Gonneke Hermanides, MD Izzy Gerstenbluth, MD epidemiologist
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1 HIV epidemic in the Caribbean Gonneke Hermanides, MD Izzy Gerstenbluth, MD epidemiologist
2 Epi (upon) - demos (people) An epidemic occurs when new cases of a certain disease, in a given human population, and during a given period, substantially exceed what is "expected, based on recent experience. The Plague of Athens, BC
3 A concise history of the HIV epidemic 1981: Emergence of AIDS epidemic in gay men East and West Coast US 1983/84: Discovery of the causative agent: HIV Nobel prize for medicine 2008 goes to AIDS pioneers and cancer researcher L. Montagnier, F. Barre-Sinoussi, professor Harald Many theories about it s origin: Hunter theory - Contaminated Needle theory Oral Polio Vaccine theory - Colonialism theory Conspiracy theory First plasma: Demographic Republic Congo 1959 Origin of HIV: ¹ (1) Worobey et al. Nature, 2008: 455: p
4 Global HIV epidemic, ¹ Number of people living with HIV (millions) 40 % HIV prevalence, adult (15 49) Number of people living with HIV % HIV prevalence, adult (15 49)
5
6 Rapid spread of the epidemic? 1. Men having sex with men 2. Poverty 3. Traveling 4. Other 0% 0% 0% 0% A. Men having sex wi.. B. Poverty C. Traveling (goed) D. Other
7
8 Highest HIV prevalence in the 1. Haiti region? (14-49) 2. Dominican Republic 3. Jamaica 4. St. Maarten 0% 0% 0% 0% Haiti Dominican Repu... Jamaica St. Maarten
9 Selected Estimated Adult HIV Prevalences (15-49) Cuba < % Canada % Mexico % Colombia % USA % Brazil % Barbados % D.R % Curaçaoao % Trin. & Tobago % Jamaica % Neth. Antilles % Suriname % Haiti % Bahamas % St. Maarten % UNAIDS Global report 2008, data for 2007
10 Estimate HIV Prevalence Netherlands Antilles by the end 2007/ beginning Island Registered PLWHA Estimated prevalence HIV Estimated prevalence HIV in yrs Curaçao ± % % Bonaire % * Sint Maarten % % Sint Eustatius % * Saba % * Neth. Ant. ± % % *Due to small or unknown numbers not calculated. ** Range prevalence calculated using multiplication factors 3 and 5 for PLWHA. Epidemiology & Research Unit; Medical and Public Health Service Curaçao. *preliminary data for 2008 Gerstenbluth & Lourents, April 2009
11 HIV prevalence in NL? % % % 4. 1% 0% 0% 0% 0% 0.00% 0.01% 0.1% 1%
12 10% 1% 0.1%
13 SXM: Newly diagnosed PLWH per year? >200 0% 0% 0% 0% >200
14 Incidence HIV + per 1000 population * 2008* Netherlands Antilles, Curaçao and Sint Maarten *preliminary data for 2008 Gerstenbluth & Lourents, April 2009
15 Limited data Laboratory based surveillance Confirmation testing Time of transmission unknown
16 Incidence of known HIV infections by year Netherlands Antilles * * *2008 Bon 1, SXM 23 Cur 90 *preliminary data for 2008 Gerstenbluth & Lourents, April 2009
17 Neth. Ant Curaçao St. Maarten Linear (Neth. Ant) Linear (Curaçao) Linear (St. Maarten) 1,4 1,2 1 0,8 0,6 0,4 0, ,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0 Neth. Ant Curaçao St. Maarten Linear (Neth. Ant) Linear (Curaçao) Linear (St. Maarten)
18 Known HIV-infected Netherlands Antilles per agegroup; Netherlands Antilles * < *preliminary data for 2008 Gerstenbluth & Lourents, April 2009
19
20 SXM: What behavior is leading the epidemic? 1. Men having Sex with Men (MSM) 2. Prostitutes 3. Answer A +B 4. None of the above 0% 0% 0% 0% Men having Sex... Prostitutes Answer A +B None of the ab...
21 Heterosexual Heterosexual MSM
22 A= Abstinence B= Be Faithfull C= Condom use
23 Last 25 year: Biomedical approach Behavioral changes Structural changes
24 Casus: What prevention intervention would you recommend a 28 year old single women? What would you recommend to a teenage boy of 15 years old? What kind of prevention intervention would you recommend to a man of 57 years old, in different concurrent relationships?
25 Effect of prevention interventions + - Sex workers, high Regular, concurrent Condom risk groups partners HIV testing HIV positive HIV negative Treatment STI's (6RCTs) Abstinence Multiple partners Male circumcision Microbicides Vaccines 1 Young people Great imact Men and women 2 (no effect on HIV), 2 (HSV) discouraging Most infection occur during 20's Not effective Not effective Reassessing HIV prevention, Potts et al. Science vol 320, 9 may 2008,
26 Recently: Infrastructure & Strategics
27 Highly Active HIV Prevention
28 Organization - Co-ordination - Collaboration Quality - Reporting - Efficacy
29 St Maarten
30 SXM: What kind of HIV 1. Low rate epidemic epidemic? 2. Concentrated epidemic 3. Generalized epidemic 4. Unknown 0% 0% 0% 0% Low rate epide... Concentrated e... Generalized ep... Unknown
31 Concluding: Epidemiology of SXM (1) Number of PLWH is relatively high HIV incidence unknown, but still growing No detailed data Certain risk behavior Sero-prevalence of HIV in certain subpopulations Data on STDs
32 Concluding: Epidemiology of SXM (2) Highly Active HIV prevention Community involvement (RED Campaign & AIDS Foundation) Leadership (Public health, RED campaign) Data on populations or behavior most at risk Through ACT RED, GO TEST
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