1. 2008 Report on the global AIDS epidemic 06/06 e Epidémiologie Mondiale du VIH/Sida Caroline Semaille Unité VIH-IST-VHC-Hépatite B chronique, Département des maladies infectieuses, Institut de Veille Sanitaire 2 Novembre 2009

2. 2008 Report on the global AIDS epidemic 06/06 e A global view of HIV infection 33 million people [30–36 million] living with HIV, 2007 2.2

3. 2008 Report on the global AIDS epidemic 06/06 e TOTAL 2.0 million [1.8 – 2.3 million] 0.8% [0.7% - 0.9%] 2.7 million [2.2 – 3.2 million] 33 million [30 – 36 million] Adult & child deaths due to AIDS Adult prevalence (15 49) [%] Adults & children newly infected with HIV Adults & children living with HIV The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information. Regional HIV and AIDS statistics and features, 2007 North America Eastern Europe & Central Asia Latin America South and South-East Asia Sub-Saharan Africa Oceania Western & Central Europe Caribbean East Asia Middle East & North Africa 23 000 [9100 – 55 000] 58 000 [41 000 – 88 000] 63 000 [49 000 – 98 000] 340 000 [230 000 – 450 000] 1.5 million [1.3 – 1.7 million] 110 000 [67 000 – 180 000] 0.6% [0.4% – 1.0%] 0.8% [0.6% – 1.1%] 0.5% [0.4% – 0.6%] 0.3% [0.2% – 0.4%] 5.0% [4.6% – 5.4%] 54 000 [9600 – 130 000] 140 000 [88 000 – 190 000] 330 000 [150 000 – 590 000] 1.9 million [1.6 – 2.1 million] 1000 [<1000 – 1400] 8000 [4800 – 17 000] 14 000 [11 000 – 16 000] 40 000 [24 000 – 63 000] 27 000 [20 000 – 35 000] 0.4% [0.3% – 0.5%] 0.3% [0.2% – 0.4%] 1.1% [1.0% – 1.2%] 0.1% [<0.1% – 0.2%] 0.3% [0.2% – 0.4%] 13 000 [ 12 000 – 15 000] 27 000 [14000 – 49 000] 20 000 [16 000 – 25 000] 52 000 [29 000 – 84 000] 40 000 [20 000 – 66 000] 22.0 million [20.5 – 23.6 million] 1.2 million [760 000 – 2.0 million] 1.5 million [1.1 – 1.9 million] 1.7 million [1.5 – 2.1 million] 4.2 million [3.5 – 5.3 million] 74 000 [66 000 – 93 000] 730 000 [580 000 – 1.0 million] 230 000 [210 000 – 270 000] 740 000 [480 000 – 1.1 million] 380 000 [280 000 – 510 000]

4. 2008 Report on the global AIDS epidemic 06/06 e Over 7400 new HIV infections a day in 2007 More than 96% are in low and middle income countries About 1000 are in children under 15 years of age About 6300 are in adults aged 15 years and older of whom: almost 50% are among women about 45% are among young people (15-24)

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6. 2008 Report on the global AIDS epidemic 06/06 e Percent of adults (15+) living with HIV who are female 1990–2007 2.4

7. 2008 Report on the global AIDS epidemic 06/06 e Children living with HIV globally, 1990–2007 2.5

8. 2008 Report on the global AIDS epidemic 06/06 e Life expectancy at birth, selected regions, 1950–1955 to 2005–2010 2.11 Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2006 Revision, http://esa.un.org/unpp

9. 2008 Report on the global AIDS epidemic 06/06 e To capture the diversity of the epidemic To explain changes over time To build up a more informative picture Second generation HIV surveillance Objectives

10. 2008 Report on the global AIDS epidemic 06/06 e Second generation HIV surveillance Objectives To capture the diversity of the epidemic To explain changes over time To build up a more informative picture

