1. The Global HIV/AIDS Epidemic Jennifer Kates, M.A., M.P.A. Vice President and Director, HIV Policy Kaiser Family Foundation KaiserEDU.org Tutorial April 2005

2. Well into the Third Decade: Key Points About the Global Epidemic Global pandemic – HIV/AIDS found throughout the world, in every region Earlier projections surpassed. HIV/AIDS on track to be the worst epidemic in history We may still be in the epidemic’s early phase HIV/AIDS is really multiple epidemics (different populations, levels, regions) Figure 1

3. Key Points Continued… Certain populations at particular risk – youth, women, men who have sex with men, injection drug users – but generalized epidemic in many countries Hardest hit countries are least equipped to respond Multi-sectoral impact, “collateral” effects: development and economic growth, education, food supply, communities, households, and individuals We know a lot and very little… Figure 2

4. Current Global Estimates Sources: UNAIDS, AIDS Epidemic Update, December 2004; World Health Organization, The World Health Report 2004. 39.4 million estimated to be living with HIV/AIDS worldwide 4.9 million new infections in 2004 (almost 14,000 each day) 3.1 million deaths in 2004 (more than 8,000 deaths per day) Most people with HIV/AIDS (95%) reside in low and middle income countries, where most AIDS-related deaths occur HIV is now the leading cause of death worldwide among those ages 15-59 Figure 3

5. People Estimated to be Living with HIV/AIDS, Global Totals, 1981-2004 Sources: UNAIDS, AIDS Epidemic Update, December 2004; UNAIDS, Data Request, November 2004. End 2004: 39.4 million Figure 4 ‘84 ‘88 ‘92 ‘96‘00 ‘04 ‘81 Years ‘86 ’90 ‘94‘98 ‘02

6. People Living with HIV/AIDS by Region, as Percent of Global Total, end of 2004 Source: UNAIDS, AIDS Epidemic Update, December 2004. Total = 39.4 million Figure 5 Sub-Saharan Africa South/South-East Asia Oceania Caribbean North Africa/Middle East Western Europe North America East Asia Eurasia Latin America <

7. People Newly Infected with HIV by Region, as Percent of Global Total, 2004 Source: UNAIDS, AIDS Epidemic Update, December 2004 Total = 4.9 million Figure 6 63%

8. Almost Two-Thirds of all People Living with HIV/AIDS are in Sub-Saharan Africa Sub-Saharan Africa 64% Rest of World 36% N = 39.4 Million Percent of Prevalence In 2004: 63% of new infections 74% of deaths South Africa – highest number of people living with HIV/AIDS (5.3m) Source: UNAIDS, 2004 Report on the Global AIDS Epidemic, July 2004; UNAIDS, AIDS Epidemic Update, December 2004. Figure 7

9. But Increasing Concern about the “Next Wave”: Large and Proximate Sources: CIA World Fact Book, 2004; Population Reference Bureau, 2004 World Data Sheet, 2004. World Population Rank, 2004: China (1) India (2) Russia (7) Rapidly growing epidemics; Projections of millions more infected Figure 8

10. Women as Percent of People* Living with HIV/AIDS, by Region, end of 2004 Ages 15-49 Source: UNAIDS, AIDS Epidemic Update, December 2004. Figure 9

11. Trends in Women as Percent of Global Total of People* Living with HIV/AIDS * Ages 15-49 Sources: UNAIDS, 2004 Report on the Global AIDS Epidemic, July 2004; UNAIDS, AIDS Epidemic Update, December 2004. Figure 10

12. Young People, Ages 15-24, as Percent of Adults* with HIV/AIDS, by Region, end of 2003 Ages 15-49. Sources: UNAIDS, 2004 Report on the Global AIDS Epidemic, July 2004; UNAIDS, Data Request, June 2004. Figure 11

13. Prevention Coverage for People with HIV/AIDS in Highly Affected Countries, 2001 Prevention of mother-to-child HIV transmission Voluntary counseling and testing Harm reduction for injecting drug users AIDS education Condoms Sources: UNAIDS, Financial Resources for HIV/AIDS Programs in Low- and Middle-income Countries Over the Next Five Years, UNAIDS/PCB(13)/02.5, November 2002; Global HIV Prevention Working Group, Access to HIV Prevention: Closing the Gap, May 2003. Percent at Risk with Access to Prevention Interventions: Figure 12 All

