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<?xml version="1.0"?>

<!DOCTYPE TEI.2 SYSTEM "base.dtd">




<title>HIV and AIDS</title></titleStmt>

<publicationStmt><distributor>BASE and Oxford Text Archive</distributor>


<availability><p>The British Academic Spoken English (BASE) corpus was developed at the

Universities of Warwick and Reading, under the directorship of Hilary Nesi

(Centre for English Language Teacher Education, Warwick) and Paul Thompson

(Department of Applied Linguistics, Reading), with funding from BALEAP,

EURALEX, the British Academy and the Arts and Humanities Research Board. The

original recordings are held at the Universities of Warwick and Reading, and

at the Oxford Text Archive and may be consulted by bona fide researchers

upon written application to any of the holding bodies.

The BASE corpus is freely available to researchers who agree to the

following conditions:</p>

<p>1. The recordings and transcriptions should not be modified in any


<p>2. The recordings and transcriptions should be used for research purposes

only; they should not be reproduced in teaching materials</p>

<p>3. The recordings and transcriptions should not be reproduced in full for

a wider audience/readership, although researchers are free to quote short

passages of text (up to 200 running words from any given speech event)</p>

<p>4. The corpus developers should be informed of all presentations or

publications arising from analysis of the corpus</p><p>

Researchers should acknowledge their use of the corpus using the following

form of words:

The recordings and transcriptions used in this study come from the British

Academic Spoken English (BASE) corpus, which was developed at the

Universities of Warwick and Reading under the directorship of Hilary Nesi

(Warwick) and Paul Thompson (Reading). Corpus development was assisted by

funding from the Universities of Warwick and Reading, BALEAP, EURALEX, the

British Academy and the Arts and Humanities Research Board. </p></availability>




<recording dur="00:49:06" n="5894">


<respStmt><name>BASE team</name>



<langUsage><language id="en">English</language>



<person id="nm0239" role="main speaker" n="n" sex="m"><p>nm0239, main speaker, non-student, male</p></person>

<personGrp id="ss" role="audience" size="s"><p>ss, audience, small group </p></personGrp>

<personGrp id="sl" role="all" size="s"><p>sl, all, small group</p></personGrp>

<personGrp role="speakers" size="3"><p>number of speakers: 3</p></personGrp>





<item n="speechevent">Lecture</item>

<item n="acaddept">Biological Sciences</item>

<item n="acaddiv">ls</item>

<item n="partlevel">UG</item>

<item n="module">unknown</item>




<u who="nm0239"> yesterday i started by talking or i finished i should say <pause dur="0.5"/> by talking to you about the different classification schemes that are available <pause dur="0.7"/> clinical classification schemes that are available for AIDS diagnosis <pause dur="1.0"/> and for monitoring the progression in the disease <pause dur="0.7"/> and you remember i said to you that there were two schemes there was one developed by the Centre for Disease Control in Atlanta <pause dur="1.0"/> and then there was a second scheme developed by the Walter Reed Hospital in Washington <pause dur="0.8"/> the <trunc>atla</trunc> the the C-D-C scheme <pause dur="0.6"/> was <pause dur="0.4"/> based primarily on clinical observation <pause dur="0.2"/> so it was not terribly laboratory based <pause dur="0.8"/> whereas the Walter Reed <pause dur="0.4"/> scheme <pause dur="0.3"/> was more based on measuring <trunc>clinic</trunc> you know measuring clinical parameters in the laboratory <pause dur="0.7"/> over the years since these two schemes <pause dur="0.6"/> came available <pause dur="0.4"/> it's the C-D-C scheme <pause dur="0.3"/> that has gained <pause dur="1.7"/> common usage <pause dur="0.7"/> and you remember that it's divided into four stages <pause dur="1.0"/> one through four <pause dur="3.1"/><kinesic desc="writes on board" iterated="y" dur="5"/>

and that i <pause dur="0.6"/> finished yesterday by talking about stage one which is the <pause dur="0.3"/> acute or primary infection stage <pause dur="0.7"/> and i said to you that <pause dur="0.5"/><kinesic desc="writes on board" iterated="y" dur="1"/> during this period <pause dur="1.3"/> that people were seroconverting they were they'd been infected <pause dur="0.4"/> they were seroconverting the important thing to remember about this stage <pause dur="0.5"/><kinesic desc="writes on board" iterated="y" dur="2"/> is there is a large viremia <pause dur="1.9"/> and so that at this stage the people <pause dur="0.4"/> are probably <pause dur="0.4"/> at greatest <pause dur="0.7"/> # chance of passing on the infections to others <pause dur="0.8"/> but in fact in the majority of cases <pause dur="0.3"/> they will not themselves at that point know that they are actually infected <pause dur="1.0"/> so the point at which they constitute the greatest risk to society in terms of passing on the infection <pause dur="0.6"/> they are probably completely unaware that they are infected themselves <pause dur="1.2"/> okay <pause dur="0.9"/> stage one is of course followed by stage two <pause dur="0.6"/> stage two is the <pause dur="1.1"/> asymptomatic infection phase <pause dur="1.1"/><kinesic desc="writes on board" iterated="y" dur="3"/> so that's the phase along here <pause dur="0.3"/> in terms of time <pause dur="1.0"/>

and whereas stage one <pause dur="1.1"/><kinesic desc="writes on board" iterated="y" dur="12"/> is measured in terms of <pause dur="0.3"/> weeks <pause dur="2.3"/> so really anything up to about <pause dur="0.3"/> sixteen to twenty weeks that sort of period <pause dur="2.1"/> stage two <pause dur="0.6"/> is measured in years <pause dur="2.2"/> and its <pause dur="0.2"/> its length <pause dur="0.3"/> is unpredictable <pause dur="3.2"/> okay so <pause dur="0.5"/> it's difficult to predict how long stage two is going to be for an individual <pause dur="1.5"/> the key thing about stage two <pause dur="0.4"/> is during stage two <pause dur="0.3"/> although the people are infected <pause dur="1.0"/> they are well <pause dur="0.2"/> they are <trunc>ge</trunc> in general terms <pause dur="0.3"/> healthy <pause dur="2.4"/> now clearly if you are someone that who is infected <pause dur="0.7"/> the thing that you want to know more than anything else <pause dur="0.5"/> is how long am i going to be in stage two <pause dur="1.5"/> if you're going to be in stage two for thirty years <pause dur="0.8"/> you're probably not going to worry too much about being infected <pause dur="0.3"/> 'cause you're probably going to die of something else before you come down with AIDS <pause dur="0.9"/> but if someone

says to you <pause dur="0.3"/> well you're likely to be in stage two for about two-and-a-half years <pause dur="0.6"/> given that you've almost certainly been infected in mid-adult life in the in the period <pause dur="0.4"/> twenty to forty <pause dur="0.7"/> then if somebody tells you that you're going to come down with AIDS in two-and-a-half years that's clearly <pause dur="0.5"/> much more profound effect on your life <pause dur="0.3"/> than if they'd said to you you were going to come down in <trunc>a</trunc> with AIDS in in thirty years <pause dur="1.7"/> so <pause dur="0.2"/> clearly one of the things that that <pause dur="0.3"/> people have looked for <pause dur="0.6"/> in <pause dur="1.4"/> trying to study this infection <pause dur="0.3"/> is prognostic indicators <pause dur="0.3"/> of the length of period <pause dur="0.7"/> of stage two <pause dur="1.4"/> so are there any indicators are there any clinical indicators of the infection <pause dur="0.4"/> that allow you to predict for an individual <pause dur="0.4"/> how long they are likely to be in stage two <pause dur="2.4"/> well what can we say about the length of <pause dur="0.5"/> stage two i've said it's in years <pause dur="4.0"/><kinesic desc="writes on board" iterated="y" dur="3"/> what do we know about the numbers <pause dur="0.7"/> well <pause dur="0.3"/> in the early days there was a <pause dur="0.3"/> study done of <pause dur="1.4"/><kinesic desc="writes on board" iterated="y" dur="2"/>

