25 years of AIDS

06/06 e 2006 Report on the

global AIDS epidemicFig

25 years of AIDS25 years of AIDS

9 In 1991-1993, HIV prevalence in young pregnant women in Uganda and in young men in Thailand begins to decrease, the first major downturns in the epidemic in developing countries

10 Highly Active Antiretroviral Treatment launched

11 Scientists develop the first treatment regimen to reduce mother-to-child transmission of HIV

12 UNAIDS is created13 Brazil becomes the first developing

country to provide antiretroviral therapy through its public health system

14 The UN General Assembly Special Session on HIV/AIDS. Global Fund to fight AIDS, Tuberculosis and Malaria launched

15 WHO and UNAIDS launch the "3 x 5" initiative with the goal of reaching 3 million people in developing world with ART by 2005

16 Global Coalition on Women and AIDS launched

40

30

20

10

0

50

35

25

15

5

45

Mill

ion

1980 1985 1990 1995 2000 2005

1 2 3 45 6

8

9

11

12

13

1415

16

7

10

1 First cases of unusual immune deficiency are identified among gay men in USA, and a new deadly disease noticed

2 Acquired Immune Deficiency Syndrome (AIDS) is defined for the first time

3 The Human Immune Deficiency Virus (HIV) is identified as the cause of AIDS

4 In Africa, a heterosexual AIDS epidemic is revealed

5 The first HIV antibody test becomes available6 Global Network of People living with HIV/AIDS

(GNP+) (then International Steering Committee of People Living with HIV/AIDS) founded

7 The World Health Organisation launches the Global Programme on AIDS

8 The first therapy for AIDS – zidovudine, or AZT -- is approved for use in the USA

People People living living with HIVwith HIV

Children Children orphaned orphaned by AIDS in by AIDS in sub-Saharan sub-Saharan AfricaAfrica

1.1



Adult (aged 15‒49 years) HIV prevalence (%) in countries in sub-Saharan Africa Adult (aged 15‒49 years) HIV prevalence (%) in countries in sub-Saharan Africa which have conducted population-based HIV surveys in recent yearswhich have conducted population-based HIV surveys in recent years

Median HIV prevalence (%) among women

attending antenatal clinics

2003‒2004*

Population-based survey prevalence (%)

(year)

2003 HIV prevalence

(%) reported in 2004 Report on the global

epidemic

Adjusted 2003 HIV

prevalence (%) in current

report

2005 HIV prevalence

(%) in current report

Trend in prevalence

Botswana Stable38.5 25.2 (2004) 38.0 24.0 24.1Burkina Faso Decline in urban areas2.5 1.8 (2003) 4.2 2.1 2.0Burundi Decline in capital city4.8 3.6 (2002) 6.0 3.3 3.3Cameroon Stable7.3† 5.5 (2004) 7.0 5.5 5.4Ethiopia Decline in urban areas8.5 1.6 (2005)§ 4.4 (1.0‒3.5) (0.9‒3.5)Ghana Stable3.1 2.2 (2003) 3.1 2.3 2.3Guinea Stable4.2 1.5 (2005) 2.8 1.6 1.5Lesotho Stable28.4 23.5 (2004) 29.3 23.7 23.2

Sierra Leone Stable3.0 1.5 (2005) - 1.6 1.6

Rwanda Decline in urban areas4.6 3.0 (2005) 5.1 3.8 3.1Senegal Stable1.9 0.7 (2005) 0.8 0.9 0.9

South Africa Increasing29.5 16.2 (2005) 20.9 18.6 18.8UR Tanzania Stable7.0 7.0 (2004) 9.0 6.6 6.5Uganda Stable6.2‡ 7.1 (2004‒5) 4.1 6.8 6.7

* WHO Africa (2005). HIV/AIDS epidemiological surveillance report for the WHO African region, 2005 Update. Harare† Estimate based on country report for 2002 (2003). Ministry of Public Health Cameroon. National HIV sentinel surveillance report 2002.‡ Estimate based on country report for 2002 (2003). Ministry of Health Uganda. STD/HIV/AIDS surveillance report. STD/AIDS control programme. Kampala§ Preliminary result. Additional analysis is ongoing.

2.1



Global HIV epidemic, 1990‒2005* HIV epidemic in sub-Saharan Africa, 1985‒2005*

Number of people living with HIV% HIV prevalence, adult (15-49)

% HIV prevalence, adult (15‒49)

Number of peopleliving with HIV (millions)

0

10

20

30

40

50

1990 1995 2000 20050.0

1.0

2.0

3.0

4.0

5.0

1985 1990 1995 2000 20050

5

10

15

20

25

30

0.0

2.5

5.0

7.5

12.5

15.0

% HIV prevalence, adult (15‒49)

Number of peopleliving with HIV (millions)

Estimated number of people living with HIV and adult HIV prevalenceEstimated number of people living with HIV and adult HIV prevalence

This bar indicates the range around the estimate

*Even though the HIV prevalence rates have stabilized in sub-Saharan Africa, the actual number of people infected continues to grow because of population growth. Applying the same prevalence rate to a growing population will result in increasing numbers of people living with HIV.

