THE EXPLODING GLOBAL HIV/AIDS PANDEMIC

THE POTENTIAL ENORMITY OF THE HIV/AIDS PANDEMIC IS PROFOUND

Three-year-old Emmanuel stands outside his house in Kampala, Uganda Three-year-old Emmanuel stands outside his house in Kampala, Uganda. Emmanuel has been infected with HIV since his birth, and lives now with some relatives as his parents, both are HIV positive, are unable to take care of him.

AIDS awareness billboard in Lundazi, Zambia

A DEADLY SITUATION “UNLESS METHODS OF PREVENTION, WITH OR WITHOUT A VACCINE, ARE SUCCESSFUL, THE WORST OF THE GLOBAL PANDEMIC WILL OCCUR IN THE 21ST CENTURY” New England Journal of Medicine

HIV HAS INFECTED MORE THAN 60 MILLION PEOPLE AROUND THE WORLD.

AIDS HAS ALREADY KILLED MORE THAN 25 MILLION PEOPLE, SURPASSING TUBERCULOSIS AND MALARIA AS THE LEADING INFECTIOUS CAUSE OF DEATH WORLDSIDE. World Health Organization

IN 2007 ALONE, A RECORD 2.61 MILLION PEOPLE HAVE DIED – INCLUDING 330,000 CHILDREN. IN 2007 33.2 MILLION PEOPLE LIVED WITH THE DISEASE.

IN AFRICA, FOR THE FIRST TIME, HIV-INFECTED WOMEN AGED 15-49 OUTNUMBER INFECTED MEN.

THE IMPACT ON DEVELOPING NATIONS IS STAGGERING, WITH EVEN GREATER POTENTIAL DISASTER TO COME.

Over 19 million women are living with HIV/AIDS. By the year 2010, five countries (Ethiopia, Nigeria, China, India, and Russia) with 40 percent of the world's population will add 50 to 75 million infected people to the worldwide pool of HIV disease.

There are 14,000 new infections every day (95 percent in developing countries). HIV/AIDS is a "disease of young people" with half of the 5 million new infections each year occurring among people ages 15 to 24.

The UN estimates that, currently, there are 14 million AIDS orphans and that by 2010 there will be 25 million.

AFRICA HAS BEEN THE EPICENTR OF HIV/AIDS GLOBALLY AND CONTINUES TO CARRY THE LARGEST DISEASE BURDEN, WITH 70% OF PEOPLE LIVING WITH AIDS WORLDWIDE, 83% OF GLOBAL AIDS DEATHS, AND 95% OF THE WORLD’S AIDS ORPHANS.

AIDS HAS REVERSED DECADES OF PROGRESS FROM IMPORTANT PUBLIC HEALTH EFFORTS TO IMMUNIZE CHILDREN, CONTROL DISEASES, AND IMPROVE NUTRITION.

AIDS IS LOWERING LIFE EXPECTANCY AND SIGNIFICANTLY AFFECTING INTERNATIONAL BUSINESS.

IF THE GLOBAL SPREAD OF HIB/AIDS CONTINUES UNCHECKED, SOUTH AND SOUTHEAST ASIA, AND PERHAPS CHINA WILL FOLLOW THE DISASTEROUS COURSE OF SUB-SARAHAN AFRICA.

CURRENTLY, THERE ARE AN ESTIMATED 6 CURRENTLY, THERE ARE AN ESTIMATED 6.7 MILLION HIV-INFECTED PEOPLE IN SOUTH AND SOUTHEAST ASIA.

IN INDIA ALONE, UNAIDS ESTIMATES THAT BETWEEN 3 AND 5 MILLION OF ITS NEARLY 1 BILLION POPULATION ARE INFECTED, AND THE NUMBER OF NEW INFECTIONS IS CONTINUING TO DOUBLE EVERY MONTH.

RAPID INCREASES ARE OCCURRING IN EASTERN EUROPE AND CENTRAL ASIA, AND AIDS REMAIN A SERIOUS THREAT IN LATIN AMERICA AND THE CARIBBEAN.

HIV INFECTIONS IN THE FORMER SOVIET UNION HAVE DOUBLED IN JUST TWO YEARS.

THE SECRETARY-GENERAL OF THE UNITED NATIONS HAS STATED THAT AIDS IS HAVING AN IMPACT ON GROSS DOMESTIC PRODUCT IN SOME COUNTRIES.

THE MICRO-ECONOMIC EFFECTS OF ABSENTEEISM, DECLINE IN A SKILLED WORKFORCE, AND PAYMENTS FOR SICKNESS AND DEATH BENEFITS IN THE DEVELOPING WORLD WILL LEAD TO MACRO-ECONOMIC EFFECTS WORLDWIDE.

THERE IS A PARALLEL EPIDEMIC OF TUBERCULOSIS IN THE DEVELOPING WORLD.

THE HIV/AIDS EPIDEMIC IN THE UNITED STATES

An estimated one million people are currently living with HIV in the United States, with approximately 40,000 new infections occurring each year.

By race, 54 percent of the new infections in the United States occur among African Americans, and 64 percent of the new infections in women occur in African American women.

75 percent of the new infections in women are heterosexually transmitted. Half of all new infections in the United States occur in people 25 years of age or younger.

IN THE UNITED STATES THE EPIDEMIC CONTINUES TO EVOLVE.

ALTHOUGH THE INCIDENCE OF NEW AIDS CASES HAS DECLINED ALTHOUGH THE INCIDENCE OF NEW AIDS CASES HAS DECLINED*, THE DECLINE IN DEATH RATES HAS LEVELED OFF. *NEW DRUG THERAPIES THAT PREVENT PROGRESSION FROM HIV INFECTION TO AIDS.

