trends in the epidemic over time

00001-E-1– 27 June 2000

Trends in the epidemic over time

UNAIDS/WHO Working Group on Global HIV/AIDS

and STI Surveillance

00001-E-2– 27 June 2000

A global view of HIV infectionA global view of HIV infection 33 million adults living with HIV/AIDS as of end 199933 million adults living with HIV/AIDS as of end 1999

Adult prevalence rate

15.0% – 36.0% 5.0% – 15.0% 1.0% – 5.0% 0.5% – 1.0% 0.1% – 0.5% 0.0% – 0.1% not available

00001-E-3– 27 June 2000

Spread of HIV over time in Latin America and Spread of HIV over time in Latin America and the Caribbean, 1984 to 1999the Caribbean, 1984 to 1999

Estimated percentage of adults

(15–49) infected with HIV 2.0% – 6.0%1.0% – 2.0%0.5% – 1.0%0.1% – 0.5%0.0% – 0.1%trend data unavailable

outside region

00001-E-4– 27 June 2000

Spread of HIV over timeSpread of HIV over timein sub-Saharan Africa, 1984 to 1999in sub-Saharan Africa, 1984 to 1999

Estimated percentage of adults

(15–49) infected with HIV 20.0% – 36.0%10.0% – 20.0% 5.0% – 10.0% 1.0% – 5.0% 0.0% – 1.0%trend data unavailable

outside region

00001-E-5– 27 June 2000

Spread of HIV over time in Asia, 1984 to 1999Spread of HIV over time in Asia, 1984 to 1999

2.0% – 5.0% 1.0% – 2.0% 0.5% – 1.0% 0.1% – 0.5% 0.0% – 0.1%trend data unavailable

outside region

00001-E-6– 27 June 2000

New

in

fect

ion

s

-

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99

Highly industrialized countries

North Africa & Middle EastEastern Europe & Central asiaSub-Saharan AfricaLatin America & the Caribbean

Southern & Eastern Asia

Estimated annual number of new HIV Estimated annual number of new HIV infections by region, 1980 to 1999infections by region, 1980 to 1999

00001-E-7– 27 June 2000

Peo

ple

liv

ing

wit

h H

IV/A

IDS

Highly industrialized countries

North Africa & Middle East

Eastern Europe & Central Asia

Sub-Saharan AfricaLatin America & the Caribbean

Southern & Eastern Asia

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99

Estimated number of people living with Estimated number of people living with HIV/AIDS by region, 1980 to 1999HIV/AIDS by region, 1980 to 1999

00001-E-8– 27 June 2000

Number of diagnosed HIV infections, Number of diagnosed HIV infections, Ukraine, 1993 to 1998Ukraine, 1993 to 1998

5,000 10,000 15,000 20,000 25,000 30,000

1998

1997

1996

1995

1994

1993

Source: National AIDS Programme, Ukraine, 1999

00001-E-9– 27 June 2000

Annual number of newly registered HIV infections, Annual number of newly registered HIV infections, Russia, 1993 to 1999Russia, 1993 to 1999

108 158 196

1,546

4,399 3,947

15,462

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

93 94 95 96 97 98 99

Year of registration

Nu

mb

er o

f H

IV i

nfe

ctio

ns

Source: Russian Federal AIDS Centre, Moscow

00001-E-10– 27 June 2000

The epidemic in sub-Saharan Africa



00001-E-11– 27 June 2000

HIV

pre

vale

nc

e (%

)

Median HIV prevalence among pregnant women Median HIV prevalence among pregnant women in urban areas in Uganda, 1985 to 1998in urban areas in Uganda, 1985 to 1998

Source: STD/AIDS Control Programme, Uganda

0

5

10

15

20

25

30

35

85 86 87 88 89 90 91 92 93 94 95 96 97 98

00001-E-12– 27 June 2000

HIV prevalence among pregnant women HIV prevalence among pregnant women in Botswana, 1998in Botswana, 1998

0

10

20

30

40

50

15-19 20-24 25-29 30-34 35-39 40-44

Age Groups

Source: Ministry of Health, Botswana

HIV

pre

vale

nc

e (%

)

