1. Global Impact of HIV/AIDS Deborah Lewinsohn, M.D. Infectious Diseases, Pediatrics Vaccine and Gene Therapy Institute Oregon Health & Science University

2. Goals Epidemiology of HIV/AIDS Impact on: –Health & Welfare –Work force/Economic stability –Vulnerable Groups: Women Youth (Education) Infants Interventions: Reversing the trend

3. Global summary of the HIV/AIDS epidemic, December 2004 Number of people living with HIV/AIDS Total39.4 million Adults37.2 million Women17.6 million Children under 15 years2.2 million People newly infected with HIV in 2004 Total4.9 million Adults4.3 million Women2 million Children under 15 years640 000 AIDS deaths in 2004 Total3.1 million Adults2.6 million Women1.2 million Children under 15 years510 000 Adapted from:

4. Adults and children estimated to be living with HIV/AIDS as of end 2004 Total: 39.4 million Western Europe 610 000 North Africa & Middle East 540 000 Sub-Saharan Africa 25.4 million Eastern Europe & Central Asia 1.4 million South & South-East Asia 7.1 million Australia & New Zealand 15 000 North America 1.0 million Caribbean 440 000 Latin America 1.5 million East Asia & Pacific 1.2 million Adapted from:

6. Estimated number of adults and children newly infected with HIV during 2004 Total: 4.9 million Western Europe 21 000 North Africa & Middle East 92 000 Sub-Saharan Africa 3.1 million Eastern Europe & Central Asia 210 000 East Asia & Pacific 290 000 South & South-East Asia 890 000 Australia & New Zealand500 North America 44 000 Caribbean 53 000 Latin America 150 000 Adapted from:

7. About 14 000 new HIV infections a day in 2002 More than 95% are in developing countries 2000 are in children under 15 years of age About 12 000 are in persons aged 15 to 49 years, of whom: — almost 50% are women — about 50% are 15–24 year olds Adapted from:

8. Estimated adult and child deaths from HIV/AIDS during 2004 Western Europe6500 North Africa & Middle East 28 000 Sub-Saharan Africa 2.3 million Eastern Europe & Central Asia 60 000 East Asia & Pacific 51 000 South & South-East Asia 490 000 Australia & New Zealand<100 North America 16 000 Caribbean 36 000 Latin America 95 000 Adapted from: Total: 3.1 million

9. Children (<15 years) estimated to be living with HIV/AIDS as of end 2002 Western Europe 5 000 North Africa & Middle East 40 000 sub-Saharan Africa 2.8 million Eastern Europe & Central Asia 16 000 East Asia & Pacific 4 000 South & South-East Asia 240 000 Australia & New Zealand < 200 North America 10 000 Caribbean 20 000 Latin America 45 000 Total: 3.2 million Adapted from:

10. Estimated deaths in children (<15 years) from HIV/AIDS during 2002 Western Europe < 100 North Africa & Middle East 6 800 sub-Saharan Africa 550 000 Eastern Europe & Central Asia < 100 East Asia & Pacific 2 000 South & South-East Asia 43 000 Australia & New Zealand < 100 North America < 100 Caribbean 7 000 Latin America 5 000 Total: 610 000 Adapted from:

11. Estimated number of children (<15 years) newly infected with HIV during 2002 Western Europe < 500 North Africa & Middle East 13 000 sub-Saharan Africa 720 000 Eastern Europe & Central Asia 1 000 East Asia & Pacific 3 000 South & South-East Asia 60 000 Australia & New Zealand < 100 North America < 500 Caribbean 7 000 Latin America 10 000 Total: 800 000 Adapted from:

12. Regional HIV/AIDS statistics and features, end of 2004 * The proportion of adults (15 to 49 years of age) living with HIV/AIDS in 2002, using 2002 population numbers ** Hetero: heterosexual transmission – IDU: transmission through injecting drug use – MSM: sexual transmission among men who have sex with men Adapted from: Epidemic started Adults & children living with HIV/AIDS Adults & children newly infected Adult prevalence rate Adult & child deaths % of HIV- positive adults who are women Main mode of transmission Sub-Saharan AfricaLate ‘70s Early ‘80s 25.4 million3.1 million7.42.3 million57%Hetero North Africa & Middle East Late ‘80s540,00092,0000.328,00048%Hetero, IDU South and South- East Asia Late ‘80s7.1 million890,0000.6490,00030%Hetero, IDU East Asia & PacificLate ‘80s1.1 million290,0000.151,00022%IDU, Hetero, MSM Latin AmericaLate ‘70s Early ‘80s 1.7 million240,0000.695,00036%MSM, IDU, Hetero CaribbeanLate 70s Early ‘80s 440,00053,0002.336,00049%Hetero, MSM Eastern Europe & Central Asia Early ‘90s1.4 million210,0000.860,00034%IDU Western EuropeLate ‘70s Early ‘80s 610,00021,0000.3650025%MSM, IDU North AmericaLate ‘70s Early ‘80s 1.0 million44,0000.616,00025%MSM, IDU, Hetero Total39.4 million4.9 million1.13.1 million50%

13. Sub-Saharan Africa: a heterogeneous epidemic * The proportion of adults (15 to 49 years of age) living with HIV/AIDS in 2002, using 2002 population numbers ** Hetero: heterosexual transmission – IDU: transmission through injecting drug use – MSM: sexual transmission among men who have sex with men Source: “AIDS Epidemic Update, December, 2004”, UNAIDS

14. Sub-Saharan Africa: Worse Case * The proportion of adults (15 to 49 years of age) living with HIV/AIDS in 2002, using 2002 population numbers ** Hetero: heterosexual transmission – IDU: transmission through injecting drug use – MSM: sexual transmission among men who have sex with men Southern Africa represents 30% of the world’s HIV-infected population,but only 2% of the world’s population Source: “AIDS Epidemic Update, December, 2004”, UNAIDS

15. Impact on Health and Welfare - Lifespan Life expectancy at birth is now < 40 years in 9 African countries (e.g. Zimbabwe: 1990 was 52 years, in 2003 was 34 years); 60 % of 15-year-olds will die before 60 years of age. The effect is greater on women than men. Source: “AIDS Epidemic Update, December, 2004”, UNAIDS

16. Impact on Health and Welfare – Poverty and Hunger AIDS-affected >> AIDS unaffected household suffer severe poverty; with AIDS income falls 66 – 80%. ↓ Income ↑ Medical & Funeral costs ↓ Food supply ↑ Food needs Poverty & Hunger Economic & Food Security Source: “AIDS Epidemic Update, December, 2004”, UNAIDS

17. Impact on Workforce and Economic Stability Source: “HIV/AIDS ad work: global estimates, impact and responses.” International Labor Office

18. Impact on Workforce and Economic Stability Source: “HIV/AIDS ad work: global estimates, impact and responses.” International Labor Office

19. Impact on Women Source: “AIDS Epidemic Update, December, 2004”, UNAIDS

20. Impact on Women –Transactional sex - Violence against women –Marriage as a risk factor - Age gap:old men/young women Source: “AIDS Epidemic Update, December, 2004”, UNAIDS Lack of education. Lack of empowerment.

21. Impact on Women ↑ Burden of care ↓ Education ↓ Access to prevention ↓Access to treatment ↓ Income Gender Gap Gender Equality Source: “AIDS Epidemic Update, December, 2004”, UNAIDS

22. Impact on Youth Direct threats to health (HIV infection) Indirect threats to health (orphanhood)

24. Impact on Youth Decreased access to education. –Need to work; lack of school fees. –Lack of teachers, public support of education.

25. Impact on Infants and Young Children

26. Global Impact of HIV/AIDS: Reversing the trend Success in Uganda: Government response. Education. Changed behavior Voluntary testing Treatment

27. Global Impact of HIV/AIDS: Reversing the trend Prevention strategies: National government response. Education about known preventive measures. Empowerment of women. Access to testing. Destigmatising HIV/AIDS

28. Global Impact of HIV/AIDS: Reversing the trend Prevention strategies: Access to treatment. Access to prophylactic treatment – preventing perinatal transmission. Vaccine development. www.UNAIDS.org

29. Resources www.unaids.org www.ilo.org/public/english/protection/t rav/aids/ www.cdc.gov/hiv