Transcript The AIDS Pandemic: an Update on the Numbers and Needs  What are the numbers for 2002?  What are the global and regional trends?  Where.

The AIDS Pandemic: an Update on the
Numbers and Needs

What are the numbers for 2002?

What are the global and regional trends?

Where do all these numbers come from?

How are the estimates made?

Can we look into the future?
00002-E-1 – 1 December 2002
What are the numbers for 2002?
00002-E-2 – 1 December 2002
Global estimates for adults and children
end 2002

People living with HIV/AIDS
42 million

New HIV infections in 2002
5 million

Deaths due to HIV/AIDS in 2002
00002-E-3 – 1 December 2002
3.1 million
Adults and children estimated to be living
with HIV/AIDS as of end 2002
North America
980 000
Caribbean
440 000
Latin America
1.5 million
00002-E-4 – 1 December 2002
Eastern Europe
Western Europe & Central Asia
570 000 1.2 million
East Asia & Pacific
North Africa
1.2 million
South
& Middle East
& South-East Asia
550 000
6 million
Sub-Saharan
Africa
29.4 million
Australia
& New Zealand
15 000
Total: 42 million (3.2 mln children)
Global Distribution of 42 million People
Living with HIV in 2002
Sub-Saharan Africa
South & Southeast Asia
East Asia & Pacific
Latin America
Eastern Europe & Central
Asia
Caribbean
North America
Western Europe
North Africa & ME
00002-E-5 – 1 December 2002
HIV Prevalence (% of adults 15-49)
by Sex and Region in 2002
Australia & NZ
East Asia & Pacific
Men
Women
North Africa & ME
Western Europe
EEurope & Central Asia
Latin America
South & Southeast Asia
North America
Caribbean
Sub-Saharan Africa
0
00002-E-6 – 1 December 2002
1
2
3
4
5
6
7
8
9
10
Estimated number of adults and children
newly infected with HIV during 2002
North America
45 000
Caribbean
60 000
Latin America
150 000
00002-E-7 – 1 December 2002
Western Europe
30 000
North Africa
& Middle East
Eastern Europe
& Central Asia
250 000East Asia & Pacific
270 000
South
83 000
Sub-Saharan
Africa
3.5 million
Total: 5 million
& South-East Asia
700 000
Australia
& New Zealand
500
(0.8 mln children)
Global Distribution of 5 million Newly
HIV Infected People in 2002
Sub-Saharan Africa
South & Southeast Asia
East Asia & Pacific
Latin America
Eastern Europe & Central
Asia
Caribbean
North America
Western Europe
North Africa & ME
00002-E-8 – 1 December 2002
The Global Distribution of Prevalence (Old +New) is still very
similar to the Global Distribution of Incidence (New)
Prevalence
00002-E-9 – 1 December 2002
Incidence
Estimated adult and child deaths
from HIV/AIDS during 2002
North America
15 000
Caribbean
42 000
Latin America
60 000
00002-E-10 – 1 December 2002
Western Europe
8 000
Eastern Europe &
Central Asia
25 000
North Africa
& Middle East
37 000
Sub-Saharan
Africa
East Asia & Pacific
45
South
& South-East Asia
000
440 000
2.4 million
Total: 3.1 million
Australia
& New Zealand
<100
Global Distribution of 3.1 million Adult and Child
Deaths from HIV/AIDS in 2002
Sub-Saharan Africa
South & Southeast Asia
East Asia & Pacific
Latin America
Eastern Europe & Central
Asia
Caribbean
North America
Western Europe
North Africa & ME
00002-E-11 – 1 December 2002
About 14 000 new HIV infections a day in 2002

More than 95% are in developing countries (70%
are in Africa)

2000 are in children under 15 years of age (9 out
of 10 are in Africa)

About 12 000 are in persons aged 15 to 49 years,
of whom:
— almost 50% are women
— about 50% are 15–24 year olds
00002-E-12 – 1 December 2002
What are the global and regional trends?
00002-E-13 – 1 December 2002
Comparing 2001 and 2002