11. 2008 Report on the global AIDS epidemic 06/06 e Autres : données sur les IST perspective = mesurer lincidence du VIH Données de surveillance : -notification du sida -notification du VIH - données de prévalence -activités de dépistage -cohortes Données comportementales -chez les UDI -chez les homosexuels -chez les hétérosexuels Dynamique de lépidémie du VIH

12. 2008 Report on the global AIDS epidemic 06/06 e Second generation HIV surveillance General concepts To concentrate data collection in populations most at risk To compare information on HIV prevalence and on the behaviours that spread it To make better use of other sources of information (communicable disease surveillance, reproductive health surveys, …) To tailor the surveillance system to the pattern of the epidemic in the country ( define 3 country profiles) Source: UNAIDS

13. 2008 Report on the global AIDS epidemic 06/06 e UNAIDS/WHO classification of epidemic states Low level Concentrated Generalised Source: UNAIDS

14. 2008 Report on the global AIDS epidemic 06/06 e Low level Principle: although HIV infection may have existed for many years, it has never spread to significant levels in any sub- population. Infection is largely confined to individuals with higher risk behaviour: e.g. sex workers, drug injectors, homosexual men. This suggests that networks of risk are rather diffuse (low levels of partner exchange or sharing of drug injecting equipment), or a very recent introduction of the virus. Source: UNAIDS

15. 2008 Report on the global AIDS epidemic 06/06 e Concentrated Concentrated Principle: HIV has spread rapidly in a defined sub-population, but is not well-established in the general population. This suggests active networks of risk within the sub- population. The future course of the epidemic is determined by the frequency and nature of links between highly infected sub-populations and the general population. Source: UNAIDS

16. 2008 Report on the global AIDS epidemic 06/06 e Principle: in generalised epidemics, HIV is firmly established in the general population. Although sub-populations at high risk may continue to contribute disproportionately to the spread of HIV, sexual networking in the general population is sufficient to sustain an epidemic independent of sub-populations at higher risk of infection. Source: UNAIDS Generalised Generalised

17. 2008 Report on the global AIDS epidemic 06/06 e UNAIDS/WHO classification of epidemic states Low Level HIV prevalence has not consistently exceeded 5% in any defined sub-population Concentrated HIV prevalence consistently >5% in at least one defined sub- populationbut <1% in pregnant women in urban areas Generalised HIV prevalence consistently >1% in pregnant women Source: UNAIDS

18. 2008 Report on the global AIDS epidemic 06/06 e Lépidémiologie du VIH en Afrique Un exemple dépidémie généralisée

19. 2008 Report on the global AIDS epidemic 06/06 e HIV prevalence (%) in adults (15–49) in Africa, 2007 2.8

20. 2008 Report on the global AIDS epidemic 06/06 e HIV prevalence (%) among pregnant women attending antenatal clinics in sub-Saharan Africa, 1997–2007 NOTE: Analysis restricted to consistent surveillance sites for all countries except South Africa (by province) and Swaziland (by region) Southern Africa 0 10 20 30 40 Median HIV prevalence (%) 50 Botswana Lesotho Mozambique Namibia South Africa Swaziland Zimbabwe 1997– 1998 1999– 2000 2001200220032004200520062007 West Africa 0 5 10 15 20 Median HIV prevalence (%) 0 5 10 15 20 Median HIV prevalence (%) Eastern Africa 1997– 1998 1999– 2000 2001200220032004200520062007 1997– 1998 1999– 2000 2001200220032004200520062007 Ethiopia Kenya Burkina Faso Côte d'Ivoire Ghana Senegal 2.9 Source: National surveillance reports and UNAIDS/WHO/UNICEF, Epidemiological Fact Sheets on HIV and AIDS. July 2008.

21. 2008 Report on the global AIDS epidemic 06/06 e HIV prevalence (%) among 15–24 years old, by sex, selected countries, 2005–2007 0510152025 % HIV prevalence Swaziland South Africa Zimbabwe Central African Republic Côte d'Ivoire Sierra Leone Rwanda Haiti Guinea Ethiopia Benin DR Congo Niger Senegal Cambodia India Uganda Chad Dominican Republic Mali Female Male 2.10 Source: Demographic and Health Surveys and other national population-based surveys with HIV testing.

