7th September 2011 GCL Event: The Prevention and Management of HIV and AIDS in Scotland and Malawi

1. Oonagh O’Brien
Institute for International Health
and Development
Queen Margaret University

2. Winnie Sseremu
from Uganda
diagnosed 1988
aged 27. Today:
50
Jaime Tovar from
Colombia.
Diagnosed 1987
with HTLV 111 aged
24, today 48.

3.  Since1999 (the year the epidemic is
thought to have peaked) new infections
have fallen by 19%.
 In33 countries HIV incidence (number of
new cases per year) has fallen by 25%
between 2001 and 2009. 22 of these
countries are in Sub Saharan Africa. The
biggest African epidemics are stabilising
or declining (UNAIDS 2010).

4.  In seven countries,
5 in eastern Europe
and central Asia,
HIV incidence
increased by 25% between 2001 and 2009.
 Decrease not evenly
spread in population
groups
 Gains are fragile…

5. Successes
Reduction in new
infections in young
people- delayed first
sex, higher use of
condoms
Treatment as
prevention-
Greatest reductions
adherence to
in HIV incidence
treatment with
(new infections)are
undetectable viral
in the countries with
load over a sustained
the highest numbers
period can lead to
of people living with
96% reduction in
HIV
transmission to
partner. May 2011
Reduction in
Huge increase of
transmission from
numbers of people
parent to child
on treatment and
including during
reduction in AIDS
breast feeding.
diagnosis and deaths
Concerted
including a 19% less
programme based
deaths in children
on evidence

6. Challenges: Numbers still extremely high…..
Still a huge gap in funding treatment-
approximately 36% of those who need
treatment in poor countries have access
Women still highly
Health systems struggling with burden
vulnerable in
of treatment roll out in all sorts of
multiple ways
different ways
linked to HIV
Stigma still in evidence
Legacy of loss: orphans
and abuse of human Growing economic
and vulnerable
rights to men who have crisis- struggle to
children, loss of
sex with men (MSM) maintain national and
communities, material
and drug users international funding
loss.
increased

7.  Goal6. Combat HIV/AIDS, malaria and
other diseases
• Target 7. Have halted by 2015 and begun to
reverse the spread of HIV and AIDS
• Target 8. Have halted by 2015 and begun to
reverse the incidence of malaria and other major
diseases

8.  Have we halted the rise of HIV?
 November 2010 BBC report - UN claim
HIV epidemic has halted.
 Unexpected consequence-
malaria reduces 75%
over 4 years in patients
on ART
(Kasirye et al IAS abstracts 2009 )

9.  Inthe report of the 2010 review of MDGS
the UN don’t use the word halted. It is
stated that cases are declining in some
areas of the world, but not all, and as well
as the success they highlight a number of
areas of concern:
• The continuing high number of cases
• Lack of knowledge about how to protect oneself
• Lack of condom use especially in poor countries

10. Human Rights • Have HRs been ignored in MDGs?
activists • Focus on targets too technical and too narrow?
• Are the Millennium Development Goals (MDGs)
Symposium MDGs and human rights complementary or conflicting?
and HR • Harvard and IDS March 2010
Interventions • MDGs do not call into question the benefits of
rather than liberalization of international trade and finance.
questioning system • Established at time of economic stability

11. MDGs – loss of focus
on wider impacts of
gender inequality-
No linking of Too focussed on
issues- i.e. narrow goals and
reducing gender outcomes- no
inequality should focus on gender
be embedded rights (UN
into poverty conferences of the
reduction 1990s)

12.  June 2011: United Nations General Assembly High Level
Meeting on AIDS
 Political Declaration on HIV/AIDS: Intensifying our Efforts to
eliminate HIV/AIDS
Agreed new AIDS targets for 2015 including:
 increase number of people on treatment to 15 million
 advance efforts towards reducing sexual transmission of HIV
and halving HIV infection among people who inject drugs
by 2015.
 push towards eliminating new HIV infections among
children in the next five years.
 reduce tuberculosis related deaths in people living with HIV
by half in the same time period.

13.  Some good news….
 But world economic crisis- reduced
income and spending may lead to
upsurge in infections and mortality
 What has been the importance of MDG 6
and where do we go with the target after
2015?
 Implications for Scotland and Malawi