AIDS in Africa An Update Basil Reekie
Contents General Statistics The trend of HIV in Africa Ugandan experience UNAIDS 2006 Latest African Statistics by Country HIV Intervention Light at the end of the tunnel? The Role of Insurance The Incentive for Intervention 1
General Statistics Sub-Saharan Africa 10% of the world s population (600 million) Home to 60% of the world s population living with HIV (+/- 25 million) The highest prevalence rate on the world (between 5.2% and 6.7%) But in Southern Africa the prevalence rates are above 18%! 2005: 3.2 million new infections 2 million deaths North Africa The lowest prevalence rate in the world matched only by the Middle East and East Asia (between 0.1% and 0.3%) 2
Source : World Bank 3
Source : World Bank 4
Source : World Bank 5
Source : World Bank 6
Conclusion on trends HIV Aids remains on the increase throughout Sub- Saharan Africa with the notable exception of Uganda 7
Source : World Bank 8
Source : World Bank 9
Source : World Bank 10
Source : World Bank 11
UNAIDS 2006 - African Statistics by Country Southern Africa 50,000,000 45,000,000 40,000,000 35,000,000 30,000,000 Estimated Population (World Atlas 2005) Estimated Prevalence (UNAIDS 2005) 40.00% 35.00% 30.00% 25.00% 25,000,000 20.00% 20,000,000 15.00% 15,000,000 10,000,000 5,000,000 10.00% 5.00% 0 South Africa Mozambique Malawi Zimbabwe Zambia Namibia Lesotho Botswana Swaziland 0.00% 12
UNAIDS 2006 - African Statistics by Country English Speaking Sub-Sahara (excl. Southern Africa) 140,000,000 120,000,000 Estimated Population (World Atlas 2005) Estimated Prevalence (UNAIDS 2005) 8.00% 7.00% 100,000,000 6.00% 80,000,000 60,000,000 5.00% 4.00% 3.00% 40,000,000 2.00% 20,000,000 1.00% 0 Nigeria Tanzania Kenya Uganda Ghana Somalia Sierra Leone Gambia Liberia 0.00% 13
UNAIDS 2006 - African Statistics by Country French Speaking Sub-Sahara Africa 70,000,000 60,000,000 Estimated Population (World Atlas 2005) Estimated Prevalence (UNAIDS 2005) 12.00% 10.00% 50,000,000 8.00% 40,000,000 30,000,000 6.00% 20,000,000 4.00% 10,000,000 2.00% 0 0.00% Congo (DRC) Madagascar Cameroon Burkina Faso Senegal Guinea Rwanda Benin Burundi Togo Central African Republic Congo Gabon Mauritius Djibouti Comoros 14
UNAIDS 2006 - African Statistics by Country Sub-Sahara Africa (excl. English and French speaking countries) 14,000,000 12,000,000 Estimated Population (World Atlas 2005) Estimated Prevalence (UNAIDS 2005) 3.90% 3.80% 3.70% 10,000,000 3.60% 8,000,000 6,000,000 3.50% 3.40% 3.30% 4,000,000 3.20% 2,000,000 3.10% 3.00% 0 Angola Guinea-Bissau Equatorial Guinea Cape Verde Sao Tome & Principe 2.90% 15
North Africa South Africa UNAIDS 2006 - African Statistics by Country 90,000,000 80,000,000 Estimated Population (World Atlas 2005) Estimated Prevalence (UNAIDS 2005) 4.00% 3.50% 70,000,000 3.00% 60,000,000 50,000,000 40,000,000 30,000,000 2.50% 2.00% 1.50% 20,000,000 1.00% 10,000,000 0.50% 0 Egypt Ethiopia Sudan Algeria Morocco Niger Mali Tunisia Chad Libya Eritrea Mauritania Western Sahara 0.00% 16
HIV Intervention Today What is intervention - More than just the availability of ARV treatment Education, VCCT, pre-haart programme (still much debate about the efficacy of this) post-haart programme Success depend on: access medication enrollment on programme compliance to treatment quality of case management (both a clinical and a soft skill ) 17
Light at the end of the tunnel? HAART Increasing accessibility in developing world Recent studies on survival rates of patients on HAART Survival prospects greater than initial expectations Study 1: Mortality drop by at least 60% due to adherence to treatment. Study 2: Mortality reduced by half from first to second year of HAART NB: Provided patients remained fully adherent to HAART programme. Non-adherence following initial treatment have a catastrophic impact on mortality (References of the above two studies can be provided on request)) Public figures with AIDS: Survival with HIV in excess of 15 years Conclusion The difference between adherence and non-adherence to HAART is potentially the difference between a death sentence and a chronic condition 18
The Role of Insurance 2005 HIV / AIDS prohibited from the exclusion clause HIV underwriting introduced more than 15 years ago Life Insurance for HIV+ people introduced in 1995 Was very expensive No treatment was yet available for AIDS sick people. Today (2007) Efficacy of HAART provide Life Insurance with new opportunities 19
The Role of Insurance Adherence to HAART Life expectancy much longer Efficacy of HAART give three options in product design: 1. Price depend on assumed level of adherence to HAART 2. Apply assessment regime at claims stage, I.e. benefit payment depends on adherence to treatment 3. Link the policy to continuing adherent behaviour throughout the duration of the policy Option 3 have a noble quality: Insurance is being used as a vehicle through which incentives are created for more responsible behavioural patterns relative to HIV treatment. 20
The Role of Insurance One new product in SA applies principle 3 above Applies the principle of continuously monitoring the adherence to treatment of HIV positive individuals in a pure risk life insurance product. Policyholders are offered assistance in understanding what is required to remain adherent to the treatment programme. Need a robust admin system to track behaviour and communicate to clients according to their behaviour. 21
Questions? 22