Transcript 2006 Report on the global AIDS epidemic: full set of

25 years of AIDS
People
living
with HIV
Million
50
1 First cases of unusual immune deficiency are identified among
gay men in USA, and a new deadly disease noticed
45
2 Acquired Immune Deficiency Syndrome (AIDS) is defined
for the first time
40
15
3 The Human Immune Deficiency Virus (HIV) is identified
as the cause of AIDS
35
9
16
14
10 Highly Active Antiretroviral Treatment
launched
4 In Africa, a heterosexual AIDS epidemic is revealed
11 Scientists develop the first treatment
regimen to reduce mother-to-child
transmission of HIV
5 The first HIV antibody test becomes available
30
13
6 Global Network of People living with HIV/AIDS
(GNP+) (then International Steering Committee
of People Living with HIV/AIDS) founded
25
11
7 The World Health Organisation launches
the Global Programme on AIDS
20
8 The first therapy for AIDS –
zidovudine, or AZT -- is approved for
use in the USA
15
10
5
1
2
3 4
5
6
10
9
12
Children
orphaned
by AIDS in
sub-Saharan
Africa
12 UNAIDS is created
13 Brazil becomes the first developing
country to provide antiretroviral therapy
through its public health system
14 The UN General Assembly Special
Session on HIV/AIDS. Global Fund to
fight AIDS, Tuberculosis and Malaria
launched
15 WHO and UNAIDS launch the "3 x 5"
initiative with the goal of reaching 3
million people in developing world with
ART by 2005
7 8
16 Global Coalition on Women and AIDS
launched
0
1980
06/06 e
In 1991-1993, HIV prevalence in young
pregnant women in Uganda and in young
men in Thailand begins to decrease, the
first major downturns in the epidemic in
developing countries
1985
1990
1995
2000
2005
2006 Report on the
global AIDS epidemic
Fig 1.1
Adult (aged 15‒49 years) HIV prevalence (%) in countries in sub-Saharan Africa
which have conducted population-based HIV surveys in recent years
Median HIV
prevalence (%)
among women
attending
antenatal clinics
2003‒2004*
Botswana
Population-based
survey prevalence (%)
(year)
2003 HIV
prevalence
(%) reported
in 2004 Report
on the global
epidemic
Adjusted 2003
HIV
prevalence
(%) in current
report
2005 HIV
prevalence
(%) in current
report
Trend in prevalence
38.5
25.2 (2004)
38.0
24.0
24.1
Burkina Faso
2.5
1.8 (2003)
4.2
2.1
2.0
Decline in urban areas
Burundi
4.8
3.6 (2002)
6.0
3.3
3.3
Decline in capital city
7.3†
5.5 (2004)
7.0
5.5
5.4
Stable
Ethiopia
8.5
(2005)§
4.4
(1.0‒3.5)
(0.9‒3.5)
Ghana
3.1
2.2 (2003)
3.1
2.3
2.3
Stable
Guinea
4.2
1.5 (2005)
2.8
1.6
1.5
Stable
Lesotho
28.4
23.5 (2004)
29.3
23.7
23.2
Stable
Rwanda
4.6
3.0 (2005)
5.1
3.8
3.1
Decline in urban areas
Senegal
1.9
0.7 (2005)
0.8
0.9
0.9
Stable
Stable
Cameroon
1.6
Stable
Decline in urban areas
Sierra Leone
3.0
1.5 (2005)
-
1.6
1.6
South Africa
29.5
16.2 (2005)
20.9
18.6
18.8
UR Tanzania
7.0
7.0 (2004)
9.0
6.6
6.5
Stable
6.2‡
7.1 (2004‒5)
4.1
6.8
6.7
Stable
Uganda
Increasing
* WHO Africa (2005). HIV/AIDS epidemiological surveillance report for the WHO African region, 2005 Update. Harare
† Estimate based on country report for 2002 (2003). Ministry of Public Health Cameroon. National HIV sentinel surveillance report 2002.
‡ Estimate based on country report for 2002 (2003). Ministry of Health Uganda. STD/HIV/AIDS surveillance report. STD/AIDS control programme. Kampala
§ Preliminary result. Additional analysis is ongoing.
06/06 e
2006 Report on the
global AIDS epidemic
Fig 2.1
Estimated number of people living with HIV and adult HIV prevalence
Global HIV epidemic, 1990‒2005*
Number of people
living with HIV (millions)
HIV epidemic in sub-Saharan Africa, 1985‒2005*
% HIV prevalence,
adult (15‒49)
50
5.0
40
4.0
30
3.0
20
2.0
10
1.0
0
0.0
1990
1995
2000
2005
Number of people
living with HIV (millions)
30
15.0
25
12.5
20
10.0
15
7.5
10
5.0
5
2.5
0
0.0
1985
1990
Number of people living with HIV
% HIV prevalence, adult (15-49)
This bar indicates the range around the estimate
06/06 e
% HIV prevalence,
adult (15‒49)
1995
2000
2005
*Even though the HIV prevalence rates have stabilized
in sub-Saharan Africa, the actual number of people
infected continues to grow because of population
growth. Applying the same prevalence rate to a
growing population will result in increasing numbers of
people living with HIV.
