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 5FB
h.barrett@coventry.ac.uk
Regional HIV/AIDS statistics, 2009
Global Region
Adults and children
living with HIV
Adults 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.
Millions
Estimated number of adult and child deaths
due to AIDS globally, 1990–2007
3.0
2.5
2.0
1.5
1.0
0.5
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
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
970,000
14%
40,000
150,000
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 List
Barnett, 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 subSaharan 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, 8599.
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.org
UNESCO, 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.