1. The HIV/AIDS Epidemic © 2008 John B. Pryor Illinois State University

2. AIDS -  Acquired  Immune  Deficiency  Syndrome HIV -  Human  Immunodeficiency  Virus

3. Ways HIV is Transmitted: 1) through unprotected sexual intercourse 2) through sharing needles 3) through exposure to contaminated blood 4) perinatal exposure 5) mother’s milk

4. Ways you cannot transmit HIV: 1) mosquito bites 2) casual contact 3) toilet seats 4) sharing food

5. Can I get HIV from oral sex?  CDC says “yes.”  Not as dangerous as vaginal sex or anal sex  Actual risk level is unknown  Oral sex is more dangerous if the person performing it has bleeding gums or cuts/abrasions in the mouth.  Oral sex is more dangerous if the person who receives it has cuts, abrasions, or sores in the genital area.

6. Natural History of HIV/AIDS HIVInfection 3-6 Weeks AcuteHIVSyndrome 6 Months Positive HIV Test 9.8 Years 14.8 Years ClinicalAIDS Death May be extended by new drug therapies

7. Advances in HIV-Testing  OraQuick Rapid HIV Test  A swab of the outer gums, upper and lower - collects oral fluid  Test takes 20 minutes  Accuracy - Correctly identified 99.3% of people who were infected with HIV (sensitivity) and 99.8 % of people who were not infected with HIV (specificity)

8. HIV/AIDS Trends in the USA

9. History of the Epidemic 1981 – 121 deaths – A disease was identified among men who have sex with men. It was first called “gay cancer” and later named Gay Related Immuno Deficiency (GRID) 1982 – 447 deaths – Institut Pasteur in France discovered Human Immunodeficiency Virus (HIV) the virus that causes Acquired Immunodeficiency Syndrome (AIDS). CDC in US announced that HIV can be spread through sexual contact or exposure to contaminated blood. 1983 – 1,476 deaths – CDC documented transmission of HIV from heterosexual contact. American Red Cross warned `high risk donors not to donate blood

16. Number of AIDS patients, AIDS deaths and patients on antiretroviral therapy among men who have sex with men (MSM), San Francisco, USA, 1980 to 1998 Source: San Francisco Department of Public Health (California), USA, 1999

17. Cases, %

21. Why is the prevalence of HIV/AIDS higher in African Americans?  POVERTY – Almost 1 in 4 African Americans live in poverty. Research by CDC shows that poverty is a strong predictor of HIV infection.  IMPRISONMENT OF BLACK MALES – Black men are more than 6 times more likely than White men to have served in prison. 1 out of every 7 Black men 25-29 is in prison. Prison is a place where there are high risks for HIV infection: male- to-male unprotected sex, IV drug use, & prison tattoos. Black men are no more likely to perform risky behaviors than White men while in prison. They are just more likely to be there. When they get out they spread HIV to their communities.  POVERTY also predicts IMPRISONMENT.

23. HIV/AIDS Trends in Illinois

28. HIV/AIDS Global Trends

29. Total: 33 million (30 – 36 million) Western & Central Europe 730 000 [580 000 – 1.0 million] Middle East & North Africa 380 000 [280 000 – 510 000] Sub-Saharan Africa 22.0 million [20.5 – 23.6 million] Eastern Europe & Central Asia 1.5 million [1.1 – 1.9 million] South & South-East Asia 4.2 million [3.5 – 5.3 million] Oceania 74 000 [66 000 – 93 000] North America 1.2 million [760 000 – 2.0 million] Latin America 1.7 million [1.5 – 2.1 million] East Asia 740 000 [480 000 – 1.1 million] Caribbean 230 000 [210 000 – 270 000] Adults and children estimated to be living with HIV, 2007

30. Estimated number of adults and children newly infected with HIV, 2007 Western & Central Europe 27 000 [14 000 – 49 000] Middle East & North Africa 40 000 [20 000 – 66 000] Sub-Saharan Africa 1.9 million [1.6 – 2.1 million] Eastern Europe & Central Asia 110 000 [67 000 – 180 000] South & South-East Asia 330 000 [150 000 – 590 000] Oceania 13 000 [12 000 – 15 000] North America 54 000 [9600 – 130 000] Latin America 140 000 [88 000 – 190 000] East Asia 52 000 [29 000 – 84 000] Caribbean 20 000 [16 000 – 25 000] Total: 2.7 million (2.2 – 3.2 million)

