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Epidemiological Patterns and Trends Epidemiological Patterns and - - PowerPoint PPT Presentation

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Epidemiological Patterns and Trends Epidemiological Patterns and Trends and their Implications for HIV Prevention and their Implications for HIV Prevention P. D. Ghys, K. Stanecki 09/06 e Early projections of the AIDS epidemic Early

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Epidemiological Patterns and Trends Epidemiological Patterns and Trends and their Implications for HIV Prevention and their Implications for HIV Prevention

  • P. D. Ghys, K. Stanecki
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Cumulative (cum.) adult AIDS cases by the Delphi projection of HIV prevalence (scenario 1, with no coordination) and the WHO model for Forecasting AIDS cases, 1980‒2000.*

Early projections of the AIDS epidemic Early projections of the AIDS epidemic (Chin et al projections) (Chin et al projections)

Source: Chin J, Sato PA, Mann JM. Projections of HIV infections and AIDS cases to the year 2000. Bulletin of the World Health Organization 1990;68(1):1-11.

*Only a small proportion

  • f worldwide cumulative

adult AIDS cases projected for mid-2000 will occur prior to 1990.

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5 10 15 20 25 30 35 40 45 Million

Number

  • f people

living with HIV

1985 1990 1995 2000 2005 Year

Oceania North Africa & Middle East Eastern Europe & Central Asia Latin America and Caribbean North America and Western Europe Asia Sub-Saharan Africa

Source: WHO/UNAIDS, 2006

Estimated number of adults and children Estimated number of adults and children living with HIV by region, 1986 living with HIV by region, 1986– –2005 2005

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Global HIV prevalence in adults, 1985 Global HIV prevalence in adults, 1985

Source: WHO/UNAIDS, 2006

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Global HIV prevalence in adults, 1995 Global HIV prevalence in adults, 1995

Source: WHO/UNAIDS, 2006

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Global HIV prevalence in adults, 2005 Global HIV prevalence in adults, 2005

Source: WHO/UNAIDS, 2006

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HIV prevalence (%) in adults in Africa, 2005 HIV prevalence (%) in adults in Africa, 2005

2.5

Source: WHO/UNAIDS. [2006 Report on the global AIDS epidemic, UNAIDS]

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In sub In sub-

  • Saharan Africa, national surveys have lead to

Saharan Africa, national surveys have lead to improved understanding and estimates improved understanding and estimates

Median HIV prevalence (%) among women attending antenatal clinics 2003‒2004* Population-based survey prevalence (%) (year) 2003 HIV prevalence (%) reported in 2004 Report

  • n the global

epidemic Adjusted 2003 HIV prevalence (%) in current report 2005 HIV prevalence (%) in current report Trend in prevalence Botswana Stable 38.5 25.2 (2004) 38.0 24.0 24.1 Burkina Faso Decline in urban areas 2.5 1.8 (2003) 4.2 2.1 2.0 Burundi Decline in capital city 4.8 3.6 (2002) 6.0 3.3 3.3 Cameroon Stable 7.3† 5.5 (2004) 7.0 5.5 5.4 Ethiopia Decline in urban areas 8.5 1.6 (2005)§ 4.4 (1.0‒3.5) (0.9‒3.5) Ghana Stable 3.1 2.2 (2003) 3.1 2.3 2.3 Guinea Stable 4.2 1.5 (2005) 2.8 1.6 1.5 Lesotho Stable 28.4 23.5 (2004) 29.3 23.7 23.2 Sierra Leone Stable 3.0 1.5 (2005)

  • 1.6

1.6 Rwanda Decline in urban areas 4.6 3.0 (2005) 5.1 3.8 3.1 Senegal Stable 1.9 0.7 (2005) 0.8 0.9 0.9 South Africa Increasing 29.5 16.2 (2005) 20.9 18.6 18.8 UR Tanzania Stable 7.0 7.0 (2004) 9.0 6.6 6.5 Uganda Stable 6.2‡ 7.1 (2004‒5) 4.1 6.8 6.7

* 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; ¶Programme National De Lutte Contre le SIDA/Infections sexuellement transmissibles/ S/C Organisation Mondiale pour la santé; ‡ 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. 2.1

Chad Stable 4.6 3.3 (2005)¶ 4.9 3.4 3.5 Source: 2006 Report on the global AIDS epidemic, UNAIDS

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HIV prevalence (%) by gender and urban/rural residence, HIV prevalence (%) by gender and urban/rural residence, selected sub selected sub-

  • Saharan African countries, 2001

Saharan African countries, 2001‒ ‒2005 2005

10 20 30 %

15‒49 years old, by gender

Lesotho South Africa Zambia Kenya Uganda UR Tanzania Burkina Faso Ghana Guinea Senegal Urban Rural Women Men Women Men

