HIV Epidemiology: Progress, challenges and Human Rights implications
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Présentation de Yves Souteyrand lors de la session d'ouverture de Vienne 2010.
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HIV Epidemiology: Progress, challenges and Human Rights implications
- 1. HIV Epidemiology : Progress, challenges and Human Rights implications Yves SOUTEYRAND Rodney KORT Ani SHAKARISHVILI Thomas REHLE Txema GARCIA-CALLEJA
- 4. Thirty years into the epidemic UNAIDS/WHO Epi update, 2009
- 7. Estimate of the annual number of infant infections averted through the provision of antiretroviral prophylaxis to HIV-positive pregnant women, globally, 1996 – 2008, UNAIDS 2009 PMTCT impact: infections averted among infants 1996 1998 2000 2002 2004 2006 2008 60 000 50 000 40 000 20 000 0 30 000 10 000 70 000 1997 1999 2001 2003 2005 2007 Infant infections averted
- 8. ART impact on the epidemic: South Africa Rehle et al. PLoS ONE, 2010 Observed HIV prevalence in 2008 (15–49) 16.9% Excess HIV prevalence thanks to ART in 2008 1.7% ( 440 000 ) Adjusted HIV Prevalence without ART in 2008 15.2%
- 11. Social determinants of health and health inequities Source: Commission on Social Determinants of Health conceptual framework Amended from Solar & Irwin, 2007 Socioeconomic & political context Governance Policy (Macroeconomic, Social, Health) Cultural and societal norms and values Social position Education Occupation Income Gender Ethnicity / Race Material circumstances Social cohesion Psychological factors Behaviours Biological factors Health Care System Distribution of health and well-being
- 16. France 2008 Spain 2008 (10 regions) SPNS, 2010 The Netherlands 2010 (modelled; sexual transmission only) Xiridou, RIVM, 2010 InVS, 2009 France 52% Spain 63% Netherlands 21% Africa 37% Other 11% Other 9% Caribbean 26% Africa 53% Latin America 16% Africa 12% Distribution of new HIV cases by country/region of origin Epidemic among migrants in Western Europe
- 18. Modes of transmission in sub-Saharan African countries Distribution of new infections by sources of risk Modes of transmission in South, East and West Africa, 2008–2009
- 22. Modeled impact of structural changes on epidemic Strathdee et al., HIV Risks Among Injection Drug Using Populations: Past, Present, and Projections for the Future ( Lancet 2010) Elimination of police beatings (Ukraine) HIV infections among IDUs averted by structural changes 4–19% decrease in incidence 2–5% decrease in incidence 3–9% decrease in incidence 662 infections averted 343 infections averted 209
- 25. " We, Head of States, … reaffirm that the full realization of all human rights and fundamental freedoms for all is an essential element in the global response to the HIV/AIDS pandemic " United Nations High-Level Meeting on AIDS, New York, June 2006
Editor's Notes
- To end this presentation on a positive note, I will focus on Ukraine`s AIDS response, which reflects how to effectively address each of the four links between epidemiology and human rights. Ukraine made concerted efforts to improve knowledge of its epidemic with a comprehensive surveillance plan, initiated in the mid 1990s. Involvement of the health sector, NGOs and IDU communities has been key to making this surveillance plan a success and ensuring robust epidemiological data. It responded to the epidemiological information by scaling up evidence-based prevention and treatment interventions for people who use drugs (including needle and syringe exchange programmes and – since 2004 - opioid substitution therapy). After ten years of consistent growth, the number of officially reported new cases of HIV has been decreasing among IDUs slowly but steadily since 2007. The success of the Ukrainian AIDS response is also reflected in significant decreases – more than twice (since 2004) in HIV prevalence among IDUs with a recent history of injection of drugs. Success is also grounded on closer collaboration among the health sector, law enforcement, IDU communities and NGOs; however, only 35% of the estimated number of IDUs have access to these services and these programmes are not available in Ukrainian prisons. Ukraine must build on its initial success by strengthening human rights protections and expanding evidence-based interventions for IDUs and other vulnerable groups.
- ``Health and human rights are ... two entirely complementary ways of speaking about—and working to ameliorate—human suffering in all its forms. We share a confidence in the future— and in our ability to contribute— each in our own ways and yet together, to the healing of the world” This has never sounded more important, or true. UNGASS So it's now time to join our efforts to make this a reality.