2010 FIFA World Cup and HIV/AIDS

“Football and sex belong together”

RisksIntuitively assume that

“football and sex” go together

Link between staging a FIFA world cup and risky sexual activity

Possible increase in HIV infection

World Cup 2006 - Germany First world country Legalised prostitution in 2002 – prostitutes have legal rights,

entitled to receive social benefits and health insurance Expected 40 000 extra commercial sex workers to be trafficked into

Germany Research – no huge increase in demand documented. Why?

Planning and coordination started more than a year before the event

Increased law enforcement during the cup Fan-base – many families and children; many low-budget

tourists who did not have extra money for sex Fan parks also decreased demand Not profitable enough event for traffickers National hotlines set up

South Africa 2010

Third world country – high levels of unemployment and poverty

Surrounded by countries who are poor

Region has highest rates of HIV infection in the world

Total: 33.2 (30.6 – 36.1) million

Western & Central Europe

760 000760 000[600 000 – 1.1 million][600 000 – 1.1 million]

Middle East & North Africa

380 000380 000[270 000 – 500 000][270 000 – 500 000]Sub-Saharan Africa

22.5 million22.5 million[20.9 – 24.3 million][20.9 – 24.3 million]

Eastern Europe & Central Asia

1.6 million 1.6 million [1.2 – 2.1 million][1.2 – 2.1 million]

South & South-East Asia

4.0 million4.0 million[3.3 – 5.1 million][3.3 – 5.1 million]Oceania

75 00075 000[53 000 – 120 000][53 000 – 120 000]

North America1.3 million

[480 000 – 1.9 million]

Latin America1.6 million1.6 million

[1.4 – 1.9 million][1.4 – 1.9 million]

East Asia800 000800 000

[620 000 – 960 000][620 000 – 960 000]Caribbean230 000

[210 000 – 270 000]

Adults and children estimated to be living with HIV, 2007

Estimated number of adults and children newly infected with HIV, 2007

Western & Central Europe

31 00031 000[19 000 – 86 000][19 000 – 86 000]

Middle East & North Africa35 00035 000

[16 000 – 65 000][16 000 – 65 000]Sub-Saharan Africa

1.7 million1.7 million[1.4 – 2.4 million][1.4 – 2.4 million]

Eastern Europe & Central Asia

150 000 150 000 [70 000 – 290 000][70 000 – 290 000]

South & South-East Asia

340 000340 000[180 000 – 740 000][180 000 – 740 000]Oceania

14 00014 000[11 000 – 26 000][11 000 – 26 000]

North America46 000

[38 000 – 68 000]

Latin America100 000100 000

[47 000 – 220 000][47 000 – 220 000]

East Asia92 00092 000

[21 000 – 220 000][21 000 – 220 000]Caribbean

17 000[15 000 – 23 000]

Total: 2.5 (1.8 – 4.1) million

Percent of adults (15+) living with HIV who are Percent of adults (15+) living with HIV who are female, 1990–2007female, 1990–2007

0

10

20

30

40

50

60

70

Percent female (%)

Sub-Saharan AfricaGLOBALCaribbeanAsia

E Europe & C AsiaLatin America

1990‘91‘92 ‘93‘94‘95‘96‘97‘98‘99‘00‘01 ‘02‘03‘04‘05‘062007

Year

5

The tipping pointEpidemics:

Takes smallest of changes to shatter an epidemic’s equilibrium

Different ways of tipping an epidemic – depends on different agents of change

tiny % of people do the majority of the workChange happens in a hurry1% = tipping point E.g. SA – took 5 years for prevalence rates to

move from 0.5% - 1%; then only 7 years to jump from 1% to 20%.

HIV prevalence in adults HIV prevalence in adults in sub-Saharan Africa, 1988−2003in sub-Saharan Africa, 1988−2003

20% − 39%

10% − 20%

5% − 10%

1% − 5%

0% − 1%

trend data unavailable

outside region

Size matters: the number of prostitutes and the global HIV/AIDS

pandemic Infection rates among CSWs (commercial sex workers) higher

than the general population (Study of data available from 77 countries)

On average, Africa = 4X as many CSWs as rest of world (as % of pop) & CSW community in Africa more than 4X as likely to be HIV infected as rest of world

“To visualise the potential power of CSWs in spreading the virus, one need only assume that in a country with 4% of its adult females working as CSWs, if each CSW has sex with 10 new male clients in a week, assuming no repeat customers in the week, this leads to contact with 40% of the adult male population in just one week”.

Male clients = spread HIV into general population – back to their mother countries.

Many illegal immigrants seeking means to survive – world cup = income generating event

Attract sex workers from neighbouring countries and from all over SA

Possibility that commercial sex work and public drinking will be legalised over world cup period – condom use?

So what are the risks?

2010 likely to increase risk of HIV infection

Spread of infection from area with one of the highest prevalence rates back to countries of origin of fans (bring them nearer to the tipping point)

Fan base? Two scenarios – ‘rich’ fans from first world countries – mainly men? Fans from neighbouring countries – poorer, also mainly men? Will this equate with unprotected casual sex?

So what are the risks? Worst case scenario: Further spread and reinfection in

SA – particularly if we have an influx of sex workers from high prevalence neighbouring countries

Unlikely that people will plan to have safe sex- unlikely that fans will know about risk (unless aggressively educated and informed)

Unlikely that sufficient condoms will be freely available

Likely that there will be lots of unprotected casual sex to ‘celebrate’ & ‘drown sorrows’

Opportunities Deliver effective preventive education – particularly targeting young

people

Generate income – eg Alive and Kicking in Kenya

Use celebrity sports stars and coaches as role models

Use sports to break down stigma and discrimination

Use events as a point of access to VCT and other health service

Use sports media profile to communicate and promote AIDS messages to a wider audience

What now?

Early and sound situation assessment – regional experts (police & NGOs)

Need co-ordinated advocacy and effective public awareness campaigns (also targeting arriving fans)

Condom availabilityHotlinesInformation kiosksTraining of key staff