14. Antiretroviral Coverage for People with HIV/AIDS in Highly Affected Countries, 2004 Source: WHO, ’3 by 5’ Progress Report, December 2004. Percent on ARVs (of those who need them): Figure 13 All Americas Eurasia Western Pacific South-East Asia Africa Eastern Mediterranean

15. Challenges to Addressing the Epidemic Many lack basic information about HIV/AIDS Most people in low- and middle-income countries do not have access to key prevention and care services Lack of infrastructure, training, quality & monitoring systems, facilities etc. may impede access; other barriers include price, patent laws and other regulatory issues; and the impact of the epidemic on the health sector and health care workers Figure 14

16. Challenges continued… Collateral effects of the epidemic (epidemic exacerbates existing problems and vice versa) There are promising research directions – microbicides, vaccines – but a vaccine is still years away Resources…$$$ Figure 15

17. Resource Needs to Address Epidemic in Hard Hit Countries NEED & AVAILABLE FUNDING  UNAIDS estimates that approximately $12 billion is needed now, to effectively respond in resource poor settings, climbing to $20 billion annually by 2007  2004 global spending estimated at approximately $6.1 billion KEY INITIATIVES  The Global Fund to Fight AIDS, Tuberculosis, and Malaria has received $6.0 billion in pledges through 2008*  President’s Emergency Plan for AIDS Relief (PEPFAR)  World Health Organization’s 3x5 Initiative *Pledges as of March 1, 2005; Sources: UNAIDS, AIDS Epidemic Update, December 2004; Global Fund, 2005; WHO. Figure 16

18. The U.S. Government Response to the Global Epidemic U.S. funding began in 1986; has increased significantly since 1999 PEPFAR  $15 billion over 5 years (starting in FY 2004)  Almost $10 billion in new money, including $1 billion for Global Fund  15 country focus  Concrete goals: prevent 7 million, treat 2 million, care for 10 million Sources: White House, 2004; Kaiser Family Foundation, U.S. Government Funding for Global HIV/AIDS Through FY 2005, June 2004; Kaiser Family Foundation, Fact Sheet: Federal Funding for HIV/AIDS: The FY 2006 Budget Request, February 2005. Figure 17

19. U.S. Government Funding for Global HIV/AIDS, FY 2004-2006 *Proposed only. Sources: Kaiser Family Foundation, U.S. Government Funding for Global HIV/AIDS Through FY 2005, June 2004; Kaiser Family Foundation, Fact Sheet: Federal Funding for HIV/AIDS: The FY 2006 Budget Request, February 2005. Figure 18 Billions

20. Key Challenges & Questions for the U.S. Response How much? How fast? Where (hard hit countries “vs” next wave)? Bilateral vs. Multilateral (Global Fund) support “Earmarks” based on politics or public health? Collaboration with in-country and multilateral partners? What is the U.S. “fair share”? Figure 19

21. Key Challenges & Questions for the U.S. Response, cont. Where does new money come from? Short term (emergency) and long term Collateral impacts – how to address? Distributive & Absorptive capacity Measures of success? Combating skepticism and apathy, showing what works How to continue addressing epidemic at home Figure 20

22. Important to Remember – The “Projected Future” is NOT inevitable Care and treatment have reduced morbidity and mortality among people with HIV/AIDS in those countries with access Prevention success stories, including Senegal, Thailand, Uganda, Zambia, U.S. With a scaled up, global response, approximately 29 million new infections can be prevented by 2010 Figure 21

23. Projected Impact of the Epidemic With and Without Scaled-Up Prevention Source: Stover, et.al, “Can we reverse the HIV/AIDS pandemic with an expanded response?” The Lancet, Vol. 360, July 2002. Figure 22 200020022004200620082010 New infections (millions) No expanded response = 45 M Expanded response = 16 M Projected Number of New Infections 6.0 5.0 4.0 3.0 2.0 1.0 0.0