00001-E-13– 27 June 2000

HIV prevalence among pregnant womenHIV prevalence among pregnant womenin South Africa, 1990 to 1999in South Africa, 1990 to 1999

Source: Department of Health, South Africa

0.71.7 2.1

4

7.6

10.4

14.2

17

22.8 22.4

0

5

10

15

20

25

90 91 92 93 94 95 96 97 98 99

HIV

pre

vale

nc

e (%

)

00001-E-14– 27 June 2000

Estimated adult HIV prevalence in Kenya, Estimated adult HIV prevalence in Kenya, 1990-19991990-1999

Source: National AIDS and STD Control Programme, 1999 and UNAIDS

0

2

4

6

8

10

12

14

16

90 91 92 93 94 95 96 97 98 99

HIV

pre

vale

nc

e (%

)

00001-E-15– 27 June 2000

The impact of the epidemic on youth



00001-E-16– 27 June 2000

HIV prevalence rate among HIV prevalence rate among 13 to 19-year-olds, Masaka, Uganda, 1989 to 199713 to 19-year-olds, Masaka, Uganda, 1989 to 1997

0

1

2

3

4

5

1989/90 1990/91 1991/92 1992/93 1993/94 1994/95 1995/96 1996/97

girls

boys

Source: Kamali et al. AIDS 2000, 14: 427-434

HIV

pre

vale

nc

e (%

)

00001-E-17– 27 June 2000

HIV prevalence rate among pregnant HIV prevalence rate among pregnant 15 to 19-year-olds, Lusaka, Zambia, 1993 to 199815 to 19-year-olds, Lusaka, Zambia, 1993 to 1998

0

5

10

15

20

25

30

35

Chelstone Chilenje Kalingalinga Matero

Clinic

199319941998

Source: Ministry of Health, Zambia, 1999

HIV

pre

vale

nc

e (%

)

00001-E-18– 27 June 2000

HIV prevalence rate among pregnant 15-24 year-olds HIV prevalence rate among pregnant 15-24 year-olds by educational status, Ugandaby educational status, Uganda

0

5

10

15

20

25

30

1991-1994 1995-1997

HIV

pre

vale

nc

e (%

)

illiterate

primary education

secondary education

Source: Kilian A et al. AIDS 1999, 13: 391-398.

00001-E-19– 27 June 2000

HIV prevalence rate among teenagers HIV prevalence rate among teenagers in Kisumu, Kenya, by agein Kisumu, Kenya, by age

0 0

3.62.2

8.68.3

17.9

29.4

22

33.3

0

5

10

15

20

25

30

35

15 16 17 18 19Age in years

HIV

pre

vale

nc

e (%

)

boys

girls

Source: National AIDS Programme, Kenya, and Population Council, 1999

00001-E-20– 27 June 2000

HIV prevalence rate among women in their teens and HIV prevalence rate among women in their teens and early twenties, various African studies, 1995-1998early twenties, various African studies, 1995-1998

0

10

20

30

40

50

60

70

Carle

tonvi

lle, S

outh A

frica

,

1998

(urb

an)

Muta

sa d

istri

ct, Z

imbab

we,

1998

(rura

l)

Kisum

u, Ken

ya, 1

997

(urb

an)

Lusaka

, Zam

bia, 1

995

(urb

an)

Mposh

i, Zam

bia, 1

996

(rura

l)

Ndola, Z

ambia

199

7 (u

rban

)

Kises

a, T

anza

nia, 1

997

(rura

l)

Yaounde,

Cam

eroon 1

997

(urb

an)

Cotonou, B

enin

199

7 (u

rban

)

Fort Porta

l, Ugan

da 19

95 (u

rban

)

Mas

aka,

Ugan

da 19

96 (r

ural)

women, 15-19

women, 20-24

HIV

pre

vale

nc

e (%

)

00001-E-21– 27 June 2000

Proportion of children testing HIV-positive at aProportion of children testing HIV-positive at asexual abuse clinic, Harare, Zimbabwe, 1998-1999sexual abuse clinic, Harare, Zimbabwe, 1998-1999

0 2 4 6 8 10 12 14

0-4

5-8

9-12

13-16

Ag

e g

rou

p (

year

s)

HIV-infected (%)

tested HIV-positive on arrival

observed to seroconvert after abuse

Source: Family Support Trust, Zimbabwe, 1999.