six-thousand-seven-hundred <pause dur="0.9"/> homosexual and bisexual men in the United States <pause dur="0.6"/> over a period of eighty-eight months <pause dur="1.2"/> now that's about seven-and-a-half years <pause dur="1.3"/> these people were all infected <pause dur="0.2"/> they were all <pause dur="0.2"/> H-I-V positive <pause dur="0.4"/> at the point when they were taken into the study <pause dur="1.3"/> and in that seven-and-a-half years thirty-six per cent of them <pause dur="0.9"/> had developed AIDS <pause dur="2.7"/> forty-four per cent of them <pause dur="0.6"/> had developed a condition called <pause dur="0.5"/> ARC <pause dur="1.2"/> ARC stands for AIDS related complex <pause dur="14.6"/><kinesic desc="writes on board" iterated="y" dur="14"/> and ARC is a series of opportunistic infections it's not full-blown AIDS <pause dur="1.5"/> but it's <pause dur="0.3"/> it's a <pause dur="0.5"/> it's <pause dur="0.4"/> what happens <pause dur="0.4"/> at the end <pause dur="0.2"/> of the asymptomatic period <pause dur="0.4"/> when people are starting to go into AIDS <pause dur="1.0"/> so forty-four per cent of them were <pause dur="0.8"/> in ARC <pause dur="0.7"/> twenty per cent of them were <pause dur="0.3"/> asymptomatic so <pause dur="0.2"/> twenty per cent of them after seven-and-a-half years <pause dur="0.4"/> were still <pause dur="0.2"/> completely well <trunc>c</trunc> still in stage two <pause dur="6.6"/> what about prognostic indicators <pause dur="1.2"/> well <pause dur="3.2"/> one of the <pause dur="0.6"/> best prognostic indicators still <pause dur="1.2"/> is the level of your C-D-four <kinesic desc="writes on board" iterated="y" dur="3"/> count <pause dur="3.7"/> you will all remember i hope that <pause dur="0.3"/> T-cells <pause dur="0.4"/> in

the blood can be divided into a number of <pause dur="0.4"/> subsets depending upon the <pause dur="0.4"/> antigens being expressed on their outer surface <pause dur="0.7"/> the two major divisions of <pause dur="0.9"/> T-cells are into C-D-four-positive cells <kinesic desc="writes on board" iterated="y" dur="2"/> and C-D-eight-<pause dur="1.1"/>positive cells <pause dur="0.5"/> the C-D-eight positive cells are the <kinesic desc="writes on board" iterated="y" dur="2"/> so-called <pause dur="0.5"/> cytotoxic T-lymphocytes <pause dur="0.7"/> so those are the affector cells <pause dur="0.3"/> of the cell mediated immune response <pause dur="0.8"/> whereas the C-D-four cells are predominantly the T-helper cells <pause dur="1.3"/> and it's C-D-four cells <pause dur="0.8"/> that H-I-V targets <pause dur="0.4"/> predominantly C-D-four cells <pause dur="0.8"/> that H-I-V will infect <pause dur="0.3"/> that's not solely the case but that's the predominant population <pause dur="0.4"/> of cells <pause dur="0.3"/> that H-I-V infects <pause dur="1.5"/> and what you can <pause dur="0.3"/> show <pause dur="0.5"/> is that <pause dur="0.5"/> if you have a C-D-four count <kinesic desc="writes on board" iterated="y" dur="2"/> of less than two-hundred <pause dur="1.9"/> per ml <pause dur="6.0"/><kinesic desc="writes on board" iterated="y" dur="1"/> then in a twenty month period in a study over

a twenty month period with where people were entering the study <pause dur="0.5"/> with less than two-hundred <pause dur="0.8"/> C-D-four positive cells per ml <pause dur="0.4"/> in their bloodstream sixty per cent of them <pause dur="2.1"/><kinesic desc="writes on board" iterated="y" dur="5"/> at the end of the <pause dur="0.6"/> twenty month period <pause dur="0.6"/> sixty per cent of them had AIDS <pause dur="2.4"/> whereas for those with <kinesic desc="writes on board" iterated="y" dur="9"/> greater than two-hundred<pause dur="1.3"/> C-D-four cells per ml <pause dur="0.6"/> only ten per cent of them <pause dur="3.6"/> were in AIDS <pause dur="2.7"/> so you can see that is a fairly good prognostic indicator <pause dur="1.5"/> if the if you measure the level of C-D-four cells in the bloodstream and you find that it's greater than two-hundred per ml <pause dur="0.7"/> then <pause dur="0.4"/> you have a <pause dur="0.4"/> relatively <pause dur="0.2"/> low chance of proceeding to AIDS <pause dur="0.5"/> in the <pause dur="0.2"/> next two-and-a-half years <pause dur="0.3"/> twenty months <pause dur="0.3"/> <trunc>two-and-a-b</trunc> <pause dur="0.3"/> # # under two years <pause dur="0.4"/> next two years just under two years <pause dur="1.2"/> whereas if your C-D-four count in the blood is less than two-hundred <pause dur="0.9"/> then you have a significantly higher chance of progressing to AIDS in the next twenty-odd months <pause dur="3.8"/>

there is one slight complication <kinesic desc="indicates point on board" iterated="n"/> in this measurement and that is that C-D-four cells undergo a <pause dur="0.6"/> diurnal rhythm <pause dur="0.2"/> that is to say they're there's a </u><gap reason="break in recording" extent="uncertain"/> <u who="nm0239" trans="pause"> if you measure them <pause dur="0.4"/> at different times of the day you get different numbers <pause dur="0.3"/> so you have to measure them at a specific time in the day because there's a natural biorhythm <pause dur="1.6"/> of C-D-four level cells in the bloodstream <pause dur="5.7"/> what about other indicators <pause dur="1.2"/> of <pause dur="1.6"/> progression out of asymptomatic phase into # <pause dur="0.9"/> into AIDS <pause dur="1.1"/> well <pause dur="0.9"/> you can look at the <pause dur="0.2"/> proliferative response <pause dur="0.2"/> induced by <pause dur="0.2"/> general antigens you will all have had <pause dur="0.4"/> the Mantoux test <pause dur="0.5"/> for T-B where <pause dur="0.2"/> some antigens are spotted on your skin <pause dur="0.3"/> and you you <pause dur="0.3"/> come up in blebs <pause dur="0.4"/> as a proliferative response to those antigens <pause dur="0.5"/> whether you've got an immune response to those antigens <pause dur="0.4"/> well you can take general antigens like that and you can test <pause dur="0.7"/> people who are H-I-V positive <pause dur="0.3"/> and ask how good is their response to such general antigens <pause dur="0.5"/> if they give a poor response to general antigens <pause dur="0.4"/> that's a bad sign <pause dur="1.5"/> okay <pause dur="1.1"/> if they