2006 Report on the
global AIDS epidemic
Fig 2.2
Regional HIV and AIDS statistics and features, 2003 and 2005
REGION
Adults (15+) and children
living with HIV
2005
Sub-Saharan Africa
North Africa and
Middle East
Asia
Oceania
Latin America
Caribbean
Eastern Europe and
Central Asia
North America, Western
and Central Europe
TOTAL
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2003
Adults (15+) and children
newly infected with HIV
2005
2003
Adult (15-49)
prevalence (%)
2005
2003
Adult (15+) and child
deaths due to AIDS
2005
2003
24.5 million
23.5 million
2.7 million
2.6 million
6.1
6.2
2.0 million
1.9 million
[21.6‒27.4 million]
[20.8‒26.3 million]
[2.3‒3.1 million]
[2.3‒3.0 million]
[5.4‒6.8]
[5.5‒7.0]
[1.7‒2.3 million]
[1.7‒2.3 million]
440 000
380 000
64 000
54 000
[250 000‒720 000]
[220 000‒620 000]
[38 000‒210 000
[31 000‒150 000
8.3 million
7.6 million
930 000
860 000
[5.7‒12.5 million]
[5.2‒11.3 million]
[620 000‒2.4 million]
[560 000‒2.3 million]
78 000
66 000
7200
9000
[48 000‒170 000]
[41 000‒140 000]
[3500‒55 000]
[4300-69 000]
1.6 million
1.4 million
140 000
130 000
[1.2‒2.4 million]
[1.1‒2.0 million]
[100 000‒420 000]
[95 000‒310 000]
330 000
310 000
37 000
34 000
[240 000‒420 000]
[230 000‒400 000]
[26 000‒54 000]
[24 000‒47 000]
1.5 million
1.1 million
220 000
160 000
[1.0‒2.3 million]
[790 000‒1.7 million]
[150 000‒650 000]
[110 000‒440 000]
2.0 million
1.8 million
65 000
65 000
[1.4‒2.9 million]
[1.3‒2.7 million]
[52 000‒98 000]
[52 000‒98 000]
0.2
0.2
[0.1‒0.4]
[0.1‒0.3]
0.4
0.4
[0.3‒0.6]
[0.2‒0.6]
0.3
0.3
[0.2‒0.8]
[0.2‒0.7]
0.5
0.5
[0.4‒1.2]
[0.4‒0.7]
1.6
1.5
[1.1‒2.2]
[1.1‒2.0]
0.8
0.6
[0.6‒1.4]
[0.4‒1.0]
0.5
0.5
[0.4‒0.7]
[0.3‒0.6]
37 000
34 000
[20 000‒62 000]
[18 000‒57 000]
600 000
500 000
[400 000‒850 000]
[340 000‒710 000]
3400
2300
[1900‒5500]
[1300‒3600]
59 000
51 000
[47 000‒76 000]
[40 000‒67 000]
27 000
28 000
[19 000‒36 000]
[19 000‒38 000]
53 000
28 000
[36 000‒75 000]
[19 000‒39 000]
30 000
30 000
[24 000‒45 000]
[24 000‒45 000]
38.6 million
36.2 million
4.1 million
3.9 million
1.0
1.0
2.8 million
2.6 million
[33.4‒46.0 million]
[31.4‒42.9 million]
[3.4‒6.2 million]
[3.3‒5.8 million]
[0.9‒1.2]
[0.8‒1.2]
[2.4‒3.3 million]
[2.2‒3.1 million]
2006 Report on the
global AIDS epidemic
Fig 2.3
A global view of HIV infection
38.6 million people [33.4‒46.0 million] living with HIV, 2005
06/06 e
2006 Report on the
global AIDS epidemic
Fig 2.4
HIV prevalence (%) in adults in Africa, 2005
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2006 Report on the
global AIDS epidemic
Fig 2.5
HIV prevalence (%) among pregnant women attending antenatal clinics
in sub-Saharan Africa, 1997/98‒2004
50
Eastern Africa
Median HIV prevalence (%)
Median HIV prevalence (%)
Southern Africa
Swaziland
40
Zimbabwe
30
20
10
South
Africa
Mozambique
0
1997‒
1998
1999‒
2000
2001
2002
2003
20
United Republic of Tanzania
15
Ethiopia
10
Kenya
5
0
1997‒
1998
2004
1999‒
2000
2001
2002
2003
2004
Median HIV prevalence (%)
West Africa
20
15
10
5
Ghana
Senegal
0
1997‒
1998
06/06 e
Côte d'Ivoire
Burkina Faso
Note: Analysis restricted to consistent
surveillance sites for all countries
except South Africa (by province) and
Swaziland (by region)
1999‒
2000
2001
2002
2003
2004
Sources: Ministry of Health (Mozambique); Department of Health (South Africa); Ministry of Health and Social Welfare (Swaziland); Ministry of Health and Child Welfare
(Zimbabwe); Adapted from Asamoah-Odei, et al. HIV prevalence and trends in sub-Saharan Africa: no decline and large subregional differences. Lancet, 2004 (Ethiopia); Ministry
of Health—National AIDS/STD Control Programme (Kenya); Ministry of Health (United Republic of Tanzania); Conseil national de lutte contre le sida et les IST (Burkina Faso);
Centers for Disease Control and Prevention (CDC)—GAP—Côte d'Ivoire (Côte d'Ivoire); Ghana Health Service (Ghana); Conseil National de Lutte Contre le SIDA (Senegal).
2006 Report on the
global AIDS epidemic
Fig 2.6
HIV prevalence (%) by gender and urban/rural residence,
selected sub-Saharan African countries, 2001‒2005
30
15‒49
years old,
by gender
20
%
Women
Men
Women
Men
Urban
Rural
10
0
30
15‒24
years old,
by gender
20
%
10
0
15‒49
years old,
by urban/
rural
residence
30
20
%
10
0
Lesotho
South
Africa
South
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Zambia
Kenya
Uganda
East
UR
Tanzania
Burkina
Faso
Ghana
Guinea
Senegal
West
Sources: Demographic and Health Survey reports (Lesotho, Zambia, Kenya, Burkina Faso, Ghana, Guinea and Senegal) (2001–2005).
Nelson Mandela Foundation (South Africa) (2005). Ministry of Health (Uganda). Tanzania Commission for AIDS (UR Tanzania) (2005).
