The beginning of the end? The HIV/AIDS pandemic in the 21st

Century Professor Hazel Barrett BA (Hons), MA, PhD, C Geog.

Associate Dean for Applied Research,Faculty of Business, Environment and Society,

Coventry University, CV1 5FBh.barrett@coventry.ac.uk

Regional HIV/AIDS statistics, 2009Global Region Adults and children

living with HIVAdults and children newly infected with HIV

%adult prevalence rate (15-49 years)

Adults and children AIDS-related deaths

Sub-Saharan Africa

22.5m 1.8m 5% 1.3m

Middle East & N. Africa

460,000 75,000 0.2% 24,000

S & SE Asia 4.1m 270,000 0.3% 260,000

E Asia 770,000 82,000 0.1% 36,000

Oceania 57,000 4,500 0.3% 1,400

Central & S America

1.4m 92,000 0.5% 58,000

Caribbean 240,000 17,000 1% 12,000

E Europe & Central Asia

1.4m 130,000 0.8% 76,000

W & Central Europe

820,000 31,000 0.2% 8,500

N America 1.5m 70,000 0.5% 26,000

Global Total 33.3m 2.6m 0.8% 1.8m

Global Prevalence of HIV, 2009

Trends in HIV prevalence rates :sub-Saharan Africa and global

total

‘...the world has turned the corner – it has halted and begun to reverse the spread of HIV.’ (UNAIDS, 2010, 7)

‘The overall growth of the global AIDS epidemic appears to have stabilized.’

(UNAIDS, 2010, 16.)

• Let us unpick this statement

• What is the data telling us?

• What are the explanations?

• Are we at the beginning of the end of the HIV/AIDS pandemic?

The Data

• 1999 was the year that annual new infections peaked.

• Since 1999 the number of new infections has decreased by 19%. In 2009 2.6 m people became newly infected with HIV, compared to 3.1m in 1999.

Number of people newly infected with HIV

• Between 2001 and 2009 HIV incidence has fallen by more than 25% in 33 countries. Of these 22 are in sub-Saharan Africa the region most severely affected by the pandemic.

• Countries with the most acute epidemics in sub-Saharan Africa now have stable or declining HIV epidemics.

• However in 7 countries, mainly in Eastern Europe and Central Asia, HIV incidence increased by more than 25% between 2001 and 2009.

• It is a complex situation where there is no room for complacency.

Changes in the incidence rate of HIV infection, 2001 to 2009, selected countries

• How has this happened?– Virtual elimination of mother-to-child

transmission– Behavioural change, especially by young

people

• Major advances in prevention of MTC HIV transmission over last 10 years, involving ARV treatment.

• In 2009 370,000 children contracted HIV from their mothers during pregnancy, childbirth and breastfeeding. Down from 500,000 in 2001. A decline of 26%.

• UNAIDS calling for virtual elimination of MTC transmission by 2015.

• Eg in South Africa 90% of HIV+ mothers to be receive ARVs has resulted in dramatic decrease in MTD transmission

• 15 countries have achieved 80%+ coverage (inc Botswana, Namibia, Swaziland)

• Shows value of appropriate and timely treatment.

• Behavioural change is the most important factor in accounting for the decline in HIV infections. This includes increased use of condoms, delayed sexual debut and reductions in multiple sexual partnerships.

• In Namibia prevention programmes aimed at young people have resulted in HIV prevalence among 15-24 year olds dropped from 10% in 2007 to 5% in 2009

• But some way to go. Globally only 34% of 15-24 year olds had comprehensive knowledge about HIV/AIDS.

• In the worst affected countries the proportion is less than 50%.

AIDS deaths decline

• AIDS deaths decline from a peak of 2.1m in 2004 to 1.8m in 2009.

• In sub-Saharan Africa AIDS deaths declined by 20% between 2004 and 2009.

