epiAfricaBQedits

Why does AIDS persist at such a high rate in Sub-Saharan Africa?: 

Why does AIDS persist at such a high rate in Sub-Saharan Africa? Helen Epstein, in NY Times Magazine, June 13, 2004, suggests that the reason is infidelity. In South Africa, Kenya and other countries, men have several on-going commitments. This contrasts to the US pattern of either 'one night stands' or serial monogamy. This argument is highly charged emotionally. Can we evaluate it biologically?

Slide2: 

A global view of HIV infection 33 million adults living with HIV/AIDS as of end 1999 Adult prevalence rate 15.0% – 36.0% 5.0% – 15.0% 1.0% – 5.0% 0.5% – 1.0% 0.1% – 0.5% 0.0% – 0.1% not available

Leading causes of disease burden globally, 1999: 

Leading causes of disease burden globally, 1999 1 Acute lower respiratory infections 2 HIV/AIDS 3 Perinatal conditions 4 Diarrhoeal diseases 5 Ischaemic heart disease 6 Unipolar major depression 7 Cerebrovascular disease 8 Malaria 12 Tuberculosis 6.7 6.2 6.2 5.0 4.1 4.1 3.5 3.1 2.3 Source: The World Health Report 2000, WHO Rank % of total

Leading causes of death globally, 1999: 

Leading causes of death globally, 1999 1 Ischaemic heart disease 2 Cerebrovascular disease 3 Acute lower respiratory infections 4 HIV/AIDS 5 Chronic obstructive pulmonary disease 6 Perinatal conditions 7 Diarrhoeal diseases 8 Tuberculosis 11 Malaria 12.7 9.9 7.1 4.8 4.8 4.2 4.0 3.0 1.9 Source: The World Health Report 2000, WHO Rank % of total

Leading causes of disease burden in Africa, 1999: 

Leading causes of disease burden in Africa, 1999 1 HIV/AIDS 2 Malaria 3 Acute lower respiratory infections 4 Diarrhoeal diseases 5 Perinatal conditions 6 Measles 7 Maternal conditions 8 Tuberculosis 9 Congenital abnormalities 10 Road traffic accidents 19.9 9.9 8.5 6.5 6.5 4.7 3.4 2.3 1.7 1.7 Source: The World Health Report 2000, WHO Rank % of total

Leading causes of death in Africa, 1999: 

Leading causes of death in Africa, 1999 1 HIV/AIDS 2 Acute lower respiratory infections 3 Malaria 4 Diarrhoeal diseases 5 Perinatal conditions 6 Measles 7 Tuberculosis 8 Cerebrovascular disease 9 Ischaemic heart disease 10 Maternal conditions 20.6 10.3 9.1 7.3 5.9 4.9 3.4 3.2 3.0 2.4 Source: The World Health Report 2000, WHO Rank % of total

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Changes in life expectancy in selected African countries with high HIV prevalence, 1950 to 2000 South-Africa 35 40 45 50 55 60 65 1950-55 1955-60 1960-65 1965-70 1970-75 1975-80 1980-85 1985-90 1990-95 1995-00 Life expectancy at birth, in years Botswana Uganda Zambia Zimbabwe Source: United Nations Population Division, 1998

Slide8: 

Estimated adult HIV prevalence in Kenya, 1990-1999 Source: National AIDS and STD Control Programme, 1999 and UNAIDS 0 2 4 6 8 10 12 14 16 90 91 92 93 94 95 96 97 98 99 HIV prevalence (%)

HIV prevalence among pregnant womenin South Africa, 1990 to 1999: 

HIV prevalence among pregnant women in South Africa, 1990 to 1999 Source: Department of Health, South Africa 0.7 1.7 2.1 4 7.6 10.4 14.2 17 22.8 22.4 0 5 10 15 20 25 90 91 92 93 94 95 96 97 98 99 HIV prevalence (%)

Slide10: 

HIV prevalence (%) Median HIV prevalence among pregnant women in urban areas in Uganda, 1985 to 1998 Source: STD/AIDS Control Programme, Uganda

HIV prevalence in military personnel in Africa: 

HIV prevalence in military personnel in Africa Nigeria: 11% among peacekeepers returning from Sierra Leone and Liberia vs 5% in adult population South Africa: 60-70% in military vs 20% in adult population Source: Nigeria AIDS bulletin No 15, May 20, 2000; The Mail andamp; Guardian, Pretoria, March 31, 2000; UNAIDS/WHO 1999 estimate

Slide12: 

HIV prevalence rate and frequency of sexually transmitted infection (STI) episodes, Carletonville miners, South Africa, 1991-1998 0 10 20 30 40 50 60 70 80 90 1 2-4 5-9 10+ Number of STI episodes HIV prevalence (%) Source: Ballard R, 2000 (unpublished data).

