Escolar Documentos
Profissional Documentos
Cultura Documentos
Commitments
15 years of triple combination antiretroviral therapy (ART) 10 years implementing the Declaration of Commitment on HIV UNGASS 2001
10 years of Millennium Development Goals (MDGs) and 5 more years to achieve them 5 years of Universal Access (UA) 2006 Political Declaration on HIV High Level Meeting (HLM), New York, June 2011 and 2nd Security Council Resolution (first was in 2000)
2001
Epidemic Minimal response
2011
Endemic Increasing services
Increasing funding
Emergency response
Flat-lined funding
Sustained response
A,B,Cs
Treatment vs prevention Criminals AIDS exceptionalism
Combination prevention
HPTN 052 (treatment for prevention); Treatment and Prevention Citizens AIDS leads the way
CAPRISA 004 trial in South Africa shows that vaginal tenofovir gel reduces womens risk of HIV acquisition by 39% over 30 months
Clinical trials in Kisumu, Kenya, and in Rakai, Uganda, confirm efficacy of male circumcision for HIV prevention
Mio 40
30
20
10
1981
1985
Zidovudine (AZT) approved for treatment
1990
ACTG protocol 076 shows that AZT prophylaxis reduces vertical transmission
1995
Effectivenes s of needle exchange programmes established
2000
Rapid HIV test approved
2005
2010 2011
Clinical trial of male circumcision in Orange Farm, South Africa, shows reduced HIV transmission
IMAGE intervention of combined microfinance and training results in reduced risk behaviour among young women
Kesho Bora study in Burkina Faso, Kenya, & South Africa reveals triple ART halves the risk of HIV transmission through breastfeeding; Partners PrEP and TDF-2 trials show 63-73% reduction in HIV acquisition; HPTN 052 trial finds ART reduces HIV transmission 96% in serodiscordant couples
Singapore, 1994 All the smartest bodies in town are wearing rubber. Design: Action for AIDS, Singapore. Museum fr Gestaltung Zrich
Eastern Europe Western & Central Europe & Central Asia North America [1.2 million 2.0 million] Middle East & North Africa Caribbean [220 000 270 000] Central & South America [1.2 million 1.6 million] [400 000 530 000] Sub-Saharan Africa [20.9 million 24.2 million]
1.5 million
[720 000 910 000] [1.3 million 1.6 million] East Asia [560 000 1.0 million]
820 000
1.4 million
770 000
240 000
460 000
4.1 million
22.5 million
1.4 million
57 000
HIV Prevalence: 33.3 million [31.4 35.3] in 2009, compared to 26.2 million [24.627.8] in 1999 (27% increase)
HIV Prevalence Proportion: constant at 0.8% of the global population since 2001
Source: UNAIDS.
Total 2.6 million [2.32.8 million] Adults 2.2 million [2.0 2.4 million] Children (<15 years) 370 000 [230 000510 000]
Total 1.8 million [1.6 million2.1 million] Adults 1.6 million [1.4 million1.8 million] Children (<15 years) 260 000 [150 000360 000]
Figure 2.6
70
Sub-Saharan Africa
60 50 40
Caribbean
GLOBAL
Eastern Europe and Central Asia Central and South America Asia Western and Central Europe and North America
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09
30
20 10 %
Source: UNAIDS.
Estimated number of adults and children newly infected with HIV 2009
Eastern Europe Western & Central Europe & Central Asia North America [44 000 130 000] Middle East & North Africa Caribbean [13 000 21 000] Central & South America [70 000 120 000] [61 000 92 000] Sub-Saharan Africa [1.6 million 2.0 million]
70 000
31 000
[110 000 160 000] East Asia 82 000 [48 000 140 000] South & South-East Asia [240 000 320 000] Oceania [3400 6000]
130 000
17 000
75 000
270 000
1.8 million
92 000
4500
Annual number of people newly infected with HIV decreased by 19% from 3.1 million [2.93.4] in 1999 to 2.6 million [2.32.8] in 2009
4.0 3.5 3.0 MILLIONS 2.5 2.0 1.5 1.0 0.5 0.0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
HIV Incidence
Dotted lines represent ranges, solid lines represent the best estimate.
Young people are leading the prevention revolution by taking definitive action to protect themselves from HIV
HIV prevalence in young people aged 15-24 has declined in 22 high burden countries in sub-Saharan Africa (by 25% in 15 of these countries): delaying onset of sex fewer partners correct and consistent condom use
Figure 2.5
Dotted lines represent ranges, solid lines represent the best estimate.
Source: UNAIDS.
A B C D F G H
Intertwined epidemiology
People are injecting drugs in 148 countries: 16 million [11-21] people worldwide (largest populations of
people who inject drugs are in USA, Russia, Brazil)
Among people who inject drugs, HIV has been documented in 120 countries:
3 million [0.8-6.6 million] people
Source: Mathers, Degenhardt, Phillips et al for the 2007 UN Reference Group on HIV and Injecting Drug Use. Lancet Sept 24, 2008
Table 3.1
Countries in which HIV infections among people who inject drugs represent 20% or more of the total number of people living with HIV
Azerbaijan
Malaysia
Canada China Estonia Georgia Indonesia Islamic Republic of Iran Italy Kazakhstan Kyrgyzstan
New Zealand Pakistan Russian Federation Spain Tajikistan Ukraine United States of America Uzbekistan
80
60
40
20
Caribbean (4)
Central and Eastern EuropeMiddle East and Sub-Saharan Western and South Americaand Central Asia North Africa Africa Central Europe (10) (12) (7) (39) (9)
* Ever-married women who experienced physical or sexual violence from their most recent spouse or coresident partner.
Used a condom at last higher risk sex females Countries with prevalence more than 2%, 19952010
) identifies statistically significant decrease in high-risk sex 2) indicates statistically significant increase in high-risk sex.
1
Number of people receiving ART in low- and middle-income countries by region 20022009
020%
Bolivia Bhutan Burundi CAR Colombia DR Congo Djibouti Egypt Gambia Iran Madagascar Maldives Mongolia Myanmar Nepal Pakistan Moldova Russian Fed Sierra Leone Somalia
4160%
Lesotho Malawi Mali Mexico PNG Senegal Suriname
6180%
Argentina Chile Namibia Slovakia
>80%
Botswana Cambodia Cuba Guyana Oman Romania Rwanda
7 6
( m illio n s)
5 4 3 2 1 0
Su b Sa h a ra n Af rica
La tin Am erica
Asia
Ocea n ia
M id d le Ea st a n d No rth Af rica
Estim ated n um b er o f AID S-related d eaths wi th and w itho ut antiretroviral therap y, g lob ally, 1 9 9 6 2 0 0 8
3 .0 2 .5
N um ber (m illio ns)
2 .0 1 .5 1 .0 0 .5 0
The number of AIDS-related deaths has declined by over 10% over the past five years
Figure V
rampant stigma and discrimination continues to contribute to rising HIV infections among key populations at higher risk and to the vulnerability of women and girls
many
countries still have laws, regulations or policies that present obstacles for populations at higher risk or other vulnerable populations to access prevention, treatment, care and support
Strategic directions:
Revolutionize prevention
Zero AIDS-related deaths Catalyze the next phase of treatment, care and support Zero discrimination Advance human rights and gender equality for the HIV response
Incidence: decreased 19% in 10 years Tracking structural determinants of HIV transmission and measuring behaviour change: need to address stigma and discrimination, criminalisation, intimate partner violence, and gender inequality Antiretroviral treatment coverage and impact: increasing Commitments: 50% transmission reductions and 15 by 15.
VISION
Mellors 5.25.10