10.0

2.2



Regional HIV and AIDS statistics and features, 2003 and 2005Regional HIV and AIDS statistics and features, 2003 and 2005

2.7 million[2.3‒3.1 million]

64 000[38 000‒210 000

930 000[620 000‒2.4 million]

7200[3500‒55 000]

140 000[100 000‒420 000]

37 000[26 000‒54 000]

220 000[150 000‒650 000]

65 000[52 000‒98 000]


37 000[20 000‒62 000]

600 000[400 000‒850 000]

3400[1900‒5500]

59 000[47 000‒76 000]

27 000[19 000‒36 000]

53 000[36 000‒75 000]

30 000[24 000‒45 000]


440 000[250 000‒720 000]


78 000[48 000‒170 000]


330 000[240 000‒420 000]




380 000[220 000‒620 000]


66 000[41 000‒140 000]


310 000[230 000‒400 000]

1.1 million[790 000‒1.7 million]



54 000[31 000‒150 000

860 000[560 000‒2.3 million]

9000[4300-69 000]

130 000[95 000‒310 000]

34 000[24 000‒47 000]

160 000[110 000‒440 000]

65 000[52 000‒98 000]

6.1[5.4‒6.8]

0.2[0.1‒0.4]

0.4[0.3‒0.6]

0.3[0.2‒0.8]

0.5[0.4‒1.2]

1.6[1.1‒2.2]

0.8[0.6‒1.4]

0.5[0.4‒0.7]

6.2[5.5‒7.0]

0.2[0.1‒0.3]

0.4[0.2‒0.6]

0.3[0.2‒0.7]

0.5[0.4‒0.7]

1.5[1.1‒2.0]

0.6[0.4‒1.0]

0.5[0.3‒0.6]


34 000[18 000‒57 000]

500 000[340 000‒710 000]

2300[1300‒3600]

51 000[40 000‒67 000]

28 000[19 000‒38 000]

28 000[19 000‒39 000]

30 000[24 000‒45 000]

Sub-Saharan Africa

North Africa and Middle East

Asia

Oceania

Latin America

Caribbean

Eastern Europe and Central AsiaNorth America, Western and Central Europe






1.0[0.9‒1.2]

1.0[0.8‒1.2]


TOTAL

Adults (15+) and children living with HIV

2005 2003

Adults (15+) and children newly infected with HIV

Adult (15-49) prevalence (%)

2005 2003

Adult (15+) and child deaths due to AIDS

2005 2003 2005 2003

REGION

2.3



A global view of HIV infectionA global view of HIV infection38.6 million people [33.4‒46.0 million] living with HIV, 2005

2.4



HIV prevalence (%) in adults in Africa, 2005HIV prevalence (%) in adults in Africa, 2005

2.5



Southern Africa

HIV prevalence (%) among pregnant women attending antenatal clinics HIV prevalence (%) among pregnant women attending antenatal clinics in sub-Saharan Africa, 1997/98‒2004in sub-Saharan Africa, 1997/98‒2004

West Africa

1997‒1998

1999‒2000

2001 2002 2003 20040

5

10

15

20

Med

ian

HIV

pre

vale

nce

(%)

Burkina Faso Côte d'Ivoire

GhanaSenegal

1997‒1998

1999‒2000

2001 2002 2003 20040

10

20

30

40

Med

ian

HIV

pre

vale

nce

(%) 50

MozambiqueSouth Africa

Swaziland

Zimbabwe

Note: Analysis restricted to consistent surveillance sites for all countries except South Africa (by province) and Swaziland (by region)

Sources: Ministry of Health (Mozambique); Department of Health (South Africa); Ministry of Health and Social Welfare (Swaziland); Ministry of Health and Child Welfare (Zimbabwe); Adapted from Asamoah-Odei, et al. HIV prevalence and trends in sub-Saharan Africa: no decline and large subregional differences. Lancet, 2004 (Ethiopia); Ministry of Health—National AIDS/STD Control Programme (Kenya); Ministry of Health (United Republic of Tanzania); Conseil national de lutte contre le sida et les IST (Burkina Faso); Centers for Disease Control and Prevention (CDC)—GAP—Côte d'Ivoire (Côte d'Ivoire); Ghana Health Service (Ghana); Conseil National de Lutte Contre le SIDA (Senegal).

1997‒1998

1999‒2000

2001 2002 2003 20040

5

10

15

20

Med

ian

HIV

pre

vale

nce

(%)

Eastern Africa

EthiopiaKenya

United Republic of Tanzania

2.6



HIV prevalence (%) by gender and urban/rural residence, HIV prevalence (%) by gender and urban/rural residence, selected sub-Saharan African countries, 2001‒2005selected sub-Saharan African countries, 2001‒2005

0

10

20

30

%

15‒49 years old,by gender

Lesotho South Africa

Zambia Kenya Uganda URTanzania

BurkinaFaso

Ghana Guinea Senegal

Urban Rural

Women Men

Women Men

0

10

20

30

%

15‒24 years old,by gender

0

10

20

30

%

15‒49 years old,by urban/rural residence

South East West

Sources: Demographic and Health Survey reports (Lesotho, Zambia, Kenya, Burkina Faso, Ghana, Guinea and Senegal) (2001–2005). Nelson Mandela Foundation (South Africa) (2005). Ministry of Health (Uganda). Tanzania Commission for AIDS (UR Tanzania) (2005). 2.7



HIV prevalence (%) in adults in Asia and Oceania, 2005HIV prevalence (%) in adults in Asia and Oceania, 2005

2.8



HIV prevalence (%) trends in India among injecting drug users HIV prevalence (%) trends in India among injecting drug users and pregnant women, selected areas, India, 1998–2004*and pregnant women, selected areas, India, 1998–2004*

AntenatalClinic attendees

Antenatalclinicattendees

Injectingdrugusers

1998 1999 2000 2001 2002 2003 2004

%

0.01.02.03.04.05.0

1998 1999 2000 2001 2002 2003 2004

%

0.00.30.60.91.21.5

1998 1999 2000 2001 2002 2003 2004

%

0.03.06.09.0

12.015.0

Andhra PradeshKarnatakaMaharashtraTamil Nadu

Madhya PradeshMizoramUttar PraheshWest Bengal

DelhiMizoramWest Bengal

2.9

*Data from consistent surveillance sites only.