have <trunc>decr</trunc> decreased natural killer cell activity <pause dur="0.6"/> that's also a bad sign <pause dur="4.6"/> other factors that seem to affect progression <pause dur="0.4"/> out of the asymptomatic stage two <pause dur="0.5"/> into the later stages <pause dur="2.6"/> well <pause dur="1.4"/> other infectious agents <pause dur="1.3"/> there is some suggestion that <pause dur="1.1"/> if you are infected for example with treponema <pause dur="0.3"/> syphilis if you have syphilis remember <pause dur="0.5"/> H-I-V is predominantly a sexually transmitted disease globally as you'll see in a minute when i come on to the global figures <pause dur="1.2"/> and <pause dur="0.9"/> a coinfection <pause dur="0.7"/> with <pause dur="0.5"/> other <pause dur="0.2"/> sexually transmitted diseases <pause dur="0.3"/> seems to be bad news <pause dur="6.5"/> there is a suggestion although it's never been quantified <pause dur="0.3"/> that there may be a genetic component <pause dur="0.9"/> to <pause dur="1.1"/> susceptibility to <pause dur="0.3"/> to <pause dur="1.0"/> progression into AIDS <pause dur="1.2"/> now that's probably almost certainly got to do with the quality of your immune response how good is the immune response that you start out with <pause dur="3.3"/> the better it is <pause dur="1.3"/> the better your chance of remaining for a longer period <pause dur="0.4"/> in the asymptomatic phase <pause dur="3.0"/> when you come out of the asymptomatic phase into

stage three <pause dur="2.3"/> stage three is <pause dur="4.5"/><kinesic desc="writes on board" iterated="y" dur="2"/> sometimes associated with this <kinesic desc="indicates point on board" iterated="n"/> AIDS related complex <kinesic desc="writes on board" iterated="y" dur="2"/> stage four <pause dur="1.4"/> is full-blown AIDS <pause dur="1.4"/> now in the last few years stage stages three and four <pause dur="0.3"/> have tended to be conflated together <pause dur="3.7"/> because once people start to show ARC <pause dur="0.5"/> they relatively rapidly progress into <pause dur="0.9"/> into AIDS <pause dur="4.3"/> now what are the symptoms of stage four <pause dur="0.7"/> what sort of things do you <pause dur="0.6"/> do you suffer from in stage four <pause dur="1.4"/> well there's a variety of symptoms <pause dur="1.3"/> chronic fevers <pause dur="0.3"/> night sweats <pause dur="0.3"/> diarrhoea <pause dur="0.6"/> dramatic weight loss <pause dur="1.4"/> herpes zoster shingles <pause dur="1.4"/> oral thrush <pause dur="1.8"/> # <pause dur="1.4"/> athlete's foot <pause dur="0.6"/> a whole series of opportunistic infections that normally your immune system <pause dur="0.4"/> would deal with relatively straightforwardly <pause dur="0.6"/> become major problems for you <pause dur="0.9"/> quite often for example AIDS sufferers have athlete's foot that comes up to the knee <pause dur="1.7"/> okay <pause dur="0.5"/> it's a very unpleasant disease <pause dur="1.1"/> once you get into full-blown AIDS <pause dur="2.0"/> what is the <pause dur="0.8"/> in order to <pause dur="0.2"/> be categorized as in

<trunc>gra</trunc> <pause dur="0.2"/> in stage four <pause dur="0.7"/> you have to have fevers for <trunc>pers</trunc> persisting for more than a month <pause dur="3.6"/> involuntary weight loss at greater than ten per cent of baseline <pause dur="1.3"/> so in other words if you weighed ten stone <pause dur="0.6"/> you've got to have lost more than a stone in a short period of time if your natural <pause dur="0.2"/> body weight <pause dur="0.4"/> is ten stone <pause dur="0.3"/> and you've gone down below nine stone <pause dur="0.4"/> then you're in then <pause dur="0.2"/> you're in <pause dur="0.3"/> full-blown AIDS by definition <pause dur="0.7"/> you need to have had diarrhoea for more than a month <pause dur="3.2"/> untreated <pause dur="0.5"/> now you should appreciate and i mean i'll come on to say something about this later on there are now of course <pause dur="0.4"/> quite a lot of antiviral agents that are being used <pause dur="0.6"/> at least in some parts of the world to treat <pause dur="0.2"/> AIDS infection <pause dur="1.0"/> but untreated <pause dur="0.2"/> the median time from entering stage four to death <pause dur="0.6"/> is about ten months <pause dur="3.5"/> it doesn't differ <pause dur="0.2"/> very much from one part of the world to the other it tends to be <pause dur="0.3"/> slightly shorter <pause dur="0.4"/> in the developing world and that's probably got simply to do with the <pause dur="0.2"/> fact that people are generally more

malnourished <pause dur="0.9"/> in the developing world so <pause dur="0.3"/> in other words you know their general state of health <pause dur="0.4"/> is poorer to start with <pause dur="0.8"/> so once they go into AIDS they die quicker basically <pause dur="0.6"/> than do people <pause dur="0.2"/> in the developed world but we're only talking about a matter of <pause dur="0.4"/> two or three months either way <pause dur="0.5"/> it is a very unpleasant death <pause dur="1.5"/> you know <pause dur="0.8"/> i mean it's a lingering death <pause dur="0.6"/> you're ill for several months you have massive weight loss <pause dur="0.4"/> people end up <pause dur="0.4"/> bleeding often from all the orifices of the body <pause dur="0.4"/> they've got all these opportunistic infections it's a very unpleasant way to die there's no doubt about that <pause dur="1.0"/> okay <pause dur="1.5"/> all right let's <pause dur="0.2"/> move on then from a description of the disease <pause dur="0.4"/> to say something about the current situation globally <pause dur="0.8"/> okay <pause dur="0.5"/> now remember <pause dur="0.3"/> i've handed you out all these handouts <pause dur="0.7"/> so the slides i'm about to show you don't need to copy down <pause dur="0.7"/> but you do need to be aware <pause dur="0.8"/> of <pause dur="0.5"/> these figures <pause dur="0.4"/> and how they're derived <pause dur="0.3"/> once H-I-V once AIDS became clearly an important <pause dur="0.3"/> progressive

<trunc>ecidem</trunc> <trunc>e</trunc> <pause dur="0.3"/> epidemic <pause dur="1.3"/> the World Health Organization set up <pause dur="0.7"/> a task force <pause dur="0.4"/> to <pause dur="0.5"/> measure the impact to measure the epidemic and its impact globally <pause dur="0.5"/> and this task force now produces a <pause dur="0.6"/> a global report <pause dur="0.2"/> annually in December <pause dur="0.9"/> and so what i'm going to show you <pause dur="0.2"/> are the figures from December nineteen-ninety-seven <pause dur="0.5"/> and in a month's or so's time <pause dur="0.3"/> there will be figures coming out for December nineteen-ninety-eight <pause dur="17.1"/> <kinesic desc="turns on projector showing slide" iterated="n"/> right this gives you an indication <pause dur="0.7"/> of the W-H-O's estimate <pause dur="0.5"/> of the number of adults and children <pause dur="0.8"/> estimated to be living with H-I-V infection <pause dur="0.8"/> at the end of nineteen-ninety-seven <pause dur="2.0"/> let me stand here it's easier <pause dur="0.9"/> now the first thing that you can see is the global figure at the bottom <pause dur="0.6"/> thirty-point-six-million the W-H-O estimates thirty-point-six-million people <pause dur="1.1"/> globally living with H-I-V <pause dur="0.9"/> at the end of nineteen-ninety-seven what does that mean in terms of the global population <pause dur="0.5"/> it means about one in

