The AIDS Pandemic: an Update on the Numbers and Needs

1
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?

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What are the numbers for 2002?
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Global estimates for adults and childrenend 2002

• People living with HIV/AIDS
• New HIV infections in 2002
• Deaths due to HIV/AIDS in 2002

42 million 5 million 3.1 million
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Adults and children estimated to be living with
HIV/AIDS as of end 2002
Eastern Europe Central Asia 1.2 million
Western Europe 570 000
North America 980 000
East Asia Pacific 1.2 million
North Africa Middle East 550 000
South South-East Asia 6 million
Caribbean 440 000
Sub-Saharan Africa 29.4 million
Latin America 1.5 million
Australia New Zealand 15 000
Total 42 million (3.2 mln children)
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Global Distribution of 42 million People Living
with HIV in 2002
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HIV Prevalence ( of adults 15-49) by Sex and
Region in 2002
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Estimated number of adults and childrennewly
infected with HIV during 2002
Eastern Europe Central Asia 250 000
Western Europe 30 000
North America 45 000
East Asia Pacific 270 000
North Africa Middle East 83 000
South South-East Asia 700 000
Caribbean 60 000
Sub-Saharan Africa 3.5 million
Latin America 150 000
Australia New Zealand 500
Total 5 million (0.8 mln children)
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Global Distribution of 5 million Newly HIV
Infected People in 2002
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The Global Distribution of Prevalence (Old New)
is still very similar to the Global Distribution
of Incidence (New)
Prevalence
Incidence
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Estimated adult and child deaths from HIV/AIDS
during 2002
Eastern Europe Central Asia 25 000
Western Europe 8 000
North America 15 000
East Asia Pacific 45 000
North Africa Middle East 37 000
South South-East Asia 440 000
Caribbean 42 000
Sub-Saharan Africa 2.4 million
Latin America 60 000
Australia New Zealand lt100
Total 3.1 million
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Global Distribution of 3.1 million Adult and
Child Deaths from HIV/AIDS in 2002
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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 1524 year olds

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What are the global and regional trends?
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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

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Trends in Number of People Living with HIV
infection 1980 - 2002 by WHO Region
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Trends in Number of People Living with HIV
infection 1980 - 2002 by WHO Region
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Trends in Number of People Living with HIV
infection 1980 - 2002 by WHO Region
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Where do all these numbers come from?
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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)

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HIV Prevalence among Women Attending Antenatal
Clinics, Uganda 1989-2001
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HIV prevalence in blood donations in Indonesia
1992 - 2001
0.016
0.014
0.012
0.010
Percentage HIV-positive
0.008
0.006
0.004
0.002
0.000
1992 1993
1993 1994
1994 1995
1995 1996
1996 1997
1997 1998
1998 1999
1999 2000
2000 2001
Source National AIDS Programme, Indonesia
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HIV Prevalence Among Pregnant Women, Male
Conscripts, and Donated Blood Thailand 1989-2000

Conscripts (age 21)
Pregnant women
Donated blood
Month/Year
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HIV prevalence among sex workers in selected
provinces in China 1993-2000
12
Guangxi
Guangzhou
Yunnan
9
HIV-positive
6
3
0
1993
1994
1995
1996
1997
1998
1999
2000
Source National AIDS Programme, China
(1993-2000). Data compiled by the US Census
Bureau
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HIV prevalence among injecting drug users
in selected sentinel sites in Myanmar Mar 1992
Mar 2001
100
INDIA
Myitkyina
l
CHINA
l
Taunggyi
LAOS
THAILAND
Source Myanmar National AIDS Programme
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How are the estimates made?
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Epidemic model
New entrants
At risk (susceptible)
Not at risk
Non-AIDS death
Non-AIDS death
Infected
Non-AIDS death
AIDS deaths
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Epidemic model
New entrants
fo
At risk (susceptible)
Not at risk
Non-AIDS death
r
phi
Non-AIDS death
Infected
Non-AIDS death
AIDS deaths
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Model epidemic curve
f0
phi
r
t0
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Can we look into the future?
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Population distribution in 2005 (6.4 billion
people)
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How bad can theAsian epidemic become?

• Growth in size of Risk groups -
• IDU, MSM,sex workers
• Chances of mixing with general population -
  peoples movement, socio-political and economic
  developments
• Response behaviour change, vaccine, STD control
  etc.

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Trends - Asia Lessons Learned

• 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)

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Global Prevention Focus Young People(Percent of
population aged 15-24 in 2000 and 2010)
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Care Projected Number of AIDS Deaths 2001-2010
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Estimated Number of People Needing Treatment by
2005
Number depends on - 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
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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