HIV prevalence trends among pregnant women in major cities HIV prevalence trends among pregnant women in major cities in Cambodia, Myanmar and Thailand, 1990–2004in Cambodia, Myanmar and Thailand, 1990–2004

Phnom Penh Mandalay and Yangon Bangkok

Sources: Cambodia National Center for HIV/AIDS, Dermatology and STDs (Phnom Penh); Myanmar Ministry of Health (Mandalay and Yangon); Thailand Ministry of Public Health (Bangkok), 2005.

19901999 2003

20040.0

1.0

2.0

3.0

4.0

5.0

19931994

19951996

19971998 2000

20012002

19911992

% HIV prevalence

2.10



HIV prevalence (%) trends among injecting drug users HIV prevalence (%) trends among injecting drug users in Bangladesh, Pakistan and the Philippines, 1998–2005*in Bangladesh, Pakistan and the Philippines, 1998–2005*

* Other sites in Bangladesh and Pakistan continue to show very low HIV prevalence in their latest surveillance surveys (0% in 13 sites in Bangladesh, and 0.5% in Lahore, Pakistan)

Pakistan [Karachi]

2003 20040%

10%

20%

30%

Bangladesh

1998–1999

1999–2000

2000–2001

2002 2003–2004

2004–2005

0%

2%

4%

6%

Northwest F1

Central A

Southeast D

Philippines [Cebu City]

2002 2003 2004 20050%

2%

4%

6%

0.0 0.0

Sources: 2005 Integrated HIV Behavioral and Serologic Surveillance Findings, Summary Report. National Epidemiology Center, Department of Health (Philippines); National HIV Serological Surveillance, 2004-2005, 6th Round Technical Report. Natonal AIDS/STD Programme, Ministry of Health and Family Welfare (Bangladesh); National Study of Reproductive Tract and Sexually Transmitted Infections, Survey of High Risk Groups in Lahore and Karachi, 2005. National AIDS Control Program, Ministry of Health (Pakistan) 2.11



Increase in reported HIV cases in the Russian Federation Increase in reported HIV cases in the Russian Federation and Ukraine, 1987–2005and Ukraine, 1987–2005

1987 1989 1991 1993 1995 1997 1999 2001 2003 20050

50 000

100 000

150 000

200 000

250 000

300 000

350 000

400 000

30 000

45 000

60 000

75 000

90 000

105 000

120 000

15 000

0

Reported HIV cases in the Russian Federation

Reported HIV cases in Ukraine

Russian Federation

Newly reported cases

Cumulative (previous years)

Ukraine

Newly reported cases

Cumulative (previous years)

2.12Sources: Russian Federal AIDS Centre; Ukranian AIDS Centre and Ministry of Health of Ukraine



HIV prevalence (%) in adults in Latin America and the Caribbean, 2005

2.13



HIV prevalence (%) among female sex workers HIV prevalence (%) among female sex workers and men who have sex with men in Latin America, 1999–2002and men who have sex with men in Latin America, 1999–2002

Provinces (7 cities)

La Paz

Santa CruzBorder cities

with Argentina

Santiago

Bogotá

Argentina

Bolivia

Chile

Colombia

0.0

% HIV prevalence

0 5 10 15 20 25 30

Buenos Aires Quito

Guayaquil

Other city ports (4)

Asunción and 4 other cities

Lima

Provinces

Montevideo

Border citieswith Brazil

Isla Margarita

Ecuador

Paraguay

Peru

Uruguay

Venezuela 0.0

% HIV prevalence

0 5 10 15 20 25 30

Female sex workers Men who have sex with men

2.14Source: Montano SM et al., JAIDS (2005).



50% coverage (3 million people on treatment)

21 countries achieved this Global target not achieved

Percentage of people with advanced HIV infection receiving antiretroviral therapy****

9% (Country range: 1%‒59% coverage), (n=41)

Percentage of youth aged 15‒24 who correctly identify ways of preventing HIV transmission and who reject major misconceptions about HIV transmission**

US$ 7.0 billion‒US$ 10.0 billionGlobal target achieved

US$ 8 297 000 000Estimated range: US$ 7.5 billion‒US$ 8.5 billion

MALE: 33% (Country range: 7%‒50% coverage), (n=16)FEMALE: 20% (Country range: 8%‒44% coverage), (n=17)

Total annual expenditure*

Percentage of HIV-positive pregnant women receiving antiretroviral prophylaxis***

2005 Country progress towards 2001 Declaration of Commitment 2005 Country progress towards 2001 Declaration of Commitment on HIV/AIDS—Global targets (low- and middle-income countries)on HIV/AIDS—Global targets (low- and middle-income countries) [First of 2 slides]

90% coverage No country achieved this

80% coverage No country achieved this

20% (Country range: 1%‒100% coverage), (n=116) 1 300 000 people on treatment

GLOBAL RESULTS 2005 GLOBAL TARGETS 2005

* See ‘Financing’ chapter** Demographic and Health Survey/AIDS Indicator Survey, 2001‒2005 (MEASURE DHS, 2006)*** Stover et al. (2006)**** “3 by 5” Report (WHO/UNAIDS, 2006) 3.1a



2005 Country progress towards 2001 Declaration of Commitment 2005 Country progress towards 2001 Declaration of Commitment on HIV/AIDSon HIV/AIDS——Global targets (low- and middle-income countries)Global targets (low- and middle-income countries) [Last of 2 slides]

GLOBAL RESULTS 2005 GLOBAL TARGETS 2005

26% of infants born to HIV-infected mothers were also infected (n=33 most affected countries)In 2001, approximately 30% of infants were infected. There has been an estimated 10% reduction in HIV transmission between 2001 and 2005.

