OVERVIEW OF

THE HIV/AIDS EPIDEMIC

Marie Laga 23-2-2005

www.unaids.org

Adults and children estimated to be living with HIV as of end 2004

Total: 39.4 (35.9 – 44.3) million

Western & Central Europe

610 000[480 000 – 760 000]

North Africa & Middle East540 000

[230 000 – 1.5 million]

Sub-Saharan Africa25.4 million

[23.4 – 28.4 million]

Eastern Europe & Central Asia1.4 million

[920 000 – 2.1 million]

South & South-East Asia7.1 million[4.4 – 10.6 million]

Oceania35 000

[25 000 – 48 000]

North America1.0 million

[540 000 – 1.6 million]

Caribbean440 000

[270 000 – 780 000]

Latin America1.7 million

[1.3 – 2.2 million]

East Asia1.1 million

[560 000 – 1.8 million]

00003-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 2004

39.4 million [35.9 – 44.3 million]

4.9 million [4.3 – 6.4 million]

3.1 million [2.8 – 3.5 million]

00003-E-3 – December 2004

About 14 000 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 12 000 are in persons aged 15 to 49 years, of whom:— almost 50% are women— about 50% are 15–24 year olds

00003-E-4 – December 2004

Trends in Number of People Living with HIV infection 1980 - 2002 by WHO

Region

0

5.000.000

10.000.000

15.000.000

20.000.000

25.000.000

30.000.000

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

AFRO

EURO

AMRO

WPRO

SEARO

EMRO

8.8%

Growth of the African epidemic

slowed down since 1997

Changes in the African epidemicwill greatly affect global numbers

HIV prevalence in adults in sub-Saharan Africa, 1986-2001

20 – 39%

10 – 20%

5 – 10%

1 – 5%

0 – 1%

trend data unavailable

outside region

1986 1991

1996 2001

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, 1997-2002

0

10

20

30

40

Botsw

ana

Mal

awi

Moza

mbiq

ue

Namib

ia

South A

frica

Swaz

iland

Zimba

bwe

1997-1998

1999-2000

2001-2002

The epidemic is leveling off at extremely high levels of prevalence

HIV prevalence by age and sex, Zambia DHS 2001-02

0

5

10

15

20

25

30

35

15-19 20-24 25-29 30-34 35-39 40-44 45-49

Men

Women

Women get infected earlier than men, often under 25 years

Sex- and age-specific HIV prevalence, 1997-98 (n=370)

0 0

42

96

18

29

22

33

0

5

10

15

20

25

30

35

15 16 17 18 19

Age (years)

Per

cen

t (%

)

MenWomen

Kisumu: Multicentre Study

*Buve et al, AIDS 2001

Deaths at ages 15-34South Africa: 1980-2025

(Estimated and projected )

0

400

800

1,200

1,600

2,000

Dea

ths

(th

ou

san

ds)

Without AIDS

With AIDS

1980-1985 1985-1990 1990-1995 1995-2000 2000-2005 2005-2010 2010-2015 2015-2020 2020-2025

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 AfricaZambia

Zimbabwe

Botswana

Burkina FasoCambodia

Côte d’Ivoire

Kenya

South AfricaZambia

Zimbabwe

Botswana

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0% 5% 10% 15% 20% 25% 30% 35% 40%

Ris

k o

f d

yin

g o

f A

IDS

current level of risk maintained

risk halved over next 15 years

Changes in life expectancyin selected African countries

with high and low HIV prevalence: 1950-2005

with high HIV prevalence:ZimbabweSouth AfricaBotswana

with low HIV prevalence:MadagascarSenegalMali

30

35

40

45

50

55

60

65

Lif

e e

xp

ecta

ncy

(y

ears

)

1950– 1955

1955- 1960

1960-1965

1965-1970

1970-1975

1975-1980

1980-1985

1985-1990

1990-1995

1995-2000

2000-2005

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 mill 64% 2.3 mill 74%

Asia 8.2 mill 21% 541.000 17%

Latin America 1.7 mill 4% 95.000 3%

West Eur/US 1.6 mill 4% 22.500 0.7%

Eastern Europe 1.4 mill 3.6% 60.000 2%

Total 39.4 million 3.1 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