Individuals are more infectious to others when they have been newly infected: 

Individuals are more infectious to others when they have been newly infected Epstein argues that the concurrent partners strategy favors widespread transmission because a newly infected individual is likely to visit several partners during the highly infectious period. An individual with 'one night stands' or serial monogamy may put fewer people at risk during this period even if the total partners per 6 months is similar.

Slide14: 

Condom use: 

Condom use Numerous studies have found that people in many locales have increased use of condoms with 'casual' partners or prostitutes. Use of condoms with regular partners has increased less dramatically. What if there are several 'regular partners?'

Why does this behavior persist?: 

Why does this behavior persist? Women without access to funds (especially younger women) rely on male partners for financial contributions In Kenya and South Africa, 'sugar daddies' commonly help girls with school fees as well as luxuries.

Uganda’s success: 

Uganda’s success Early devastating epidemic created public awareness Cultural openness about sexual matters Visible campaign- ABC: Abstain, Be Faithful, Use Condoms Zero Grazing Participation of women’s activist groups

Slide18: 

The AIDS story as it is told in Uganda

What do we know?What do we need to know?: 

What do we know? What do we need to know? How can we shape this into a workable case study? Is there adequate room for complexity, for multiple approaches, for scientific investigation? Can we tie in questions that lead students to explore the mechanisms of drug action, vaccines or the immune response?

Impact of HIV/AIDS on urban households, Côte d’Ivoire: 

Impact of HIV/AIDS on urban households, Côte d’Ivoire General population Families living with AIDS Source: Simulation-based on data from Bechu, Delcroix and Guillaume, 1997 Monthly income per capita Monthly consumption per capita 0 5 000 10 000 15 000 20 000 25 000 – 5 000 30 000 Francs CFA Savings/Disavings

Reduction in production in a household with an AIDS death, Zimbabwe: 

Reduction in production in a household with an AIDS death, Zimbabwe Crops Maize Cotton Vegetables Groundnuts Cattle owned Reduction in output 61% 47% 49% 37% 29% Source: Stover andamp; Bollinger, 1999

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HIV prevalence rate among teenagers in Kisumu, Kenya, by age 0 0 3.6 2.2 8.6 8.3 17.9 29.4 22 33.3 0 5 10 15 20 25 30 35 15 16 17 18 19 Age in years HIV prevalence (%) boys girls Source: National AIDS Programme, Kenya, and Population Council, 1999

Slide23: 

Projected population structure with and without the AIDS epidemic, Botswana, 2020 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5 0 0 20 40 60 80 100 120 140 0 20 40 60 80 100 120 140 Males Females Deficits due to AIDS Projected population structure in 2020 Population (thousands) Age in years Source: US Census Bureau, World Population Profile 2000

Slide24: 

HIV prevalence rate among 13 to 19-year-olds, Masaka, Uganda, 1989 to 1997 0 1 2 3 4 5 1989/90 1990/91 1991/92 1992/93 1993/94 1994/95 1995/96 1996/97 girls boys Source: Kamali et al. AIDS 2000, 14: 427-434 HIV prevalence (%)

Slide25: 

HIV prevalence rate among pregnant 15-24 year-olds by educational status, Uganda Source: Kilian A et al. AIDS 1999, 13: 391-398.

Slide26: 

Estimated impact of AIDS on under-5 child mortality rates, selected African countries, 2010 Botswana Kenya Malawi Tanzania Zambia Zimbabwe 0 50 100 150 200 250 Deaths per 1000 live births Without AIDS With AIDS Source: US Census Bureau

Slide27: 

Source: National STD/AIDS Control Programmes, Senegal and Uganda Armed Forces Research Institute of Medical Sciences, Thailand 0 5 10 15 20 25 30 89 90 91 92 93 94 95 96 97 98 99 HIV prevalence (%) Kampala, andlt;20 year old ANC Thailand, 21 year old military conscripts Dakar, all ages ANC Trends in HIV prevalence in selected populations in Kampala, Uganda; Dakar, Senegal; and Thailand; 1989 to 1999