Escolar Documentos
Profissional Documentos
Cultura Documentos
Total: 38.6M
Sub-Saharan Africa: 24.5
M
Asia: 8.3M
LatAm and Carib: 1.9M
* 11 MMWR
Reports by
September
1982
The “Race” is On: April 23,
1984
PREDICTIONS
Blood test, widely available 6 months YES
“We hope to have such a vaccine ready for testing in approximately
two years,” HHS Secretary Margaret Heckler YES, BUT NO
“What we have at the moment is not particularly of great benefit to
people who have the disease…but it hopefully will be in a short
while,” Asst. Sec. of Health, Edward Brandt NO
The #1 Problem
9
subtypes
Namibia: 19.6%
Botswana: 24.1%
South Africa: 18.8%
CAR: 10.7%
Swaziland: 33.4%
Lesotho: 23.2%
Zambia: 17.0 %
Malawi: 14.1%
Zimbabwe: 20.1%
Mozambique: 16.1%
Why the high Prevalence in
Sub-Saharan Africa?
70%
1990 1989
1990 1996
60%
50%
1988
40%
30%
20%
1989
1989
10%
1987 1988 1995
1988
0%
Yunnan Manipur Myanmar Bangkok, Chiang Nikolayev,
Province, State, Thailand Rai, Ukraine
China India Thailand
Preventing an IDU epidemic
slows or averts a sex work
epidemic…
Projected epidemic in Jakarta with and w/o IDUs
120,000
s
80
Supposing condom
use drops to 60%
starting 1998
1400
Latin America and
Caribbean
Caribbean: highest
prevalence outside Sub-
Saharan Africa
Drivers:
• Migration
• Poverty
• Sex tourism
• Clients of sex work
Contrasts Abound • MSM
Evolution of Epidemic
Lowered prevalence
Pioneered treatment of poor
Dominican Republic’s
Challenges
Bateyes
Sex work
Treatment programs
Puerto Rico
IDU driven
Topnotch research
MSM
Migration
Wars, Gangs
Special
populations
Sex Work
Honduras Hotspot
Garifunas MSM
Migration Sex workers
Prisons
Regional wars
Mexico
MSM
Anti-homophobia campaign
Migration
Guatemala:
Treatment and Care Uneven
Centralized
Drug supply
Discrimination
Transition
issues
South America
Brazil > ½
cases
Andean
region MSM
Southern
cone was IDU
Brazil
Epidemics change
Was IDU cocaine and MSM
Now primarily heterosexual
Peru
Research magnet
MSM
Leading researchers from community
One Size Doesn’t Fit All
Prevention Efforts Woefully
Lacking
AZT
d4T RT
ddI NRTI
ddC NNRTI
NVP PI
EFV FI
IND CD4
SQV CCR5
3TC VL
FTC
T-20
The Cocktails Work
40
Frank Palella/HOPS
Resistance and Side Effects
Other Treatment Limitations
for Rich and Poor Countries
Alike
Many HIV+ don’t know infected
Adherence: Simpler regimens needed
Training of clinicians
Proper monitoring
No cure exists
The Story of Henan
$5.5 Billion
Committed
President’s Emergency
Plan for AIDS Relief
$15 billion/5 years
(PEPFAR) $150
Million
To Fund,
>$500
Million to
HIV
Vaccine
Mind the Gap
Future Treatment
Possibilities
New Targets: Integrase, APOBEC-3B
The Search for an AIDS
Vaccine: A Long Battle
Exposed,
uninfected
Protected
monkeys
Longterm
nonprogressor
s
Global HIV Vaccine
Enterprise