Estimated percentage of infants born to HIV-infected mothers who are infected in 2005******

20% reduction 11 of the most affected countries

achieved this

25% reduction in most affected countries

6 of the most affected countries achieved this

MALES: 1.4% (Measure of uncertainty: 1.1%‒1.8%), (n=54) FEMALES: 3.8% (Measure of uncertainty: 3.0%‒4.7%), (n=54)No comparable global data on this age cohort is available from 2001. Progress towards target can only be measured in individual countries.

Percentage of young males and females, aged 15‒24, who are HIV infected*****

***** UNAIDS/WHO 2005 Estimates for countries with generalized epidemics****** UNAIDS/WHO 2005 Estimates 3.1b



Access to mother-to-child prevention services (all pregnant

women)

Comparison of 2003 and 2005 data on the coverage Comparison of 2003 and 2005 data on the coverage of antiretroviral therapy, access to mother-to-child prevention services of antiretroviral therapy, access to mother-to-child prevention services

and coverage of HIV-infected mothers who received antiretroviral prophylaxis and coverage of HIV-infected mothers who received antiretroviral prophylaxis to prevent mother-to-child transmissionto prevent mother-to-child transmission

Coverage of antiretroviral therapy

7.0

20.0

0

5

10

15

20

25

2003 2005

%7.6

9.0

0

5

10

15

20

25

2003 2005

%

Coverage of HIV-infected mothers who received antiretroviral prophylaxis

3.3

9.2

0

5

10

15

20

25

2003 2005

%

Sources: WHO/UNAIDS (2006). Progress on global access to HIV antiretroviral therapy: a report on “3 by 5” and beyond; USAID et al. (2006). Coverage of selected services for HIV/AIDS prevention, care and support in low and middle income countries in 2003 and 2005. 3.2



Coverage of HIV-infected mothers who received antiretroviral prophylaxis

Comparison of 2003 and 2005 data on the expansion of antiretroviral therapy Comparison of 2003 and 2005 data on the expansion of antiretroviral therapy and coverage of HIV-infected mothers who received antiretroviral prophylaxis and coverage of HIV-infected mothers who received antiretroviral prophylaxis

in three sub-Saharan African countriesin three sub-Saharan African countries

Coverage of antiretroviral therapy

30

40

50

60

%

20

10

0Kenya UgandaNamibia

1.07.0 4.6

9.3

25.0

12.0

30

40

50

60

%

20

10

0Kenya UgandaNamibia

3.00.0

6.3

19.7

35.0

56.0

2003 2005

3.3Sources: Individual country reports (2005).



Comprehensive knowledge about HIV and AIDS Comprehensive knowledge about HIV and AIDS among young males aged 15–24, by level of education, among young males aged 15–24, by level of education,

in 11 sub-Saharan African countries, 2000–2004in 11 sub-Saharan African countries, 2000–2004

Sources: Demographic and Health Surveys; HIV/AIDS Indicator Surveys (2000–2004).

01020304050607080

BurkinaFaso Cameroon

GhanaKenya

MaliMozambique

NamibiaNigeria

RwandaUganda

Zambia

%

No education Primary education Secondary education and beyond

3.4



Comprehensive knowledge about HIV and AIDS Comprehensive knowledge about HIV and AIDS among young females aged 15–24, by level of education, among young females aged 15–24, by level of education,

in 11 sub-Saharan African countries, 2000–2004in 11 sub-Saharan African countries, 2000–2004

Sources: Demographic and Health Surveys; HIV/AIDS Indicator Surveys (2000–2004).

01020304050607080

BurkinaFaso Cameroon

GhanaKenya

MaliMozambique

NamibiaNigeria

RwandaUganda

Zambia

%

No education Primary education Secondary education and beyond

:

3.5



Percentage of young people aged 15–24 reporting the use of a condom during Percentage of young people aged 15–24 reporting the use of a condom during sexual intercourse with a non-regular partnersexual intercourse with a non-regular partner, , Sub-Saharan Africa, 2001–2005Sub-Saharan Africa, 2001–2005

MaleFemale

Countries with date of survey indicated

1000 10 20 30 40 50 60 70 80 90

%

Benin 2001Botswana 2001

Burkina Faso 2003Cameroon 2004

Chad 2004Ghana 2003Guinea 2005Kenya 2003

Lesotho 2004Madagascar 2003

Malawi 2004Mali 2001

Mozambique 2003Nigeria 2003

Rwanda 2004Senegal 2005

United Republic of Tanzania 2003Uganda 2004Zambia 2003

Sources: Demographic Health Surveys; HIV/AIDS Indicator Surveys (2001-2005).3.6



Median percentage of most-at-risk populations reached Median percentage of most-at-risk populations reached with prevention programmes and those who received HIV testing with prevention programmes and those who received HIV testing

in the last 12 months and who knew their resultsin the last 12 months and who knew their results

Sex workers Men who have sex with men Injecting drug users

0

10

20

30

40

50

Percentage who received HIV testing and who knew their results

Percentage reached with prevention programmes

%

42% (n=13)

19% (n=10)23% (n=10)

17% (n=10)

38% (n=9)

28% (n=10)

3.7



Estimated total annual resources available for AIDS, 1996‒2005Estimated total annual resources available for AIDS, 1996‒2005

2921623

8297*

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

US$

mill

ion

Signing of Declaration of Commitment on HIV/AIDS

Data include:

• International donors, domestic spending (including public spending and out-of-pocket expenditures)

• International Foundations and Global Fund included from 2003 onwards, PEPFAR included from 2004 onwards

* Projections based on previous pledges and commitments (range of the estimation: US$7.5 to US$8.5 billion).