Estimated number of adult and child deaths due to AIDS globally, 1990–2007

Year

Mill

ions

0

1.5

2.0

2.5

3.0

1990 19911992 1993 1994 1995 199619971998 1999 2000 2001 2002 2003 2004 2005 2006 2007

0.5

1.0

This bar indicates the range around the estimate

5.3

AIDS deaths decline. Why?

Images of antiretroviral drugs removed for copyright reasons

Numbers of people receiving and needing ARV therapy in December 2005, by WHO region.

(Source: WHO, 2006)

WHO Region Estimated no. of people receiving ARV December 2005

Estimated no of people under 49 years needing ARV 2005

ARV coverage, December 2005

African Region 810,000 4,700,000 17%

Region of the Americas

315,000 465,000 68%

European Region 21,000 160,000 13%

Eastern Mediterranean Region

4,000 75,000 5%

South-East Asia Region

Western Pacific region

140,000

40,000

970,000

150,000

14%

27%

TOTAL 1,330,000 6,500,000 20%

• In 2009 5.2m people had access to ARVs, reaching 36% of those in need.

• 8 countries have achieved over 80% coverage. A further 21 countries have coverage rates of 50-80%.

• Worldwide estimated that 14.4m life years have been saved due to ARV.

Summary• Number of HIV infections are declining

• AIDS deaths are declining

• Scale up of ARV

• Numbers of infections are still high and the number of people living with HIV is increasing

• There is geographical variability

Is this the beginning of the end of HIV/AIDS pandemic?

Model of an epidemic

• Certainly investments in prevention and treatment have resulted in a stabilisation of the pandemic.

• For the pandemic to be beaten these investments must be sustained.

• Whilst the pandemic has stabilised, HIV still affects many millions of people and will continue to do so for many years to come.

• Let us hope we are seeing the beginning of the end......

Reading ListBarnett, T & Whiteside, A, 2003, AIDS in the twenty-first century: disease and

globalisation. Palgrave Macmillan, Basingstoke.Barrett, H. R, 2007, Too little too late: responses to the HIV/AIDS epidemics in sub-

Saharan Africa. Geography, 92(2), 87-96.Barrett, H. R, 2007, As`easy as ABC…? Uganda’s fight against HIV/AIDS. Geography,

92(2),154-157.Basu, S, 2004, AIDS, empire and public health behaviourism. International

Journal of Health Services, 34 (1), 155-167.Campbell, C, 2003, ‘Letting them die’: why HIV/AIDS prevention programmes fail.

International African Institute, Oxford.Hemrich, G & Topouzis, D, 2000, Multi-sectoral responses to HIV/AIDS: constraints and

opportunities for technical cooperation. Journal of International Development, 12, 85-99.

Iliffe, J, 2006, The History of the African AIDS Epidemic. J Currey.Parker, R.G, Easton, D & Klein, C.H, 2000, Structural barriers and facilitators in

HIV prevention: a review of international research. AIDS, 14 (1), S22-S32.Potts,M & Walsh, J, 2003, Tackling India’s epidemic: lessons from Africa. BMJ, 326,

1389-1392.SIPAA, 2005, Building bridges with SIPAA:lessons from an African response to

HIV and AIDS. www. sipaa.org.

Reading List (continued)

UNAIDS, 2003, AIDS epidemic update December 2003. www.unaids.org.UNAIDS, 2004, AIDS epidemic update December 2004. www.unaids.org.UNAIDS, 2005, AIDS epidemic update December 2005. www.unaids.org.UNAIDS, 2006, AIDS epidemic update December 2006. www.unaids.org.UNAIDS, 2006, Report on the global AIDS epidemic. www.unaids.org.UNAIDS, 2010, Report on the global AIDS epidemic 2010. www.unaids.orgUNESCO, 2005, UNESCO’s response to HIV and AIDS. www.unesco.org.World Bank, 1997, Confronting AIDS: public priorities in a global epidemic. OUP, Oxford.WHO, 2006, Progress on global access to HIV antiretroviral therapy: a report on “3 by 5”

and beyond. www.who.org.