CoBaSys il punto di vista del medico: prof. Giovanni Guaraldi

Community based System in HIV
treatment - CoBaSys
Giovanni Guaraldi
Rector's Delegate
to Cooperation for Development in the Third Countries
2
Title of the action:
Community based system in HIV
treatment - CoBaSys
Empowering community to support
antiretroviral delivery programmes for
patients with HIV infection in Southern and
Eastern African Countries: a regional
network for policy advocacy targeting
vulnerable groups.
3
Empowering community to
support antiretroviral delivery
programmes for patients with
antiretroviral
delivery
HIV infection in Southern and
programmes for patients
Easternwith
African
Countries:
a
HIV infection
regional network for policy
advocacy targeting vulnerable
groups.
4
Il workshop ha l’obiettivo di lavorare insieme
sulla tematica del progetto CoBaSys,
attraverso una sua declinazione in chiave
multidisciplinare.
Cobasys mira alla costruzione di un
network in grado di ottenere un “voce” piu’
autorevole sulla formulazione di politiche
in tema di salute per la difesa dei gruppi
piu’ vulnerabili.
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Sessione 1
Moderatore: prof.ssa Elisabetta Genovese
ore 9.30 - Saluti e Introduzione della giornata (prof.
Giovanni Guaraldi, direttore CUSCOS)
ore 10.00 - Accenni storico-politico-geografico dei paesi
africani coinvolti nel progetto (prof. Mario Zamponi,
Facolta’ di scienze politiche, Universita’ di Bologna)
Ore 10.30 - Inizio relazioni tematiche
10.30 - 10. 50 Cobasys il punto di vista del medico
prof. Giovanni Guaraldi
11.00 - 11.20 Cobasys il punto di vista
dell’economista prof. Enrico Giovannetti
11.30 - 11.50 Cobasys il punto di vista dell’africanista
dott.ssa Roberta Pellizzoli
12.00 - 12.20 Cobasys il punto di vista del sociologo
prof. Claudio Baraldi
12.30 - 12.50 Cobasys il punto di vista dell’agronomo
prof. Emilio Stefani
Sessione 2
Moderatore: dott.ssa Donatella Franzi
ore 14.00 - Come si traduce un’idea in un progetto?
Analisi delle Guide-Line ACP S&T
dott.ssa Donatella Franzi
14.30- 16.30 Lavori di gruppo. Ogni focus group
discutera’ su un singolo Work Package e dovra’
pianificare a una serie di possibili sub-attivita’ per
garantire la realizzazione del progetto,
sottolineando i rischi per ciascuna.
16.30. Restituzione in plenaria del lavoro dei gruppi e
commento del lavoro svolto
dott. Nicola Dorigo
17.00 Conclusioni
13.00- 14.00 pausa pranzo
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Work Pakages
1. WP 1 Management and Coordination of
the project + WP 7 Dissemination
activities
2. WP 2 Start-up of local focus group
3. WP 3 Definition of a model for community
based care system that will promote the
local stakeholders advocacy
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Relevance of the action:
The African states involved in
the project currently record the
highest HIV/AIDS prevalence
and incidence rates in the
world
The debate on ART in
developing countries has
irrevocably moved from the
question of whether the
introduction of ART is
feasible to questions of how
can best be delivered and
sustained
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A Global view of HIV infection, 2007
33 million people [30-36 million] living with HIV
More than 25 million people have died of AIDS since 1981
The latest statistics on the world epidemic of HIV
and AIDS were published by UNAIDS/WHO in July
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2008, and refer to the end of 2007.
Regional statistics for HIV & AIDS, end of 2007
10
Global HIV/AIDS estimates, end of 2007
The latest statistics on the world epidemic of HIV and AIDS were published by
UNAIDS/WHO in July 2008, and refer to the end of 2007.
11
Speranza di vita e PIL
Giappone
82 y.
Sierra Leone
34 y.
The Millennium Preston curve in Marmot M., The Lancet, 2006; 368: 2081-94
HIV prevalence and GDP per capita
(data from UNAIDS and the World Bank)
There is no systematic relationship between poverty and HIV,
although malnutrition and economic vulnerability may well
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increase the risk of HIV infection in some contexts
A combined microfinance and
training intervention can lead to
reductions in levels of intimatepartner violence in programme
participants.