00001-E-22– 27 June 2000

The impact of the epidemic on other populations and groups



00001-E-23– 27 June 2000

HIV prevalence among people consuming alcoholHIV prevalence among people consuming alcoholand among non-drinkers, Carletonville, South Africa, 1998and among non-drinkers, Carletonville, South Africa, 1998

0

10

20

30

40

50

60

70

men women women in commercial sex areas

HIV

pre

vale

nc

e (%

)

drinkers

non-drinkers

Source: Campbell et al. (unpublished data)

00001-E-24– 27 June 2000

HIV prevalence rate and frequency HIV prevalence rate and frequency of sexually transmitted infection (STI) episodes, of sexually transmitted infection (STI) episodes,

Carletonville miners, South Africa, 1991-1998Carletonville miners, South Africa, 1991-1998

0

10

20

30

40

50

60

70

80

90

1 2-4 5-9 10+

Number of STI episodes

HIV

pre

vale

nc

e (%

)

Source: Ballard R, 2000 (unpublished data).

00001-E-25– 27 June 2000

HIV prevalence in military personnel in AfricaHIV prevalence in military personnel in Africa

Nigeria: 11% among peacekeepers returning from

Sierra Leone and Liberia vs 5% in adult

population

South Africa: 60-70% in military vs 20% in adult

population

Source: Nigeria AIDS bulletin No 15, May 20, 2000; The Mail & Guardian, Pretoria, March 31, 2000; UNAIDS/WHO 1999 estimate

00001-E-26– 27 June 2000

The demographic impact of the epidemic



00001-E-27– 27 June 2000

Projected population structure with and Projected population structure with and without the AIDS epidemic, Botswana, 2020without the AIDS epidemic, Botswana, 2020

80757065605550454035302520151050

020406080100120140 0 20 40 60 80 100 120 140

Males Females Deficits due to AIDS

Projected population structure in 2020

Population (thousands)

Ag

e in

yea

rs

Source: US Census Bureau, World Population Profile 2000

00001-E-28– 27 June 2000

Increase in mortality among men between 15 and 60, selected African countries, 1986-1997

0

10

20

30

40

50

60

70

80

Tanzania, 1996 Malawi, 1992 Zimbabwe, 1994 Uganda, 1995 Zambia, 1996-97

Pro

ba

bil

ity

of

dy

ing

fro

m a

ll c

au

se

s estimated for 6 years before survey estimated for year of survey

Source: Timaeus I, AIDS 1998, 12 (suppl): S15-S27

00001-E-29– 27 June 2000

Adult mortality attributable to HIV, Adult mortality attributable to HIV, community-based studies in Africa, 1990-1996 community-based studies in Africa, 1990-1996

0 5 10 15 20 25 30 35 40

Rakai, Uganda (21% HIV)

Masaka, Uganda (8% HIV)

Kisesa, Tanzania (7% HIV)

Mwanza, Tanzania (4% HIV)

Mortality per 1,000 person - years

Mortality among HIV-negatives

Excess mortality due to HIV

Source: Boerma JT et al, AIDS 1998, 12 (suppl 1): S3-S14

00001-E-30– 27 June 2000

Trends in mortality among children under five yearsTrends in mortality among children under five yearsold and end-1999 adult HIV prevalence rate, old and end-1999 adult HIV prevalence rate,

selected African countries, 1981-1996selected African countries, 1981-1996

KenyaHIV prevalence 14.1%

ZambiaHIV prevalence 19.9%

CameroonHIV prevalence 7.7%

80 %

85 %

90 %

95 %

100 %

105 %

110 %

80 82 84 86 88 90 92 94 96 98

Rel

ati

ve

un

der

-5 m

ort

alit

y (

198

1 =

10

0%)

Source: Demographic and Health Surveys, Macro International, USA

00001-E-31– 27 June 2000

Probability of a Zimbabwean boy Probability of a Zimbabwean boy aged 15 dying before age 50, aged 15 dying before age 50,

trends over time, various national surveystrends over time, various national surveys

0

5

10

15

20

25

30

35

40

45

50

55

60

1980 1985 1990 1995 2000

Pro

bab

ilit

y o

f d

yin

g b

efo

re a

ge

50 (

%)

reports from surviving siblings

death registration

household reports of death

Source: Feeney G, 1999 (unpublished data).