31. Estimated adult and child deaths from AIDS, 2007 Western & Central Europe8000 [4800 – 17 000] Middle East & North Africa 27 000 [20 000 – 35 000] Sub-Saharan Africa 1.5 million [1.3 – 1.7 million] Eastern Europe & Central Asia 58 000 [41 000 – 88 000] South & South-East Asia 340 000 [230 000 – 450 000] Oceania1000 [<1000 – 1400] North America 23 000 [9100 – 55 000] Latin America 63 000 [49 000 – 98 000] East Asia 40 000 [24 000 – 63 000] Caribbean 14 000 [11 000 – 16 000] Total: 2.0 million (1.8 – 2.3 million)

32. Western & Central Europe1300 [<1000 – 1800] Middle East & North Africa 26 000 [18 000 – 34 000] Sub-Saharan Africa 1.8 million [1.7 – 2.0 million] Eastern Europe & Central Asia 12 000 [9100 – 15 000] South & South-East Asia 140 000 [110 000 – 180 000] Oceania1100[1200] North America 4400 [2600 – 7300] Latin America 44 000 [37 000 – 58 000] East Asia7800 [5300 – 11 000] Caribbean 11 000 [9400 – 12 000] Children (<15 years) estimated to be living with HIV, 2007 Total: 2.0 million (1.9 – 2.3 million)

33. Western & Central Europe<200[<100] Middle East & North Africa5700 [3800 – 8000] Sub-Saharan Africa 330 000 [300 000 – 360 000] Eastern Europe & Central Asia3200 [2400 – 4300] South & South-East Asia 21 000 [14 000 – 29 000] Oceania<1000 North America < <500 [<200] Latin America4600 [4200 – 8300] East Asia2000 [1200 – 3100] Caribbean 1800 [1500 – 2100] Estimated number of children (<15 years) newly infected with HIV, 2007 Total: 370 000 (330 000 – 410 000)

34. Western & Central Europe<200 Middle East & North Africa4400 [3300 – 5400] Sub-Saharan Africa 240 000 [220 000 – 260 000] Eastern Europe & Central Asia1600 [1100 – 2200] South & South-East Asia 17 000 [13 000 – 20 000] Oceania<500 North America <200 [<100 – <500] Latin America3100 [2300 – 4400] East Asia1200 [<1000 – 1900] Caribbean 1200 [<1000 – 1400] Estimated deaths in children (<15 years) from AIDS, 2007 Total: 270 000 (250 000 – 290 000)

35. HIV/AIDS Trends in Africa

36. HIV prevalence (%) in adults (15–49) in Africa, 2007 2.8 Namibia Botswana Zimbabwe Zambia

37. 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.

38. 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

39. 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

40. HIV/AIDS Trends in Eastern Europe & Asia

41. HIV prevalence (%) in adults in Eastern Europe and Central Asia, 2007

42. HIV/AIDS Trends in

43. Most-affected regions in the Russian Federation Source: Russian Federal AIDS Centre, based on registered number of people living with HIV through 22 March 2004. Compiled by AIDS Foundation East-West. The designations employed and the presentation of material on this map do not imply the expression of any opinion whatsoever on the part of UNAIDS/WHO concerning the legal status of any country, territory, city or area or of its authority, or concerning the delimitation of its frontiers or boundaries. AIDS epidemic update, December 2004. Fig. 18.

44. 33.3 63.5 34.1 40.0 0 20 40 60 80 100 % HIV prevalence 15-1920-2425-2930-34 Age-group HIV prevalence among female sex workers, by age-group, St. Petersburg, Russian Federation, 2003 Source: T. Smolskaya, et al., XV International AIDS Conference, 11-16 July 2004. Abstract No. ThOrC1371. AIDS epidemic update, December 2004. Fig.1 9.

45. 0.0 30.8 40.0 53.8 66.7 0 20 40 60 80 100 % HIV prevalence 0-1 partner 2-4 partners 5-9 partners 10-19 partners 20 or more partners HIV prevalence among sex workers, by number of commercial partners in past seven days, St. Petersburg, Russian Federation, 2003 Source: T. Smolskaya, et al., XV International AIDS Conference, 11-16 July 2004. Abstract No. ThOrC1371. AIDS epidemic update, December 2004. Fig 20.

46. Newly diagnosed HIV infections per million population in Eastern European and Central Asian countries, 1996—2003 Source: (1) HIV /AIDS Surveillance in Europe, EuroHIV mid-year report 2003, no. 69. (2) AIDS Foundation East West 0 200 400 600 800 1,000 1,200 19931994199519961997199819992000200120022003 New HIV infection per million population Estonia Russian Federation Ukraine Belarus Moldova, Republic of Latvia Kazakhstan Uzbekistan Kyrgyzstan 2004 Report on the Global AIDS Epidemic (Fig 9)