EPIDIOMOLGY OF HIV IN NIGERIA by Dr Ibrahim M Kida

HIV EPID SUBSAHARAN AFRICA Sub-Saharan Africa continues to be the hardest-hit area in the world. Only 10% of the worlds population lives in sub- Saharan Africa, But 68% of the worlds HIV-infected, 76% of all AIDS deaths in 2007 occurred in that region. Of the 33 million individuals infected worldwide, 22.5 million are living in sub-Saharan Africa alone. More than one half of the 2.5 million new infections that occurred in 2007 were in sub-Saharan Africa.

Cont. All countries in Africa have an HIV seroprevalence rate greater than 5%, with some as high as 25%. In contrast with the developed world, where HIV- infected men outnumber infected women, the majority (61%) of HIV infections in Africa occur in womenan expression of the often highly unequal socioeconomic statuses of women and men in most of the region. Three quarters of all women living with HIV in the world are in sub-Saharan Africa; with a total of 13.2 million, women comprise approximately 61% of infected adults in this region.

Cont. AIDS continues to be the single largest cause of mortality in Africa. The HIV/AIDS epidemic has reversed trends toward longer life expectancy throughout much of Africa. For example, until the mid-1980s, life expectancy in Botswana, South Africa, Swaziland, Namibia, and Zimbabwe was increasing; however, the HIV/AIDS epidemic has had a profound effect in the reduction of life expectancy by approximately 13 years in many of these areas. Although somewhat mixed, access to treatment has increased considerably in some sub-Saharan African countries,

Cont. the beneficial effects of such increases are starting to be translated into declining numbers of AIDS cases and HIV/AIDS-related deaths. Botswana, for example, has one of the highest incidences of HIV infection in the world, but a successful nationwide rollout of antiretroviral therapy has led to the beginnings of a decline in AIDS-related mortality.

HIV IN NIGERIA. In Nigeria, an estimated 3.6 percent of the population are living with HIV and AIDS. Although HIV prevalence is much lower in Nigeria than in other African countries such as South Africa and Zambia, the size of Nigerias population (around 149 million) meant that by the end of 2009, there were almost 3 million people living with

HIV seroprevalence trend in Nigeria ( ) 2/12/2014 Advanced ART Training-Abuja 6th-9th october

CONT. Approximately 192,000 people died from AIDS in 2009.AIDS With AIDS claiming so many lives, Nigerias life expectancy has declined significantly. In 1991 the average life expectancy was 54 years for women and 53 years for men. In 2009 these figures had fallen to 48 for women and 46 for men.

HIV/AIDS in Nigeria Population, ,600,000 People living with HIV/AIDS, 20072,600,000 Women (aged 15+) with HIV/AIDS, 20071,400,000 Children with HIV/AIDS, ,000 Adult HIV prevalence (%), AIDS deaths, ,000 Source: Population Reference Bureau & UNAIDSPopulation Reference BureauUNAIDS

10 Advanced ART Training-Abuja 6th-9th october 2009 Scope of MTCT Estimated number of Nigerian infants born with HIV each year 64,900–103,840 2/12/2014

Comprehensive PMTCT package Primary prevention among young girls and women of reproductive age Prevention of unwanted/unplanned pregnancies among those infected Interventions to prevent MTCT among infected women that desire children or are pregnant Continuous care and support after delivery 2/12/2014 Advanced ART Training-Abuja 6th-9th october

Primary prevention A=Abstinence B=Be faithful to one uninfected partner C=Universal access and use of condoms D=Drugs? 2/12/2014 Advanced ART Training-Abuja 6th-9th october

Prevention of unintended pregnancies Family planning education Access to services Wide availability of effective options 2/12/2014 Advanced ART Training-Abuja 6th-9th october

Western & Central Europe1300 [<1000 – 1800] Middle East & North Africa [ – ] Sub-Saharan Africa 1.8 million [1.7 – 2.0 million] Eastern Europe & Central Asia [9100 – ] South & South-East Asia [ – ] Oceania1100[1200] North America 4400 [2600 – 7300] Latin America [ – ] East Asia7800 [5300 – ] Caribbean [9400 – ] Children (<15 years) estimated to be living with HIV, 2007 Total: 2.0 million (1.9 – 2.3 million) 2/12/ Advanced ART Training-Abuja 6th-9th october 2009

Western & Central Europe<200[<100] Middle East & North Africa5700 [3800 – 8000] Sub-Saharan Africa [ – ] Eastern Europe & Central Asia3200 [2400 – 4300] South & South-East Asia [ – ] Oceania<1000 North America < <500 [<200] Latin America4600 [4200 – 8300] East Asia2000 [1200 – 3100] Caribbean 1800 [1500 – 2100] Estimated number of children (<15 years) newly infected with HIV, 2007 Total: ( – ) 2/12/ Advanced ART Training-Abuja 6th-9th october 2009

Percentage of people receiving antiretroviral therapy who are children in Sub-Saharan Africa Nigeria 3% Côte dIvoire 5% Malawi 5% Mozambique 6% Rwanda 7% Namibia 7% Zimbabwe 7% Kenya 8% South Africa 8% Zambia 8% Central African Republic 9% Uganda 9% United Republic of Tanzania 11% Median 7% Source: WHO/UNAIDS (2006). Progress on global access to HIV antiretroviral therapy: a report on 3 by 5 and beyond. Geneva, World Health Organization

Summary Statistics 33m globally living with HIV/AIDS 2.7m new infections in % are females of reproductive age Risk of MTCT 90% of MTCT occur in sub-Saharan Africa Prevention an important focus for pediatric HIV 2/12/2014 Advanced ART Training-Abuja 6th-9th october UNAIDS 2009 report