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Hunger / HDI | Public Health
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What's Inside

 

According to the report titled: AIDS at 30: Nations at the crossroads (2011), which has been brought out by UNAIDS, please click here to access:  

• The number of people living with HIV was around 34 million worldwide in 2010.

• There were 2.6 million new HIV infections worldwide in 2009.

• Between 1981 and 2000, the number of people living with HIV rose from less than one million to an estimated 27.5 million [26–29 million].

• Low- and middle-income countries accounted for 95% or more of the global HIV burden by 1998.

• While less than 1% of adults in South Africa were living with HIV in 1990, 16.1% were living with HIV a decade later. During the same period, adult HIV prevalence rose from less than 1% to 24.5% in Lesotho, and from 3.5% to 26% in Botswana.

• Half of HIV infections in Eastern Europe and Central Asia in 2010 were due to drug users sharing needles.

• Clinical trials show that male circumcision reduces the chance of men becoming HIV-positive by about 60%.

• Beginning in 2005, a series of randomized controlled trials in sub-Saharan Africa found that circumsising adult men reduced their risk of infection by about 60%.

• Scientific knowledge about HIV expanded steadily in the years 1981–2000. The virus was identified in 1983, and the first serologic test became available in 1985. In the 1990s, studies demonstrated in developed and low- and middle-income countries the possibility of significantly lowering the risk of vertical transmission.

• Today, 94% of countries (162 of 172 countries reporting) have national HIV strategic plans, up from 87% in 2006. The coordination of national responses also improved during the epidemic’s third decade. Two out of three (67%) countries in 2010 reported having a single HIV monitoring and evaluation system, up from 46% in 2006, although country reports cite insufficient coordination of diverse partners as a continuing challenge to national responses.

• According to the latest UNGASS reports, AIDS expenditures in 2009 totalled US$ 1.07 billion. Estimates based on the methodology suggested by the Commission on AIDS in Asia indicate that US$ 3.3 billion is needed for a targeted response across the region.

• There was a significant increase in investment in the HIV response in low- and middle-income countries between 2001 and 2009, with total expenditure rising nearly 10-fold, from US$ 1.6 billion to US$ 15.9 billion.

• Public and private domestic resources accounted for 52% of total spending on HIV programmes in low- and middle-income countries in 2009, but many low-income countries remain heavily dependent on external financing. In 56 countries, international donors supply at least 70% of HIV resources. This pattern potentially encourages the emergence of new global inequities, as millions of people in sub-Saharan Africa now rely on external donors on a daily basis for the drugs and services that keep them alive.

• The UNAIDS Domestic Investment Priority Index, a formula that accounts for total HIV burden and government resources, shows that eight of 14 countries in West and Central Africa, six of 16 countries in Eastern and Southern Africa, and all but four countries in Asia were allocating inadequate resources to HIV in  2009.

• According to research from nine countries under the People Living with HIV Stigma Index, 53% of Rwandans living with HIV have been verbally insulted, 33% of rural Zambians living with HIV have experienced physical violence, and 65% of Rwandans living with HIV have lost a job or income opportunity. Furthermore, women living with HIV from various countries report abuses of their sexual and reproductive health and rights. Nearly 20% of women in Namibia who participated in discussions and interviews with the International Community of Women Living with HIV (ICW), reported that they had been coerced or forced into sterilization. Such deep-seated social ostracism and discriminatory actions discourage people from being tested for HIV or seeking other needed services.

• Among young women in South Africa, experience of intimate partner violence increases the odds of becoming infected with HIV by 11.9%, while gender inequality within a relationship increases the risk by 13.9%, according to a study reported in The Lancet in 2010.

• According to the UNAIDS Global Report 2010, the proportion of countries reporting programmes to address stigma and discrimination increased from 39% in 2006 to 92% in 2010, although a budget for these programmes was in place in less than half of these countries.