2006 Report on the
global AIDS epidemic
Fig 2.7
HIV prevalence (%) in adults in Asia and Oceania, 2005
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2006 Report on the
global AIDS epidemic
Fig 2.8
HIV prevalence (%) trends in India among injecting drug users
and pregnant women, selected areas, India, 1998–2004*
15.0
Injecting
drug
users
12.0
Delhi
9.0
%
6.0
Mizoram
3.0
West Bengal
0.0
1998
1999
2000
2001
2002
2003
2004
1.5
Antenatal
clinic
attendees
Madhya Pradesh
1.2
%
0.9
Mizoram
0.6
Uttar Prahesh
0.3
West Bengal
0.0
1998
1999
2000
2001
2002
2003
2004
5.0
*Data from
consistent
surveillance
sites only.
06/06 e
Antenatal
Clinic
attendees
Andhra Pradesh
4.0
%
3.0
Karnataka
2.0
Maharashtra
1.0
Tamil Nadu
0.0
1998
1999
2000
2001
2002
2003
2004
2006 Report on the
global AIDS epidemic
Fig 2.9
HIV prevalence trends among pregnant women in major cities
in Cambodia, Myanmar and Thailand, 1990–2004
5.0
4.0
% HIV
prevalence
3.0
2.0
1.0
0.0
1990
1992
1994
1996
1998
2000
2002
2004
1991
1993
1995
1997
1999
2001
2003
Phnom Penh
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Mandalay and Yangon
Bangkok
Sources: Cambodia National Center for HIV/AIDS, Dermatology and STDs (Phnom Penh); Myanmar Ministry of Health (Mandalay and
Yangon); Thailand Ministry of Public Health (Bangkok), 2005.
2006 Report on the
global AIDS epidemic
Fig 2.10
HIV prevalence (%) trends among injecting drug users
in Bangladesh, Pakistan and the Philippines, 1998–2005*
Bangladesh
Pakistan [Karachi]
6%
30%
Central A
4%
20%
2%
10%
Northwest F1
Southeast D
0%
0%
1998–
1999
1999–
2000
2000–
2001
2002
2003–
2004
2004–
2005
2003
2004
Philippines [Cebu City]
* Other sites in Bangladesh and Pakistan
continue to show very low HIV prevalence
in their latest surveillance surveys (0% in
13 sites in Bangladesh, and 0.5% in
Lahore, Pakistan)
6%
4%
2%
0.0
0.0
2002
2003
0%
06/06 e
2004
2005
Sources: 2005 Integrated HIV Behavioral and Serologic Surveillance Findings, Summary Report. National Epidemiology Center, Department of Health (Philippines); National HIV
Serological Surveillance, 2004-2005, 6th Round Technical Report. Natonal AIDS/STD Programme, Ministry of Health and Family Welfare (Bangladesh); National Study of
Reproductive Tract and Sexually Transmitted Infections, Survey of High Risk Groups in Lahore and Karachi, 2005. National AIDS Control Program, Ministry of Health (Pakistan)
2006 Report on the
global AIDS epidemic
Fig 2.11
Increase in reported HIV cases in the Russian Federation
and Ukraine, 1987–2005
Reported HIV cases
in the Russian Federation
Reported HIV cases
in Ukraine
400 000
120 000
Russian Federation
350 000
105 000
Newly reported cases
300 000
90 000
Cumulative (previous years)
250 000
75 000
Ukraine
200 000
Newly reported cases
150 000
45 000
Cumulative (previous years)
100 000
30 000
50 000
15 000
0
0
1987
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60 000
1989
1991
1993
1995
1997
1999
Sources: Russian Federal AIDS Centre; Ukranian AIDS Centre and Ministry of Health of Ukraine
2001
2003
2005
2006 Report on the
global AIDS epidemic
Fig 2.12
HIV prevalence (%) in adults in Latin America
and the Caribbean, 2005
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2006 Report on the
global AIDS epidemic
Fig 2.13
HIV prevalence (%) among female sex workers
and men who have sex with men in Latin America, 1999–2002
Argentina
Ecuador
Buenos Aires
Quito
Provinces (7 cities)
Guayaquil
La Paz
Other city ports (4)
Bolivia
Paraguay
Santa Cruz
Border cities
with Argentina
Chile
Colombia
Asunción and
4 other cities
Peru
Santiago 0.0
Provinces
Uruguay
Bogotá
0
Lima
5
10
15
20
Border cities
with Brazil
25 30
% HIV prevalence
Montevideo
Venezuela
Isla Margarita 0.0
0
5
10
15
20
25 30
% HIV prevalence
Female sex workers
06/06 e
Source: Montano SM et al., JAIDS (2005).
Men who have sex with men
2006 Report on the
global AIDS epidemic
Fig 2.14
2005 Country progress towards 2001 Declaration of Commitment
on HIV/AIDS—Global targets (low- and middle-income countries) [First of 2 slides]
GLOBAL RESULTS 2005
GLOBAL TARGETS 2005
Total annual expenditure*
US$ 8 297 000 000
Estimated range: US$ 7.5 billion‒US$ 8.5 billion
US$ 7.0 billion‒US$ 10.0 billion
Global target achieved
Percentage of youth aged 15‒24 who correctly identify ways of preventing HIV transmission and who reject major
misconceptions about HIV transmission**
MALE: 33% (Country range: 7%‒50% coverage), (n=16)
FEMALE: 20% (Country range: 8%‒44% coverage), (n=17)
90% coverage
No country achieved this
Percentage of HIV-positive pregnant women receiving antiretroviral prophylaxis***
9% (Country range: 1%‒59% coverage), (n=41)
80% coverage
No country achieved this
Percentage of people with advanced HIV infection receiving antiretroviral therapy****
20% (Country range: 1%‒100% coverage), (n=116)
1 300 000 people on treatment
06/06 e
* See ‘Financing’ chapter
** Demographic and Health Survey/AIDS Indicator Survey, 2001‒2005 (MEASURE DHS, 2006)
*** Stover et al. (2006)
**** “3 by 5” Report (WHO/UNAIDS, 2006)
50% coverage (3 million people on treatment)
21 countries achieved this
Global target not achieved
2006 Report on the
global AIDS epidemic
Fig 3.1a
2005 Country progress towards 2001 Declaration of Commitment
on HIV/AIDS—Global targets (low- and middle-income countries) [Last of 2 slides]
GLOBAL RESULTS 2005
GLOBAL TARGETS 2005
Percentage of young males and females, aged 15‒24, who are HIV infected*****
MALES: 1.4% (Measure of uncertainty: 1.1%‒1.8%), (n=54)
FEMALES: 3.8% (Measure of uncertainty: 3.0%‒4.7%), (n=54)
No comparable global data on this age cohort is available from 2001.
