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Public Policy Making Process is complex Research results seldom have immediate impact on government policy, The political system in the country determines the policy making process The nature of problems, proposed solutions and politics may determine the policy making process, and A linear approach to policy making is unlikely to succeed. HIV/AIDS FIGURES more than 34 million people infected by end of 1999 o more than 67% are in developing countries 15,7 million are women o some areas 1/3 pregnant women are infected 1,3 million children were infected in 1999 o 90% of these were due to MTCT more than 2 million Africans died of AIDS in 1999 alone Distribution of Number of People Infected with HIV Total = 10.7 million in 2000 Swaziland Zambia South Africa Zimbabwe Botswana Malawi Namibia Lesotho Mozambique Projected HIV Prevalence 40 Botswana Lesotho South Africa Swaziland Zimbabwe Namibia Mozambique Malawi Zambia 35 30 25 20 15 10 5 0 1980 1985 1990 1995 2000 2005 2010 2015 Women can be especially vulnerable to the HIV/AIDS epidemic... … subordinate position to males can make it difficult to protect selves against HIV Women & AIDS … certain cultural and economic practices can increase the risk of transmission … burden of care in AIDS affected households falls on women and children Selected studies documenting STIs and their relative risk for HIV Transmission Reference Study Population Cameron, et al. STI Studied Heterosexual Genital ulcer men (Kenya) (mainly chancroid) Relative Risk 4.7 Darrow, et MSM (USA) al Syphilis 1.5-2.2 Holmberg , et al Herpes 4.4 MSM (USA) Laga, et al Heterosexual Gonorrhoea women Chlamydia (Zaire) infection 3.5 3.2 2.7 Trichomoniasis Stamm et al. MSM (USA) Herpes 3.3-8.5 Syphilis 8.4-8.5 Deaths per 100,000 Population Trends in Annual Rates of Death from Leading Causes of Death Among Persons 25-44 Years Old, USA, 1982-1998 40 Unintentional injury Cancer 35 30 Heart disease 25 Suicide 20 15 HIV infection 10 Homicide 5 Chronic liver disease Stroke 0 82 84 86 National Center for Health Statistics National Vital Statistics System 88 90 Year 92 94 96 98* *Preliminary 1998 data Diabetes Deaths per 100,000 Population Trends in Annual Rates of Death from Leading Causes of Death Among White Men 25-44 Years Old, USA, 1982-1998 70 60 Unintentional injury Heart disease 50 Suicide 40 Cancer 30 HIV infection 20 Homicide 10 Liver disease 0 82 84 86 National Center for Health Statistics National Vital Statistics System 88 90 Year 92 94 96 98* *Preliminary 1998 data Stroke Diabetes Deaths per 100,000 Populatio n Trends in Annual Rates of Death from Leading Causes of Death Among Black Women 25-44 Years Old, USA, 1982-1998 Cancer 55 50 45 40 35 30 25 20 15 10 5 0 Heart disease HIV infection Unintentional injury Homicide Stroke Diabetes 82 84 86 National Center for Health Statistics National Vital Statistics System 88 90 Year 92 94 96 98* *Preliminary 1998 data Liver disease Suicide Deaths per 100,000 Population Trends in Annual Rates of Death from Leading Causes of Death Among Black Men 25-44 Years Old, USA, 1982-1998 200 180 160 140 120 100 80 60 40 20 0 HIV infection Homicide Unintentional injury Heart disease Cancer Suicide Stroke 82 84 86 National Center for Health Statistics National Vital Statistics System 88 90 Year 92 94 96 * Preliminary 98 1998 data Diabetes Liver disease COMBINED PROFITS OF NINE MOST PROFITABLE COMPANIES IN SELECT FORTUNE 500 INDUSTRIES 1999 $27.5 $16.5 $15.3 $13.5 $4.5 Drug Companies Auto Companies Oil Companies Security Firms Source: Fortune Magazine, April 2000, Fortune 500 (www.fortune.com) Airlines Non-Drug Costs Associated with ARV Therapy (US$) ITEM UNIT COST CD4 cell count 30-157 Viral Load Test 130-163 Complete Blood Count 2-21 Chemistry Panel 12-35 Serum amylase 18 Transfusion for ZDV-induced anaemia 580 HIV ELISA test 3-6 Rapid HIV test (Capillus) 3 Rapid HIV test (Abbot) 10 Pre-test/post-test Counse-lling Visit for HIV- Person 22/33 Pre-test/post-test Counse-lling Visit for HIV+ Person 22/77 Test +Counselling 18/12 Outpatient Visit (not specific to ARV therapy related) 17-120 Source: WHO unpublished slide OPPORTUNITIES TO IMPLEMENT ACCESS TO AIDS DRUG POLICIES Implement Clinton’s Executive Order on access to pharmaceuticals Import ARV’s and other drugs from countries like Brazil and Thailand Learn the technology to produce these drugs Negotiate cheaper prices for diagnostic kits and reagents Establish sustainable financing mechanisms to ensure reliable distribution and access to drugs. Use existing tertiary facilities to provide ARV’s