Download Doing the right thing

Doing the Right Thing
Karen A. Stanecki
XV International AIDS Conference
Millions
Trends in global adult HIV prevalence
50
40
Global Report 2002
30
Estimated number
of people
living with HIV
20
Global Report 2004
10
0
1991
1993
1995
1997
1999
2001
2003
Millions
Steadily rising annual HIV infections
and AIDS deaths
5
New infections
Global
Sub-Saharan Africa
4
3
2
Deaths due to AIDS
1
0
Global
Sub-Saharan Africa
1991
1993
1995
1997
1999
2001
2003
Rising HIV infection among injecting drug users,
followed by rising infection among sex workers
100
90
80
70
% HIV
positive
IDU (Guangxi, China)
IDU (Jakarta, Indonesia)
60
50
40
IDU (Hanoi, Vietnam)
30
Sex workers (Guangxi, China)
20
Sex workers (Hanoi, Vietnam)
Sex workers (Jakarta, Indonesia)
10
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
High proportions of men who inject
drugs are also clients of sex workers
Hanoi, Vietnam
Bangkok, Thailand**
Katmandhu Valley, Nepal
Surabaya, Indonesia
Delhi, India
Sichuan, China*
Central Bangladesh
0
10
20
30
Unprotected commercial sex
Source: Behavioural surveillance reports
40
50
%
60
70
80
Commercial sex with a condom
90
100
Increasing condom use and
decreasing HIV infections in Cambodia
100
%
80
Condom use,
Female sex workers
60
HIV prevalence,
female sex workers
40
20
0
1995
1997
1999
2001
Source: Cambodia National Center for HIV/AIDS Dermatology and STDs, Ministry of Health
2003
Needle-exchange programmes promote
healthy sexual behaviour and safe injection
Bangladesh
100
Participated in needle exchange
90
90
Did not participate
80
72
70
59
Percent
60
51
50
38
40
30
20
21
16
17
10
0
Used needle
after other injector
last time
Used needle
after other injector
in the last week
* of sexually active respondents; ** of respondents reporting STIs
Source: National behavioural surveillance data
Reported STI
symptom
past year*
Sought medical
treatment for STI**
Asia’s HIV prevention successes
have three features in common
1. They recognize and target the behaviors
that are causing most new infections
2. They use the most effective
interventions that directly reduce the
risk of HIV transmission
3. They provide the services to the
population at greatest risk of HIV
exposure
Treatment is critical, and HIV prevention
services remain a major priority
in Indonesia
Sex workers needing
condoms and STI services
200 000
Drug injectors needing
needles and condoms
115 000
High-risk MSM needing
condoms and lubricant
63 000
Prisoners needing
prevention services
110 000
Men and women
needing antiretrovirals
8 500
0
50 000
100 000
150 000
Source: Based on national estimates of people at risk for HIV, Ministry of Health , Indonesia
200 000
250 000
HIV prevalence in adults, end 2003
38 million people [range: 35-42 million] living with HIV as of end 2003
Adult prevalence %
15.0% − 39.0%
5.0% − 15.0%
1.0% − 5.0%
0.5% − 1.0%
0.1% − 0.5%
0.0% − 0.1%
not available
HIV prevalence among 15−24-year-olds
in selected sub-Saharan African countries,
2001−2003
20
% HIV prevalence
Men
Women
15
10
5
0
Niger
Mali
Burundi
Kenya
Zambia
South
Africa
Zimbabwe
(2002)
(2001)
(2002)
(2003)
(2001-2002)
(2003)
(2001-2002)
2004 Report on the Global AIDS Epidemic (Fig 7)
It’s about human rights
Every person in need must have
access to HIV treatment.
And the more people have access
to effective prevention,
the fewer people will be
in need of treatment.