Progress towards target can only be measured in individual countries.
25% reduction in most affected countries
6 of the most affected countries
achieved this
Estimated percentage of infants born to HIV-infected mothers who are infected in 2005******
26% of infants born to HIV-infected mothers were also infected
(n=33 most affected countries)
In 2001, approximately 30% of infants were infected. There has been an estimated
10% reduction in HIV transmission between 2001 and 2005.
06/06 e
***** UNAIDS/WHO 2005 Estimates for countries with generalized epidemics
****** UNAIDS/WHO 2005 Estimates
20% reduction
11 of the most affected countries
achieved this
2006 Report on the
global AIDS epidemic
Fig 3.1b
Comparison of 2003 and 2005 data on the coverage
of antiretroviral therapy, access to mother-to-child prevention services
and coverage of HIV-infected mothers who received antiretroviral prophylaxis
to prevent mother-to-child transmission
Coverage of antiretroviral therapy
Access to mother-to-child prevention
services (all pregnant women)
25
Coverage of HIV-infected mothers who
received antiretroviral prophylaxis
25
25
20
20
20
15
15
15
20.0
%
%
10
7.0
7.6
%
5
5
0
0
0
2005
2003
2005
9.2
10
5
2003
06/06 e
10
9.0
3.3
2003
Sources: WHO/UNAIDS (2006). Progress on global access to HIV antiretroviral therapy: a report on “3 by 5” and beyond; USAID et al.
(2006). Coverage of selected services for HIV/AIDS prevention, care and support in low and middle income countries in 2003 and 2005.
2005
2006 Report on the
global AIDS epidemic
Fig 3.2
Comparison of 2003 and 2005 data on the expansion of antiretroviral therapy
and coverage of HIV-infected mothers who received antiretroviral prophylaxis
in three sub-Saharan African countries
Coverage of HIV-infected mothers
who received antiretroviral prophylaxis
Coverage of antiretroviral therapy
60
60
56.0
50
50
40
40
35.0
% 30
% 30
19.7
20
10
20
6.3
3.0
9.3
10
12.0
7.0
4.6
1.0
0.0
0
0
Kenya
Namibia
Uganda
Kenya
2003
06/06 e
25.0
Sources: Individual country reports (2005).
Namibia
Uganda
2005
2006 Report on the
global AIDS epidemic
Fig 3.3
Comprehensive knowledge about HIV and AIDS
among young males aged 15–24, by level of education,
in 11 sub-Saharan African countries, 2000–2004
80
70
60
50
% 40
30
20
10
0
Burkina
Ghana
Faso Cameroon
No education
06/06 e
Mali
Kenya
Namibia
Rwanda
Zambia
Mozambique
Nigeria
Uganda
Primary education
Secondary education and beyond
Sources: Demographic and Health Surveys; HIV/AIDS Indicator Surveys (2000–2004).
2006 Report on the
global AIDS epidemic
Fig 3.4
Comprehensive knowledge about HIV and AIDS
among young females aged 15–24, by level of education,
in 11 sub-Saharan African countries, 2000–2004
80
70
60
50
% 40
30
20
10
0
Burkina
: Ghana
Faso Cameroon
No education
06/06 e
Mali
Kenya
Namibia
Rwanda
Zambia
Mozambique
Nigeria
Uganda
Primary education
Secondary education and beyond
Sources: Demographic and Health Surveys; HIV/AIDS Indicator Surveys (2000–2004).
2006 Report on the
global AIDS epidemic
Fig 3.5
Percentage of young people aged 15–24 reporting the use of a condom during
sexual intercourse with a non-regular partner, Sub-Saharan Africa, 2001–2005
Benin 2001
Botswana 2001
Burkina Faso 2003
Countries
Cameroon 2004
with
Chad 2004
date of
Ghana 2003
survey
Guinea 2005
Kenya 2003
indicated
Lesotho 2004
Madagascar 2003
Malawi 2004
Mali 2001
Mozambique 2003
Nigeria 2003
Rwanda 2004
Senegal 2005
United Republic of Tanzania 2003
Uganda 2004
Zambia 2003
0
10
20
30
40
Female
Male
06/06 e
Sources: Demographic Health Surveys; HIV/AIDS Indicator Surveys (2001-2005).
50
60
70
80
90
100
%
2006 Report on the
global AIDS epidemic
Fig 3.6
Median percentage of most-at-risk populations reached
with prevention programmes and those who received HIV testing
in the last 12 months and who knew their results
50
42% (n=13)
40
38% (n=9)
30
28% (n=10)
23% (n=10)
%
19% (n=10)
20
17% (n=10)
10
0
Percentage who received HIV
testing and who knew their results
Sex workers
06/06 e
Percentage reached with
prevention programmes
Men who have sex with men
Injecting drug users
2006 Report on the
global AIDS epidemic
Fig 3.7
Estimated total annual resources available for AIDS, 1996‒2005
9000
Signing of
Declaration of
Commitment
on HIV/AIDS
8000
7000
US$ million
6000
8297*
5000
Data include:
• International donors,
domestic spending
(including public spending
and out-of-pocket
expenditures)
• International Foundations
and Global Fund included
from 2003 onwards,
PEPFAR included from
2004 onwards
4000
3000
2000
1623
1000
292
* Projections based on previous pledges
and commitments (range of the
estimation: US$7.5 to US$8.5 billion).
