1. Estimating and Projecting National HIV/AIDS Epidemics UNAIDS Reference Group on Estimates, Models and Projections

2. Approach to Estimates and Projections Surveillance data EPP/Concentrated epidemic spreadsheet Adult HIV prevalence UN Pop Division population estimates UNAIDS epidemic patterns Spectrum Number infected New infections AIDS deaths

3. Standard Approach Incidence Prevalence Mortality New infections # HIV+ AIDS deaths

4. Spectrum Approach Prevalence t Population t HIV+ t New infections t-1,t Non-AIDS deaths of HIV t-1,t AIDS deaths t-1,t HIV+ t-1

5. Spectrum: Standard epidemic patterns Sex ratio of prevalence Age distribution of infection Progression from infection to death Adults Children Mother-to-child transmission Fertility reduction

6. Ratio of Female to Male Prevalence – Generalized Epidemics Mutasa Village 1998 Masaka Rakai trading center 1990 Mwanza urban 90-91 Mwanza roadside 90-91 Zambia rural 1999 Mutasa Estate 1998 Rwanda 1986 Uganda 1988 Zambia DHS

7. Ratio of Female to Male Prevalence – Generalized Epidemics Kenya AIDS Ethiopia AIDS Tanzania AIDS

8. Ratio of Female to Male Prevalence – Generalized Epidemics

9. Ratio of Female to Male Reported AIDS Cases – Concentrated Epidemics Guatemala Panama Mexico Brazil Thailand Peru

10. Ratio of Female to Male Reported AIDS Cases – Concentrated Epidemics Guatemala Panama Mexico Brazil Thailand Peru

11. Sex ratio of infection

12. Sex Ratio for Concentrated Epidemics Sex ratio can be calculated by spreadsheet and EPP for concentrated epidemics This ratio can be transferred to Spectrum to replace the default pattern

13. Age-Specific Prevalence - Males

14. Ratio to prevalence at 25-29 - Males

16. Age-Specific Prevalence - Females

17. Ratio to prevalence at 25-29 - Females

19. Age Distribution of Cumulative Reported AIDS Cases - Female

20. Age Distribution of Cumulative Reported AIDS Cases - Male

21. Age distribution of infection

22. Adult HIV Prevalence – Southern Mozambique

23. Adult HIV Prevalence – Southern Mozambique and Sex Ratio of Prevalence

24. HIV Incidence – Southern Mozambique

25. Male Population by Age in Mozambique

26. HIV+ Males by Age in Southern Mozambique

27. New Male HIV Infections by Age in Southern Mozambique

28. New Male AIDS Cases by Age in Southern Mozambique

29. Progression to AIDS death Median = 9.4Median = 8.6

30. Progression to AIDS death

31. MTCT and fertility Mother-to-child transmission of HIV Default value = 32 percent Can be changed as PMTCT programs scale-up Fertility change due to HIV infection 15-19 = 50% increase 20-49 = 20% decrease

32. Anti-retroviral therapy Can specify the percentage of population in need of ARV that receives it Population in need = HIV+ within two years of AIDS death without ARV Assumption : percent of those on ARV surviving to the following year Assumption : effect of ARV on prevalence

33. Percent Surviving on ARVs by Annual Survival Rate

34. Effect of ARV on Prevalence by Value of Effect Assumption

35. Orphan Estimates Orphan: a child under the age of 15 that has lost one or both parents Maternal, paternal, dual, total AIDS, non-AIDS, total