Epidemiological Patterns and Trends Epidemiological Patterns and - PowerPoint PPT Presentation

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 projections of the AIDS epidemic (Chin et al projections) (Chin et al projections) *Only a small proportion of worldwide cumulative adult AIDS cases projected for mid-2000 will occur prior to 1990. 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.* Source: Chin J, Sato PA, Mann JM. Projections of HIV infections and AIDS cases to the year 2000. Bulletin of the 09/06 e World Health Organization 1990;68(1):1-11.

Estimated number of adults and children Estimated number of adults and children living with HIV by region, 1986– –2005 2005 living with HIV by region, 1986 45 Million Oceania 40 North Africa & Middle East 35 Eastern Europe & Central Asia 30 Latin America and Caribbean Number 25 North America and Western Europe of people 20 living Asia 15 with HIV Sub-Saharan Africa 10 5 0 1985 1990 1995 2000 2005 Year Source: WHO/UNAIDS, 2006 09/06 e

Global HIV prevalence in adults, 1985 Global HIV prevalence in adults, 1985 Source: WHO/UNAIDS, 2006 09/06 e

Global HIV prevalence in adults, 1995 Global HIV prevalence in adults, 1995 Source: WHO/UNAIDS, 2006 09/06 e

Global HIV prevalence in adults, 2005 Global HIV prevalence in adults, 2005 Source: WHO/UNAIDS, 2006 09/06 e

HIV prevalence (%) in adults in Africa, 2005 HIV prevalence (%) in adults in Africa, 2005 Source: WHO/UNAIDS. [2006 Report on the global AIDS epidemic, UNAIDS] 09/06 e 2.5

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 Population-based 2003 HIV Adjusted 2003 2005 HIV Trend in prevalence prevalence (%) survey prevalence (%) prevalence HIV prevalence among women (year) (%) reported prevalence (%) in current attending in 2004 Report (%) in current report antenatal clinics on the global report 2003 ‒ 2004* epidemic Botswana 38.5 25.2 (2004) 38.0 24.0 24.1 Stable 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 † Cameroon 5.5 (2004) 7.0 5.5 5.4 Stable Chad 4.6 3.3 (2005) ¶ 4.9 3.4 3.5 Stable (1.0 ‒ 3.5) (0.9 ‒ 3.5) 1.6 (2005) § Ethiopia 8.5 4.4 Decline in urban areas 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 Sierra Leone 3.0 1.5 (2005) - 1.6 1.6 Stable South Africa 29.5 16.2 (2005) 20.9 18.6 18.8 Increasing UR Tanzania 7.0 7.0 (2004) 9.0 6.6 6.5 Stable 7.1 (2004 ‒ 5) 6.2 ‡ Uganda 4.1 6.8 6.7 Stable * 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. Source: 2006 Report on the global AIDS epidemic, UNAIDS 09/06 e 2.1

HIV prevalence (%) by gender and urban/rural residence, HIV prevalence (%) by gender and urban/rural residence, ‒ 2005 Saharan African countries, 2001 ‒ selected sub- -Saharan African countries, 2001 2005 selected sub 30 15 ‒ 49 20 Women Men years old, % by gender 10 0 30 15 ‒ 24 20 Women Men years old, % by gender 10 0 15 ‒ 49 30 years old, 20 Urban Rural by urban/ % rural 10 residence 0 South UR Burkina Lesotho Zambia Kenya Uganda Ghana Guinea Senegal Africa Tanzania Faso 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). 09/06 e 2.7 [2006 Report on the global AIDS epidemic, UNAIDS]

Geographical variation: HIV prevalence by province Geographical variation: HIV prevalence by province Kenya DHS 2003 Kenya DHS 2003 Nyanza 15.1 Nairobi 9.9 Coast 5.8 Rift Valley 5.3 Western 4.9 Central 4.9 Eastern 4.0 North Eastern 0.0 0 2 4 6 8 10 12 14 16 % HIV prevalence Sources: Kenya Demographic and Health Survey 2003. Central Bureau of Statistics, Ministry of Health, Kenya Medical Research Institute, 09/06 e National Council for Population and Development, ORC Macro, Centers for Disease Control and Prevention (Nairobi, Kenya)

HIV prevalence (%) among pregnant women attending antenatal clinics ics HIV prevalence (%) among pregnant women attending antenatal clin ‒ 2004 Saharan Africa, 1997/98 ‒ in sub- -Saharan Africa, 1997/98 2004 in sub Southern Africa Eastern Africa 50 20 Median HIV prevalence (%) Median HIV prevalence (%) Swaziland United Republic of Tanzania 40 15 Zimbabwe 30 Ethiopia 10 20 Kenya South Mozambique 5 Africa 10 0 0 1997 ‒ 1999 ‒ 1997 ‒ 1999 ‒ 2001 2002 2003 2004 2001 2002 2003 2004 1998 2000 1998 2000 West Africa 20 Median HIV prevalence (%) 15 Note : Analysis restricted to consistent 10 surveillance sites for all countries Côte d'Ivoire Burkina Faso except South Africa (by province) and 5 Swaziland (by region) Ghana Senegal 0 1997 ‒ 1999 ‒ 2001 2002 2003 2004 1998 2000 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 09/06 e 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); 2.6 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).

HIV prevalence (%) in adults in Asia and Oceania, 2005 HIV prevalence (%) in adults in Asia and Oceania, 2005 Source: WHO/UNAIDS. [2006 Report on the global AIDS epidemic, UNAIDS] 09/06 e 2.8

HIV prevalence among men who have sex with men HIV prevalence among men who have sex with men in selected parts of Asia, 2003– –2005 2005 in selected parts of Asia, 2003 Phnom Penh (2005) CAMBODIA 8.9% Provinces (2005) 0.8% CHINA Beijing (2004) 0.8% Beijing (2005) 4.6% NEPAL Kathmandu (2005) 4.7% THAILAND Bangkok (2003) 17.3% Bangkok (2005) 28.3% Chiang Mai (2005) 15.3% Phuket (2005) 5.5% VIET NAM Khanh Hoa province (2005) 0.0% 0 5 10 15 20 25 30 % HIV Prevalence 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 09/06 e 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]

Recent steep rises in HIV infection among drug injectors has been followed n followed Recent steep rises in HIV infection among drug injectors has bee by a rise in HIV among sex workers in parts of China, Indonesia and Vietnam and Vietnam by a rise in HIV among sex workers in parts of China, Indonesia IDU (Guangxi, China) Sex workers (Guangxi, China) 100 IDU (Jakarta, Indonesia) Sex workers (Jakarta, Indonesia) 90 IDU (Hanoi, Vietnam) Sex workers (Hanoi, Vietnam) 80 70 60 % HIV 50 positive 40 30 20 10 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Source: National surveillance reports. [AIDS in Asia, Face the Facts. 2004 MAP Report] 09/06 e

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 160 140 Spouse 50% 120 IDU 20% New HIV SW 15% 100 infections MTCT 15% 80 (number SW 90% of people, 60 Spouse 5% in thousands) 40 IDU 5% 20 0 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Year 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] 09/06 e