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
06/06 e
2006 Report on the
global AIDS epidemic
Fig 3.8
Per capita HIV and AIDS expenditures by country income level*
2.5
Low income
2.0
Lower middle
US$ 1.5
per
capita 1.0
Higher middle
Low income SSA
0.5
0.0
2000
2001
2002
2003
2004
2005
• Trends based on a sample of 25 countries from sub-Saharan Africa
and 57 countries from other regions
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2006 Report on the
global AIDS epidemic
Fig 3.9
Progress towards achieving the “Three Ones”: Percentage of countries with
one national coordinating body, one national HIV/AIDS strategy or framework
and one national monitoring and evaluation plan
100
90
85
80
60
50
%
40
20
0
National body
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National framework
National monitoring
and evaluation plan
2006 Report on the
global AIDS epidemic
Fig 3.10
Impact of AIDS on life expectancy in five African countries, 1970–2010
70
65
Botswana
60
55
Life
expectancy
at birth
(years)
South Africa
50
45
Swaziland
40
Zambia
35
30
Zimbabwe
25
20
1970–1975
1980–1985
1990–1995
2000–2005
1975–1980
1985–1990
1995–2000
2005–2010
06/06 e
Source: United Nations Population Division (2004). World Population Prospects: The 2004 Revision, database.
2006 Report on the
global AIDS epidemic
Fig 4.1
Percentage of distribution of deaths by age in southern Africa,
1985–1990 and 2000–2005
40
35
30
25
Percentage
of total deaths
20
15
10
5
0
0–4
5–19
20–29
30–39
40–49
50–59
60+
Age-groups
:
1985-1990
06/06 e
2000-2005
Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat (2005). World Population
Prospects: The 2004 Revision. Highlights. New York: United Nations.
2006 Report on the
global AIDS epidemic
Fig 4.2
Wealth, poverty and HIV:
countries grouped by region and HIV prevalence
80
70
60
Industrialized
countries
Countries with HIV prevalence
over 1.9% in 2002
Countries according to level of
HIV prevalence in 2001 (%)
50
% 40
30
20
10
0
All (48)
Africa
Asia*
Latin
America
and
Caribbean
1-5
5-10
10-20
over 20
% of population living on less that $1 per day
Relative income of richest 10% to poorest 10%
06/06 e
Source: UN Population Division( 2005a). Most figures relate to 2002, or earlier.
*except Japan
2006 Report on the
global AIDS epidemic
Fig 4.3
Violations of reproductive rights—
women surveyed in four Asian countries
70
60
50
40
%
30
20
10
0
India
Indonesia
Philippines
Thailand
Total
Mandatory HIV testing during pregnancy or due to illness of child
Coerced into abortion due to HIV status
Advised not to have a child since HIV-positive diagnosis
06/06 e
Source: Paxton S, et al. (2005) AIDS-related discrimination in Asia.
2006 Report on the
global AIDS epidemic
Fig 4.4
TB notification rate in 20 African countries* versus HIV prevalence
in sub-Saharan Africa, 1990–2004
200
180
160
140
120
8
7
6
5
TB notification
rate per 100,000 100
80
population
4
3
60
40
20
0
% Adult HIV
prevalence
(15-49)
2
1
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
TB notification rate
HIV prevalence
• Consistently reporting each year: Algeria, Angola, Botswana, Cameroon, Comoros, Congo, Côte d'Ivoire, Democratic Republic of Congo,
Ghana, Guinea, Kenya, Malawi, Mauritius, Mozambique, Nigeria, Senegal, South Africa, Uganda, United Republic of Tanzania, Zimbabwe
06/06 e
Sources: World Health Organization (2006), Global TB database; UNAIDS (2006)
2006 Report on the
global AIDS epidemic
Fig 4.5
Estimated impact of AIDS on under-five mortality rates 2002–2005,
selected countries in sub-Saharan Africa
42
Botswana
106
98
Kenya
118
71
Lesotho
123
Namibia
43
South Africa
43
78
74
73
Swaziland
143
142
Zambia
173
78
Zimbabwe
117
0
20
40
60
80
100
120
140
160
180
200
Deaths per 1,000 live births
Without AIDS
06/06 e
With AIDS
Sources: UNICEF (2005); United Nations Population Division, World Population Prospects: The 2004 Revision, database.
2006 Report on the
global AIDS epidemic
Fig 4.6
Impact of orphanhood on school attendance
among 10–14-year-olds (%)
West
(9 countries)
Central
(6 countries)
Eastern
(9 countries)
Southern
(10 countries)
All
(34 countries)
Percentage in school
Non-orphans
Orphans
Double orphans
67
58
57
75
69
58
70
54
49
88
84
80
74
69
64
Ratios
Double vs. non-orphans
Boys
Girls
06/06 e
0.86
0.96
0.91
0.94
0.96
0.94
0.72
0.82
0.88
0.90
0.93
0.96
Source: Roeland Monasch and J. Ties Boerma, Orphanhood and childcare patterns in sub-Saharan Africa: an analysis of national surveys
from 40 countries. AIDS 2004, 18 (suppl 2): S55-S65.