<trunc>ha</trunc> one in one-hundred <pause dur="0.4"/> adults <pause dur="1.8"/> so one in a hundred adults round the world is H-I-V positive <pause dur="2.1"/> now remember that the median time <pause dur="0.4"/> between infection <pause dur="0.9"/> and full-blown AIDS <pause dur="1.4"/> is now established in developed countries such as North America to be about ten years <pause dur="0.5"/> right around about ten years <pause dur="1.8"/> in the developing countries <pause dur="0.8"/> the median time between infection <pause dur="0.5"/> and full-blown AIDS is about eight years <pause dur="0.3"/> it's not that much <pause dur="0.4"/> less <pause dur="1.6"/> in untreated remember <pause dur="2.2"/> you're going to die in about a year just under a year <pause dur="1.5"/> so what do these figures mean these figures mean that in sub-Saharan Africa <pause dur="0.4"/> we can expect <pause dur="0.5"/> somewhere in the excess of twenty-one-million deaths <pause dur="0.4"/> in the next ten years </u><gap reason="break in recording" extent="uncertain"/> <u who="nm0239" trans="pause"> okay <pause dur="1.1"/> in Latin America <pause dur="0.5"/> one-point-three in the Caribbean three-hundred-thousand in North America approximately a million <pause dur="0.9"/> people <pause dur="1.2"/> northern Africa two-hundred-thousand Europe half-a-million <pause dur="0.7"/> eastern Europe central Asia <pause dur="0.2"/> two-hundred-thousand <pause dur="0.8"/> eastern Pacific four-hundred-and-twenty-thousand <pause dur="1.0"/> south-east Asia six-million <pause dur="0.6"/> Australasia

relatively small numbers <pause dur="0.3"/> you can see from these figures <pause dur="0.5"/> that the area <pause dur="0.6"/> of greatest importance in terms of the the epidemic is sub-Saharan Africa <pause dur="0.6"/> something like two-thirds of the total number <pause dur="0.4"/> of people infected <pause dur="0.4"/> are in the countries referred to as sub-Saharan Africa <pause dur="4.2"/><kinesic desc="changes slide" iterated="n"/> those are the <trunc>f</trunc> those are the figures for <pause dur="1.0"/> adults and children <pause dur="0.4"/> of those about a million <pause dur="0.8"/> are children <pause dur="0.2"/> under the age of fifteen years <pause dur="0.3"/> and predominantly <pause dur="0.8"/> those children have been infected at birth <pause dur="1.8"/> the chance of <pause dur="1.1"/> a pregnant woman passing on the infection to her child at birth <pause dur="0.3"/> varies somewhat from country to country <pause dur="0.5"/> but is roughly thirty per cent <pause dur="4.9"/> and of course these children <pause dur="0.2"/> are infected <pause dur="1.0"/> and infectious <pause dur="0.2"/> as a result <pause dur="0.4"/> although in the asymptomatic period because of the low levels of virus <pause dur="0.3"/> you're not very infectious <pause dur="1.3"/> and they're going to die before their tenth birthday the majority of them <pause dur="1.6"/> okay <pause dur="0.3"/> you can see again that the the <trunc>f</trunc> <pause dur="0.2"/> place where the figure is <pause dur="0.8"/> largest <pause dur="0.4"/> is sub-Saharan Africa <pause dur="0.7"/> almost all of

the million-<pause dur="0.8"/>plus is in sub-Saharan Africa <pause dur="4.3"/><kinesic desc="changes slide" iterated="n"/> what about the number of deaths <pause dur="0.9"/> from the beginning of the epidemic <pause dur="0.7"/> until the end of nineteen-ninety-seven <pause dur="1.0"/> so this is a cumulative total how many people have died <pause dur="0.4"/> of AIDS in the last <pause dur="1.0"/> almost twenty years seventeen eighteen years <pause dur="0.5"/> you can see that the cumulative total is now eleven-point-seven-million <pause dur="2.8"/> of which <pause dur="0.3"/> approximately nine-and-a-half-million this thing is really giving up the ghost <pause dur="0.5"/><event desc="changes pointer" iterated="n"/><kinesic desc="indicates point on slide" iterated="n"/> approximately nine-and-a-half-million again are in sub-Saharan Africa <pause dur="1.1"/> four-hundred-and-twenty-thousand in North America <pause dur="0.6"/>two-hundred-thousand in western Europe <pause dur="5.5"/><kinesic desc="changes slide" iterated="n"/> estimated deaths in children <pause dur="0.2"/> of those eleven-point-seven-million <pause dur="0.4"/> it's estimated that two-point-seven-million of those are children <pause dur="0.2"/> under the age of fifteen <pause dur="5.8"/><kinesic desc="changes slide" iterated="n"/> estimated deaths during nineteen-ninety-seven <pause dur="2.3"/> two-point-three-million <pause dur="0.5"/> the number of deaths is accelerating of course as we get further into the epidemic <pause dur="0.4"/> the total number of infected people <pause dur="0.9"/> #

is getting larger <pause dur="2.2"/> and of course there are more people who have now been suffering from infection for a longer period of time <pause dur="0.3"/> and so they are starting to die <pause dur="0.8"/> in large numbers two-point-three-million of which one-point-eight-million <pause dur="0.7"/> died in sub-Saharan Africa <pause dur="0.7"/> in the last year in the in the year of nineteen-ninety-seven <pause dur="0.9"/> we're talking big numbers here <pause dur="1.0"/> as you can see i mean <pause dur="0.7"/> you will have seen if you've read the news <pause dur="0.3"/> that it's estimated that this is on a par with the number of people dying from malaria <pause dur="0.4"/> each year <pause dur="6.1"/><kinesic desc="changes slide" iterated="n"/> estimated that half-a-million children <pause dur="0.5"/> died from last year from <pause dur="0.2"/> H-I-V infection <pause dur="7.7"/><kinesic desc="changes slide" iterated="n"/> this is an interesting figure <pause dur="0.4"/> the estimate of the number of people who newly acquired <pause dur="2.1"/> H-I-V <pause dur="0.5"/> during nineteen-<pause dur="0.2"/>ninety-seven <pause dur="1.2"/><event desc="looks through notes" iterated="y" dur="11"/> let me get to that on my # <pause dur="9.5"/> five-point-eight-million <pause dur="1.6"/> that's about a hundred-and-sixty-thousand people a day <pause dur="0.8"/> being infected <pause dur="0.6"/> roughly <pause dur="1.8"/> again the great bulk of them <pause dur="0.4"/> in sub-Saharan Africa nearly <trunc>four-point</trunc> <pause dur="0.4"/> nearly <pause dur="0.2"/>

well <pause dur="0.2"/> just exactly four-million of the five-point-eight-million <pause dur="0.5"/> being infected <pause dur="0.3"/> in sub-Saharan Africa <pause dur="1.1"/> number's much lower in North America and western Europe <pause dur="1.7"/> in fact in North America <pause dur="0.8"/> the infection rate is declining <pause dur="6.0"/><kinesic desc="changes slide" iterated="n"/> number of children <pause dur="2.1"/> you can see <pause dur="1.2"/> nearly six-hundred-thousand children <pause dur="0.2"/> infected last year but look <pause dur="0.2"/> how many of those six-hundred-thousand it's estimated were infected <pause dur="0.6"/> in sub-Saharan Africa <pause dur="7.9"/> what does this mean <pause dur="0.7"/> what are the social consequences of some of these numbers <pause dur="3.3"/><kinesic desc="changes slide" iterated="n"/> this is an estimate <pause dur="0.5"/> of the number of children <pause dur="0.2"/> orphaned <pause dur="0.7"/> by AIDS <pause dur="3.0"/> during the epidemic <pause dur="1.9"/> so it's estimated that something like eight-point-two-million children globally have been orphaned <pause dur="0.4"/> by their parents dying of this disease <pause dur="1.0"/> of which nearly eight-million are in sub-Saharan Africa <pause dur="1.9"/> okay <pause dur="1.1"/> i mean these are really these are numbers that clearly you only have to stop and give a little bit of <pause dur="0.5"/> social thought to this to realize these are numbers that have profound <pause dur="0.4"/> social consequences <pause dur="1.0"/> you