00001-E-32– 27 June 2000

Estimated impact of AIDS on under-5 child Estimated impact of AIDS on under-5 child mortality rates, selected African countries, 2010mortality rates, selected African countries, 2010

Botswana Kenya Malawi Tanzania Zambia Zimbabwe

0

50

100

150

200

250Deaths per 1000 live births

Without AIDS

With AIDS

Source: US Census Bureau

00001-E-33– 27 June 2000

Changes in life expectancy in selected African countries with high HIV prevalence, 1950 to 2000

South-Africa

35

40

45

50

55

60

65

1950-55 1955-60 1960-65 1965-70 1970-75 1975-80 1980-85 1985-90 1990-95 1995-00

Lif

e e

xp

ecta

ncy

at

bir

th,

in y

ears

Botswana

Uganda

Zambia

Zimbabwe

Source: United Nations Population Division, 1998

00001-E-34– 27 June 2000

0 10 20 30 40 50 60 70

Cambodia

Haiti

Mozambique

Rwanda

Côte d'Ivoire

Zambia

Kenya

South Africa

Zimbabwe

Botswana

Life expectancy at birth (years)

Predicted life expectancy Loss in life expectancy due to HIV/AIDS

Source: U.S. Census Bureau, 2000

Predicted loss in life expectancy Predicted loss in life expectancy due to HIV/AIDS in children born in 2000due to HIV/AIDS in children born in 2000

00001-E-35– 27 June 2000

Lifetime risk of AIDS death for 15-year-old boys, Lifetime risk of AIDS death for 15-year-old boys, assuming unchanged or halved risk of becoming assuming unchanged or halved risk of becoming

infected with HIV, selected countriesinfected with HIV, selected countries

Source: Zaba B, 2000 (unpublished data)

Current adult HIV prevalence rate

Burkina Faso

Cambodia

Côte d’Ivoire

Kenya

South AfricaZambia

Zimbabwe

Botswana

Burkina FasoCambodia

Côte d’Ivoire

Kenya

South AfricaZambia

Zimbabwe

Botswana

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0% 5% 10% 15% 20% 25% 30% 35% 40%

Ris

k o

f d

yin

g o

f A

IDS

current level of risk maintained

risk halved over next 15 years

00001-E-36– 27 June 2000

Leading causes of death in Africa, 1999Leading causes of death in Africa, 1999

1 HIV/AIDS 2 Acute lower respiratory infections 3 Malaria 4 Diarrhoeal diseases 5 Perinatal conditions 6 Measles 7 Tuberculosis 8 Cerebrovascular disease 9 Ischaemic heart disease 10 Maternal conditions

20.6

10.3

9.1

7.3

5.9

4.9

3.4

3.2

3.0

2.4

Source: The World Health Report 2000, WHO

Rank % of total

00001-E-37– 27 June 2000

Leading causes of death globally, 1999Leading causes of death globally, 1999

1 Ischaemic heart disease 2 Cerebrovascular disease 3 Acute lower respiratory infections 4 HIV/AIDS 5 Chronic obstructive pulmonary disease 6 Perinatal conditions 7 Diarrhoeal diseases 8 Tuberculosis

11 Malaria

12.7

9.9

7.1

4.8

4.8

4.2

4.0

3.0

1.9


Rank % of total

00001-E-38– 27 June 2000

Leading causes of disease burden Leading causes of disease burden in Africa, 1999in Africa, 1999

1 HIV/AIDS 2 Malaria 3 Acute lower respiratory infections 4 Diarrhoeal diseases 5 Perinatal conditions 6 Measles 7 Maternal conditions 8 Tuberculosis 9 Congenital abnormalities 10 Road traffic accidents