0.87
0.94
0.93
2006 Report on the
global AIDS epidemic
Fig 4.7
Projected reduction in African agricultural labour force
due to HIV and AIDS by 2020
Namibia
Botswana
Zimbabwe
Mozambique
South Africa
Kenya
Malawi
Uganda
UR Tanzania
Central African Republic
Côte d’Ivoire
2020
2000
Cameroon
0
5
10
15
20
25
30
Projected labor force loss (%) by year
06/06 e
Sources: ILO (2004). HIV/AIDS and work: global estimates, impact and responses
2006 Report on the
global AIDS epidemic
Fig 4.8
Impact of three scenarios on HIV infection
in sub-Saharan Africa, 2003–2020
5.0
4.0
Number
of new HIV
infections
(millions)
3.0
2.0
1.0
0.0
2003
2005
2010
2015
2020
Year
06/06 e
Baseline
Treatment-centered
Prevention-centered
Comprehensive response
Source: Salomon JA et al. (2005). Integrating HIV prevention and treatment: from slogans to impact
2006 Report on the
global AIDS epidemic
Fig 6.1
Impact of AIDS-related deaths in sub-Saharan Africa, 2003–2020
3.0
2.5
Number
of AIDSrelated
deaths
(millions)
2.0
1.5
1.0
0.5
0.0
2003
2005
2010
2015
2020
Year
06/06 e
Baseline
Treatment-centered
Prevention-centered
Comprehensive response
Source: Salomon JA et al. (2005). Integrating HIV prevention and treatment: from slogans to impact
2006 Report on the
global AIDS epidemic
Fig 6.2
06/06 e
2006 Report on the
global AIDS epidemic
Fig 6.3
Number of people on antiretroviral therapy
in low- and middle-income countries, 2002–2005
1400
1200
People
receiving
1000
therapy
(thousands)
800
North Africa and the Middle East
Europe and Central Asia
East, South and South-East Asia
600
Latin America and the Caribbean
400
Sub-Saharan Africa
200
0
End
2002
06/06 e
Mid2003
End
2003
Mid2004
End
2004
Mid2005
End
2005
Source: WHO/UNAIDS (2005). Progress on global access to HIV antiretroviral therapy: An update on “3 by 5.”
2006 Report on the
global AIDS epidemic
Fig 7.1
People in sub-Saharan Africa on antiretroviral treatment
as percentage of those in need, 2002–2005
2005
2002
2003
2004
06/06 e
Source: WHO/UNAIDS (2005). Progress on global access to HIV antiretroviral therapy: An update on “3 by 5.”
2006 Report on the
global AIDS epidemic
Fig 7.2
Percentage of people on treatment who are children,
by country, 2005
Latin America and Caribbean [Median: 8%]
Africa [Median: 7%]
Panama
Honduras
Argentina
Haiti
Guyana
Brazil
El Salvador
Venezuela
Peru
UR Tanzania
Uganda
Central African Republic
Zambia
South Africa
Kenya
Zimbabwe
Namibia
Rwanda
Mozambique
Malawi
Côte d'Ivoire
Nigeria
Ghana
0%
0%
4%
6%
8% 10% 12% 14% 16%
4%
6%
8% 10% 12% 14% 16%
Asia [Median: 4%]
2%
4%
6%
8% 10% 12% 14% 16%
Cambodia
Viet Nam
India
China
0%
06/06 e
2%
2%
Source: WHO/UNAIDS (2005). Progress on global access to HIV antiretroviral therapy: An update on “3 by 5.”
2006 Report on the
global AIDS epidemic
Fig 7.3
Women as a percentage of all adults receiving antiretroviral therapy
in 30 countries: actual versus expected percentages, 2005a
Latin America and Caribbean
Sub-Saharan Africa
Argentina
Brazil
El Salvador
Guyana
Haiti
Honduras
Panama
Peru
Venezuela
Botswana
Burundi
Central African Republic
Côte d'Ivoire
Ethiopia
Ghana
Kenya
Malawi
Mozambique
Namibia
Nigeria
Rwanda
South Africa
UR Tanzania
Uganda
Zambia
Zimbabwe
0%
0%
20%
40%
60%
80%
20%
40%
60%
80%
Asia
Cambodia
China
India
Viet Nam
20%
40%
60%
80%
0%
a
The expected percentage of women
receiving ARV therapy is based on the
percentage of people living with
HIV/AIDS who are women
06/06 e
Expected percentage of women receiving ARV therapy
Source: WHO/UNAIDS (2006). Progress on global access to HIV antiretroviral therapy. A report on “3 by 5” and beyond.
2006 Report on the
global AIDS epidemic
Fig 7.4
Country Coordinating Mechanisms (CCMs): Entities participating in preparation
of Round Four proposals, 100% = all representatives of all 78 surveyed CCMs
Religious/faith-based groups 5%
Private sector 7%
People living with the disease 4%
Academic/educational 4%
organizations
20% Government health
ministry
19% Government other
ministries
NGO/community-based 17%
organizations
International NGOs 3%
15% UN/Multilateral
agencies
Bilateral agencies 6%
Non-public sector
06/06 e
Source: The Global Fund to Fight AIDS, Tuberculosis and Malaria
Public sector
2006 Report on the
global AIDS epidemic
Fig 9.1
Sector of recipients
51% Government
25% Non-governmental and
community-based organizations
06/06 e
4%
People living with HIV,
Tuberculosis or Malaria
5%
Academic institutions
5%
Faith-based organizations
5%
Private sector
5%
Other
Source: The Global Fund to Fight AIDS, Tuberculosis and Malaria. Rounds 2‒4 only. Information not available for Round 1.
2006 Report on the
global AIDS epidemic
Fig 9.2
AIDS funding requirements for low- and middle-income countries
US$ billion
2006‒2008
2006
2007
2008
Prevention
8.4
10.0
11.4
29.8
Care and treatment
3.0
4.0
5.3
12.3
Support for orphans and vulnerable children
1.6
2.1
2.7
6.4
Programme costs
1.5
1.4
1.8
4.6
Human resources
0.4
0.6
0.9
1.9
14.9
18.1
22.1
55.1
TOTAL
06/06 e
Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.