know <pause dur="0.2"/> these countries are having to deal with <pause dur="0.4"/> eight-million children <pause dur="1.2"/> under the age of fourteen <pause dur="0.2"/> who have no parents <pause dur="1.0"/> okay <pause dur="0.6"/> this is not a small orphan problem this is an enormous problem <pause dur="1.3"/> and of course <pause dur="0.6"/><kinesic desc="indicates point on slide" iterated="n"/> these are the countries that are really with the exception of South Africa itself <pause dur="0.3"/> are really very poverty-stricken countries <pause dur="4.0"/><kinesic desc="changes slide" iterated="n"/> what can we say about the <pause dur="0.5"/> regional statistics <pause dur="1.0"/> okay <pause dur="0.4"/> the W-H-O divides the world into a number of regions <pause dur="0.4"/> i mean the interesting thing about this table <pause dur="0.5"/> i'm not going to go through it in <pause dur="0.6"/> great detail <pause dur="0.4"/><kinesic desc="indicates point on slide" iterated="n"/> but i want you to <pause dur="0.4"/> focus your attention <pause dur="1.4"/> on this column here <pause dur="2.6"/> this is <pause dur="0.2"/> adult prevalence rate <pause dur="2.0"/> so this is the number of adults in your population who are infected <pause dur="2.0"/> and if we take sub-Saharan Africa as a whole <pause dur="1.1"/> it's seven-point-five seven-point-four per cent <pause dur="2.9"/> now the consequences of that are <pause dur="0.5"/> that <pause dur="1.1"/> unless <pause dur="0.7"/> there's some treatment that is come up with that is be able to be that is cheap enough to be used on a very large scale <pause dur="1.6"/> in ten

years' time <pause dur="0.4"/> seven-and-a-half per cent of the adult population in sub-Saharan African is going to be dead <pause dur="1.6"/> okay <pause dur="0.8"/> i mean again <pause dur="0.3"/> you just have to stop and think about what the <trunc>enormou</trunc> <pause dur="0.4"/> and this hides some <pause dur="0.3"/> really even more horrific figures for example in Botswana <pause dur="0.3"/> something like twenty-four per cent of the adult population <pause dur="0.6"/> is H-I-V positive <pause dur="1.6"/> think of the consequences for example of Coventry <pause dur="0.4"/> of going into Coventry <pause dur="0.6"/> and killing <pause dur="0.5"/> in a ten year period <pause dur="0.2"/> twenty-four per cent of the adult population of Coventry <pause dur="0.5"/> how would the city of Coventry <pause dur="0.3"/> survive as a social structure how would it run <pause dur="1.1"/> you know it's not easy to see <pause dur="0.3"/> how these societies socially <pause dur="0.3"/> are going to cope with the consequences <pause dur="0.6"/> of this infection <pause dur="0.5"/> yeah <pause dur="0.9"/> these are very large numbers and nobody really knows actually <pause dur="0.8"/> what are going to be the <pause dur="0.2"/> the social consequences <pause dur="0.4"/> you can see that they're bound to be profound <pause dur="1.1"/> but in the end no one is sure exactly what they will be </u><gap reason="break in recording" extent="uncertain"/> <u who="nm0239" trans="pause"> <kinesic desc="changes slide" iterated="n"/> this is a <pause dur="0.3"/> a global view of infection <pause dur="1.1"/> at the end of

nineteen-ninety-seven and this is really just a way of <pause dur="0.4"/> of showing you where the hot spots are basically <pause dur="0.4"/> and of course it just reiterates that the hot spots are in sub-Saharan Africa <pause dur="0.9"/><kinesic desc="indicates point on slide" iterated="n"/> <trunc>s</trunc> <pause dur="0.9"/> the cool spots <pause dur="0.2"/> appear to be <pause dur="0.6"/><kinesic desc="indicates point on slide" iterated="n"/> places like <pause dur="1.3"/> # Russia <pause dur="0.9"/><kinesic desc="indicates point on slide" iterated="n"/> north Africa <pause dur="0.7"/><kinesic desc="indicates point on slide" iterated="n"/> western Europe <pause dur="0.2"/> Australasia <pause dur="12.8"/><kinesic desc="indicates point on slide" iterated="n"/> these diagrams are <pause dur="0.6"/> are there to give you an idea of the spread of the disease over time <pause dur="1.5"/><kinesic desc="indicates point on slide" iterated="n"/> and you can see here is what it looked like in the <pause dur="0.7"/> early nineteen-eighties in fact <pause dur="0.4"/> the epicentre in Africa <pause dur="0.4"/> in the early nineteen-eighties was <pause dur="0.6"/> <trunc>n</trunc> <pause dur="0.3"/> the northern region of sub-Saharan Africa <pause dur="1.2"/> areas such as <pause dur="0.3"/> Kenya <pause dur="1.0"/> Uganda <pause dur="2.4"/> but over the years what you can see is it <trunc>pread</trunc> spreading progressively out from that epicentre <pause dur="0.3"/> and particularly spreading progressively south <pause dur="1.0"/> and so now <pause dur="0.5"/> the epicentre is down <kinesic desc="indicates point on slide" iterated="n"/> here countries like Namibia <pause dur="0.6"/> Botswana <pause dur="2.0"/> Zimbabwe <pause dur="1.6"/> and look at the figures <pause dur="0.9"/> estimated percentage of adults in the fifteen to forty-nine group <pause dur="0.3"/> who are infected <pause dur="0.5"/> between sixteen and thirty-two per cent <pause dur="0.9"/> in these

countries <pause dur="5.0"/><kinesic desc="changes slide" iterated="n"/> here's a similar thing for <pause dur="0.3"/> South America and the Caribbean area <pause dur="1.0"/> you can see that the values are much lower <pause dur="2.7"/> but they're still in some countries quite <pause dur="0.4"/> profound i mean two to eight per cent of your population in Guyana for example <pause dur="1.2"/> if you lose eight per cent of your adult population in a ten year period that's going to have pretty dramatic social consequences <pause dur="3.9"/><kinesic desc="changes slide" iterated="n"/> this is <pause dur="1.3"/> # <pause dur="1.0"/> spread of H-I-V <pause dur="0.7"/> throughout <pause dur="0.4"/> south-east Asia <pause dur="1.4"/> and the key thing to pick up here <pause dur="0.5"/> is the very rapid spread <pause dur="0.4"/> in the latter part of the nineties <pause dur="0.8"/> in <kinesic desc="indicates point on slide" iterated="n"/> India <pause dur="0.6"/> and the countries here <pause dur="1.1"/> Thailand <pause dur="1.0"/> <trunc>miran</trunc> Miranmar or what we used to know as Burma <pause dur="1.1"/><kinesic desc="indicates point on slide" iterated="n"/> Bangladesh <pause dur="1.7"/><kinesic desc="indicates point on slide" iterated="n"/> you can see the figures are between half a per cent and eight per cent <pause dur="0.2"/> prevalence <pause dur="2.1"/> i'll throw you out a statistic from <pause dur="0.7"/> from last year's <pause dur="0.6"/> # report and i i will put <pause dur="0.3"/> copies of these reports <pause dur="0.3"/><kinesic desc="holds up report" iterated="n"/> which can actually be downloaded from the W-H-O web site but i'll put copies in the library of the nineteen-ninety-<pause dur="0.6"/>seven <pause dur="1.0"/> end of ninety-seven figures