10 20 30 %

15‒24 years old, by gender

10 20 30 %

15‒49 years old, by urban/ rural residence

South East 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, UNAIDS]

2.7

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Geographical variation: HIV prevalence by province Geographical variation: HIV prevalence by province Kenya DHS 2003 Kenya DHS 2003

0.0 4.0 4.9 4.9 5.3 5.8 9.9 15.1

2 4 6 8 10 12 14 16

North Eastern Eastern Central Western Rift Valley Coast Nairobi Nyanza % HIV prevalence

Sources: Kenya Demographic and Health Survey 2003. Central Bureau of Statistics, Ministry of Health, Kenya Medical Research Institute, National Council for Population and Development, ORC Macro, Centers for Disease Control and Prevention (Nairobi, Kenya)

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Southern Africa

HIV prevalence (%) among pregnant women attending antenatal clin HIV prevalence (%) among pregnant women attending antenatal clinics ics in sub in sub-

  • Saharan Africa, 1997/98

Saharan Africa, 1997/98‒ ‒2004 2004

West Africa

1997‒ 1998 1999‒ 2000 2001 2002 2003 2004 5 10 15 20

Median HIV prevalence (%)

Burkina Faso Côte d'Ivoire Ghana Senegal 1997‒ 1998 1999‒ 2000 2001 2002 2003 2004 10 20 30 40

Median HIV prevalence (%)

50 Mozambique South Africa Swaziland Zimbabwe Note: Analysis restricted to consistent surveillance sites for all countries except South Africa (by province) and Swaziland (by region)

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

  • f 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).

1997‒ 1998 1999‒ 2000 2001 2002 2003 2004 5 10 15 20

Median HIV prevalence (%)

Eastern Africa

Ethiopia Kenya United Republic of Tanzania

2.6

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HIV prevalence (%) in adults in Asia and Oceania, 2005 HIV prevalence (%) in adults in Asia and Oceania, 2005

2.8

Source: WHO/UNAIDS. [2006 Report on the global AIDS epidemic, UNAIDS]

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HIV prevalence among men who have sex with men HIV prevalence among men who have sex with men in selected parts of Asia, 2003 in selected parts of Asia, 2003– –2005 2005

Provinces (2005) Phnom Penh (2005) Beijing (2005) Beijing (2004) Kathmandu (2005) Phuket (2005) Chiang Mai (2005) Bangkok (2005) Bangkok (2003) Khanh Hoa province (2005) CAMBODIA CHINA NEPAL THAILAND VIET NAM 5 10 15 20 25 30 % HIV Prevalence

8.9% 0.8% 0.8% 4.6% 4.7% 28.3% 15.3% 5.5% 0.0% 17.3%

Sources: M. Phalkun, et al. HIV, sexually transmitted infections, related risk behaviour among Cambodian men who have sex with men. (Cambodia); X. Ma, et al. Possible rise in HIV prevalence among men who have sex with men in Beijing. (China); L.B. Acharya, et al. HIV and STI prevalence among MSM in Kathmandu, Nepal. (Nepal); F. van Griensven, et al. Surveillance of HIV prevalence among populations of men who have sex with men in Thailand, 2003‒2005. (Thailand); M. Truong Tan, et al. HIV risk behavior and prevalence among MSM in Khanh Hoa province, Viet Nam. (Viet Nam) [XVI International AIDS Conference abstracts]

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% HIV positive 10 20 30 40 50 60 70 80 90 100

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Sex workers (Hanoi, Vietnam) IDU (Guangxi, China) IDU (Jakarta, Indonesia) IDU (Hanoi, Vietnam) Sex workers (Jakarta, Indonesia) Sex workers (Guangxi, China)

Source: National surveillance reports. [AIDS in Asia, Face the Facts. 2004 MAP Report]

Recent steep rises in HIV infection among drug injectors has bee Recent steep rises in HIV infection among drug injectors has been followed n followed by a rise in HIV among sex workers in parts of China, Indonesia by a rise in HIV among sex workers in parts of China, Indonesia and Vietnam and Vietnam

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20 40 60 80 100 120 140 160

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Year New HIV infections

(number

  • f people,

in thousands)

IDU: HIV transmission through injecting drug use; MTCT: mother to child transmission of HIV Spouse: heterosexual transmission of HIV in cohabiting partnerships; SW: HIV transmission through sex work

Source: Thai Working Group on HIV/AIDS Projections, 2001. [2004 Report on the global AIDS epidemic, UNAIDS]

SW 90% Spouse 5% IDU 5% Spouse 50% IDU 20% SW 15% MTCT 15%

Estimated number of new HIV infections in Thailand Estimated number of new HIV infections in Thailand by year and changing mode of transmission by year and changing mode of transmission