• More than 56 countries have laws that specifically criminalize HIV transmission or exposure, with the majority of prosecutions reported in high-income countries. As of April 2011, 47 countries, territories and areas imposed some form of restriction on the entry, stay and residence of people living with HIV. However, in a more positive development, China, Namibia and USA lifted their HIV-related travel restrictions in 2010, while Ecuador and India clarified that no such restrictions were in place.

• In 116 countries, territories and areas, some aspect of sex work is criminalized. Seventy-nine countries and territories worldwide criminalize consensual same-sex sexual relations, including 85% of countries in Eastern and Southern Africa, 81% in the Middle East and North Africa, and 69% in the Caribbean.

• Thirty-two countries have laws that allow for the death penalty for drug-related offences, and 27 provide for the compulsory detention of people who use drugs, often without due process or minimum standards of detention or treatment. Such laws, as well as abusive law enforcement and poor access to legal services, deter individuals from seeking needed services, increase their vulnerability to becoming HIV-positive, and intensify their social isolation.

• As of December 2010, an estimated 6.6 million people in low- and middle-income countries were receiving antiretroviral therapy, an increase of 1.4 million from a year earlier. Between 2001 and 2010, the number of people receiving antiretroviral treatment rose nearly 22-fold, a vivid illustration of the power of international solidarity, innovative approaches and people-centred responses.

• In sub-Saharan Africa the number of people receiving antiretroviral treatment in 2010 increased by 31%; in the Middle East and North Africa, that figure was 21%.

• As of December 2009, seven countries had already reached at least 80% of treatment-eligible individuals with antiretroviral treatment. Eighteen countries reported treatment coverage of at least 60%.

• Since its emergence in 1996, highly active anti retroviral therapy has saved an estimated 14.4 million life years worldwide as of December 2009. Although 54% of life-years saved between 1995 and 2009 were in Western Europe and North America, where antiretroviral therapy has long been available, 3.7 million life-years have been saved in sub-Saharan Africa. The pace of reducing morbidity and mortality in sub-Saharan Africa has accelerated since 2005 as a result of dramatic programme scale-up.

• In 2009, nearly one in five people (18%) who started antiretroviral therapy in low- and middle-income countries were no longer in care 12 months later.

• At present, more than 95% of patients on treatment are on first-generation antiretroviral medicines, the majority of which are off-patent. As drug resistance increases over time, more patients will require second- and third-generation medicines. Most of these more recent medicines will remain under patent protection for years to come, resulting in potentially drastic increases in treatment costs. This can be alleviated to a large extent by making use of the flexibilities of public health related TRIPS (trade-related aspects of intellectual property rights). In March 2011, UNAIDS, WHO and UNDP issued a policy brief calling on all countries to use TRIPS flexibilities to lower costs and improve access to HIV treatment. By 2005, five years after affordable means of preventing vertical transmission became available, only 15% of HIV-positive pregnant women in low- and middle-income countries received antiretroviral prophylaxis.

• More than 50% of pregnant women who tested positive for HIV in 2010 were assessed for their eligibility to receive antiretroviral therapy for their own health. These gains in reducing vertical transmission have helped to reduce childhood mortality. The number of children newly infected with HIV in 2009 (370 000 [230 000–510 000]) was 26% lower than in 2001.

• According to the most recent population-based surveys in low- and middle-income countries with available data, only 24% of young women and 36% of young men responded correctly when asked five questions about HIV prevention methods and popular misconceptions about HIV transmission. Young women tend to be less likely than young men to be aware of the prevention benefits of consistent condom use. When prompted, 74% of young males in DHS surveys knew that using a condom helps to prevent HIV infection, while only 49% of young females knew the right answer. Some 78% of young males also knew that having a single, faithful partner lowers the risk of HIV infection, compared to only 59% of young females.

• In 14 countries where HIV prevalence exceeds 2% and where nationally representative data are available, more than 70% of men and women who had high-risk sex in the past year report not using a condom the last time they had sex.

