Transcript Total = 10.7 million in 2000

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