00001-E-50– 27 June 2000

Leading causes of death globally, 1999Leading causes of death globally, 1999

1 Ischaemic heart disease

2 Cerebrovascular disease

3 Acute lower respiratory infections

4 HIV/AIDS

5 Chronic obstructive pulmonary disease

6 Perinatal conditions

7 Diarrhoeal diseases

8 Tuberculosis

11 Malaria

12.7

9.9

7.1

4.8

4.8

4.2

4.0

3.0

1.9

Source: The World Health Report 2000, WHO

Rank % of total

Plague Doctor 1656

2000 Global HIV/AIDS Estimates Children and Adults

• People living with HIV/AIDS

• New HIV infections in 2000

• Deaths due to HIV/AIDS in 2000

• Cumulative number of deaths due to HIV/AIDS

36.1 million

5.3 million

3.0 million

21.8 million

00001-E-19– 27 June 2000

New

infe

ctio

ns

-

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99

Highly in dustrialized countries

North Africa & Middle EastEastern Europe & Central asiaSub-Saharan AfricaLatin America & the Caribbean

Southern & Eastern Asia

Estimated annual number of new HIVEstimated annual number of new HIVinfections by region, 1980 to 1999infections by region, 1980 to 1999

Click for larger picture

00001-E-20– 27 June 2000

Peo

ple

livin

g w

ith H

IV/A

IDS

Highly in dustrialized countries

North Africa & Middle East

Eastern Europe & Central Asia

Sub-Saharan AfricaLatin America & the Caribbean

Southern & Eastern Asia

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99

Estimated number of people living withEstimated number of people living withHIV/AIDS by region, 1980 to 1999HIV/AIDS by region, 1980 to 1999

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HIV/AIDS comes to China

NY Times 5/27/01

00001-E-46– 27 June 2000

Changes in life ex pectancy in sele cted African count rieswith high HIV prevalence , 1950 to 2000

South-Africa

35

40

45

50

55

60

65

1950-55 1955-60 1960-65 1965-70 1970-75 1975-80 1980-85 1985-90 1990-95 1995-00

Life

exp

ecta

ncy

at

birt

h, i

n ye

ars

Botswana

Uganda

Zambia

Zimbabwe

Source: United Nations Population Division, 1998

Click for larger picture

00001-E-15– 27 June 2000

Projected population structure with and Projected population structure with and without the AIDS epidemic, Botswana, 2020without the AIDS epidemic, Botswana, 2020

80757065605550454035302520151050

020406080100120140 0 20 40 60 80 100 120 140

Males Females Deficits due to AIDS

Projected populati on structure in 2020

Population (thousands)

Age

in y

ears

Source: US Census Bureau, World Population Profile 2000

Click for larger picture

00001-E-47– 27 June 2000

0 10 20 30 40 50 60 70

Cambodia

Haiti

Mozambique

Rwanda

Côte d'Ivoire

Zambia

Kenya

South Africa

Zimbabwe

Botswana

Life expectancy at birth ( years)

Predicted life expectancy Loss in l ife expectancy due to HIV/AIDS

Source: U.S. Census Bureau, 2000

Predicted loss in life expectancyPredicted loss in life expectancydue to HIV/AIDS in children born in 2000due to HIV/AIDS in children born in 2000

Click for larger picture

00001-E-48– 27 June 2000

Lifetime risk of AIDS death for 15-year-old boys,Lifetime risk of AIDS death for 15-year-old boys,assuming unchanged or halved risk of becomingassuming unchanged or halved risk of becoming

infected with HIV, selected countriesinfected with HIV, selected countries

Source: Zaba B, 2000 (unpublished data)

Current adult HIV prevalence rate

Burkina Faso

Cambodia

Côte d’Ivoire

Kenya

South AfricaZambia

Zimbabwe

Botswana

Burkina FasoCambodia

Côte d’Ivoire

Kenya

South AfricaZambia

Zimbabwe

Botswana

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0% 5% 10% 15% 20% 25% 30% 35% 40%

