OVERVIEW OF THE HIV/AIDS EPIDEMIC Marie Laga

Adults and children estimated to be living with HIV as of end 2004 Total: 39.4 (35.9 – 44.3) million Western & Central Europe [ – ] North Africa & Middle East [ – 1.5 million] Sub-Saharan Africa 25.4 million [23.4 – 28.4 million] Eastern Europe & Central Asia 1.4 million [ – 2.1 million] South & South-East Asia 7.1 million [4.4 – 10.6 million] Oceania [ – ] North America 1.0 million [ – 1.6 million] Caribbean [ – ] Latin America 1.7 million [1.3 – 2.2 million] East Asia 1.1 million [ – 1.8 million] E-2 – December 2004

Global estimates for adults and children end 2004 People living with HIV New HIV infections in 2004 Deaths due to AIDS in million [35.9 – 44.3 million] 4.9 million [4.3 – 6.4 million] 3.1 million [2.8 – 3.5 million] E-3 – December 2004

About new HIV infections a day in 2004 More than 95% are in low and middle income countries Almost 2000 are in children under 15 years of age About are in persons aged 15 to 49 years, of whom: — almost 50% are women — about 50% are 15–24 year olds E-4 – December 2004

Trends in Number of People Living with HIV infection by WHO Region Growth of the African epidemic slowed down since 1997 Changes in the African epidemic will greatly affect global numbers

HIV prevalence in adults in sub-Saharan Africa, – 39% 10 – 20% 5 – 10% 1 – 5% 0 – 1% trend data unavailable outside region Source: UNAIDS/WHO July 2002 Large differences in severity within Africa: Southern >> Eastern and Central > Western Source: UNAIDS/WHO July 2002

Trends in median HIV prevalence in the same antenatal sites by country and period, Southern Africa, The epidemic is leveling off at extremely high levels of prevalence

HIV prevalence by age and sex, Zambia DHS Women get infected earlier than men, often under 25 years

Kisumu: Multicentre Study *Buve et al, AIDS 2001

Deaths at ages South Africa: (Estimated and projected ) ,200 1,600 2,000 Deaths (thousands) Without AIDS With AIDS

Lifetime risk of AIDS death for 15-year-old boys, assuming unchanged or halved risk of becoming infected with HIV, selected countries Source: Zaba B, 2000 (unpublished data) Current adult HIV prevalence rate Burkina Faso Cambodia Côte d’Ivoire Kenya South Africa Zambia Zimbabwe Botswana Burkina Faso Cambodia Côte d’Ivoire Kenya South Africa Zambia Zimbabwe Botswana 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0%5%10%15%20%25%30%35% 40% Risk of dying of AIDS current level of risk maintained risk halved over next 15 years

Changes in life expectancy in selected African countries with high and low HIV prevalence: with high HIV prevalence: Zimbabwe South Africa Botswana with low HIV prevalence: Madagascar Senegal Mali Life expectancy (years) 1950–

AIDS orphans in South Africa

HIV prevalence and deaths due to AIDS 2004 Living with HIV % of total Death due to AIDS % Sub-saharan Africa 25.4 mill64%2.3 mill74% Asia8.2 mill21% % Latin America1.7 mill4% % West Eur/US1.6 mill4% % Eastern Europe1.4 mill3.6% % Total39.4 million3.1 million

The Cycle of HIV Disease 1. Incidence of HIV Infection 3. Incidence AIDS 2. Prevalence of HIV Infection 4. Prevalence of AIDS 5. Mortality from AIDS

Prevention of new HIV infections ? No preventive vaccine in near future <20% of people at risk have access to proven HIV prevention interventions –condom programs –needle exchange Contextual factors such as stigma and gender inequality remain major barriers