so that you can read through it it's about a <pause dur="0.4"/><kinesic desc="holds up report" iterated="n"/> thirty or forty page report and it gives much more detail <pause dur="0.4"/> than i am able to give in this lecture about the numbers in different parts of the world <pause dur="1.1"/> but for example in India <pause dur="2.3"/> the main route of spread <pause dur="0.8"/> of <pause dur="0.4"/> H-I-V in India is by heterosexual contact <pause dur="3.6"/> in the area around Bombay <pause dur="0.7"/> the W-H-O estimates that there are a hundred-thousand prostitutes <pause dur="1.0"/> with an average a five <pause dur="1.1"/> clients a night <pause dur="0.9"/> and greater than twenty per cent of them are <trunc>H</trunc> of the prostitutes that is are H-I-V positive <pause dur="1.2"/> now if you just think about the implications of that in terms of a <pause dur="0.8"/> explosive spread of disease <pause dur="0.9"/> okay and you'll see in a minute something about <pause dur="0.7"/> some some figures about the number of people using condoms in some of these areas that are undergoing explosive spread of the disease <pause dur="3.8"/><kinesic desc="changes slide" iterated="n"/> this is this is a a table that's important to look at because this gives <pause dur="1.9"/> some idea of <pause dur="0.2"/> of the picture now what this is telling you <pause dur="0.9"/> is the proportional increase <pause dur="0.6"/> in <pause dur="0.2"/>

prevalence rates <trunc>bet</trunc> in the last three years <pause dur="1.7"/> so this tells you where things are <pause dur="0.6"/> spreading <pause dur="0.5"/> where the disease is spreading most rapidly <pause dur="2.4"/> not surprisingly some of the <trunc>s</trunc> countries of sub-Saharan Africa come into it <pause dur="0.9"/> but look at this <pause dur="0.9"/> i mean this is a very worrying thing <pause dur="0.6"/> in the former Soviet Union <pause dur="0.4"/> they've seen a greater than hundred per cent increase <pause dur="1.1"/> in prevalence rate <pause dur="0.4"/> in the last three years <pause dur="1.7"/> okay <pause dur="5.2"/><kinesic desc="changes slide" iterated="n"/> so i've already given you this figure <pause dur="0.8"/> more <trunc>tha</trunc> about a hundred-and-sixty-thousand <pause dur="1.5"/> new infections a day <pause dur="1.8"/> more than ninety per cent of the infections are in developing countries <pause dur="1.2"/> the important point about that <pause dur="0.6"/> is that whereas <pause dur="0.2"/> as i'll come on to in later lectures <pause dur="0.7"/> there are now <pause dur="0.8"/> AIDS therapies available <pause dur="0.7"/> A-Z-T various protease inhibitors <pause dur="0.4"/> these are all expensive <pause dur="0.6"/> and there's just no chance whatsoever in the foreseeable future <pause dur="0.5"/> that these therapies are going to be used in these developing countries they simply cannot afford to do it <pause dur="3.5"/> about sixteen-hundred of this

hundred-and-sixty-thousand are children under the age of fifteen that's per day we're talking about <pause dur="1.7"/> fourteen-thousand <pause dur="0.4"/> about <pause dur="0.3"/> this is the important point that i haven't alluded to before because i've <pause dur="0.6"/> talked when i was talking yesterday <pause dur="0.4"/> about the initial phase of the <pause dur="0.3"/> the epidemic in North America <pause dur="0.5"/> where the high risk group <pause dur="0.4"/> were <pause dur="0.2"/> homosexual males <pause dur="0.5"/> you remember i said to you that there was a profound change in their social behaviour <pause dur="0.6"/> associated with <pause dur="0.5"/> the <trunc>o</trunc> the spread of the <trunc>epi</trunc> epidemic <pause dur="0.4"/> from one of <pause dur="0.5"/> high promiscuity <pause dur="0.2"/> I-E high risk <pause dur="0.5"/> to one of essentially monogamy they became married <pause dur="0.2"/> more or less <pause dur="0.8"/> and as a result <pause dur="0.3"/> the infection rates in homosexual males <pause dur="0.3"/> in North America dropped dramatically <pause dur="1.5"/> but <pause dur="0.5"/> it is a sexually transmitted disease globally <pause dur="0.3"/> forty per cent of the people being infected are women <pause dur="1.2"/> fifty <trunc>f</trunc> per cent are in the fifteen to twenty-four age group <pause dur="0.2"/> they're in your <kinesic desc="indicates audience" iterated="n"/> age category <pause dur="1.7"/> okay globally <pause dur="2.3"/> i should just say in passing in case case i forget to mention it again <pause dur="0.6"/> for women who get infected <pause dur="0.6"/> if

you're infected with H-I-V <pause dur="0.2"/> about the worst thing that can happen to you is to get pregnant <pause dur="1.6"/> and the reason why that's a problem is because <pause dur="0.3"/> one of the consequences of pregnancy <pause dur="0.4"/> is a natural immunosuppression <pause dur="2.2"/> so <pause dur="0.3"/> as a result of becoming pregnant <pause dur="0.3"/> a woman will naturally immunosuppress <pause dur="0.5"/> that is a question of <pause dur="0.6"/> preventing rejection of the foetus of course <pause dur="0.6"/> now if you're suffering from an immunosuppressive disease <pause dur="0.3"/> if you naturally immunosuppress yourself <pause dur="0.6"/> that's bad news <pause dur="0.6"/> and a very common scenario <pause dur="0.5"/> for <pause dur="0.3"/> H-I-V infected women <pause dur="0.2"/> who become pregnant <pause dur="0.5"/> is the <pause dur="0.4"/> the becoming pregnant <pause dur="0.2"/> tips them over from being asymptomatic <pause dur="0.4"/> into <pause dur="0.2"/> suffering from AIDS <pause dur="2.0"/> they're suffering from AIDS so at the time of delivery <pause dur="0.3"/> there'll be a lot of virus around <pause dur="0.5"/> high chance of infecting the child <pause dur="1.0"/> or a common scenario is <pause dur="1.3"/> the child is born <pause dur="0.2"/> is infected <pause dur="0.2"/> the mother dies within <pause dur="0.3"/> a few months three or four months of birth <pause dur="0.4"/> you're left with an infected baby that's orphaned <pause dur="0.9"/> and is itself going to die <pause dur="0.8"/> before the age of ten

