1. Global HIV Epidemiology Carey Farquhar, MD, MPH Grace John-Stewart MD, PhD Departments of Medicine, Epidemiology and Global Health

2. Outline Historical perspective Prevalence, new infections, deaths Treatment Co-infections HIV Testing Prevention 1996 Newsweek Headline: “The End of AIDS?”

5. December 2009 Total: 33.4 million (31.1 – 35.8 million) Western & Central Europe 850 000 [710 000 – 970 000] Middle East & North Africa 310 000 [250 000 – 380 000] Sub-Saharan Africa 22.4 million [20.8 – 24.1 million] Eastern Europe & Central Asia 1.5 million [1.4 – 1.7 million] South & South-East Asia 3.8 million [3.4 – 4.3 million] Oceania 59 000 [51 000 – 68 000] North America 1.4 million [1.2 – 1.6 million] Latin America 2.0 million [1.8 – 2.2 million] East Asia 850 000 [700 000 – 1.0 million] Caribbean 240 000 [220 000 – 260 000] Adults and children estimated to be living with HIV, 2008

8. December 2009 Estimated number of adults and children newly infected with HIV, 2008 Western & Central Europe 30 000 [23 000 – 35 000] Middle East & North Africa 35 000 [24 000 – 46 000] Sub-Saharan Africa 1.9 million [1.6 – 2.2 million] Eastern Europe & Central Asia 110 000 [100 000 – 130 000] South & South-East Asia 280 000 [240 000 – 320 000] Oceania3900 [2900 – 5100] North America 55 000 [36 000 – 61 000] Latin America 170 000 [150 000 – 200 000] East Asia 75 000 [58 000 – 88 000] Caribbean 20 000 [16 000 – 24 000] Total: 2.7 million (2.4 – 3.0 million)

9. December 2009 Over 7400 new HIV infections a day in 2008 More than 97% are in low- and middle-income countries About 1200 are in children under 15 years of age About 6200 are in adults aged 15 years and older, of whom: — almost 48% are among women — about 40% are among young people (15–24)

10. Decreasing HIV incidence in Africa 22 countries in Africa with decreased HIV incidence >25% decrease in incidence between 1999-2009

13. Treatment

14. Number of people receiving antiretroviral therapy by region, 2002–2010 UNAIDS 2011

15. ARV coverage in 2009

16. Median annual cost of first-line antiretrovirals 2008–2010

17. ART Updates > 6 million individuals on ART end of 2011 Coverage ~50% Retention –81% 12 mos –75% 24 mos –67% 60 mos Any concerns?

18. ART Updates > 6 million individuals on ART end of 2011 Coverage >50% Retention –81% 12 mos –75% 24 mos –67% 60 mos 3% on second-line therapy >50 surveys, 13 countries –Baseline resistance at ART 6% –Viral failure 10% at 12 mos –Transmitted resistance 3.7%

19. Need to test in order to treat Must increase test availability and options <40% know HIV status Percentage of adults who had ever received HIV test results, South Africa

20. Rapid HIV tests and self-testing

21. Coinfections

22. Why was there a decline in opportunistic infections?

25. NEJM 2008

27. Prevention

28. Success stories Mother-to-Child Transmission Risk: ~40% <1-3% 2010 1990

31. Reported percentage condom use at last sexual intercourse among women 15–49 years old who had sex, 2005–2007

32. The face of AIDS is increasingly young and female, and the statistics are startling. Nearly half of people living with HIV worldwide are women, and 76% of youth living with HIV in sub-Saharan Africa are young women and girls. Intersecting with the growing feminization of the global AIDS epidemic is another epidemic – that of violence against women and girls.

33. Women and HIV Global Perspective Women: >50% world’s HIV ~60% of Africa’s HIV Africa has 80% of world’s HIV-infected women 15-24 young women 8-fold increased risk

34. Age Group (Years) HIV Prevalence (N=1237) ≤1610.6% 17-1821.3% 19-2033.0% 21-2244.3% 23-2451.1% HIV prevalence in pregnant women in rural Vulindlela, South Africa (2005-2008)

35. BAT 24 coitally-related gel use –Insert 1 gel up to 12 hours Before sex, –insert 1 gel as soon as possible within 12 hours After sex, –no more than Two doses in 24 hours CAPRISA 004: 1% tenofovir gel Science 2010

36. HIV infection rates in the tenofovir and placebo gel groups: Kaplan-Meier survival probability

37. Antiretrovirals for HIV control SS and QA Abdool Karim, Lancet 2011

38. Outline Historical perspective Prevalence, new infections, deaths Treatment Co-infections HIV Testing Prevention 1996 Newsweek Headline: “The End of AIDS?”

40. Thank you! Photo Virot UNAIDS