Pandemic Ii In Real Life
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Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to:. Type 508 Accommodation and the title of the report in the subject line of e-mail. The Global HIV/AIDS Pandemic, 2006Please note: An erratum has been published for this article. To view theerratum, please click.Since the first cases of acquired immunodeficiency syndrome (AIDS) were reported in 1981, infection withhuman immunodeficiency virus (HIV) has grown to pandemic proportions, resulting in an estimated 65 million infections and25 million deaths (,2).
During 2005 alone, an estimated 2.8 million persons died from AIDS, 4.1 million were newlyinfected with HIV, and 38.6 million were living with HIV( 2). HIV continues to disproportionately affect certain geographicregions (e.g., sub-Saharan Africa and the Caribbean) and subpopulations (e.g., women in sub-Saharan Africa, men whohave sex with men MSM, injection-drug users IDUs, and sex workers). Effective prevention and treatment ofHIV infection with antiretroviral therapy (ART) are now available, even in countries with limited resources( 2). Nonetheless, comprehensive programs are needed to reach all persons whorequire treatment and to prevent transmission of new infections.This report, published on the eve of the sixteenth International AIDS Conference (August 13-18, 2006, inToronto, Canada), summarizes selected regional trends in theHIV/AIDS pandemic, based largely on data from the2006 Report on the Global AIDS Epidemic by the Joint UnitedNations Programme on HIV/AIDS (UNAIDS) ( 2).
Related reports in this issueof MMWR describe the prevalence of HIV infection among MSM in Thailand, HIV-related practices at chest clinics inGuyana, and HIV-related risk behaviors among high school students in the United States.Sub-Saharan Africa. Approximately 10% of the world population lives in sub-Saharan Africa, but the region is hometo approximately 64% of the world population living with HIV( 2). Transmission is primarily through heterosexual contact,and more women are HIV infected than men.
Southern Africa is the epicenter of the AIDS epidemic; all countries in theregion except Angola have an estimated adult (i.e., aged 15-49 years) HIV prevalence exceeding 10%( 2). In Botswana, Lesotho, Swaziland, and Zimbabwe, the estimated adult HIV prevalence exceeds 20%( 2). South Africa, with an HIV prevalenceof 18.8% and 5.5 million persons living with HIV, has, along with India, the largest number of persons living with HIV inthe world ( 2). Recently, declines in adult HIV prevalence have been observed in Kenya, Uganda, Zimbabwe, and urban areasof Burkina Faso. Although in these countries, HIV-related sexual risk behaviors and HIV incidence have decreased, AIDSdeath rates continue to rise.
In sub-Saharan Africa, 17% of the estimated number of persons in need of ART received it in 2005( 3).Asia. Adult HIV prevalence is lower in Asian countries than in countries in sub-Saharan Africa, and the epidemic inmost Asian countries is attributable primarily to various high-risk behaviors (e.g., unprotected sexual intercourse with sexworkers, IDUs, or MSM and injection-drug use). Of the 8.3 million HIV-infected persons in Asia, 5.7 million live in India, wherethe prevalence varies by state. Approximately 80% of HIV infections in India are acquired heterosexually. Recent data fromfour Indian states indicated a decline in HIV prevalence among pregnant women aged 15-24 years, from 1.7% in 2000 to 1.1%in 2004 ( 4). In China, where 650,000 IDUs account for approximately half of persons living with HIV infection; incontrast, the epidemics in Thailand and Cambodia have been driven largely by commercial sex.
In Thailand, HIV prevalencein pregnant women declined from 2.4% in 1995 to 1.2% in 2003. However, HIV prevalence among MSM inBangkok increased from 17% in 2003 to 28% in 2005( ). Only 16% of persons in need of ART in Asiareceived it in 2005 ( 3).Americas. HIV infections are reported mostly among MSM, IDUs, and sex workers in the Americas.
Brazil, thesecond most populous country in the Americas (after the United States), has an adult HIV prevalence of 0.5% andhas approximately 30% of the population living with HIV in South and Central America and the Caribbean. High-riskbehavior among Brazilians aged 15-24 years remains high; one in threereport initiating sexual activity before age 15 years, and onein five report having had more than 10 sex partners. Brazil provides free ART to all in need of treatment, andapproximately 83% of HIV-infected persons receive therapy.
After sub-Saharan Africa, the Caribbean is the second most HIV-affected regionof the world. Like sub-Saharan Africa, HIV transmission in the Caribbean is largely heterosexual. HIV prevalence has declinedin urban areas of Haiti but has remained constant in other areas of the Caribbean. Overall in South and Central America andthe Caribbean, approximately 68% of persons in need of ART received it in 2005( 3).In the United States, recent evidence suggests a resurgence of HIV transmission among MSM; during 2001-2004,an estimated 44% of new HIV infections were in MSM, and 17% were in IDUs( ).
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In addition, blacks and Hispanics togetheraccount for 69% of all reported HIV/AIDS cases. In the United States, 55% of persons in need of ART received itin 2005.Reported by: World Health Organization, Geneva, Switzerland. Interagency Surveillance and Survey Working Group, Office of the USGlobal AIDS Coordinator, US Dept of State. Div of Global AIDS, National Center for HIV, Viral Hepatitis, STDs, and TuberculosisPrevention (proposed), CDC. Editorial Note:This report summarizes certain regional trends in the HIV/AIDS pandemic, which has reversed the courseof human development ( 7) and eroded improvements in lifeexpectancy in countries with the highest prevalence of infection( 2). The greatest HIV burden is in sub-Saharan Africa, home to 15 countries with the highest prevalence of HIVinfection in the world. In most other regions, HIV infections have been concentrated in various high-risk populations.
