flexible • Equipped with a greater scope of interventions • Consistent with the MDG timeframe and target-based approach • Compatible with UNAIDS targets for 2010 universal access • More user-friendly interface
2. Unfold all 1.Fold all
Proxy 1: 2.6 customers per sex worker per day (= 2.6*5 days * 51 wks = 663 commercial sex acts per year) (Study of sex workers in Kolkatta, India) Proxy 2: XYZ..
PICs with highest cumulative HIV incidence per 100,000 Return Source: ADB (2005)
Seafarers and their spouses are vulnerable to HIV Spouses of seafarers (13%) 63% Seafarers (50%) Return Source: ADB (2005)