HIV and AIDS Scenarios for South Africa: 2005 – 2025 November 2006

1. HIV and AIDS Scenarios for South Africa: 2005 – 2025 November 2006

2. Current Reality • Wide-spread HIV epidemic • Growing number of AIDS related deaths • Resultant impacts e.g. orphans • Myriad of efforts – largely uncoordinated with some gaps • Mixed, inconsistent messages • Sense of hopelessness

3. Live the Future Model • Create a shared understanding • Create a vision of an ideal future • Inspire new thinking • Stimulate discussion and informed action • identify and implement actions • maximise synergies for better use of limited resources • influence policies and agendas

4. How will HIV and AIDS and our responses shape the future of South Africa? 2005 to 2025 Key Question

5. Scenario Process • Deductive process • Synthesised findings from 9 studies since 2001 • Scenario participants involving multi-sectors • Commissioned desk research • Revised scenarios – qualitative narratives • Assumptions used to inform quantitative analyses • demographic projections • orphanhood projections • public health sector costing

6. Key Driving Forces - some examples - INESCAPABLES • The epidemic is with us for the next 20 years • Some poverty, inequality and unemployment remain • Government resources have limits • People are on the move • Other diseases UNCERTAINTIES • Will there be a ‘magic bullet’? • Who leads? Who has the power? How will it be used? • Response to inequality • Beliefs about HIV & AIDS • South African economy • Level of collaboration and goodwill

7. Scenario Branching Points Scenario 2 Scenario 4 Scenario 3 Scenario 1

8. HIV & AIDS Scenarios for South Africa

9. HIV & AIDS Scenarios for South Africa

10. Low economic growth / low social collaboration • Weak self-serving leadership • Few partnerships • Focus on blame, stigma and conspiracy • No behaviour change: drugs, sexual violence, gender inequality • Contradictory beliefs about AIDS • High crime • AIDS response: fake cures, corrupt systems

11. HIV & AIDS Scenarios for South Africa

12. High economic growth / low social collaboration • Leadership driven by growth • Exclusive partnerships • Significant income differentials • Treatment and care is available, prevention is lacking • Little behaviour change • Gender inequality and sexual violence • Limited acceptance of HIV positive people • AIDS response intellectualised

13. HIV & AIDS Scenarios for South Africa

14. Lower economic growth / high social collaboration • Idealistic broad-based but uncoordinated leadership • Small duplicating partnerships • Powerful pockets in civil society responding well • Focus on acceptance and care • Moderate behaviour change • Better gender equality • AIDS response: chronic, manageable disease

15. HIV & AIDS Scenarios for South Africa

16. High economic growth / high social collaboration • Strong collaborative leadership committed to a developmental society and led by government together with all role players • Effective large-scale public-private partnerships • Focus on prevention, also provide treatment and care • Personal responsibility for health • Wide-spread behaviour change • Strong social net • AIDS response integrated

17. Scenario Responses in 2025 • The Economy • High GDP Growth across society • Market is buoyant and wealth is better spread • SA becomes more competitive globally • Strong foreign investment due to confidence on growth and HIV and AIDS risk management • Skills are developed and retained • Trade barriers put in place to limit skills loss • New treaties signed to tap into emerging industry and secure jobs for unemployed • Human Development Index increases after 2005

18. Scenario Responses in 2025 • Government • New infrastructure supports broad based development • Social welfare programmes responsive but needed by fewer • Clinics become centres for out-reach • Effective law enforcement – more reporting and convictions re sexual violence and drugs • Business • HIV workplace programmes become standard • Compulsory counselling and voluntary testing is common • Big business supports SMMEs ito HIV programmes • Suppliers expected to have relevant programmes in place • Public-private healthcare partnerships – improves basic access to all • Tax concessions granted • Donors • Funding informed by national agenda, longer term, more sustainable • All funding via central fund – better coordination, gaps filled

19. Scenario Responses in 2025

20. People living with HIV and AIDS in South Africa SOURCE: ASSA2002 with revised assumptions by Nathea Nicolay and Stephen Kramer

21. 2 0 1 8 1 9 % 1 8 % 1 6 1 4 1 2 1 3 % 1 0 1 1 % 8 6 7 % 4 2 0 2 0 0 5 e s t i m a t e W i n t e r A u t u m n S p r i n g S u m m e r ( A S S A 2 0 0 3 ) 5 1 5 0 5 5 5 6 5 9 SOURCE: ASSA2002 with revised assumptions by Nathea Nicolay and Stephen Kramer HIV Prevalence in 2025 (Age 20-64)

22. Cumulative New and Averted HIV Infections 2005 - 2025 SOURCE: ASSA2002 with revised assumptions by Nathea Nicolay and Stephen Kramer

23. Cumulative and Averted AIDS Deaths2005 - 2025 SOURCE: ASSA2002 with revised assumptions by Nathea Nicolay and Stephen Kramer

24. Orphanhood Projections for Scenarios SOURCE: Stephen Kramer: Models used in calculating the orphan numbers are adapted versions of the ASSA2002(full) AIDS and Demographic model (publicly available), and the Orphanhood Model (used with permission of Mr. Leigh Johnson of CARe). See also Johnson L. F. and Dorrington R. E. (2001) The impact of AIDS on orphanhood in South Africa: a quantitative analysis. Centre for Actuarial Research. Monograph 4.

25. Orphanhood Projections:Maternal Orphans due to AIDS by 2025

26. Total Public Health Sector Costing for HIV and AIDS Source: Cost projections by Andrew Boulle using the Cape Town Antiretroviral Costing Model, February 2006; Demographic projections by Nathea Nicolay using ASSA2002

27. 3 0 0 2 8 4 2 5 0 2 6 1 2 0 0 2 0 7 1 5 0 1 0 0 1 4 4 5 0 0 W i n t e r A u t u m n S p r i n g S u m m e r SOURCE: A.Boulle, 2006 Cumulative Public Health Sector Costs in Managing HIV and AIDS2005 - 2025

28. Summer as the Preferred Scenario • Summer is just the beginning of a better future for all • Summer is a glorious season of endless positive possibilities • If we choose Summer, we are making a firm commitment to a future where HIV is managed effectively, where we can dream of a generation free of AIDS, and where everyone reaps the benefits of economic prosperity and social collaboration

29. Urgent and Sustainable Action Needed Now! • Dare to Dream: A generation free of AIDS • The time is right for powerful collaborative action to address challenges • It is much more than a health issue • Strong leadership needed at all levels • Map, align and integrate efforts to maximise synergies • Think creatively • Broaden partnerships across all sectors • Private sector can make a unique contribution

30. LEADERSHIP BY ALL, AT ALL LEVELS Manage effects of death Prevent HIV Infection Manage HIV Manage AIDS Who must take action?

31. ACT NOW! Be part of the “Summer for All People” • Everyone can play a role • Act in areas where you have influence • Even the small things count • Set or review your target • Determine what you need to do differently

32. Choose to be part of the Summer for All People

33. Desiree Daniels: + 27 82 459 1102 Nathea Nicolay: +27 82 786 4677 Email: livethefuture@metropolitan.co.za Website: www.livethefuture.co.za For more details