19.9

9.9

8.5

6.5

6.5

4.7

3.4

2.3

1.7

1.7


Rank % of total

00001-E-39– 27 June 2000

Leading causes of disease burden Leading causes of disease burden globally, 1999globally, 1999

1 Acute lower respiratory infections 2 HIV/AIDS 3 Perinatal conditions 4 Diarrhoeal diseases 5 Ischaemic heart disease 6 Unipolar major depression 7 Cerebrovascular disease 8 Malaria

12 Tuberculosis

6.7

6.2

6.2

5.0

4.1

4.1

3.5

3.1

2.3


Rank % of total

00001-E-40– 27 June 2000

The economic impact of the epidemic



00001-E-41– 27 June 2000

Newly diagnosed AIDS cases and medical expenditure Newly diagnosed AIDS cases and medical expenditure on an agricultural estate in Kenya, 1989 to 1997on an agricultural estate in Kenya, 1989 to 1997

0

20

40

60

80

100

120

89 90 91 92 93 94 95 96 97

Nu

mb

er o

f n

ewly

dia

gn

ose

d A

IDS

cas

es

0

5

10

15

20

25

Med

ical

exp

end

itu

re (

KS

h m

illi

on

s)new AIDS cases

medical spending

Source: Rugalema et al. HIV/AIDS and the commercial agricultural sector of Ken UNDP/FAO, 1999

00001-E-42– 27 June 2000

Impact of HIV/AIDS on urban households, Côte d’Ivoire

Impact of HIV/AIDS on urban households, Côte d’Ivoire

General populationGeneral population Families living with AIDSFamilies living with AIDS

Source: Simulation-based on data from Bechu, Delcroix and Guillaume, 1997

Monthly income per capitaMonthly income per capita

Monthly consumptionper capitaMonthly consumptionper capita

00

5 0005 000

10 00010 000

15 00015 000

20 00020 000

25 00025 000

– 5 000– 5 000

30 000 Francs CFA30 000 Francs CFA

Savings/DisavingsSavings/Disavings

00001-E-43– 27 June 2000

Reduction in production in a household with an AIDS death, Zimbabwe

Crops

Maize

Cotton

Vegetables

Groundnuts

Cattle owned

Reduction in output

61%

47%

49%

37%

29%

Source: Stover & Bollinger, 1999

00001-E-44– 27 June 2000

Factors that determine the spread of the epidemic: Knowledge and behaviour



00001-E-45– 27 June 2000

Percentage of 15-19 girlsPercentage of 15-19 girlswho do not know that a HIV-infected person who do not know that a HIV-infected person

may look healthy, 1994-1999may look healthy, 1994-1999

Sources: UNICEF, DHS surveys and other nationwide surveys, 1994-99.

0

83 81 80

7368 67 66 66

62 6257 56 54

51 5047 47 45 45

41 40 39 39 37 35 33 32 31 3128 26

23 22

14

10

20

30

40

50

60

70

80

90

100

Benin

Domin

ican

Rep

ublic

Camer

oonChad

Comoro

s

Côte d

'Ivoire

Brazil

Kenya

Mad

agas

car

Mal

awi

Mal

i

Moza

mbiq

ueHai

ti

Niger

Tanza

nia

Uganda

Zambia

Zimbab

we

Nepal

Lesoto

Bangla

desh

Cambodia

Guatem

ala

Papua

New G

uinea

Mongolia

South A

frica

Viet N

am

Cape

Verde

Centra

l Afri

can R

epublic

Eritre

a

Roman

ia

Turkey

TogoPer

u

Pe

rce

nta

ge

wh

o d

o n

ot

kn

ow

00001-E-46– 27 June 2000

Knowledge of condoms among Knowledge of condoms among adolescent boysadolescent boys