3.8



Per capita HIV and AIDS expenditures by country income level*Per capita HIV and AIDS expenditures by country income level*

0.0

0.5

1.0

1.5

2.0

2.5

2000 2001 2002 2003 2004 2005

US$ per capita

Low income

Lower middle

Higher middle

Low income SSA

• Trends based on a sample of 25 countries from sub-Saharan Africa and 57 countries from other regions

3.9



Progress towards achieving the “Three Ones”: Percentage of countries with Progress towards achieving the “Three Ones”: Percentage of countries with one national coordinating body, one national HIV/AIDS strategy or framework one national coordinating body, one national HIV/AIDS strategy or framework

and one national monitoring and evaluation planand one national monitoring and evaluation plan

50

9085

0

20

40

60

80

100

National body National framework National monitoringand evaluation plan

%

3.10



Impact of AIDS on life expectancy in five African countries, 1970–2010Impact of AIDS on life expectancy in five African countries, 1970–2010

Life expectancy at birth (years)

Source: United Nations Population Division (2004). World Population Prospects: The 2004 Revision, database.

Botswana

South Africa

Swaziland

Zambia

Zimbabwe

1970–1975 1975–1980

1980–19851985–1990

1990–19951995–2000

2000–20052005–2010

7065

60

55

50

45

4035

30

25

20

4.1



Percentage of distribution of deaths by age in southern Africa, Percentage of distribution of deaths by age in southern Africa, 1985–1990 and 2000–20051985–1990 and 2000–2005

0–4 5–19 20–29 30–39 40–49 50–59 60+

40

35

30

25

20

15

10

5

0

1985-1990 2000-2005

Percentage of total deaths

Age-groups:

Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat (2005). World Population Prospects: The 2004 Revision. Highlights. New York: United Nations. 4.2



Wealth, poverty and HIV: Wealth, poverty and HIV: countries grouped by region and HIV prevalencecountries grouped by region and HIV prevalence

01020304050607080

over 20

%

10-205-101-5LatinAmerica

andCaribbean

Asia*AfricaAll (48)

% of population living on less that $1 per day

Relative income of richest 10% to poorest 10% *except Japan

Industrializedcountries

Countries with HIV prevalenceover 1.9% in 2002

Countries according to level ofHIV prevalence in 2001 (%)

Source: UN Population Division( 2005a). Most figures relate to 2002, or earlier.4.3



Violations of reproductive rights—Violations of reproductive rights—women surveyed in four Asian countrieswomen surveyed in four Asian countries

India Indonesia Philippines Thailand Total

70

60

50

40

30

20

10

0

%

Mandatory HIV testing during pregnancy or due to illness of childCoerced into abortion due to HIV statusAdvised not to have a child since HIV-positive diagnosis

Source: Paxton S, et al. (2005) AIDS-related discrimination in Asia. 4.4



TB notification rate in 20 African countries* versus HIV prevalence TB notification rate in 20 African countries* versus HIV prevalence in sub-Saharan Africa, 1990–2004in sub-Saharan Africa, 1990–2004

Sources: World Health Organization (2006), Global TB database; UNAIDS (2006)

• Consistently reporting each year: Algeria, Angola, Botswana, Cameroon, Comoros, Congo, Côte d'Ivoire, Democratic Republic of Congo, Ghana, Guinea, Kenya, Malawi, Mauritius, Mozambique, Nigeria, Senegal, South Africa, Uganda, United Republic of Tanzania, Zimbabwe

020406080

100120140160180200

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 20040

1

2

3

4

5

6

7

8

TB notification rate

TB notification rate per 100,000 population

% Adult HIV prevalence (15-49)

HIV prevalence

4.5



Estimated impact of AIDS on under-five mortality rates 2002–2005, Estimated impact of AIDS on under-five mortality rates 2002–2005, selected countries in sub-Saharan Africaselected countries in sub-Saharan Africa

Without AIDS With AIDS

Sources: UNICEF (2005); United Nations Population Division, World Population Prospects: The 2004 Revision, database.

Deaths per 1,000 live births

117

173

143

74

78

123

118

106

78

142

73

43

43

71

98

42

0 20 40 60 80 100 120 140 160 180 200

Botswana

Kenya

Lesotho

Namibia

South Africa

Swaziland

Zambia

Zimbabwe

4.6



Source: Roeland Monasch and J. Ties Boerma, Orphanhood and childcare patterns in sub-Saharan Africa: an analysis of national surveys from 40 countries. AIDS 2004, 18 (suppl 2): S55-S65.

