Global AIDS Epidemic Overview 2008: Insights and Impact

3. Global summary of the AIDS epidemic December 2008 Number of people living with HIV in 2008 Total 33.4 million [31.1 million–35.8 million] Adults 31.3 million [29.2 million–33.7 million] Women 15.7 million [14.2 million–17.2 million] Children under 15 years 2.1 million [1.2 million–2.9 million] What is the ratio – percentage of global population that is living with?

4. People newly infected with HIV in 2008 • Total 2.7 million [2.4 million–3.0 million] • Adults 2.3 million [2.0 million–2.5 million] • Children under 15 years 430 000 [240 000–610 000] • How many infections per month/week/day/hour/minute/second?

5. AIDS-related deaths in 2008 • Total 2.0 million [1.7 million–2.4 million] • Adults 1.7 million [1.4 million–2.1 million] • Children under 15 years 280 000 [150 000–410 000] • Ratio – percentage of global population? The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information.

6. Oceania - Latest epidemiological trends • An estimated 59 000 [51 000–68 000] people were living with HIV in Oceania in 2008, of which 3900 [2900–5100] were new infections. • There is generally a very low HIV prevalence in Oceania compared with other regions. In the small island nations, adult HIV prevalence tends to be well below 0.1%. Australia’s epidemic is considerably less severe (0.2% prevalence) than those of any other high-income countries. • What is 1% of your country’s population have been tested positive? • Island Business cited that it could be 2%, how many would that be?

7. Excluding the high-income countries of Australia and New Zealand, Papua New Guinea accounted for more than 99% of reported HIV cases in the region in 2007. • Outside of Papua New Guinea, the island nations of New Caledonia, Fiji, French Polynesia and Guam account for the vast majority of HIV infections in the region. • New Caledonia, Fiji, French Polynesia and Guam –common factor? • While most epidemics in the region appear to be stable, new infections in Papua New Guinea are on the rise. HIV infections are also increasing in Fiji. WHY?

8. Key regional dynamics • Heterosexual transmission accounts for 95% of HIV infections in Papua New Guinea, and 88% in Fiji. • In high-income countries, heterosexual HIV transmission is significantly lower. In Australia, heterosexual transmission accounted for 21% of new HIV infections between 2003 and 2007. In New Zealand, one in three new HIV infections were a result of heterosexual contact. • According to surveys conducted in the region, the level of HIV knowledge among young people is below the global average, although the vast majority of young people at higher risk knew that condoms could protect against sexual HIV transmission.

9. In Papua New Guinea, fewer than half of young people surveyed reported using a condom during their last sexual encounter. • Why? • Sex between men is the main driver of several epidemics in the region. In 2003–2007, men who have sex with men made up 86% of new HIV infections in Australia. In New Zealand, men who have sex with men represented 49% of new cases diagnosed in 2008. • Why?

10. Injecting drug use is responsible for a modest share of new HIV infections in the region—2% of new HIV infections in Australia between 2003 and 2007 and 1% in New Zealand in 2008. • Injecting drug users account for a higher percentage of HIV infections in the smaller island nations—11.7% of HIV cases in French Polynesia and 5.7% in Melanesia (excluding Papua New Guinea). • Oceania is home to some of the world’s earliest harm reduction programmes. Early in the epidemic, Australia and New Zealand invested in harm reduction services to avert HIV transmission during drug use. New Zealand began offering needle exchange services in 1987. • Mother-to-child HIV transmission is on the rise in Papua New Guinea. Services to prevent mother-to-child transmission have been expanded in the country, but prevention coverage in antenatal settings was only 2.3% in 2007. • Why?

12. Action on! • What can be done? • Who should do it? • How? • When?

13. Taking the powerful view • When something happens we don’t like we have a choice of how to view it -- we can look out through the window at who did it to us or look in the mirror at ourselves looking at what we did or didn’t do.

14. Blaming the circumstances “People are always blaming their circumstances for what they are. I don’t believe in circumstances. The people who get on in the world are the people who get up and look for the circumstances they want, and if they can’t find them, make them.” George Bernard Shaw

15. Language of Blame • Easily produced, comfortable to express • Holds others responsible for the gaps between committed intentions and reality • Frequently generates frustration and a sense of impotence in the speaker • Frequently generates defensiveness in others • Reduces the chance for learning

16. The Path of Power • No responsibility = I am the victim of these circumstances. I can react to them but I don’t have the feeling that I am being the creator of my actions. • Responsibility = Response Ability

17. Radical Responsibility • I choose to take the view that 100% of what is happening is my responsibility. • This is a radical declaration of responsibility not something is true or that I could prove by evidence. It is a stand I take because to do so empowers me. • This is beyond asking what I did or didn’t do, this is choosing to stand as responsible even if I didn’t do or not do anything that influenced the situation. • Radical responsibility starts with the willingness to declare oneself as cause in the matter. • Great organizations have many people in them who are responsible in this way. • Is your organization a great one? Do you want to make it a great one? How will you do that? How many great people are in your organisation?

18. Declare a ‘responsibility’ statement to address this finding • According to surveys the level of HIV knowledge among young people is below the global average, although the vast majority of young people at higher risk knew that condoms could protect against sexual HIV transmission.