Slide 2 Key Points Although HIV/AIDS is found throughout the world, most people living with HIV/AIDS reside in low- and middle-income countries More people.
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0 The Current State of the Global HIV/AIDS Epidemic Alicia L. CarbaughSenior Policy Analyst, HIV PolicyKaiser Family FoundationforKaiserEDU.org TutorialDecember 2008Hello. I am Alicia Carbaugh, Senior Policy Analyst for HIV Policy at the Kaiser Family Foundation.In this tutorial, I will be providing you with an overview of the global HIV/AIDS epidemic, including current data, trends, and some of the key issues and challenges that remain in addressing the epidemic.Return to KaiserEDU.org
1 Slide 2Key PointsAlthough HIV/AIDS is found throughout the world, most people living with HIV/AIDS reside in low- and middle-income countriesMore people are living with HIV/AIDS than ever before and millions of people are infected each yearHIV/AIDS is multiple epidemics. Communities, regions and populations are affected differentlyIt is important to take stock of where we are and where we have come from. We have surpassed a quarter century of the HIV/AIDS epidemic. The past 25 years plus have yielded several observations and key points important for consideration.HIV/AIDS is found throughout the world and in every region, but most people living with the disease reside in low and middle-income countries, where most new HIV infections and AIDS-related deaths occur;More people are living with HIV/AIDS than ever before and millions of people are infected each year;HIV/AIDS is really multiple epidemics. Not all communities, regions and populations are affected in the same way.
2 Current Global HIV Estimates Slide 3Current Global HIV Estimates33 Million80%31%This figure shows the latest global estimates for HIV/AIDS.There are more than 30 million people estimated to be living with HIV/AIDS worldwide, including more than two and a half million who became infected last year alone (or more than 7,000 per day). However, new HIV infections are believed to have peaked in the late 1990s and have declined since This decline is attributable to natural trends in the epidemic itself and to prevention efforts.HIV is among the leading causes of death worldwide and the number one cause of death in Sub-Saharan Africa. There were about 2 million AIDS deaths last year (or more than 5,000 per day). Annual deaths have actually declined in the last couple of years due in part to expanded access to antiretroviral treatment.Despite this expanded access, less than a third of those who need antiretroviral (ARV) therapy, sometimes called ART, the drugs that have been responsible for reducing sickness and death in many parts of the world, have access to them.And, still, most people infected with HIV do not even know it.2.7 Million2.0 MillionPeople Livingwith HIV/AIDS(end 2007)NewInfections(in 2007)Deaths(in 2007)Percent onARTs*(as of December 2007)Percent w/ HIVWho Don’t KnowThey’re Infected*Of those needing antiretroviral (ART) therapy in low and middle-income countries.Sources: UNAIDS, 2008 Report on the Global AIDS Epidemic, 2008; WHO/UNAIDS/UNICEF Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector, Progress Report, June 2008.
3 Global Estimates of People Living with HIV/AIDS, 1980–2007 Slide 4In MillionsNumber of PeopleEnd 2007:33 millionAs you can see, the growth in HIV/AIDS prevalence, or the number of people living with HIV/AIDS, has grown significantly over time. While the percentage of people living with HIV/AIDS, or the prevalence rate, around the world has stabilized, the number of people living with HIV/AIDS keeps growing as people live longer with the disease due to treatment and millions still become infected each year.Sources: UNAIDS, 2008 Report on the Global AIDS Epidemic, 2008 and Special Data Request.
4 People Living with HIV/AIDS by Region, as Percent of Global Total, 2007 Slide 5Total = 33 millionSome regions of the world have been particularly hard hit by HIV/AIDS. This figure shows the distribution of HIV/AIDS prevalence, the number of people living with HIV/AIDS, by region.Two-thirds of people living with HIV/AIDS live in Sub-Saharan Africa, a region of more than 40 countries, including Ethiopia, Nigeria, Mozambique, South Africa, Swaziland and Uganda.And, more than 10% of people living with HIV/AIDS are in South/South-East Asia, which includes India.Source: UNAIDS, 2008 Report on the Global AIDS Epidemic, 2008.
5 Estimated Adult HIV/AIDS Prevalence Rate by Region, 2007 Slide 6Another way in which to look at the impact of the epidemic across the world is to look at adult prevalence rates, or the percentage of adults living with HIV/AIDS. These rates are among those agedIn this figure, we see that the global adult prevalence rate is less than 1%, meaning that less than 1% of all adults around the world are living with HIV/AIDS.We also see that the adult prevalence rate in Sub-Saharan Africa is much higher than the global rate.While the prevalence rates for other regions may look small, even small percentages translate into thousands of people or more.Note: Prevalence rates are among adults agedSource: UNAIDS, 2008 Report on the Global AIDS Epidemic, 2008.
