Place matters: why cities are key to ending AIDS Cities for Social Transformation Towards Ending AIDS 20 th International AIDS Conference Melbourne, Australia 19 July 2014 Steven J. Kraus Director UNAIDS Regional Support Team, Asia and the Pacific
Today half the world s population is urban, and this is expected to increase further Percentage of total population living in urban areas
Urbanization: faster than ever before London took 130 years for a 8 times increase in population Bangkok took 45 years Cities in Africa and China doubling every seven years - will take just over 20 years for 8 times increase in population
Rapid urbanization and GDP growth are taking place in Asia and the Pacific 100% Proportion of urban and rural population 8 % GDP(constant prices), percentage change 80% 6 60% 4 40% 20% 2 0% 0 2012 2013 2014 2015 2016 2017 2018 2019 Australia and New Zealand % urban population East Asia South Asia % rural population Southeast Asia World Prepared by www.aidsdatahub.org based on United Nations, Department of Economic and Social Affairs, Population Division. World Urbanization Prospects: The 2011 Revision; International Monetary Fund, World Economic Outlook Database (April 2014)
Globally, 96% of the increase in population in developing countries between now and 2030 will be in urban areas Global, 2030 Asia and the Pacific, 2030 40% 60% % urban population % rural population 46% 54% Prepared by www.aidsdatahub.org based on United Nations, Department of Economic and Social Affairs, Population Division. World Urbanization Prospects: The 2011 Revision and Word Bank and IMF. (2013). Global Monitoring Report 2013: Rural-Urban Dynamics and the Millennium Development Goals
Urban areas have more HIV infections than rural areas a trend that will continue as urban populations grow Urban/ rural adult (15-49 years) HIV prevalence in selected African countries
HIV prevalence is high among key populations in cities in Asia and the Pacific
An estimated 20 million people living with HIV live in cities - more than half the global epidemic 35M PLHIV in the world 20M (19M -21M) in cities Estimated HIV infections in cities zoom-in 4.8M PLHIV in Asia and the Pacific 25% in 30 big cities 24.7M PLHIV in Sub-Saharan Africa 30% in 70 big cities 0.86M PLHIV in West and Central Europe 60% in 20 big cities Source: Prepared by www.aidsdatahub.org based on UNAIDS. (2014). The Gap Report; and UNAIDS. (2014). Cities at the Centre: Mobilizing City-led Responses for Ending the Global AIDS Epidemic: Draft background paper for 2014 International AIDS Conference, Melbourne,19 20 July 2014.
But, cities will be at the centre to ending AIDS The disease burden in 220 cities
Cities have a huge urban advantage that can help scale up the response But cities have often not capitalized on this Less than 20% of those who need treatment receive it in many large cities Prevention coverage of key populations is less than a third Less than a third know their HIV status
HIV prevalence (%) HIV infections are concentrated in urban areas among key populations at higher risk 70% HIV prevalence (mean) 95% CI Lower bound 95% CI Upper bound 60% 50% 40% 30% 20% 10% 12 10 8 6 4 2 0 Rural Men 3.7 Rural Women 5.4 5.6 Urban Men 9.0 Urban Women % Rural Men Rural Women Urban Men Urban Adults (M&F) Women in Capital cities Urban Women MSM (range) IDU (range) FSW (range) Source: Prepared by www.aidsdatahub.org based UNAIDS. (2014). Cities at the Centre: Mobilizing City-led Responses for Ending the Global AIDS Epidemic: Draft background paper for 2014 International AIDS Conference, Melbourne,19 20 July 2014.
HIV in Asia and the Pacific region is concentrated among key populations especially in cities HIV prevalence (national, %) HIV prevalence (city, %) 60 40 20 0 20 40 60 People who inject drugs Indonesia, 36% Jakarta, 56% Men who have sex with men Thailand, 7% Bangkok, 24% Cities Female sex workers Viet Nam, 2.7% Hanoi, 23% National Source: Prepared by www.aidsdatahub.org based on HIV sentinel surveillance reports, integrated biological and behavioral surveillance reports and www.aidsinfoonline.org
Key populations are highly concentrated in cities and could be game changers: yet, ART coverage of key populations is lower than for other populations ART coverage for general population global: 37% ART coverage for KP : 5 to 20 % estimated ART Coverage in high income countries: > 80%
Our information systems are not sensitive to real needs: The location of the epidemic versus the location of services often does not match
Epidemics grow nationally as we delay taking strategic action in a few cities Source: Faran Emmanuel, University of Manitoba
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 Strategic city responses can impact ending AIDS nationally condom promotion in city brothels in Thailand spearheaded a national decline New HIV infections in Thailand, Asian Epidemic Model 1985 2030: 180,000 Clients Male IDU MSW MSM NI FSW Low-risk males Low-risk females 160,000 140,000 120,000 100,000 80,000 60,000 10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 40,000 20,000 0 Prepared by www.aidsdatahub.org based on personal communication from S. Sarkar, UNAIDS
Cites can act faster and better Pass special health regulations, and dedicated services for key populations (e.g. license sex workers to ensure decriminalised services, Male Health Clinics, offer drug substitution clinics) Offer community-based testing and treatment initiation by non-physicians Offer treatment to migrants Ensure follow-up to enhance treatment retention Private-public and community partnerships for effective service delivery
But, our financing systems should also acknowledge growing role of cities Innovative financing for cities based response Facilitate twinning and south to south approaches for cities Better and improved systems for tracking epidemic and real time corrective action Improved partnership between civic authorities, communities and private sector for effective delivery
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