ACCORDING TO THE CDC, THE RATE OF NEW HIV INFECTIONS HAS BEEN CONSTANT SINCE 1990 WITH NO DECLINE, MEANING THAT THE OVERALL EPIDEMIC IS CONTINUING TO EXPAND.

HIV INFECTION RATES ARE CONTINUING TO CLIMB IN A NUMBER OF SUBPOPULATION GROUPS, SUCH AS WOMEN, RACIAL AND ETHNIC MINORITIES, YOUNG HOMOSEXUAL MEN, PEOPLE OVER 50 YEARS OF AGE, AND INDIVIDUALS WITH ADDICTIVE DISORDERS.

THE RECENT APPEARANCE OF MULTI-DRUG RESISTANT STRAINS OF HIV PRESENT A SERIOUS PUBLIC HEALTH CONCERN.

THESE DATA FOREBODE AN EPIDEMIC OF EVEN GREATER MAGNITUDE AHEAD.

CDC ESTIMATES THAT ABOUT ONE MILLION AMERICANS ARE CURRENTLY INFECTED WITH HIV.

PREVALENCE OF AIDS IS HIGHER AMONG AFRICAN AMERICANS AND HISPANICS, WHO ACCOUNT FOR 45% AND 20% RESPECTIVELY.

OF WOMEN WITH AIDS, MINORITIES ACCOUNT FOR 80% OF CASES; AMONG MEN, MINORITIES ACCOUNT FOR 61% OF CASES.

AIDS RESEARCH NIH HAS DEVELOPED A COMPREHENSIVE BIOMEDICAL AND BEHAVIORAL RESEARCH PROGRAM TO BETTER UNDERSTAND THE BASIC BIOLOGY OF HIV, DEVELOP EFFECTIVE THERAPIES TO TREAT IT, AND DESIGN INTERVENTIONS TO PREVENT NEW INFECTIONS FROM OCCURING.

THE TRANSMISSIBLE NATURE OF HIV MAKES IT RADICALLY DIFFERENT FROM NON-TRANSMISSIBLE DISEASES SUCH AS HEART DISEASE AND CANCER.

THE TRANSMISSIBILITY OF HIV - BETWEEN INDIVIDUALS AND ACROSS BORDERS AND POPULATIONS - IS WHAT DEFINES THE GLOBAL PANDEMIC AND MAKES IT IMPERATIVE THAT THE U.S. HELP ADDRESS PREVENTION AND TREATMENT WORLDWIDE.

THE TRANSMISSIBILITY OF THE INFECTION MEANS THAT THERE IS THE POTENTIAL FOR UNLIMITED GLOBAL SPREAD.

IT ALSO MEANS THAT, WITH THE DEVELOPMENT OF APPROPRIATE BIOMEDICAL AND BEHAVIORAL INTERVENTIONS, THERE IS THE POSSIBILITY FOR DRAMATIC REDUCTIONS IN NEW INFECTIONS - AND ULTIMATE CONTROL OF THE PANDEMIC - IN A WAY THAT WILL NEVER BE POSSIBLE FOR NONINFECTIOUS DISEASES.

NIH CONTINUES TO PLACE A HIGH PRIORITY ON PRIMARY PREVENTION OF NEW HIV INFECTIONS AS THE MOST EFFECTIVE MEANS OF CONTROLLING THE SPREAD OF THE EPIDEMIC IN THE UNITED STATES AND GLOBALLY.

NATIONAL INSTITUTES OF HEALTH RESEARCH PRIORITIES

PRIORITY: HEALTH DISPARITIES IN THE UNITED STATES AIDS REMAINS THE NUMBER ONE CAUSE OF DEATH FOR YOUNG AFRICAN AMERICAN MEN.

PRIORITY: BETTER THERAPIES

PRIORITY: BETTER THERAPIES PRIORITY: HIV PREVENTION

PRIORITY: BETTER THERAPIES PRIORITY: HIV PREVENTION PRIORITY: VACCINES

PREVENTION: NIH CONTINUES TO PLACE A HIGH PRIORITY ON PRIMARY PREVENTION OF NEW HIV INFECTIONS AS THE MOST EFFECTIVE MEANS OF CONTROLLING THE SPREAD OF THE EPIDEMIC IN THE UNITED STATES AND GLOBALLY.

VACCINES A SAFE AND EFFECTIVE HIV PREVENTION VACCINE IS ESSENTIAL FOR THE GLOBAL CONTROL OF THE AIDS PANDEMIC.

TREATMENTS: THERE ARE TREATMENTS THAT HAVE EXTENDED LIFE AND IMPROVED THE QUALITY OF LIFE FOR MANY HIV-INFECTED PEOPLE IN THE UNITED STATES AND WESTERN EUROPE.

TREATMENT FAILURE NOW AFFECTS A GROWING PROPORTION OF THOSE RECEIVING TREATMENT. TREATMENT IS TOO ARDUOUS, TOXICITIES DEVELOP, AND IT COSTS TOO MUCH. $15,00O PER YEAR FOR DRUGS.

THE NEED FOR SIMPLER, LESS TOXIC, AND CHEAPER DRUGS AND DRUG REGIMENS TO TREAT HIV INFECTION CONTINUE TO BE ITEMS OF HIGH PRIORITY FOR RESEARCHERS. IMPROVED REGIMENS ARE NOW IN CLINICAL TRIALS, AND SOME WILL BE AVAILABLE IN THE NEXT FEW YEARS.

AS ALWAYS, IT IS VERY EXPENSIVE...

END OF LECTURE FOR NOVEMBER 3rd, 2010 QUESTIONS?