Social and economic development
interventions have the potential to
alter risk environments for HIV and
intimate-partner violence in southern
Africa.
The intervention did not affect the
rate of unprotected sexual
intercourse with a non-spousal
partner in cohort two, and there was
no effect on the rate of unprotected
sexual intercourse at last occurrence
with a non-spousal partner
15
Strategies to alleviate
poverty,
whilst valuable in
themselves, are unlikely to
be effective in
combating the HIV
epidemic.
16
Nicoli Nattrass, AIDS Behav (2009) 13:833–840
Of all the study participants, 32% of
women and 22% of men had
experienced food insufficiency in the
preceding 12 months.
“The results were striking”.
Food insufficiency was associated
with increased HIV risk behaviour,
and this association was much more
marked in women than men. Risk
behaviour included inconsistent
condom use, sex exchange,
increased intergenerational sex, and
lack of control over sexual
relationships
17
The fact that most people living with HIV in
the region today are poor simply reflects
the fact that the epidemic has now spread
throughout the generalized population in a
region that has a high proportion of poor
people
Not
to poverty itself but to
economic and
gender inequalities and
weakened
“social cohesion”
18
The link between extreme poverty and AIDS is
mediated byvulnerable group in the comunity
Poverty
Vulnerable
Groups
AIDS
19
African women and AIDS
Between 15 and 19 years old
infection rate is 5-6 fold
higher than men (UNAIDS,
2000).
Biological, social and
cultural factors involved:
• Frequent sexual
intercourses between
teenagers
• Lower access to instruction
• Lower monetary availability
• Lower access to prevention
and to health services
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Social rights inequity between men and women is a risk factor.
AIDS orphans
• 79% of all AIDS orphans live in Africa
• 15 million children have lost one or both parents
• 5.8% of all children in africa are orphan
35
Absolute number and percentage of children aged 6-14
years who have lost one or both parents to AIDS in subSaharan Africa
50
45
30
40
absolute number
%
25
35
30
20
25
15
20
15
10
10
5
5
0
0
1990
1995
2000
years
2005
2010
HIV Prevalence and Income Inequality in Africa
The Gini coefficient has a value between 0 and 1, representing the
extremes of income distribution.
A zero value corresponds to the situation where everyone in the
population has exactly the same income, whereas a value of 1 would
correspond to extreme concentration of income in one person. A high
value indicates a more unequal income distribution.
Conclusions
• AIDS pandemic is a globalized problem and
economic sustainability of ART is necessary to
be found in a world global economic resources.
• We need to keep going in community
sustainability of AIDS programs were
Africans are actively involved in keeping
prevention and treatment opportunity
tightly linked.
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2000: Gli obiettivi del Millennio
1) Eradicare la fame e l’estrema povertà
2) Raggiungere l’istruzione di base universale
3) Promuovere la parità di genere
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2000: Gli obiettivi del Millennio
4) Ridurre la mortalità infantile
-
Ridurre di due terzi la mortalità <5 a
5) Migliorare la salute materna
-
Ridurre di 3/4 il tasso di mortalità materna
6) Combattere HIV/AIDS, malaria e altre malattie
infettive
- Interrompere ed iniziare a ridurre la diffusione dell’ HIV/AIDS
- Interrompere ed iniziare a ridurre la diffusione della malaria e di altre
malattie importanti
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2000: Gli obiettivi del Millennio
7) Assicurare la sostenibilità ambientale
• Ridurre alla metà la percentuale della popolazione senza
accesso ad acqua sicura
8) Costruire una partnership globale per lo sviluppo
• In cooperazione con le imprese farmaceutiche assicurare
l’accesso a farmaci essenziali nei paesi in via di sviluppo
• In cooperazione con il settore privato, assicurare la
disponibilità di nuove tecnologie, specialmente quelle dell’
informazione e della comunicazione
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Il ruolo delle Università
- Formazione
- Ricerca
- Comunità accademica
- Coscienza critica
CENTRO UNIVERSITARIO DI SERVIZI PER LA
COOPERAZIONE ALLO SVILUPPO
http://www.cuscos.unimore.it/on-line/Home.html