Modest increase in people living with HIV from 40
to 42 million, new infections still about 5 million,
deaths about 3 million
– 0.9 mln increase in Africa,
– 0.8 mln South, Southeast, East Asia
– 0.2 mln Eastern Europe and Central Asia
00002-E-14 – 1 December 2002
Trends in Number of People Living with HIV
infection 1980 - 2002 by WHO Region
30,000,000
25,000,000
20,000,000
15,000,000
10,000,000
5,000,000
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
0
00002-E-15 – 1 December 2002
AFRO
EURO
AMRO
WPRO
SEARO
EMRO
Trends in Number of People Living with HIV
infection 1980 - 2002 by WHO Region
8,000,000
7,000,000
AFRO
EURO
AMRO
WPRO
SEARO
EMRO
6,000,000
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
0
00002-E-16 – 1 December 2002
Trends in Number of People Living with HIV
infection 1980 - 2002 by WHO Region
2,000,000
1,800,000
1,600,000
AFRO
EURO
AMRO
WPRO
SEARO
EMRO
1,400,000
1,200,000
1,000,000
800,000
600,000
400,000
200,000
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
0
00002-E-17 – 1 December 2002
Where do all these numbers come from?
00002-E-18 – 1 December 2002
UNAIDS/WHO
Classification of epidemic states

LOW LEVEL:
– HIV prevalence has not consistently exceeded 5% in any
defined sub-population (surveillance: high risk group focus)

CONCENTRATED
– HIV prevalence consistently over 5% in at least one defined
sub-population but below one percent in pregnant women in
urban areas (surveillance: high risk groups + bridgers)

GENERALISED
– HIV prevalence consistently over 1% in pregnant women
nation-wide (surveillance: general population + high risk
groups)
00002-E-19 – 1 December 2002
HIV Prevalence among Women Attending
Antenatal Clinics, Uganda 1989-2001
Nsambya
35
Rugaba
30
Mbarara
25
Tororo
Jinja
Mbale
20
Kilembe
15
Soroti
10
Arua
Hoima
Pallisa
5
Matany
Kagadi
0
Mutolere
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Moyo
Lacor
00002-E-20 – 1 December 2002
HIV prevalence in blood donations
in Indonesia: 1992 - 2001
0.016
Percentage HIV-positive
0.014
0.012
0.010
0.008
0.006
0.004
0.002
0.000
1992 –
1993
1993 –
1994
1994 –
1995
1995 –
1996
Source: National AIDS Programme, Indonesia
00002-E-21 – 1 December 2002
1996 –
1997
1997 –
1998
1998 –
1999
1999 –
2000
2000 –
2001
HIV Prevalence Among Pregnant Women,
Male Conscripts, and Donated Blood
Thailand 1989-2000
%
4.5
Conscripts (age 21)
4
3.5
3
2.5
Pregnant women
2
1.5
Donated blood
1
0.5
Source: Sentinel Serosurveillance, Division of Epidemiology, Ministry of Public Health.
Remark:
Switching from bi-annually (June and December) to annually in June since 1995
Conscript data in November of each year since 1995 were not shown here
00002-E-22 – 1 December 2002
Jun-02
Jun-01
Jun-00
Jun-99
Jun-98
Jun-97
Jun-96
Dec-95
Jun-95
Dec-94
Jun-94
Dec-93
Jun-93
Dec-92
Jun-92
Dec-91
Jun-91
Dec-90
Jun-90
Dec-89
Jun-89
0
Month/Year
HIV prevalence among sex workers
in selected provinces in China: 1993-2000
12
% HIV-positive
Guangxi
Guangzhou
Yunnan
9
6
3
0
1993
1994
1995
1996
1997
1998
Source: National AIDS Programme, China (1993-2000). Data compiled by the US Census Bureau
00002-E-23 – 1 December 2002
1999
2000
HIV prevalence among injecting drug users in
selected sentinel sites in Myanmar: Mar 1992 – Mar 2001
100
INDIA
90