Do not know condomsDo not know condoms

Know condoms but Know condoms but not where to get themnot where to get them

Know condoms and Know condoms and where to get themwhere to get them

0%

25%

50%

75%

100%Bra

zil

Brazi

l

Domin

ican

Rep

ublic

Domin

ican

Rep

ublic

Haiti

Haiti

Peru

Peru

Boliv

ia

Boliv

iaM

alaw

i

Mal

awi

Nicar

agua

Nicar

agua

Zam

bia

Zam

bia

Zim

babw

e

Zim

babw

eTa

nzan

ia

Tanz

ania

Kenya

Kenya

Ugand

a

Ugand

a

Mal

iM

ali

Niger

Niger

Moz

ambi

que

Moz

ambi

que

Chad

Chad

Sources: UNICEF, DHS surveys, 1994-1999

Per

cen

tag

e o

f 15

-19

year

old

bo

ys

00001-E-47– 27 June 2000

Percentage of 15-49 year old women Percentage of 15-49 year old women who are aware that HIV can be transmitted who are aware that HIV can be transmitted

from a mother to her child, 1994-1999from a mother to her child, 1994-1999

Sources: UNICEF, DHS and other nationwide surveys, 1994-1999

96%

Niger

Chad

Mali

Madagascar

Benin

Cameroon

Cote d'Ivoire

CAR

Tanzania

Haiti

Peru

South Africa

Kenya

Uganda

Zambia

Zimbabwe

Dominican Rep.

0% 10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

26%

36%

41%

58%

62%

65%

66%

70%

73%

74%

79%

84%

85%

85%

88%

92%

00001-E-48– 27 June 2000

Risk perceptionRisk perception percentage of sexually active women (15-19) percentage of sexually active women (15-19)

that perceive not to be at risk at all of getting AIDSthat perceive not to be at risk at all of getting AIDS

HIV Prevalence (at time of survey *)

*HIV prevalence in women attending antenatal care clinics in major urban areas

Zimbabwe

Zambia

UgandaKenya

CARHaiti

Togo

CameroonMali

Chad

BeninNiger

Dominican Rep.

Brazil

Guatemala

BoliviaColombia

Nepal

Nicaragua

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

50%

52%21%

36%

41%

63%45%

43%

46%

60%54%

87%

76%52%

87%54%

58%93%

68%

30%

27%

19%16%

10%

10%7%

6%

3%

2%2%

1%1%1%

1%

1%1%

0%

0%

Sources: UNICEF, DHS surveys, 1994-1999

Percentage of 15-19 year old girls who think they are not at risk of AIDS

00001-E-49– 27 June 2000

Knowledge and beliefs concerning AIDS Knowledge and beliefs concerning AIDS among AIDS orphans, Rusinga Island, Kenyaamong AIDS orphans, Rusinga Island, Kenya

Source: Source: Johnston T et al. Population Communication Africa, Kenya, 1999Johnston T et al. Population Communication Africa, Kenya, 1999

99.699.6

39.339.3

18.318.3

0000

1010

2020

3030

4040

5050

6060

7070

8080

9090

100100

Know aboutKnow aboutAIDSAIDS

Believe people in Believe people in extended family extended family

died of AIDS died of AIDS

Believe parents Believe parents died of AIDS died of AIDS

Orp

han

s h

old

ing

th

e b

elie

f (%

)O

rph

ans

ho

ldin

g t

he

bel

ief

(%)

Believe many people in their community have died of AIDS

00001-E-50– 27 June 2000

Casual sex and condom use Casual sex and condom use by educational status, Mozambiqueby educational status, Mozambique

Number of years respondent spent in school

Res

po

nd

ents

rep

ort

ing

th

e b

eh

avio

ur

(%)

0

10

20

30

40

50

60

0-2 3-6 7-9 10+

casual sex in the past year

condom use at last casual sex

Source: Agha S, et al. The promotion of safer sex among high-risk individuals in Mozambique, Population Services International, USA, 1999

00001-E-51– 27 June 2000

Number of reported rapes and convictions Number of reported rapes and convictions in Botswana, 1984 to 1997in Botswana, 1984 to 1997

0

200

400

600

800

1000

1200

1400

84 85 86 87 88 89 90 91 92 93 94 95 96 97

reported rapes

convictions

Source: Emang Basadi Women’s Association, Botswana, 1998

Nu

mb

er

00001-E-52– 27 June 2000

Reported incidence of syphilis and gonorrhoea Reported incidence of syphilis and gonorrhoea in China, 1989 to 1998in China, 1989 to 1998