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24. 2008 Report on the global AIDS epidemic 06/06 e Changes in population structure: Ghana and Lesotho 2.12 Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2006 Revision, http://esa.un.org/unpp

25. 2008 Report on the global AIDS epidemic 06/06 e Estimated number of children under 18 orphaned by AIDS in sub-Saharan Africa (1990–2007) 6.2 Source: UNAIDS/WHO unpublished estimates, 2007. Millions 19902006200320051995200020042002 0 2 4 6 8 10 12 14 2007

26. 2008 Report on the global AIDS epidemic 06/06 e Relationship between tuberculosis notification rate and HIV prevalence in Zimbabwe, 1990–2006 5.6 Source: WHO Global TB control report 2008 (WHO, 2008a); UNAIDS HIV prevalence estimates. 50 100 150 200 250 300 350 400 450 500 198519901995200020052010 TB notification rate (per 100 000 population) % HIV prevalence in all ages TB notification rate (new and relapse), rate per 100 000 population HIV prevalence in all (%) 10 12 14 16 18 0 2 4 6 8

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28. 2008 Report on the global AIDS epidemic 06/06 e HIV prevalence (%) in adults (15–49) in Middle East and North Africa, 2007 2.21

29. 2008 Report on the global AIDS epidemic 06/06 e Lépidémiologie du VIH en Asie

30. 2008 Report on the global AIDS epidemic 06/06 e HIV prevalence (%) in adults (15–49) in Asia, 2007 2.13

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34. 2008 Report on the global AIDS epidemic 06/06 e 2004 <5% High Risk Group > 5% High Risk Group >1%Antenatal Women 8 M HIV+ I M new Infections 0.5 M deaths

35. 2008 Report on the global AIDS epidemic 06/06 e HIV prevalence (%) trends in India among injecting drug users and pregnant women, selected areas, India, 1998–2004* Antenatal Clinic attendees Antenatal clinic attendees Injecting drug users 1998199920002001200220032004 % 0.0 1.0 2.0 3.0 4.0 5.0 1998199920002001200220032004 % 0.0 0.3 0.6 0.9 1.2 1.5 1998199920002001200220032004 % 0.0 3.0 6.0 9.0 12.0 15.0 Andhra Pradesh Karnataka Maharashtra Tamil Nadu Madhya Pradesh Mizoram Uttar Prahesh West Bengal Delhi Mizoram West Bengal 2.9 *Data from consistent surveillance sites only.

36. 2008 Report on the global AIDS epidemic 06/06 e HIV prevalence trends among pregnant women in major cities in Cambodia, Myanmar and Thailand, 1990–2004 Phnom PenhMandalay and YangonBangkok Sources: Cambodia National Center for HIV/AIDS, Dermatology and STDs (Phnom Penh); Myanmar Ministry of Health (Mandalay and Yangon); Thailand Ministry of Public Health (Bangkok), 2005. 1990 19992003 2004 0.0 1.0 2.0 3.0 4.0 5.0 1993 1994 1995 1996 1997 19982000 2001 2002 1991 1992 % HIV prevalence 2.10

37. 2008 Report on the global AIDS epidemic 06/06 e Trend in HIV prevalence in 21-year-old military conscripts in Thailand: 1989-1999 Source: Armed Forces Research Institute of Medical Sciences, Thailand HIV prevalence (%) 1989199019911992199319941995199619971998 1999 0 5 4 3 2 1

38. 2008 Report on the global AIDS epidemic 06/06 e General population Populations à risque EuroHIV Illustration de la possibilité de diffusion du VIH des groupes à risques vers la population générale Cette diffusion dépend des liens qui existent entre ces populations à risque et la population générale - Homosexuels masculins - Usagers de drogues - Patients atteints dune IST - Migrants - Prostituées Taille de la population à risque, liens avec la population générale ?