To beeffective, prevention measures must be tailored to the local epidemiology of HIV infection, based on the behaviors andexposures associated with new transmission.From 2003 to 2005, estimates of adult HIV prevalence were lowered in many countries. Some of these reductions mightbe attributable to the addition of new surveillance sites and population-based surveys that provide better estimatesin rural populations, which usually have lower HIV prevalence.
However, some countries (including Kenya, Uganda,Zimbabwe, and urban parts of Burkina Faso and Haiti) havereported evidence of actual declines in HIV prevalence. Changes insexual behavior (e.g., delayed initiation of sexualintercourse, decrease in number of sex partners, or increase in condom use)appear at least partly responsible for these declines,although increasing mortality might have been a contributing factor( 8).During 2003-2005, substantial gains were made in the number of persons receiving ART in resource-limited countries( 3).
The '3 by 5' initiative, a strategy of the World Health Organization and UNAIDS, sought to provide treatment to 3million persons (50% of those in need of treatment worldwide) in low- and middle-income countries by 2005. ByDecember 2005, 18 countries had met their '3 by 5' target, and the number of persons receiving ART had increased from 400,000in December 2003 to 1.3 million ( 3). Overall, this 225% increase can be attributed to commitments by thePresident's Emergency Plan for AIDS Relief (PEPFAR); the Global Fund To Fight AIDS, Tuberculosis, and Malaria; and the WorldBank. By the end of March 2006, PEPFAR supported ART for 561,000 persons in 15 countries( 9).Despite the gains in ART, only 20% of persons in need of treatment in low- and middle-income countries were receivingit in December 2005 ( 3). Despite a 5-year scale-up of interventions to prevent mother-to-child transmission (PMTCT) ofHIV, approximately one in 10 pregnant women were offered PMTCT services, and fewer than one in 10 HIV-positivepregnant women received ART prophylaxis for PMTCT( 2). Expansion of HIV testing, including the routine offer of testingand counseling in clinical settings, will be needed to identify more persons in need of ART and PMTCT services; improvementsin infrastructure and human resources will be needed to deliver quality services to the increasing number of personsrequiring treatment. As more HIV-infected persons receive ART, the number of persons living with HIV infection willincrease, requiring that prevention programs scale up to prevent HIV transmission from those living with HIV infection and forthose at risk for infection.
Prevention measures directed toward populations most likely to be exposed to HIV in low-leveland concentrated epidemics. and toward young persons and those with HIV infection in generalized epidemics must be scaledup in parallel with care and treatment programs.To maximize the effectiveness of HIV/AIDS programs, the quality and coverage of services should be evaluated, andthe success of interventions should be assessed by analyzing trends in morbidity, mortality, and behaviors of populationsinfected with HIV or at risk for HIV infection.
Using these data to modify and improve HIV/AIDS programs, an approachintegrating prevention and treatment is being developed that could reduce treatment need by as much as 50% by 2020( 10). WHO and UNAIDs define these three types of epidemics as follows: low level: HIV prevalence has not consistently exceeded 5% in any definedsubpopulation; concentrated: HIV prevalence is consistently 5% in at least one defined subpopulation and is 1% in pregnant women. References. Joint United Nations Programme on HIV/AIDS (UNAIDS). 2006 report on the global AIDS epidemic. Geneva, Switzerland: UNAIDS;2006.
Available at. World Health Organization, Joint United Nations Programme on HIV/AIDS (UNAIDS). Progress on global access to HIV antiretroviral therapy:a report on '3 by 5' and beyond, 2006. Geneva, Switzerland: World Health Organization, Joint United Nations Programme onHIV/AIDS (UNAIDS); 2006. Available at. Kumar R, Jha P, Arora P, et al.
Trends in HIV-1 in young adults in south India from 2000 to 2004: a prevalence study. Lancet 2006;367: 1164-72. United Nations Development Programme. Human development report, 2005.
International cooperation at a crossroads: aid, trade and securityin an unequal world. New York, NY: United Nations Development Programme; 2005. Available at. Hallett TB, Aberle-Grasse J, Bello G, et al. Declines in HIV prevalence can be associated with changing sexual behaviour in Uganda, urbanKenya, Zimbabwe, and urban Haiti.
Sex Transm Infect 2006;82(Suppl 1):i1-i8. Office of Global AIDS Coordinator. President's Emergency Plan for AIDS Relief. Making a difference: supporting antiretroviraltreatment, 2006. Washington, DC: Office of Global AIDS Coordinator; 2006. Available at. Salomon JA, Hogan DR, Stover J, et al.
Integrating HIV prevention and treatment: from slogans to impact. PLoS Med 2005;2:e16.Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department ofHealth and Human Services.References to non-CDC sites on the Internet areprovided as a service to MMWR readers and do not constitute or implyendorsement of these organizations or their programs by CDC or the U.S.Department of Health and Human Services. CDC is not responsible for the contentof pages found at these sites.
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