Impact of orphanhood on school attendance Impact of orphanhood on school attendance among 10–14-year-olds (%)among 10–14-year-olds (%)

West

(9 countries)Central

(6 countries)Eastern

(9 countries)Southern

(10 countries)All

(34 countries)

Percentage in school Non-orphans Orphans Double orphans

675857

756958

705449

888480

746964

Ratios Double vs. non-orphans Boys Girls

0.860.960.91

0.940.960.94

0.720.820.88

0.900.930.96

0.870.940.93

4.7



Projected reduction in African agricultural labour force Projected reduction in African agricultural labour force due to HIV and AIDS by 2020due to HIV and AIDS by 2020

Sources: ILO (2004). HIV/AIDS and work: global estimates, impact and responses

Projected labor force loss (%) by year

NamibiaBotswanaZimbabwe

MozambiqueSouth Africa

KenyaMalawi

UgandaUR Tanzania

Central African RepublicCôte d’Ivoire

Cameroon

0 5 10 15 20 25 30

2020 2000

4.8



Impact of three scenarios on HIV infection Impact of three scenarios on HIV infection in sub-Saharan Africa, 2003–2020in sub-Saharan Africa, 2003–2020

0.0

1.0

2.0

3.0

4.0

5.0

2003 2005 2010 2015 2020

Year

Treatment-centeredPrevention-centeredBaseline

Comprehensive response

Number of new HIV infections (millions)

Source: Salomon JA et al. (2005). Integrating HIV prevention and treatment: from slogans to impact6.1



Impact of AIDS-related deaths in sub-Saharan Africa, 2003–2020Impact of AIDS-related deaths in sub-Saharan Africa, 2003–2020

2003 2005 2010 2015 2020

Year

Treatment-centeredPrevention-centeredBaseline

Comprehensive response

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Number of AIDS- relateddeaths (millions)

Source: Salomon JA et al. (2005). Integrating HIV prevention and treatment: from slogans to impact6.2


global AIDS epidemicFig 6.3



Number of people on antiretroviral therapy Number of people on antiretroviral therapy in low- and middle-income countries, 2002–2005in low- and middle-income countries, 2002–2005

North Africa and the Middle East

Europe and Central Asia

East, South and South-East Asia

Latin America and the Caribbean

Sub-Saharan Africa

Source: WHO/UNAIDS (2005). Progress on global access to HIV antiretroviral therapy: An update on “3 by 5.”

0

200

400

600

800

1000

1200

1400

End 2002

Mid-2003

End 2003

Mid-2004

End 2004

Mid-2005

End 2005

People receiving therapy (thousands)

7.1



People in sub-Saharan Africa on antiretroviral treatment People in sub-Saharan Africa on antiretroviral treatment as percentage of those in need, 2002–2005as percentage of those in need, 2002–2005

20022003

2004

2005

7.2Source: WHO/UNAIDS (2005). Progress on global access to HIV antiretroviral therapy: An update on “3 by 5.”



Percentage of people on treatment who are children, Percentage of people on treatment who are children, by country, 2005by country, 2005

Zambia

0% 2% 4% 6% 8% 10% 12% 14% 16%

AfricaAfrica [Median: 7%] UR Tanzania

UgandaCentral African Republic

South AfricaKenya

ZimbabweNamibiaRwanda

MozambiqueMalawi

Côte d'IvoireNigeriaGhana

Haiti

Latin America and CaribbeanLatin America and Caribbean [Median: 8%] Panama

HondurasArgentina

GuyanaBrazil

El SalvadorVenezuela

Peru

0% 2% 4% 6% 8% 10% 12% 14% 16%

0% 2% 4% 6% 8% 10% 12% 14% 16%

CambodiaViet Nam

IndiaChina

AsiaAsia [Median: 4%]

Source: WHO/UNAIDS (2005). Progress on global access to HIV antiretroviral therapy: An update on “3 by 5.”7.3



Women as a percentage of all adults receiving antiretroviral therapy Women as a percentage of all adults receiving antiretroviral therapy in 30 countries: actual versus expected percentages, 2005in 30 countries: actual versus expected percentages, 2005aa

Latin America and CaribbeanLatin America and Caribbean

Guyana

ArgentinaBrazil

El Salvador

HaitiHonduras

PanamaPeru

Venezuela

0% 20% 40% 60% 80%

0% 20% 40% 60% 80%

CambodiaChinaIndia

Viet Nam

AsiaAsia

Sub-Saharan AfricaSub-Saharan Africa

Kenya

0% 20% 40% 60% 80%

MalawiMozambique

NamibiaNigeria

RwandaSouth AfricaUR Tanzania

UgandaZambia

Zimbabwe

Côte d'Ivoire Ethiopia

Ghana

BotswanaBurundi

Central African Republic

Expected percentage of women receiving ARV therapy

7.4Source: WHO/UNAIDS (2006). Progress on global access to HIV antiretroviral therapy. A report on “3 by 5” and beyond.

a The expected percentage of women receiving ARV therapy is based on the percentage of people living with HIV/AIDS who are women



Country Coordinating Mechanisms (CCMs): Entities participating in preparation Country Coordinating Mechanisms (CCMs): Entities participating in preparation of Round Four proposals, 100% = all representatives of all 78 surveyed CCMsof Round Four proposals, 100% = all representatives of all 78 surveyed CCMs

Source: The Global Fund to Fight AIDS, Tuberculosis and Malaria

20% Government health ministry

19% Government other ministries

15% UN/Multilateral agencies

Religious/faith-based groups 5%

Private sector 7%People living with the disease 4%

Academic/educational 4% organizations

International NGOs 3%

Bilateral agencies 6%

NGO/community-based 17%organizations

Public sectorNon-public sector

9.1



Sector of recipientsSector of recipients

25% Non-governmental andcommunity-based organizations

4% People living with HIV, Tuberculosis or Malaria

5% Academic institutions

5% Faith-based organizations5% Private sector

5% Other

51% Government

Source: The Global Fund to Fight AIDS, Tuberculosis and Malaria. Rounds 2‒4 only. Information not available for Round 1.9.2



AIDS funding requirements for low- and middle-income countriesAIDS funding requirements for low- and middle-income countries