6 Women as Share of Adults Living with HIV/AIDS by Region, 2007 Slide 7Women, in particular, are disproportionately affected by the HIV/AIDS epidemic in some regions.Worldwide, half of adults living with HIV/AIDS are women, a share that has remained stable in recent years.The impact on women is more significant in Sub-Saharan Africa and the Middle East and North Africa, where women account for over half of adults living with HIV/AIDS.Gender inequalities in social and economic status and sexual violence may contribute to women’s risk of HIV. The epidemic also has multiple effects on women, such as added responsibilities of caring for sick family members, loss of property if they become widowed and/or infected, and even violence if their HIV status is discovered.Source: UNAIDS, 2008 Report on the Global AIDS Epidemic, 2008.
7 Young People as a Percent of New HIV Infections, 2007 Slide 8Under 15 14%Aged %Aged %Teens and young adults, particularly young girls and women, continue to be heavily impacted.Over half of new infections were among those under 25 globally.In some regions, particularly Sub-Saharan Africa and the Caribbean, studies have shown that young women and girls have higher prevalence than young men and boys in the same age group.There are some encouraging signs, however. Recent data indicate that HIV among young pregnant women attending antenatal clinics in certain countries has declined and preliminary data from several countries indicate reductions in risk behavior among young people.Although not shown here, there are a few million children living with HIV/AIDS, and millions more who have lost one or both parents to HIV/AIDS. The majority of children living with HIV/AIDS and AIDS orphans are in Sub-Saharan Africa.New Infections = 2.7 millionSource: Calculations based on UNAIDS/WHO, Core Slides: Global Summary of the HIV and AIDS Epidemic, 2007, 2008.
8 Sub-Saharan Africa is the World’s Hardest Hit Region Slide 9The next few slides show the impact of HIV/AIDS in the countries that are most severely affected by the epidemic. Most of these countries are in Sub-Saharan Africa. This region is the most severely impacted by far—two-thirds of all people living with HIV/AIDS, more than two-thirds of new infections and three-quarters of all AIDS deaths occur in this region. Yet, this region accounts for just about a little over one-tenth of the world’s population.Sources: UNAIDS, 2008 Report on the Global AIDS Epidemic, 2008; UNAIDS/WHO, Core Slides: Global Summary of the HIV and AIDS Epidemic, 2007, 2008; Population Reference Bureau, 2007 World Population Data Sheet, 2007.
9 Top 15 Countries by Number of People Living with HIV/AIDS, 2007 Slide 10Top 15 Countries by Number of People Living with HIV/AIDS, 2007This slide ranks the top 15 nations by the number of people living with HIV. As you can see, many countries are in Sub-Saharan Africa and South Africa is home to the largest number of people living with HIV/AIDS—over five million people. You can also see that there are countries outside of Africa that have large numbers of people living with HIV, including India, the United States, Russia, Brazil, China and Thailand.Source: UNAIDS, 2008 Report on the Global AIDS Epidemic, 2008;
10 Top 15 Countries by Adult HIV/AIDS Prevalence Rate, 2007 Slide 11When looking at adult prevalence rates, the share of a country’s adult population already infected with HIV, the top 15 countries differ from the previous slide in that they are all located in Sub-Saharan Africa. Recent data show that in a number of countries in Sub-Saharan Africa, national HIV prevalence has either stabilized or is showing signs of decline. Despite this promising data, rates are still very high when compared to other countries around the world.Note: Prevalence rates are among adults agedSource: UNAIDS, 2008 Report on the Global AIDS Epidemic, 2008;
11 Top 15 Countries by Number of Women Living with HIV/AIDS, 2007 Slide 12This figure shows the top 15 countries by the number of women estimated to be living with HIV/AIDS. Once again, the majority of these countries are located in the Sub-Saharan region of Africa.Source: UNAIDS, 2008 Report on the Global AIDS Epidemic, 2008;
12 Access to Antiretroviral (ARV) Treatment by Region, December 2007 Slide 13Percent on ARVs as of end of 2007(of those who need them in low and middle-income countries)AllSub-Saharan AfricaLatin America/CaribbeanEast/South/South-East AsiaAccess to antiretrovirals, which are critical to the treatment of HIV, still remains limited. Antiretroviral treatment is responsible for dramatically reducing illness and death among people with HIV/AIDS who have access. However,While coverage has grown significantly in recent years, less than one-third of people in developing and transitional countries have access.As you can see, access to treatment differs by region. The share in Latin America where there are more resources is very high, but is low in other regions of the world.Europe/Central AsiaNorth Africa/Middle EastSource: WHO/UNAIDS/UNICEF, Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector, Progress Report; June 2008.