almost certainly <pause dur="0.3"/> who's going to look after it <pause dur="0.8"/> who's going to want to foster <pause dur="0.5"/> an H-I-V infected child it's not <pause dur="0.3"/> not a thing that's <pause dur="0.4"/> you know these are <pause dur="0.5"/> these are <pause dur="0.3"/> # facts that have profound social consequences like i've <pause dur="0.3"/> tried to emphasize over and over again <pause dur="3.6"/><kinesic desc="changes slide" iterated="n"/> now this is just a reiteration of the tables i showed you before cumulative numbers <pause dur="2.5"/><kinesic desc="changes slide" iterated="n"/> and also for children <kinesic desc="changes slide" iterated="n"/> i'll pass over those relatively quickly <pause dur="2.0"/> here are some figures for <pause dur="0.6"/> southern Africa <pause dur="0.9"/> looking at prevalence rates <pause dur="0.5"/> in different <pause dur="0.3"/> states different provinces of southern Africa <pause dur="1.1"/> and look at the tracking since the early nineteen-nineties since nineteen-ninety <pause dur="0.7"/> through to nineteen-ninety-seven <pause dur="1.7"/> <unclear>just</unclear> look how fast <pause dur="0.7"/> the epidemic is spreading <pause dur="1.1"/> you've gone from <pause dur="0.4"/> you know <pause dur="0.2"/> about one per cent one or two per cent <pause dur="0.3"/> in Kwazulu and Natal <pause dur="0.7"/> in nineteen-ninety one to two per cent of adults being infected which itself is bad enough <pause dur="0.7"/> to now <pause dur="0.5"/> greater than twenty-five per cent <pause dur="0.4"/> adults infected <pause dur="0.4"/>

in that small province <pause dur="4.3"/><kinesic desc="changes slide" iterated="n"/> similar figures for the <trunc>s</trunc> Soviet Union <pause dur="2.2"/> newly number of diagnosed infections <pause dur="0.3"/> starting in nineteen-eighty-seven <pause dur="0.7"/> and running through to nineteen-ninety-seven <pause dur="0.5"/> the key feature to look at is <kinesic desc="indicates point on slide" iterated="n"/> here look what's happened in the last two years <pause dur="1.1"/> you've got an exponential <pause dur="0.4"/> growth going up from <pause dur="0.9"/> less than five-hundred <pause dur="0.3"/> to fifteen-hundred <pause dur="0.4"/> to four-and-a-half-thousand <pause dur="3.9"/><vocal desc="sniff" iterated="n"/><pause dur="2.5"/> this is transmission route <pause dur="0.3"/> for the Soviet Union <pause dur="1.4"/> what you can see is that the main route <pause dur="1.3"/> of transmission in the Soviet Union at present <pause dur="0.4"/> is intravenous drug abuse <pause dur="2.1"/> the use of uncontaminated # the use excuse me of contaminated needles <pause dur="0.9"/> following intravenous drug abuse that's the most <pause dur="0.5"/> prevalent cause of infection <pause dur="6.1"/><kinesic desc="changes slide" iterated="n"/> one of the things that you see when social structures break down and you get sexually transmitted diseases <pause dur="0.6"/> is it isn't only H-I-V that's a problem <pause dur="0.6"/><kinesic desc="indicates point on slide" iterated="n"/> here you see the figures for some of the former Soviet Union states Belarus <pause dur="0.4"/> Moldova <pause dur="0.2"/> <trunc>fede</trunc> <pause dur="0.5"/>

Russian Federation and Ukraine <pause dur="0.2"/> for syphilis <pause dur="0.8"/> from nineteen-seventy-six to nineteen-ninety-seven <pause dur="0.9"/> what you can see is nothing much is happening pretty low levels <pause dur="0.7"/> to nineteen-ninety-one <pause dur="0.8"/> and then up it starts to come <pause dur="6.4"/><kinesic desc="changes slide" iterated="n"/> this is an interesting figure <pause dur="2.0"/> for a number of countries of southern Africa <pause dur="0.9"/> this is a life expectancy <pause dur="1.9"/> calculated life expectancy value <pause dur="0.6"/> now what you can see is that <pause dur="0.5"/> from the nineteen-fifties <pause dur="1.2"/> through to the middle eighteen middle nineteen-eighties <pause dur="0.6"/> the life expectancy <pause dur="0.7"/> in <pause dur="0.6"/> Africa <pause dur="0.2"/> was increasing <pause dur="0.8"/> this is a mark of <pause dur="0.6"/> man being able to combat infectious diseases <pause dur="0.5"/> improvements in combating infectious diseases <pause dur="0.4"/> and general malnourishment is resulting for example in Botswana <pause dur="0.6"/> in an increase of in the average life expectancy from about forty-three <pause dur="0.8"/> up to <pause dur="0.4"/> over sixty <pause dur="0.5"/> not too different from what the life expectancy was in <trunc>dev</trunc> is in developed countries <pause dur="0.8"/> in the upper sixties i think it's sixty <pause dur="0.6"/> sixty-seven for man and seventy-three for woman if i remember rightly <pause dur="1.3"/> but you can see in the last <pause dur="1.4"/>

ten years <pause dur="0.7"/> it's dropping back again <pause dur="0.7"/> in all of these countries some more quickly than others <pause dur="0.5"/> the ones it's dropping back in most quickly are the ones with the highest prevalence rate <pause dur="0.7"/> for H-I-V infection <pause dur="1.6"/> so <pause dur="0.6"/> you know not to put too fine a point on it this is almost like a biblical plague here in these countries i mean this isn't just <pause dur="0.4"/> capping off <pause dur="0.9"/> your life expectancy it's actually reducing life expectancy in the population as a whole <pause dur="3.5"/><kinesic desc="changes slide" iterated="n"/> by contrast <pause dur="1.2"/> in western Europe <pause dur="1.0"/> what you can see is that <pause dur="0.3"/> it looks like in western Europe <pause dur="0.8"/> the <pause dur="2.2"/> infection is <pause dur="0.6"/> being got under control in the sense that the number of new AIDS cases <pause dur="0.3"/> is now actually dropping <pause dur="2.8"/> now that's a combination of <pause dur="0.8"/> a reduction in infection rates <pause dur="0.8"/> and also <pause dur="0.4"/> the <pause dur="0.2"/> increasingly widespread use <pause dur="0.3"/> of antiviral chemotherapy <pause dur="0.4"/> holding people <pause dur="0.6"/> in the asymptomatic phase <pause dur="1.4"/> so it's not solely due to changes in the infection rate <pause dur="5.4"/><kinesic desc="changes slide" iterated="n"/> well this is just another i mean you can i mean i won't go through this this is

just impact of AIDS on under child <trunc>fi</trunc> under <pause dur="0.2"/> under five child mortality rates in a number of African countries <pause dur="0.7"/> that <trunc>d</trunc> <pause dur="0.2"/> with and without AIDS you can see that of course <pause dur="0.4"/> AIDS have a <pause dur="0.3"/> AIDS has a dramatic effect <pause dur="1.9"/><kinesic desc="changes slide" iterated="n"/> mother to child transmission <pause dur="1.3"/> you can see <pause dur="1.0"/> # <pause dur="0.3"/> how it's rapidly gone up transmission <pause dur="0.9"/> by <pause dur="1.9"/> # mother to child transmission direct transmission of H-I-V or transmission through <pause dur="0.3"/> breastfeeding they both go up you can <trunc>trans</trunc> <pause dur="0.4"/> transmit H-I-V by breastfeeding <pause dur="6.0"/> well this is just another way of depicting the graph i showed you earlier this is <pause dur="0.3"/> increased mortality rates <pause dur="0.2"/> among men in the fifteen to sixty age group <pause dur="1.0"/> based on whether or not whether or not <pause dur="0.8"/> there is <pause dur="1.0"/> # <pause dur="0.7"/> high levels of H-I-V <pause dur="4.0"/><kinesic desc="changes slide" iterated="n"/> proportion of <pause dur="1.2"/> adult mortality <pause dur="0.5"/> attributable to H-I-V <pause dur="0.8"/> well you can see that in a small Ugandan town <pause dur="1.2"/> it's about <pause dur="1.1"/> two-thirds to three-quarters of it <pause dur="1.4"/> so this has become a really major killer <pause dur="7.2"/><kinesic desc="changes slide" iterated="n"/> well <pause dur="0.7"/> you can take from this what you will i'm not

