00002-E-1 – 1 December 2002 The AIDS Pandemic: an Update on the Numbers and Needs l What are the...

00002-E-1 – 1 December 2002

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-2 – 1 December 2002

What are the numbers for 2002?

00002-E-3 – 1 December 2002

Global estimates forGlobal estimates for adults and childrenadults and childrenend 2002end 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

00002-E-4 – 1 December 2002

Adults and children estimated to be Adults and children estimated to be living living with HIV/AIDSwith HIV/AIDS as of end 2002 as of end 2002

Total: 42 million (3.2 mln children)

Western Europe

570 000570 000North Africa & Middle East

550 000550 000Sub-Saharan

Africa

29.4 million29.4 million

Eastern Europe & Central Asia


South & South-East Asia

6 million6 million

Australia & New Zealand

15 00015 000

North America

980 000980 000Caribbean

440 000440 000

Latin America


East Asia & Pacific


00002-E-5 – 1 December 2002

Global Distribution of 42 million People Living with HIV in 2002

Sub-Saharan Africa

South & Southeast Asia

East Asia & Pacific

Latin America

Eastern Europe & CentralAsia

Caribbean

North America

Western Europe

North Africa & ME

00002-E-6 – 1 December 2002

HIV Prevalence (% of adults 15-49) by Sex and Region in 2002

0 1 2 3 4 5 6 7 8 9 10

Sub-Saharan Africa

Caribbean

North America


Latin America

EEurope & Central Asia

Western Europe

North Africa & ME

East Asia & Pacific

Australia & NZ

Men

Women

00002-E-7 – 1 December 2002

Estimated number of adults and childrenEstimated number of adults and childrennewly infectednewly infected with HIV during 2002 with HIV during 2002

Total: 5 million (0.8 mln children)

Western Europe



Africa


Eastern Europe & Central Asia

250 000250 000East Asia & Pacific

270 000270 000South & South-East Asia

700 000700 000


500500

North America

45 00045 000Caribbean

60 00060 000

Latin America

150 000150 000

00002-E-8 – 1 December 2002

Global Distribution of 5 million Newly HIV Infected People in 2002

Sub-Saharan Africa


East Asia & Pacific

Latin America


Caribbean

North America

Western Europe

North Africa & ME

00002-E-9 – 1 December 2002

The Global Distribution of Prevalence (Old +New) is still very similar to the Global Distribution of Incidence (New)

Prevalence Incidence

00002-E-10 – 1 December 2002

Estimated Estimated adult and child deathsadult and child deaths from HIV/AIDS during 2002from HIV/AIDS during 2002

Total: 3.1 million

Western Europe



Africa


Eastern Europe &Central Asia

25 00025 000East Asia & Pacific

45 00045 000South & South-East Asia

440 000440 000


<100<100

North America

15 00015 000Caribbean

42 00042 000

Latin America

60 00060 000

00002-E-11 – 1 December 2002

Global Distribution of 3.1 million Adult and Child Deaths from HIV/AIDS in 2002

Sub-Saharan Africa


East Asia & Pacific

Latin America


Caribbean

North America

Western Europe

North Africa & ME

00002-E-12 – 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-13 – 1 December 2002

What are the global and regional trends?

00002-E-14 – 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-15 – 1 December 2002

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

AFRO

EURO

AMRO

WPRO

SEARO

EMRO

00002-E-16 – 1 December 2002


0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

AFRO

EURO

AMRO

WPRO

SEARO

EMRO

00002-E-17 – 1 December 2002


0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

2,000,000

AFRO

EURO

AMRO

WPRO

SEARO

EMRO

00002-E-18 – 1 December 2002

Where do all these numbers come from?

00002-E-19 – 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-20 – 1 December 2002