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HIV prevalence (%) trends in India among injecting drug users HIV prevalence (%) trends in India among injecting drug users and pregnant women, selected areas, India, 1998 and pregnant women, selected areas, India, 1998– –2004* 2004*

Antenatal Clinic attendees Antenatal clinic attendees Injecting drug users

1998 1999 2000 2001 2002 2003 2004 %

0.0 1.0 2.0 3.0 4.0 5.0

1998 1999 2000 2001 2002 2003 2004 %

0.0 0.3 0.6 0.9 1.2 1.5

1998 1999 2000 2001 2002 2003 2004 %

0.0 3.0 6.0 9.0 12.0 15.0

Andhra Pradesh Karnataka Maharashtra Tamil Nadu Madhya Pradesh Mizoram Uttar Prahesh West Bengal Delhi Mizoram West Bengal

2.9

*Data from consistent surveillance sites only. Source: National AIDS Control Organization (NACO), 2005. [2006 Report on the global AIDS epidemic, UNAIDS]

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HIV prevalence (%) in adults HIV prevalence (%) in adults in Eastern Europe and Central Asia, 2005 in Eastern Europe and Central Asia, 2005

2.13

Source: WHO/UNAIDS. [2006 Report on the global AIDS epidemic, UNAIDS]

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Increase in reported HIV cases in the Russian Federation Increase in reported HIV cases in the Russian Federation and Ukraine, 1987 and Ukraine, 1987– –2005 2005

1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 50 000 100 000 150 000 200 000 250 000 300 000 350 000 400 000 30 000 45 000 60 000 75 000 90 000 105 000 120 000 15 000 Reported HIV cases in the Russian Federation Reported HIV cases in Ukraine Russian Federation Newly reported cases Cumulative (previous years) Ukraine Newly reported cases Cumulative (previous years)

2.12

Sources: Russian Federal AIDS Centre; Ukranian AIDS Centre and Ministry of Health of Ukraine. [2006 report on the global AIDS epidemic, UNAIDS]

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2.12

Sources: CDC Central Asia offices (Almaty & Tashkent), National and City HIV/AIDS centers [XVI International AIDS Conference abstract]

HIV prevalence among injecting drug users, sex workers HIV prevalence among injecting drug users, sex workers and men who have sex with men in Central Asia, 2005 and men who have sex with men in Central Asia, 2005

10 20 30 40 50 60

* Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan

15.0% Kazakhstan 2.0% Kyrgyzstan

Sex workers

10.4% Kazakhstan 52.5% Uzbekistan

Injecting drug users Sex workers who were injecting drug users Sex workers who were not injecting drug users

44.0% 2.0%

Men who have sex with men

0.3% 4 Central Asian republics* combined

% HIV prevalence

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HIV prevalence (%) in adults in Latin America and the Caribbean, 2005

2.13

Source: WHO/UNAIDS. [2006 Report on the global AIDS epidemic, UNAIDS]

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HIV prevalence (%) among female sex workers HIV prevalence (%) among female sex workers and men who have sex with men in Latin America, 1999 and men who have sex with men in Latin America, 1999– –2002 2002

Provinces (7 cities) La Paz Santa Cruz Border cities with Argentina Santiago Bogotá

Argentina Bolivia Chile Colombia

0.0

% HIV prevalence

5 10 15 20 25 30

Buenos Aires Quito Guayaquil Other city ports (4) Asunción and 4 other cities Lima Provinces Montevideo Border cities with Brazil Isla Margarita

Ecuador Paraguay Peru Uruguay Venezuela

0.0

% HIV prevalence

5 10 15 20 25 30

Female sex workers Men who have sex with men

2.14

Source: Montano SM et al., JAIDS (2005). [2006 Report on the global AIDS Epidemic, UNAIDS]

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Trends in ART treatment

2.13

2002 2004 2003 2005

Percentage of people in sub-Saharan Africa

  • n antiretroviral therapy among those in need

Source: WHO/UNAIDS (2005). [Progress on global access to HIV antiretroviral therapy: An update on “3 by 5.”]

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Number of people on antiretroviral therapy Number of people on antiretroviral therapy in low in low-

  • and middle

and middle-

  • income countries, 2002

income countries, 2002– –2006 2006

Source: WHO/UNAIDS (2005). [Progress on global access to HIV antiretroviral therapy: An update on “3 by 5.” ] [Updated with 2006 data, WHO/UNAIDS]

7.1

North Africa and the Middle East Europe and Central Asia East, South and South-East Asia Latin America and the Caribbean Sub-Saharan Africa

End 2002 Mid- 2003 End 2003 Mid- 2004 End 2004 Mid- 2005 End 2005

People receiving therapy (thousands)

Mid- 2006

200 400 600 800 1000 1200 1400 1600 1800