Prevention 8.4 10.0 11.4 29.8

Care and treatment 3.0 4.0 5.3 12.3

Support for orphans and vulnerable children 1.6 2.1 2.7 6.4

Programme costs 1.5 1.4 1.8 4.6

Human resources 0.4 0.6 0.9 1.9

TOTAL 14.9 22.1 55.118.1

2006 2007 2008 2006‒2008US$ billion

Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.10.1



PREVENTION ACTIVITIES (US$ million) 2006 2007 2008 2006–08Mass media 91 100 109 299Community mobilization 449 608 772 1830Voluntary counselling and testing 451 569 690 1710

Youth in school 101 104 108 313Youth out of school 768 945 1126 2838

Programmes focused on sex workers and their clients 429 552 682 1663

Programmes focused on men who have sex with men 312 407 499 1218

Harm reduction programmes for injecting drug users 114 149 180 443Workplace 421 523 628 1573Prevention programmes for people living with HIV 22 33 48 103Special populations 151 252 252 654Condom social marketing 159 175 190 525Public and commercial sector condom provision 1381 1501 1625 4506

Improving management of sexually transmitted infections 672 718 764 2154

Prevention of mother-to-child transmission 206 264 324 794Blood safety 226 228 231 685Post-exposure prophylaxis (health care setting, rape) 1 2 2 5Safe medical injections 897 897 897 2690Universal precautions 1590 1944 2303 5838

TOTAL 8441 9969 11 430 29 840

Funding required for preventionFunding required for prevention

10.2Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.



Distribution by region of the funding required for preventionDistribution by region of the funding required for prevention

Latin America/Caribbean: 9%Eastern Europe: 12%North Africa/Middle East: 3%

Africa: 29%

South/South-East Asia: 21%

East Asia/Pacific: 26%




Year People on ART (million)

ART coverage of urgent cases

Total Funding(US$ million)

2006 3.0 55% 2986

2007 4.8 67% 4029

2008 6.6 75% 5250

2009 8.3 79% -

2010 9.8 80% -

Funding required for treatment and care, Funding required for treatment and care, including antiretroviral therapy (ART), including antiretroviral therapy (ART),

in order to achieve the coverage targets shownin order to achieve the coverage targets shown




TREATMENT AND CARE ACTIVITIES (US$ million) 2006 2007 2008 2006–08

Palliative care 308 302 295 905

Provider initiated testing 66 79 109 254

Opportunistic infections treatment 686 703 707 2096

Opportunistic infections prophylaxis 287 403 510 1200

Antiretroviral therapy, including nutritional support 1642 2482 3624 7748

Laboratory testing 54 79 104 237

TOTAL 3043 4048 5349 12 440

Distribution by activity of the funding required Distribution by activity of the funding required for treatment and carefor treatment and care




Distribution by region of the funding required for treatment and careDistribution by region of the funding required for treatment and care

Latin America/Caribbean: 17%Eastern Europe: 7%North Africa/Middle East: 1%

Africa: 55%

South/South-East Asia: 4%East Asia/Pacific: 16%




ORPHAN-SUPPORT ACTIVITIES (US$ million) 2006 2007 2008 2006–08

Education 193 287 443 923

Health care and support 145 174 200 519

Family/home support 971 1255 1604 3830

Community support 14 18 25 57

Organization costs 246 322 422 990

TOTAL 3043 4048 5349 12 440

Funding required for activities supporting orphans Funding required for activities supporting orphans and vulnerable childrenand vulnerable children




PROGRAMME ACTIVITIES (US$ million) 2006 2007 2008 2006–08

Management 485 376 390 1251

Advocacy and communications 118 111 111 340

Monitoring and Evaluation 148 138 146 432

Operations Research 11 7 7 25

Training 72 136 231 439

Logistics and suppy, including transportation 305 259 304 868

Supervision of personnel and patient tracking 97 68 92 257

Drug resistance surveillance 69 68 68 205

Construction of new health centers 60 23 167 250

Laboratory and other infrastructure upgrading 121 185 236 542

PROGRAMME AND INFRASTRUCTURE COSTS 1486 1371 1753 4610

Funding required for programme support and infrastructureFunding required for programme support and infrastructure




(US$ million) 2006 2007 2008 2006–2008

Education 50 89 123 262

Nurses’ wage supplements 153 261 370 784

Doctors’ wage supplements 152 258 366 776

TOTAL 355 608 859 1822

Funding required for building human resource capacityFunding required for building human resource capacity




Sources of the estimated and projected funding Sources of the estimated and projected funding for the AIDS response from 2005 to 2007*for the AIDS response from 2005 to 2007*

* Assuming there are no new commitments

Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.

Domestic

Bilateral

Multilateral

Private Sector

2005 2006 2007

US$ billion

0

2

4

6

8

10

12

10.10



Sources of HIV spending in three countries, 2004Sources of HIV spending in three countries, 2004

US$ 1.87

HIV and AIDS spending per capita

US$ 0.59 US$ 0.28

World Bank loan 27%

All donors 14%

Public 86%

Public 9%

Global Fund9%

Bilateral 35%

World Bankcredit 32%

Multilateral(excluding GF) 15%

Bilateral32%

Public 36%

Global Fund 2%

Multilateral(excluding GF) 3%

India Russian FederationBurkina Faso

10.11Source: UNAIDS, based on National AIDS Spending Assessments.



HIV spending by programmatic area in four countries, 2004HIV spending by programmatic area in four countries, 2004

Thailand

Senegal

Ethiopia

Burkina Faso

PreventionTreatment and careOrphans and vulnerable childrenProgram developmentOther

US$ 1.87

US$ 0.45

US$ 1.40

US$ 1.91

Total AIDS spending per capita

0 20 40 60 80 100%

10.12Source: UNAIDS, based on National AIDS Spending Assessments.