HIV Prevalence among Women Attending Antenatal Clinics, Uganda 1989-2001

0

5

10

15

20

25

30

35

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Nsambya

Rugaba

Mbarara

Jinja

Tororo

Mbale

Kilembe

Soroti

Hoima

Arua

Pallisa

Matany

Kagadi

Mutolere

Moyo

Lacor

00002-E-21 – 1 December 2002

HIV prevalence in blood donations in Indonesia: 1992 - 2001

Per

cen

tag

e H

IV-p

os

itiv

e

0.000

0.002

0.004

0.006

0.008

0.010

0.012

0.014

0.016

1992 – 1993

1993 – 1994

1994 – 1995

1995 – 1996

1996 – 1997

1997 – 1998

1998 – 1999

1999 – 2000

2000 – 2001

Source: National AIDS Programme, Indonesia

00002-E-22 – 1 December 2002

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Ju

n-8

9

De

c-8

9

Ju

n-9

0

De

c-9

0

Ju

n-9

1

De

c-9

1

Ju

n-9

2

De

c-9

2

Ju

n-9

3

De

c-9

3

Ju

n-9

4

De

c-9

4

Ju

n-9

5

De

c-9

5

Ju

n-9

6

Ju

n-9

7

Ju

n-9

8

Ju

n-9

9

Ju

n-0

0

Ju

n-0

1

Ju

n-0

2

HIV Prevalence Among Pregnant Women, Male Conscripts, and Donated Blood

Thailand 1989-2000%

Month/Year

Pregnant women

Donated blood

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

Conscripts (age 21)

00002-E-23 – 1 December 2002

HIV prevalence among sex workers in selected provinces in China: 1993-2000

Source: National AIDS Programme, China (1993-2000). Data compiled by the US Census Bureau

0

3

6

9

12

1993 1994 1995 1996 1997 1998 1999 2000

% H

IV-p

osi

tiv

e

Guangxi Guangzhou Yunnan

00002-E-24 – 1 December 2002

HIV prevalence among injecting drug users in selected sentinel sites in Myanmar: Mar 1992 – Mar 2001

Myitkyina

Taunggyi

THAILAND

LAOS

CHINA

INDIA100

Sentinel Year

94M

01m

0

10

20

30

40

50

60

70

80

90

Per

cen

t (%

)

92M 92S 93M 93S 94S 95M 95S 96M 96S 97M 97S 98M 98S 99M 99S 00M

Myitkyina

Taunggyi

Source: Myanmar National AIDS Programme

00002-E-25 – 1 December 2002

How are the estimates made?

00002-E-26 – 1 December 2002

Epidemic modelNew entrants

Not at risk At risk (susceptible)

Infected

AIDS deaths

Non-AIDS deathNon-AIDS death

Non-AIDS death

00002-E-27 – 1 December 2002

Epidemic modelNew entrants

Not at risk At risk (susceptible)

Infected

AIDS deaths

Non-AIDS deathNon-AIDS death

Non-AIDS death

fo

rphi

00002-E-28 – 1 December 2002

Model epidemic curve

0%

5%

10%

15%

20%

25%

30%

35%

1980 1985 1990 1995 2000 2005 2010

Adult H

IV p

revale

nce

t0

r

phi

f0

00002-E-29 – 1 December 2002

00002-E-30 – 1 December 2002

Can we look into the future?

00002-E-31 – 1 December 2002

Population distribution in 2005 (6.4 billion people)

13%

60%

9%

18%

Africa

Asia

LAC

Eur, Nam, Au

00002-E-32 – 1 December 2002

How bad can theAsian 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.

World Health Organization 6

No. of predicted HIV(+) in China: 1999-2010

0

2

4

6

8

10

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Millio

ns Increased by 10%

Increased by 30%

Evolution of the Epidemic

00002-E-33 – 1 December 2002

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)

Trends in HIV prevalence among pregnant women inCambodia and Thailand, 1991-2002

0

1

2

3

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Percen

t H

IV i

nfe

cte

d

Thailandresponse

Cambodiaresponse

00002-E-34 – 1 December 2002

Global Prevention Focus: Young People(Percent of population aged 15-24 in 2000 and 2010)

0

5

10

15

20

25

Africa Asia LAC Moredeveloped

2000

2010

00002-E-35 – 1 December 2002

Care Projected Number of AIDS Deaths 2001-2010

0

500

1,000

1,500

2,000

2,500

3,000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Africa

S/SE Asia

E Asia/Pacific

LA

E Europe

NA/NE

00002-E-36 – 1 December 2002

Estimated Number of People Needing Treatment by 2005

0

1

2

3

4

5

6

Million of people

Africa Asia LAC E Europe

Number depends on:

- accuracy of the numbers of deaths projections- decisions on when to start treatment (clinical, lab)- how many people are already ontreatment in preceding years- children

Need 6-9 million by 2005

00002-E-37 – 1 December 2002

Coverage of ART, December 2002 (adults by region)

Region N of people on ART Estimated need Coverage (%)Sub Saharan Africa 50,000 4,100,000 1Asia 43,000 1,000,000 4North Africa, Middle East 3,000 7,000 29Eastern Europe, CentralAsia

7,000 80,000 9

Latin America, Caribbean 196,000 370,000 53

Total 300,000 5,500,000 5

00002-E-38 – 1 December 2002

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-1 – 1 December 2002 The AIDS Pandemic: an Update on the Numbers and Needs l What are the...

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