Myitkyina
80
Percent (%)
70
60
50
CHINA
Myitkyina

Taunggyi
Taunggyi
LAOS
40
THAILAND
30
20
10
0
92M 92S 93M 93S 94M 94S 95M 95S 96M 96S 97M 97S 98M 98S 99M 99S 00M
Sentinel Year
Source: Myanmar National AIDS Programme
00002-E-24 – 1 December 2002
01m
How are the estimates made?
00002-E-25 – 1 December 2002
Epidemic model
New entrants
Not at risk
At risk (susceptible)
Non-AIDS death
Non-AIDS death
Infected
Non-AIDS death
AIDS deaths
00002-E-26 – 1 December 2002
Epidemic model
New entrants
fo
At risk (susceptible)
Not at risk
Non-AIDS death
phi
r
Non-AIDS death
Infected
Non-AIDS death
AIDS deaths
00002-E-27 – 1 December 2002
Model epidemic curve
35%
f0
Adult HIV prevalence
30%
25%
phi
20%
r
15%
10%
t0
5%
0%
1980
00002-E-28 – 1 December 2002
1985
1990
1995
2000
2005
2010
00002-E-29 – 1 December 2002
Can we look into the future?
00002-E-30 – 1 December 2002
Population distribution in 2005 (6.4 billion people)
18%
13%
Africa
Asia
LAC
Eur, Nam, Au
9%
60%
00002-E-31 – 1 December 2002
How bad can the
Asian epidemic
become?

Growth in size of Risk groups -

IDU, MSM,sex workers

Chances of mixing with general population - people’s movement,
socio-political and economic developments

Response: behaviour change, vaccine, STD control etc.
00002-E-32 – 1 December 2002
Trends in HIV prevalence among pregnant women in
Cambodia and Thailand, 1991-2002
Trends - Asia:
Lessons Learned
Cambodia
response
Percent HIV infected
3
Thai land
response
2
1
0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Asian epidemics spread through specific, identifiable behaviors
& populations

Asian epidemics are vulnerable to focused prevention efforts

Prevention in Asia produces huge benefits (Thailand averted over 5
million infections)
00002-E-33 – 1 December 2002
Global Prevention Focus: Young People
(Percent of population aged 15-24 in 2000 and 2010)
25
20
15
2000
2010
10
5
0
Africa
00002-E-34 – 1 December 2002
Asia
LAC
More
developed
Care Projected Number of
AIDS Deaths 2001-2010
3,000
Africa
2,500
S/SE Asia
2,000
E Asia/Pacific
1,500
LA
1,000
E Europe
500
NA/NE
0
2001
2002
2003
00002-E-35 – 1 December 2002
2004
2005
2006
2007
2008
2009
2010
Estimated Number of People
Needing Treatment by 2005
Number depends on:
6
5
4
Million of
3
people
2
1
0
Africa
LAC
Asia
E Europe
- accuracy of the numbers of
deaths projections
- decisions on when to start
treatment (clinical, lab)
- how many people are already on
treatment in preceding years
- children
Need 6-9 million by 2005
00002-E-36 – 1 December 2002
Coverage of ART, December 2002 (adults by region)
Region
Sub Saharan Africa
Asia
North Africa, Middle East
Eastern Europe, Central
Asia
Latin America, Caribbean
Total
00002-E-37 – 1 December 2002
N of people on ART Estimated need Coverage (%)
50,000
4,100,000
1
43,000
1,000,000
4
3,000
7,000
29
7,000
80,000
9
196,000
370,000
53
300,000
5,500,000
5
Global Goals: UNGASS and MDG

In terms of global numbers and needs the epidemic will be
driven by Africa and Asia

UNGASS Target: 25% reduction globally by 2010 in prevalence
among young people (15-24 years) (25% by 2005 in most
severely affected countries)

MDG Target: turn around the epidemic by 2015
00002-E-38 – 1 December 2002