2006 Report on the
global AIDS epidemic
Fig 10.1
Funding required for prevention
PREVENTION ACTIVITIES (US$ million)
Mass media
Community mobilization
Voluntary counselling and testing
Youth in school
Youth out of school
Programmes focused on sex workers and their clients
Programmes focused on men who have sex with men
Harm reduction programmes for injecting drug users
Workplace
Prevention programmes for people living with HIV
Special populations
Condom social marketing
Public and commercial sector condom provision
Improving management of sexually transmitted infections
Prevention of mother-to-child transmission
Blood safety
Post-exposure prophylaxis (health care setting, rape)
Safe medical injections
Universal precautions
TOTAL
06/06 e
2006
2007
2008
2006–08
91
100
109
299
449
608
772
1830
451
569
690
1710
101
104
108
313
768
945
1126
2838
429
552
682
1663
312
407
499
1218
114
149
180
443
421
523
628
1573
22
33
48
103
151
252
252
654
159
175
190
525
1381
1501
1625
4506
672
718
764
2154
206
264
324
794
226
228
231
685
1
2
2
5
897
897
897
2690
1590
1944
2303
5838
8441
9969
11 430
29 840
Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.
2006 Report on the
global AIDS epidemic
Fig 10.2
Distribution by region of the funding required for prevention
Latin America/Caribbean: 9%
Eastern Europe: 12%
North Africa/Middle East: 3%
Africa: 29%
South/South-East Asia: 21%
East Asia/Pacific: 26%
06/06 e
Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.
2006 Report on the
global AIDS epidemic
Fig 10.3
Funding required for treatment and care,
including antiretroviral therapy (ART),
in order to achieve the coverage targets shown
06/06 e
Year
People on ART
(million)
ART coverage of
urgent cases
Total Funding
(US$ million)
2006
3.0
55%
2986
2007
4.8
67%
4029
2008
6.6
75%
5250
2009
8.3
79%
-
2010
9.8
80%
-
Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.
2006 Report on the
global AIDS epidemic
Fig 10.4
Distribution by activity of the funding required
for treatment and care
TREATMENT AND CARE ACTIVITIES (US$ million)
Palliative care
2006
2007
2008
2006–08
308
302
295
905
66
79
109
254
Opportunistic infections treatment
686
703
707
2096
Opportunistic infections prophylaxis
287
403
510
1200
1642
2482
3624
7748
54
79
104
237
3043
4048
5349
12 440
Provider initiated testing
Antiretroviral therapy, including nutritional support
Laboratory testing
TOTAL
06/06 e
Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.
2006 Report on the
global AIDS epidemic
Fig 10.5
Distribution by region of the funding required for treatment and care
Latin America/Caribbean: 17%
Eastern Europe: 7%
North Africa/Middle East: 1%
Africa: 55%
South/South-East Asia: 4%
East Asia/Pacific: 16%
06/06 e
Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.
2006 Report on the
global AIDS epidemic
Fig 10.6
Funding required for activities supporting orphans
and vulnerable children
2006
2007
2008
Education
193
287
443
923
Health care and support
145
174
200
519
Family/home support
971
1255
1604
3830
Community support
14
18
25
57
Organization costs
246
322
422
990
TOTAL
3043
4048
5349
12 440
ORPHAN-SUPPORT ACTIVITIES (US$ million)
06/06 e
Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.
2006–08
2006 Report on the
global AIDS epidemic
Fig 10.7
Funding required for programme support and infrastructure
PROGRAMME ACTIVITIES (US$ million)
2006
2007
2008
Management
485
376
390
1251
Advocacy and communications
118
111
111
340
Monitoring and Evaluation
148
138
146
432
Operations Research
11
7
7
25
Training
72
136
231
439
Logistics and suppy, including transportation
305
259
304
868
Supervision of personnel and patient tracking
97
68
92
257
Drug resistance surveillance
69
68
68
205
Construction of new health centers
60
23
167
250
121
185
236
542
1486
1371
1753
4610
Laboratory and other infrastructure upgrading
PROGRAMME AND INFRASTRUCTURE COSTS
06/06 e
Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.
2006–08
2006 Report on the
global AIDS epidemic
Fig 10.8
Funding required for building human resource capacity
(US$ million)
2006
2007
2008
50
89
123
262
Nurses’ wage supplements
153
261
370
784
Doctors’ wage supplements
152
258
366
776
TOTAL
355
608
859
1822
Education
06/06 e
Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.
2006–2008
2006 Report on the
global AIDS epidemic
Fig 10.9
Sources of the estimated and projected funding
for the AIDS response from 2005 to 2007*
12
US$
billion
10
Private Sector
8
Multilateral
6
Bilateral
4
Domestic
2
0
2005
2006
2007
* Assuming there are no new commitments
06/06 e
Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.
2006 Report on the
global AIDS epidemic
Fig 10.10
Sources of HIV spending in three countries, 2004
Burkina Faso
World Bank
loan 27%
Public 9%
World Bank
credit 32%
Bilateral
35%
Global Fund
9%
Multilateral
(excluding GF)
15%
Russian
Federation
India
All donors
14%
Public
36%
Global Fund
2%
Multilateral
(excluding GF)
3%
Bilateral
32%
Public 86%
HIV and AIDS spending per capita
US$ 1.87
06/06 e
Source: UNAIDS, based on National AIDS Spending Assessments.
US$ 0.59
US$ 0.28
2006 Report on the
global AIDS epidemic
Fig 10.11
HIV spending by programmatic area in four countries, 2004
Total AIDS spending
per capita
Burkina Faso
US$ 1.87
Ethiopia
US$ 0.45
Senegal
US$ 1.40
Thailand
US$ 1.91
0
20
40
60
80
100
%
Prevention
Treatment and care
Orphans and vulnerable children
Program development
Other
06/06 e
Source: UNAIDS, based on National AIDS Spending Assessments.