39. 2008 Report on the global AIDS epidemic 06/06 e Drivers of the epidemic: familiar pattern in countries Source: Thai Working Group on HIV/AIDS Projections, 2001 70% IDU SW 26 % 90% SW Spouse 5% IDU 5% 50% Spouse SW 15% IDU 20% MTCT 15%

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41. 2008 Report on the global AIDS epidemic 06/06 e HIV prevalence (%) in adults (15–49) in Eastern Europe and Central Asia, 2007 2.16

42. 2008 Report on the global AIDS epidemic 06/06 e Increase in reported HIV cases in the Russian Federation and Ukraine, 1987–2005 1987198919911993199519971999200120032005 0 50 000 100 000 150 000 200 000 250 000 300 000 350 000 400 000 30 000 45 000 60 000 75 000 90 000 105 000 120 000 15 000 0 Reported HIV cases in the Russian Federation Reported HIV cases in Ukraine Russian Federation Newly reported cases Cumulative (previous years) Ukraine Newly reported cases Cumulative (previous years) 2.12 Sources: Russian Federal AIDS Centre; Ukranian AIDS Centre and Ministry of Health of Ukraine

43. 2008 Report on the global AIDS epidemic 06/06 e Lépidémiologie du VIH en Amérique Latine

44. 2008 Report on the global AIDS epidemic 06/06 e HIV prevalence (%) in adults (15–49) in the Caribbean, 2007 2.17

45. 2008 Report on the global AIDS epidemic 06/06 e HIV prevalence (%) in adults (15–49) in Latin America, 2007 2.18

46. 2008 Report on the global AIDS epidemic 06/06 e HIV prevalence (%) among female sex workers and men who have sex with men in Latin America, 1999–2002 Provinces (7 cities) La Paz Santa Cruz Border cities with Argentina Santiago Bogotá Argentina Bolivia Chile Colombia 0.0 % HIV prevalence 051015202530 Buenos Aires Quito Guayaquil Other city ports (4) Asunción and 4 other cities Lima Provinces Montevideo Border cities with Brazil Isla Margarita Ecuador Paraguay Peru Uruguay Venezuela 0.0 % HIV prevalence 051015202530 Female sex workersMen who have sex with men 2.14 Source: Montano SM et al., JAIDS (2005).

47. 2008 Report on the global AIDS epidemic 06/06 e Lépidémiologie du VIH dans les pays industrialisés

48. 2008 Report on the global AIDS epidemic 06/06 e HIV prevalence (%) in adults (15–49) in North America, Western and Central Europe, 2007 2.19

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50. 2008 Report on the global AIDS epidemic 06/06 e Annual diagnoses of HIV infection and AIDS in Australia 1981–2006 2.23 AIDS diagnosesHIV diagnoses 198119861991199620012006 Year 0 400 800 1200 1600 2000 2400 Number of diagnoses Source: National Centre in HIV Epidemiology and Clinical Research, 2007. Data available at http://www.nchecr.unsw.edu.au/NCHECRweb.nsf/resources/SurvRep07/$file/ASR2007.pdf

51. 2008 Report on the global AIDS epidemic 06/06 e HIV prevalence (%) in adults (15–49) in Oceania, 2007 2.22

52. 2008 Report on the global AIDS epidemic 06/06 e Epidémiologie du VIH aux Etats-Unis Une population noire américaine plus touchée par le VIH que la population blanche américaine ou hispanique Des contaminations par usages de drogues encore très fréquentes Pour la première fois en 2008, les USA ont estimé lincidence du VIH : 22 cas pour 100 000, 56 300 contaminations en 2006

53. 2008 Report on the global AIDS epidemic 06/06 e Estimation de lincidence du VIH aux Etats-Unis pour lannée 2006, Jama 2008

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61. 2008 Report on the global AIDS epidemic 06/06 e Distribution by region of the funding required for treatment and care Latin America/Caribbean: 17% Eastern Europe: 7% North Africa/Middle East: 1% Africa: 55% South/South-East Asia: 4% East Asia/Pacific: 16% Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries. 10.6