13 Access to Prevention Services Slide 14Access to Prevention ServicesAccess to prevention services is limited as well. Recent data has shown that:33% of pregnant women with HIV received antiretroviral therapy to prevent transmission of HIV to their babies10-11% of people in low and middle-income countries have been tested for HIV and received results10% of injection drug users in Eastern Europe and Central Asia have access to prevention programsDespite these challenges, there have been successful prevention efforts in different parts of the world.Access to prevention services, including testing, remains limited as well. Recent data has shown that:About one-third of pregnant women with HIV received antiretrovirals to prevent the transmission of HIV to their babies.Only about a tenth of people in low and middle-income countries have ever been tested for HIV and received their results.Only about a tenth of injecting drug users in Eastern Europe and Central Asia have access to prevention programs.Despite the challenges, there has been some strong evidence for success in prevention programs throughout the world, including in Senegal, Thailand, Uganda, Zambia, and the United States. These include education/awareness campaigns, behavior change strategies and condoms.Source: WHO/UNAIDS/UNICEF, Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector, Progress Report; June 2008.
14 Critical Challenges to Addressing the Epidemic Slide 15Many lack basic information about HIV/AIDS and HIV-related stigma remainsLimited access to key prevention and care services and system capacity issuesNeed for more training, quality & monitoring systems, facilitiesNeed to address healthcare workforce shortagesOther barriers to access may include price, patent laws and other regulatory issuesPoverty and collateral effects (epidemic exacerbates existing problems in other sectors)Research and development continue but a vaccine is still years awayWhile much progress has been made in terms of the response to HIV/AIDS, there are persistent challenges that remain.Many lack basic information about HIV/AIDS and HIV-related stigma remains throughout the world.Most people in low and middle-income countries do not have access to key prevention and care services.There are system capacity issues in many countries. The lack of infrastructure, training capabilities, quality and monitoring systems, and health facilities may impede access to prevention and treatment services.There are significant health care workforce shortages in certain regions.Other barriers include price, patent laws and other regulatory issues.In addition, poverty and other collateral effects of the epidemic may exacerbate existing problems in a country.HIV/AIDS research and development continue, but a vaccine or other new technologies such as a microbicide to prevent infection are still years away.Finally, while significant resources have been dedicated to HIV/AIDS, what is available falls short of need and thinking about how to sustain the response is important.Meeting needs with available resources and sustaining the response
15 Resource Needs, Funding & Key Initiatives Slide 16NEED & AVAILABLE FUNDINGUNAIDS estimates that approximately $18.1 billion was needed to effectively respond in low and middle-income countries in 2007Estimate of available funding in 2007: $10 billionKEY INITIATIVES/ORGANIZATIONSThe Global Fund to Fight AIDS, Tuberculosis and MalariaU.S. President’s Emergency Plan for AIDS Relief (PEPFAR)World Bank’s MAP InitiativeDespite the great need for resources, actual funding levels fall far short of meeting the needs of people with HIV. Although there has been a significant increase over time in the amount of resources provided by donors, affected country governments, and others, there is still a major gap between what is needed and what is available.UNAIDS estimated that approximately $18 billion was needed in 2007 to effectively respond to the epidemic in resource poor settings.Yet, last year, an estimated $10 billion was available. While this is a significant increase from a few years ago, it still falls far short of meeting the need.Several key initiatives have emerged over the past few years to address the epidemic, either by focusing attention on or providing resources for HIV prevention and treatment, including:The Global Fund to Fight AIDS, Tuberculosis, and MalariaThe U.S. President’s Emergency Plan for AIDS Relief (known as PEPFAR)The World Bank’s Multi-Country HIV/AIDS Program (or MAP) in Africa and the CaribbeanUnited Nations’ Universal Access Initiative for prevention and treatmentAlso, the United Nations’ Millennium Development Goals (or MDGs), which target a number of global challenges, aim to halt the spread of HIVFinally, the private sector, including foundations, businesses and the pharmaceutical industry.United Nations’ Universal Access InitiativeUnited Nations’ Millennium Development Goals (MDGs)Private sector – foundations, businesses, pharmaceutical industrySources: UNAIDS & Kaiser Family Foundation, Financing the Response to AIDS in Low- and Middle- Income Countries: International Assistance from the G8, European Commission and Other Donor Governments, 2007, July 2008; UNAIDS, 2008 Report on the Global AIDS Epidemic, 2008.