DAC member’s Official Development Assistance DAC member’s Official Development Assistance in 2003 and 2004in 2003 and 2004

NorwayDenmark

LuxembourgSweden

NetherlandsPortugal

FranceSwitzerland

Belgium

IrelandUnited Kingdom

FinlandGermany

CanadaAustralia

Spain

New ZealandAustriaGreece

JapanUnited States

Italy0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.020 18 16 14 12 10 8 6 4 2 0

Averagecountryeffort, 0.42%

UN target, 0.70%

20042003

20032004

Source: Organisation for Economic Co-operation and Development (2005).

ODA (US$billion) current

ODA/GNI (%)

10.13



DAC members’ Official Development Assistance DAC members’ Official Development Assistance committed to HIV in 2004committed to HIV in 2004

Source: UNAIDS, based on data from DAC members’ reports to OECD.

CanadaSweden

NetherlandsLuxembourg

DenmarkNorway

United KingdomBelgium

United States

FinlandGermany

IrelandAustralia

SwitzerlandNew Zealand

Spain

AustriaItaly

France

GreecePortugal

Japan 30.1

1171181476

1058

15731

2626

49660

1160

373843

7286

100103108

126167172

114445781012

202 208

50 100 150 200 250 300400 300 200 100 0120011001000 900 800 700 600 5001300

Aid for HIV (US$ million) Aid for HIV per million GNI

10.14



DAC members’ bilateral commitments DAC members’ bilateral commitments to HIV-related programmes in 2004to HIV-related programmes in 2004

France 0.9%

United Kingdom 20.5%

United States 49.6%

Other DAC country members 13.1% Italy 0.5%

European Community 4.3% Canada 4.1%

Germany 3.5% Japan 3.4%

Total: US$ 2.7 billion




UNAIDS Unified Budget compared to resources available UNAIDS Unified Budget compared to resources available for HIV in low- and middle-income countriesfor HIV in low- and middle-income countries

Total funding for AIDS

UNAIDS Unified Budget*

2003 2004 2005

US$ million

0

2000

4000

6000

8000

10 000

12 000

2006 2007

• UNAIDS Unified Budget includes core, supplemental and agency own resources. It does not include estimates of country-level spending by Cosponsors.

Source: UNAIDS (2005). UNAIDS Unified Budget and Workplan 2006-2007.10.16



Commitments by foundations based in the United States Commitments by foundations based in the United States to domestic and global HIV projects, 2000–2003to domestic and global HIV projects, 2000–2003

Source: Funders Concerned About AIDS (2005).

US$ million

0

100

200

300

400

500

600

10.17

2000 2001 2002 2003



Annual public sector investment in preventive HIV vaccine research and Annual public sector investment in preventive HIV vaccine research and development between 2000 and 2005 by regiondevelopment between 2000 and 2005 by region

US$ million

0

100

200

300

400

500

600

700

US Europe Other Public Sector Multilaterals

Source: HIV Vaccines and Microbicides Resource Tracking Working Group (2005). 10.18

2000 2001 2002 2003 20052004



2000 2001 2002 2003 2004 2005

PUBLIC SECTORUnited States 34.6 61.3 75.3 78.8 92.0 99.3

Europe 0.7 0.4 5.1 10.6 29.9 37.8

Other 0.3 <0.1 0.2 0.9 2.0 5.0

Multilaterals <0.1 0.3 0.4 <0.1 0.2 0.2

Total public 35.7 62.0 81.0 90.2 124.2 142.3

PHILANTHROPIC SECTORTotal philanthropic 29.4 3.4 24.8 16.9 18.1 21.1

NON-COMMERCIAL (PUBLIC & PHILANTHROPIC)Total non-commercial 65.1 65.4 105.8 107.1 142.3 163.4

Annual public and philanthropic sector investment in microbicide research Annual public and philanthropic sector investment in microbicide research and development between 2000 and 2005 (US$ million)and development between 2000 and 2005 (US$ million)

10.19Source: HIV Vaccines and Microbicides Resource Tracking Working Group (2005).



Stakeholder participation in development Stakeholder participation in development of national AIDS plans in 79 countries, 2004of national AIDS plans in 79 countries, 2004

full participationinsufficient but increasing participationinsufficient participation with no signs of improvementno participation

Source: (UNAIDS 2006) From advocacy to action: A progress report on UNAIDS at country-level, UNAIDS.

UN agenciesCivil society/NGOs

People living with HIVDonors

Line ministriesMedia

District and local authoritiesFaith-based organizations

Private sectorWomen’s groups

0% 20% 40% 60% 80% 100%

11.1



Sites Involved with Collaborative Fund Sites Involved with Collaborative Fund for HIV Treatment Preparedness, March 2006for HIV Treatment Preparedness, March 2006

Sources: The International Treatment Preparedness Coalition (2006); TIDES Foundation (2006)11.2



Trends in HIV and AIDS per-capita expenditures in current US$, Trends in HIV and AIDS per-capita expenditures in current US$, selected sub-Saharan countriesselected sub-Saharan countries

0.22

0.65

0.31

0.15

0.49

0.0

0.10.2

0.3

0.4

0.50.6

0.7

0.80.9

1.0

2001 2002 2003 2004 2005

HIV per capita spending (US$)

Sources: Countries reporting on UNGASS on domestic public expenditure; UNAIDS estimates11.3



Countries using the Country Response Information System Countries using the Country Response Information System (92 countries as of January 2006)(92 countries as of January 2006)

Sources: Countries reporting on UNGASS; UNAIDS (Country Coordinator Reports and Monitoring and Evaluation Officers’ personal communications) 11.4

Documents

25 years of AIDS