Ris

k of

dyi

ng o

f A

IDS

current level of risk maintained

risk halved over next 15 year s

Click for larger picture

00001-E-26– 27 June 2000

Reduction in production in a household withan AIDS death, Zimbabwe

Crops

Maize

Cotton

Vegetables

Groundnuts

Cattle owned

Reduction in output

61%

47%

49%

37%

29%

Source: Stover & Bollinger, 1999

HIV/AIDS Prevention

• Condoms- accessible, cheap

• Sex education, early & often

• Counseling, testing

• Prevent mother to child transmission

• Reduce harm of drug use

• Access to care, treatment

PREVENTABLE DEATHS

Measles Child vaccination 98% Malaria Pesticide bednets 50% Tuberculosis DOT-S 60% Diarrheas Oral rehydration 90% Pneumonias Appropriate antibiotics 90% HIV/AIDS Condoms, sex ed, etc 70%

Costs of Prevention Strategies

Intervention Cost-$/person EffectivenessTuberculosis Rx $20 95%

HIV-condoms 1 yr $14 99%

Malaria- bednets $00.05 50%

Diarrhea- salts,H20 $00.33 99%

Pneumonia- antibiotics $00.27 90%

Measles- vaccine $00.26 98%

Total cost to prevent infectious diseases-$7 billion

Which way will the world turn?

Will the nations of the earth make the resources available:

“To prevent disease in the weakest to protect the strongest”

? ? ? ?

00001-E-3– 27 June 2000

HIV prevalence among pregnant womenHIV prevalence among pregnant womenin South Africa, 1990 to 1999in South Africa, 1990 to 1999

Source: Department of Health, South Africa

0.71.7 2.1

4

7.6

10.4

14.2

17

22.8 22.4

0

5

10

15

20

25

90 91 92 93 94 95 96 97 98 99

HIV

pre

vale

nce

(%)

Click for larger picture

00001-E-13– 27 June 2000

HIV prevalence in military personnel in Africa

Nigeria: 11% among peacekeepe rs returning

from Sierra Leone and Liberia vs 5% in adult

population

South Africa: 60-70% in military vs 20% in

adult population

Source: Nigeria AIDS bulletin No 15, May 20, 2000; The Mail & Guardian, Pretoria,March 31, 2000; UNAIDS/WHO 1999 estimate

Life Expectancy at Birth(both sexes, years)

Area 1995-2000 2010-2015 2045-2050

World 65.0 68.7 76.0

Japan 80.5 81.5 88.0

France 78.1 80.3 84.0

USA 76.5 79.2 82.6

China 69.8 73.5 79.0

Russia 66.1 69.3 76.9

Sierra Leone 37.3 40.5 61.5

Click forlargerpicture

Life Expectancy at Birth (both sexes, years)

Area 1995-2000

World 65.0

Japan 80.5

France 78.1

USA 76.5

China 69.8

Russia 66.1

Afghanistan 47.0

Sierra Leone 37.3

Infant Mortality Rate(infant deaths per 1000 live births)

Area 1995-2000 2010-2015 2045-2050

World 59.6 43.4 19.4

Japan 3.5 3.3 2.5

France 5.5 4.6 3.6

USA 7.6 5.8 4.4

Russia 16.7 14.0 7.2

China 41.4 28.6 13.3

Sierra Leone 165.4 124.0 53.9

Infant Mortality Rate(infant deaths per 1000 live births)

Area 1995-2000

World 59.6

Japan 3.5

France 5.5

USA 7.6

Russia 16.7

China 41.4

Afghanistan 165.0

Sierra Leone 165.4

Reduction in maternal mortality(%) from hand washing with a chlorine solution- Semmelweis,PI 1861

Semmelweis before and after insisting on hand disinfection with chlorine and lime