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Global HIV Epidemiology Carey Farquhar, MD, MPH Grace John-Stewart MD, PhD Departments of Medicine, Epidemiology and Global Health
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Outline Historical perspective Prevalence, new infections, deaths Treatment Co-infections HIV Testing Prevention 1996 Newsweek Headline: “The End of AIDS?”
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December 2009 Total: 33.4 million (31.1 – 35.8 million) Western & Central Europe 850 000 [710 000 – 970 000] Middle East & North Africa 310 000 [250 000 – 380 000] Sub-Saharan Africa 22.4 million [20.8 – 24.1 million] Eastern Europe & Central Asia 1.5 million [1.4 – 1.7 million] South & South-East Asia 3.8 million [3.4 – 4.3 million] Oceania 59 000 [51 000 – 68 000] North America 1.4 million [1.2 – 1.6 million] Latin America 2.0 million [1.8 – 2.2 million] East Asia 850 000 [700 000 – 1.0 million] Caribbean 240 000 [220 000 – 260 000] Adults and children estimated to be living with HIV, 2008
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December 2009 Estimated number of adults and children newly infected with HIV, 2008 Western & Central Europe 30 000 [23 000 – 35 000] Middle East & North Africa 35 000 [24 000 – 46 000] Sub-Saharan Africa 1.9 million [1.6 – 2.2 million] Eastern Europe & Central Asia 110 000 [100 000 – 130 000] South & South-East Asia 280 000 [240 000 – 320 000] Oceania3900 [2900 – 5100] North America 55 000 [36 000 – 61 000] Latin America 170 000 [150 000 – 200 000] East Asia 75 000 [58 000 – 88 000] Caribbean 20 000 [16 000 – 24 000] Total: 2.7 million (2.4 – 3.0 million)
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December 2009 Over 7400 new HIV infections a day in 2008 More than 97% are in low- and middle-income countries About 1200 are in children under 15 years of age About 6200 are in adults aged 15 years and older, of whom: — almost 48% are among women — about 40% are among young people (15–24)
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Decreasing HIV incidence in Africa 22 countries in Africa with decreased HIV incidence >25% decrease in incidence between 1999-2009
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Treatment
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Number of people receiving antiretroviral therapy by region, 2002–2010 UNAIDS 2011
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ARV coverage in 2009
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Median annual cost of first-line antiretrovirals 2008–2010
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ART Updates > 6 million individuals on ART end of 2011 Coverage ~50% Retention –81% 12 mos –75% 24 mos –67% 60 mos Any concerns?
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ART Updates > 6 million individuals on ART end of 2011 Coverage >50% Retention –81% 12 mos –75% 24 mos –67% 60 mos 3% on second-line therapy >50 surveys, 13 countries –Baseline resistance at ART 6% –Viral failure 10% at 12 mos –Transmitted resistance 3.7%
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Need to test in order to treat Must increase test availability and options <40% know HIV status Percentage of adults who had ever received HIV test results, South Africa
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Rapid HIV tests and self-testing
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Coinfections
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Why was there a decline in opportunistic infections?
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NEJM 2008
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Prevention
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Success stories Mother-to-Child Transmission Risk: ~40% <1-3% 2010 1990
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Reported percentage condom use at last sexual intercourse among women 15–49 years old who had sex, 2005–2007
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The face of AIDS is increasingly young and female, and the statistics are startling. Nearly half of people living with HIV worldwide are women, and 76% of youth living with HIV in sub-Saharan Africa are young women and girls. Intersecting with the growing feminization of the global AIDS epidemic is another epidemic – that of violence against women and girls.
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Women and HIV Global Perspective Women: >50% world’s HIV ~60% of Africa’s HIV Africa has 80% of world’s HIV-infected women 15-24 young women 8-fold increased risk
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Age Group (Years) HIV Prevalence (N=1237) ≤1610.6% 17-1821.3% 19-2033.0% 21-2244.3% 23-2451.1% HIV prevalence in pregnant women in rural Vulindlela, South Africa (2005-2008)
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BAT 24 coitally-related gel use –Insert 1 gel up to 12 hours Before sex, –insert 1 gel as soon as possible within 12 hours After sex, –no more than Two doses in 24 hours CAPRISA 004: 1% tenofovir gel Science 2010
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HIV infection rates in the tenofovir and placebo gel groups: Kaplan-Meier survival probability
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Antiretrovirals for HIV control SS and QA Abdool Karim, Lancet 2011
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Outline Historical perspective Prevalence, new infections, deaths Treatment Co-infections HIV Testing Prevention 1996 Newsweek Headline: “The End of AIDS?”
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Thank you! Photo Virot UNAIDS
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