• Globally, HIV prevalence levels above those reported in the general population have been documented among men who have sex with men (MSM), transgender people, people who inject drugs (IDUs), and sex workers.

• According to the most recently available data, the proportion of countries reporting that they conduct systematic surveillance of HIV among key populations increased between 2008 and 2010: for sex workers, from 44% to 50%; for MSM, from 30% to 36%; while among IDUs it remained stable at 28%.

• An estimated 20% of the 15.9 million IDUs worldwide are living with HIV. This statistic underscores the world’s failure to put the lessons of harm reduction to use. In at least 69 countries where injecting drug use has been documented, no programme to provide even sterile needles and syringes exists.

• The epidemic among MSM communities is a worldwide phenomenon, with 63 out of 67 countries reporting in 2009 a higher HIV prevalence among MSM compared with the general population.

• At least 79 countries, territories and areas have laws against male–male sexual contact, including some that authorize the death penalty.

• Among 56 countries reporting in both 2008 and 2010, median condom use with the most recent client reached 84%, with a range from about two thirds to nearly 100%.

• According to recent estimates, HIV is a leading cause of pregnancyrelated deaths, accounting for about 11% of all maternal deaths in 2008.

• HIV-positive newborns have about a 50% risk of death before age two in the absence of treatment.

• In 2009, HIV accounted for 2.1% (1.2–3.0%) of under-five deaths in low- and middle-income countries, a decline from 2.6% (1.6–3.5%) in 2000.

• In sub-Saharan Africa, HIV was responsible for 3.6% (2.0–5.0%) of all deaths in children under five in 2009. Here, too, striking achievements are evident, as the HIV share of all under-five deaths has sharply fallen from the 5.4% (3.3%–7.3%) reported in 2000.

• Universal access to effective prevention, diagnosis and treatment for HIV-related tuberculosis (TB) could prevent up to one million TB deaths in people living with HIV between now and 2015, but the world is falling far short of this target.

• Only 28% of TB patients globally knew their HIV status in 2009, and only 5% of people living with HIV were screened for TB. Although early initiation of antiretroviral therapy significantly reduces the risk of death among HIV-positive people with TB, only 37% of these HIV-positive TB patients got HIV therapy in 2009.

• According to data compiled by WHO, 10 countries accounted for more than 69% of all people with HIV-related TB in 2009.

• 25% of all TB deaths are in people with HIV, and there are one million cases of TB in people with HIV a year.

• Between 2001 and 2009, global HIV incidence steadily declined, with the annual rate of new infections falling by nearly 25%.

• Above-average declines in HIV incidence have occurred in sub-Saharan Africa and in South and South-East Asia, while Latin America and the Caribbean and Oceania regions experienced more modest reductions of less than 25%.

• Rates of new infections have remained relatively stable in East Asia, Western and Central Europe, and North America. HIV incidence has steadily increased in the Middle East and North Africa, while in Eastern Europe and Central Asia, a decline in new infections was reversed mid-decade, with incidence rising slightly from 2005 to 2009.

• Coverage of services to prevent new child infections increased from 15% in 2005 to 54% in 2009. The HIV incidence rate declined by more than 25% between 2001 and 2009. Antiretroviral treatment coverage is increasing.

• Some 22.5 million people now live with HIV in Africa. The majority (60%) are women and girls. HIV prevalence is as high as 25% in some countries, and the rate of people becoming newly infected outpaces treatment access. Of the 16.6 million children globally who have lost one or both parents to an AIDS-related illness, 14.9 million are in Africa.

• The Asia Pacific region has made significant progress in controlling HIV’s spread. The number of people living with HIV has remained stable for the past five years and estimated new infections are 20% lower than in 2001. Thailand, Cambodia and certain parts of India have turned their epidemics around by providing quality services to their key populations at higher risk.

• In 2009, median reported prevention coverage for people who inject drugs was 17%; for men who have sex with men 36.5%; and for female sex workers 41%. Programmes in key affected populations to prevent transmission to intimate sexual partners are severely lacking.
 

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