16 The U.S. Government Response to the Global Epidemic Slide 17U.S. funding began in 1986; has increased significantly since 1999PEPFAR (The U.S. President’s Emergency Plan for AIDS Relief)Originally authorized at $15 billion over 5 years (starting in FY 2004); actual spending higherMost $ supports 15 “focus” countries, remainder for bilateral efforts in ~100 other countries and support for The Global FundLegislation reauthorized in 2008 at $48 billion over 5 years (starting FY 2009)Concrete goals for next 5 years: prevent 12 million infections, treat at least 3 million, provide care for 12 millionSince the early days of the epidemic, the role of the United States government in addressing global HIV/AIDS has grown considerably.The U.S. government has committed the largest dollar amount to the global fight against HIV/AIDS of any nation.In 2003, President Bush announced PEPFAR, The President’s Emergency Plan for AIDS Relief, a 5-year, $15 billion initiative starting in Fiscal Year 2004 to address HIV/AIDS, tuberculosis, and malaria.Actual spending has been higher, however.Most PEPFAR funding has been concentrated in 15 “focus” countries; the remainder being for bilateral aid efforts in about 100 other countries as well as contributions to The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.In July 2008, the legislation was reauthorized for another 5 years starting in FY 2009 and continuing to FY The new legislation authorizes up to $48 billion for not only HIV/AIDS, but also tuberculosis and malaria efforts. The majority of the money will be used to address HIV/AIDS.PEPFAR set concrete goals for the next 5 years, which include: preventing 12 million new infections, treating at least 3 million people, and providing care for 12 million people, including 5 million orphans and vulnerable children. In addition, PEPFAR will support the training of health care workers.Sources: White House, 2004; Kaiser Family Foundation, Reauthorization of PEPFAR, The United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act: A Side-by-Side Comparison to Current Law, July 2008;
17 SuccessesSlide 18Despite the challenges, there have been some important successes and promising signs:Care and treatment have reduced morbidity and mortality among people with HIV/AIDS in those countries with access.Prevention works – evidence from a number of different countries worldwide.The global prevalence rate has leveled off, and there are signs of stable or declining rates in certain areas/among certain populations; annual new infections and deaths have declined in recent years.Despite all of the challenges, it is important to remember that there have been some very important successes and other promising signs in the past decade.In particular, care and treatment have reduced morbidity and mortality among people with HIV/AIDS in those countries with access to antiretrovirals. While access to care and treatment is still limited in many areas, it has significantly increased in recent years. Treatments have also improved over time and prices for drugs have come down.Prevention works. As mentioned earlier, there is some strong evidence for success in prevention programs in certain countries throughout the world, these include education and awareness campaigns, behavior change strategies and condoms.The global prevalence rate has leveled off, and there are signs of stable or declining rates in certain areas and among certain populations.Annual new infections and deaths have declined in recent years, both resulting, in part, from the global response to the epidemic.Yet, the epidemic is not over. Building upon these successes will continue to require a response that is global, involves multiple sectors and levels of society, and is long-term.Yet, the epidemic is far from over and the continued response to HIV/AIDS will be a global, multi-sector, long-term endeavor.
18 Key ResourcesSlide 19UNAIDS, 2008 Report on the Global AIDS Epidemic, 2008:WHO/UNAIDS/UNICEF, Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector, Progress Report, June 2008:Kaiser Family Foundation, The Global HIV/AIDS Epidemic, Fact Sheet, July 2008:Kaiser Family Foundation/UNAIDS, Financing the Response to AIDS in Low- and Middle-Income Countries: International Assistance from the G8, European Commission and Other Donor Governments, 2007, July 2008:Kaiser Family Foundation, Reauthorization of PEPFAR, The United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Act: A Side-by-Side Comparison to Prior Law, July 2008:Kaiser Family Foundation, Globalhealthfacts.org:Kaiser Family Foundation, Global HIV/AIDS Timeline:Kaiseredu Reference Libraries on HIV/AIDS:Global HIV Prevention Working Group:I hope you now have a better sense of the key statistics and issues in the global HIV/AIDS epidemic. To learn more about HIV/AIDS globally and in the U.S., please go to as well as these other resources.