going to go through all of these in great detail <pause dur="1.2"/> this is an interesting one that i alluded to earlier <pause dur="2.2"/> the percentage of sexually active men using condoms <pause dur="0.7"/> by age and group and type of partner <pause dur="0.8"/> in nineteen-ninety-six for <pause dur="1.1"/> couple of countries where there is a big H-I-V problem despite the fact <pause dur="0.9"/> that they've got a big H-I-V problem and it's due to heterosexual spread <pause dur="0.4"/> look how <pause dur="0.4"/> you know in Malawi <pause dur="2.1"/> where there'll be fifteen to twenty per cent of the adult population is infected so your chance <pause dur="0.5"/> with unprotected sex of being infected is very high <pause dur="0.4"/> nevertheless still only <pause dur="0.4"/> twenty-odd per cent of males <pause dur="0.5"/> are using condoms <pause dur="1.8"/><kinesic desc="changes slide" iterated="n"/> and just to show you that i'm not sexist <pause dur="1.1"/> okay <pause dur="0.3"/> this shows you the figures for women <pause dur="1.7"/> okay <pause dur="0.8"/> same thing i mean very low levels of women <pause dur="0.2"/> using condoms <pause dur="2.3"/> and what's the <pause dur="3.2"/><kinesic desc="changes slide" iterated="n"/> # <pause dur="2.8"/> i alluded earlier to the fact that if you're H-I-V positive as a woman <pause dur="0.7"/> about the worst thing that can happen to you <pause dur="0.5"/> is that you get pregnant <pause dur="1.5"/> look at the pregnancy rates <pause dur="0.8"/> for by

the age of nineteen in a selection of these countries that are most highly affected <pause dur="1.5"/> okay <pause dur="0.6"/> i mean <pause dur="1.4"/> in virtually all case well in all cases including Senegal it's greater than forty per cent <pause dur="2.6"/> so that would mean <pause dur="0.5"/> that you know forty per cent of you in this room if you were in these countries forty per cent of the women that is would have already had a child by now <pause dur="1.0"/> okay <pause dur="1.1"/> and of course with high prevalence rates of H-I-V infection <pause dur="0.8"/> this is a real problem <pause dur="2.4"/><kinesic desc="changes slide" iterated="n"/> okay we'll we'll pass over that <pause dur="0.2"/> and come back to that later <pause dur="4.9"/><event desc="turns off projector" iterated="n"/> what i've tried to give you then in those handouts and in the slides i've gone through <pause dur="0.6"/> is a picture <event desc="turns on lights" iterated="n"/><pause dur="1.0"/> globally of the disease as at the end of nineteen-ninety-seven <pause dur="1.4"/> the numbers are very large of course <pause dur="0.7"/> yeah <pause dur="1.1"/> and <pause dur="0.3"/> the disease is having profound social consequences around the world <pause dur="1.3"/> the reason i've laboured in going through this is because as i said to you <pause dur="0.3"/> when you go out of here with a degree in microbiology and virology <pause dur="0.3"/> and you

tell somebody you know something about viruses <pause dur="0.6"/> almost certainly the virus that they will ask you about is H-I-V <pause dur="0.7"/> and they will expect you to be reasonably informed and what they won't want to know from you <pause dur="0.3"/> is how tat and rev works <pause dur="0.6"/> okay what they'll want to know from you is <pause dur="0.7"/> what's the sort of number of people who are suffering from this <pause dur="0.7"/> where is it the biggest problem <pause dur="1.4"/> what are your chances of being infected <pause dur="0.5"/> okay <pause dur="0.6"/> now on the end of the handout i've <pause dur="0.3"/> tacked out given out to you <pause dur="0.4"/> i've tacked on <pause dur="0.4"/> the last two monthly reports <pause dur="0.4"/> from the Public Health Laboratory Service <pause dur="0.4"/> of the situation in the United Kingdom <pause dur="1.6"/> and <pause dur="0.4"/> the best one <pause dur="1.2"/> to look at <pause dur="1.7"/> is actually the one from the end of August because that gives you some breakdown <pause dur="0.9"/> by region <pause dur="1.2"/> as to <pause dur="0.2"/> the numbers involved <pause dur="4.1"/> and the important point <pause dur="0.9"/><event desc="looks through notes" iterated="y" dur="5"/> i can't i can't find the table i'm looking for in the <pause dur="0.2"/> sheets i brought with me <pause dur="0.5"/> yeah oh yeah it's it's <kinesic desc="holds up sheet" iterated="n"/> this table here it's actually in the September one

not i think it's the very last page <pause dur="1.4"/> of the handout i gave you <pause dur="3.1"/> what you can see <pause dur="0.3"/> is that <pause dur="0.8"/> there's something like thirty-thousand <pause dur="0.3"/> <unclear>well</unclear> just over thirty-thousand <pause dur="0.5"/> H-I-V positive people <pause dur="1.5"/> in Britain <pause dur="0.7"/> somewhere over three-and-a-half-thousand of them have died of AIDS so far <pause dur="0.7"/> it's not a uniform distribution <pause dur="0.6"/> across the country <pause dur="1.4"/> # <pause dur="1.1"/> the West Midlands there are about a thousand people thousand H-I-V positive people in the West Midlands which compares to something like fifteen-thousand as you can see <pause dur="0.3"/> nearly sixteen-thousand <pause dur="0.5"/> in North Thames which is north London <pause dur="1.4"/> so the infection in the United Kingdom <pause dur="0.2"/> is <pause dur="0.5"/> pretty localized <pause dur="2.7"/> there is <pause dur="0.3"/> it's still the case <pause dur="0.5"/> that <pause dur="0.2"/> the epidemic in the United Kingdom <pause dur="0.6"/> the highest risk <trunc>f</trunc> risk factor is still <pause dur="0.3"/> homosexuality <pause dur="1.3"/> it's still true that more homosexuals many more homosexuals than heterosexual <pause dur="0.4"/> spread <pause dur="1.3"/> but <pause dur="0.2"/> as you can see from one of the tables <pause dur="0.4"/> heterosexual spread is starting

to <sic corr="occur">incur</sic> <pause dur="0.9"/> so there is depending again on the area in the country where you are there is a finite risk of heterosexual spread of this disease <pause dur="1.2"/> if you start having large numbers of sexual partners <pause dur="1.6"/> and just as it was the case in the homosexual spread in North America that i talked about yesterday <pause dur="0.6"/> the same is true in heterosexual spread <pause dur="0.8"/> in unprotected sex <pause dur="0.4"/> the more partners you have <pause dur="0.3"/> the greater is your risk of contracting the disease <pause dur="0.6"/> it's a straightforward <pause dur="0.3"/> linear relationship one against the other <pause dur="1.4"/> okay <pause dur="0.9"/> all right i <pause dur="0.3"/> i'll stop a little bit early because i've reached a natural break point <pause dur="0.5"/> and i'll continue tomorrow <pause dur="1.3"/> when i shall start talking about the virus that causes this disease <pause dur="0.4"/> rather than the disease itself <pause dur="0.9"/> thanks very much indeed