2006 Report on the
global AIDS epidemic
Fig 10.12
DAC member’s Official Development Assistance
in 2003 and 2004
Norway
Denmark
Luxembourg
Sweden
Netherlands
Portugal
Belgium
Switzerland
France
Ireland
United Kingdom
Finland
Germany
Canada
Australia
Spain
Greece
Austria
New Zealand
Japan
United States
Italy
ODA (US$billion) current
2004
2003
Average
country
effort,
0.42%
ODA/GNI (%)
2004
2003
20 18 16 14 12 10
06/06 e
UN
target,
0.70%
8
6
4
2
0
0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0
Source: Organisation for Economic Co-operation and Development (2005).
2006 Report on the
global AIDS epidemic
Fig 10.13
DAC members’ Official Development Assistance
committed to HIV in 2004
Canada
Sweden
Netherlands
Luxembourg
Denmark
Norway
United States
Belgium
United Kingdom
Finland
Germany
Ireland
Australia
Switzerland
New Zealand
Spain
France
Italy
Austria
Greece
Portugal
Japan
202
208
60
172
96
167
4
26
108
26
103
1160
100
31
86
157
72
8
43
105
38
6
Aid for HIV (US$ million)
Source: UNAIDS, based on data from DAC members’ reports to OECD.
37
7
12
4
10
1
8
8
7
11
5
7
4
1
4
1
4
0.1
1
3
1
1300120011001000 900 800 700 600 500 400 300 200 100
06/06 e
126
0
50 100 150 200 250 300
Aid for HIV per million GNI
2006 Report on the
global AIDS epidemic
Fig 10.14
DAC members’ bilateral commitments
to HIV-related programmes in 2004
United States 49.6%
United Kingdom 20.5%
European Community 4.3%
Canada 4.1%
Germany 3.5%
Japan 3.4%
France 0.9%
Italy 0.5%
Other DAC country members 13.1%
Total: US$ 2.7 billion
06/06 e
Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.
2006 Report on the
global AIDS epidemic
Fig 10.15
UNAIDS Unified Budget compared to resources available
for HIV in low- and middle-income countries
12 000
US$
million
10 000
Total funding for AIDS
8000
6000
4000
2000
UNAIDS Unified Budget*
0
2003
2004
2005
2006
2007
• UNAIDS Unified Budget includes core, supplemental and agency own resources.
It does not include estimates of country-level spending by Cosponsors.
06/06 e
Source: UNAIDS (2005). UNAIDS Unified Budget and Workplan 2006-2007.
2006 Report on the
global AIDS epidemic
Fig 10.16
Commitments by foundations based in the United States
to domestic and global HIV projects, 2000–2003
600
US$
million
500
400
300
200
100
0
2000
06/06 e
Source: Funders Concerned About AIDS (2005).
2001
2002
2003
2006 Report on the
global AIDS epidemic
Fig 10.17
Annual public sector investment in preventive HIV vaccine research and
development between 2000 and 2005 by region
700
600
US$
million
500
400
300
200
100
0
2000
US
06/06 e
2001
Europe
2002
2003
Other Public Sector
Source: HIV Vaccines and Microbicides Resource Tracking Working Group (2005).
2004
2005
Multilaterals
2006 Report on the
global AIDS epidemic
Fig 10.18
Annual public and philanthropic sector investment in microbicide research
and development between 2000 and 2005 (US$ million)
2000
2001
2002
2003
2004
2005
34.6
61.3
75.3
78.8
92.0
99.3
Europe
0.7
0.4
5.1
10.6
29.9
37.8
Other
0.3
<0.1
0.2
0.9
2.0
5.0
Multilaterals
<0.1
0.3
0.4
<0.1
0.2
0.2
Total public
35.7
62.0
81.0
90.2
124.2
142.3
29.4
3.4
24.8
16.9
18.1
21.1
105.8
107.1
142.3
163.4
PUBLIC SECTOR
United States
PHILANTHROPIC SECTOR
Total philanthropic
NON-COMMERCIAL (PUBLIC & PHILANTHROPIC)
Total non-commercial
06/06 e
65.1
65.4
Source: HIV Vaccines and Microbicides Resource Tracking Working Group (2005).
2006 Report on the
global AIDS epidemic
Fig 10.19
Stakeholder participation in development
of national AIDS plans in 79 countries, 2004
UN agencies
Civil society/NGOs
People living with HIV
Donors
Line ministries
Media
District and local authorities
Faith-based organizations
Private sector
Women’s groups
0%
20%
40%
60%
80%
100%
full participation
insufficient but increasing participation
insufficient participation with no signs of improvement
no participation
06/06 e
Source: (UNAIDS 2006) From advocacy to action: A progress report on UNAIDS at country-level, UNAIDS.
2006 Report on the
global AIDS epidemic
Fig 11.1
Sites Involved with Collaborative Fund
for HIV Treatment Preparedness, March 2006
06/06 e
Sources: The International Treatment Preparedness Coalition (2006); TIDES Foundation (2006)
2006 Report on the
global AIDS epidemic
Fig 11.2
Trends in HIV and AIDS per-capita expenditures in current US$,
selected sub-Saharan countries
1.0
0.9
0.8
0.7
HIV
per capita
spending
(US$)
0.65
0.6
0.5
0.4
0.3
0.49
0.31
0.22
0.2
0.15
0.1
0.0
2001
06/06 e
2002
2003
2004
Sources: Countries reporting on UNGASS on domestic public expenditure; UNAIDS estimates
2005
2006 Report on the
global AIDS epidemic
Fig 11.3
Countries using the Country Response Information System
(92 countries as of January 2006)
06/06 e
Sources: Countries reporting on UNGASS; UNAIDS (Country Coordinator Reports and Monitoring and Evaluation Officers’ personal
communications)
2006 Report on the
global AIDS epidemic
Fig 11.4