0

5

10

15

20

25

30

89 90 91 92 93 94 95 96 97 98

Rep

ort

ed c

ase

s p

er 1

00,0

00R

epo

rted

ca

ses

per

100

,000

Gonorrhoea

Syphilis

Source: Chen X-S et al. Sex Transm Dis 2000, 27:138-142

00001-E-53– 27 June 2000

Prevalence of syphilis among pregnant women Prevalence of syphilis among pregnant women attending antenatal clinics in the Moscow region, attending antenatal clinics in the Moscow region,

1993 to 19971993 to 1997

0

100

200

300

400

500

600

700

800

1993 1994 1995 1996 1997

Pre

vale

nce

pe

r 10

0,0

00

Source: Borisenko KK et al. Int J STD & AIDS, 1999, 10:665-668

00001-E-54– 27 June 2000

Proportion of all new HIV infections that are inProportion of all new HIV infections that are ininjecting drug users, selected countries, 1998-1999injecting drug users, selected countries, 1998-1999

0

10

20

30

40

50

60

70

80

90

100

Canada China Latvia Malaysia Moldova RussianFederation

Ukraine Viet Nam

Source: National AIDS Programmes

Per

cen

tag

e

00001-E-55– 27 June 2000

Rectal gonorrhoea and sexual risk behaviour among men Rectal gonorrhoea and sexual risk behaviour among men who have sex with men, San Francisco, USA, 1994 to 1998 who have sex with men, San Francisco, USA, 1994 to 1998

Pro

po

rtio

n r

epo

rtin

g r

isk

be

hav

iou

r (%

)

multiple partners in the past six months

unprotected anal sex in the past six months

42

33

23

2021

27

38 38

44

0

20

40

60

80

100

90 91 92 93 94 95 96 97 98

rectal gonorrhoea rate

Cases of rectal gonorrhoeaCases of rectal gonorrhoeaper 100,000 populationper 100,000 population

Source: San Francisco Department of Public Health (California), USA, 1999

00001-E-56– 27 June 2000

Proportion of newly reported AIDS cases by Proportion of newly reported AIDS cases by race/ethnicity, 1985-1999, United Statesrace/ethnicity, 1985-1999, United States

0

10

20

30

40

50

60

70

85 86 87 88 89 90 91 92 93 94 95 96 97 98 99

Per

cen

tag

e o

f A

IDS

cas

es

White, not HispanicBlack, not HispanicHispanicAsian / Pacific IslanderAmerican Indian / Alaska native

Source: U.S. Centers for Disease Control and Prevention, 2000

00001-E-57– 27 June 2000

Increase in proportion Increase in proportion of ethnic minority members among newly diagnosed of ethnic minority members among newly diagnosed

AIDS cases, Canada, 1990 to 1999AIDS cases, Canada, 1990 to 1999

Source: Health Canada, HIV and AIDS in Canada. Surveillance Report to December 31, 1999.

0

2

4

6

8

10

12

14

16

90 91 92 93 94 95 96 97 98 99

Per

cen

tag

e et

hn

ic m

ino

rity

me

mb

ers

Aboriginal

Black

Latin American

00001-E-58– 27 June 2000

Percentage of women who are mothers Percentage of women who are mothers or pregnant by the end of their teens, 1990-1998 or pregnant by the end of their teens, 1990-1998

0

10

20

30

40

50

60

70

80

Benin

Camer

oon

CAR

Comoro

s

Côte d

'Ivoire

Ghana

Kenya

Mad

agas

car

Mal

i

Moza

mbiq

ue

Namib

ia

Niger

Niger

ia

Rwanda

Seneg

al

Togo

Uganda

Zambia

Zimbab

we

Source: Demographic and Health Surveys, various countries

Per

cen

tag

e o

f w

om

en

00001-E-59– 27 June 2000

Proportion of children aged 10-14 who are still Proportion of children aged 10-14 who are still in school according to whether their parents are alive, in school according to whether their parents are alive,

surveys in various countries, 1994-1998surveys in various countries, 1994-1998

0

10

20

30

40

50

60

70

80

90

100

Benin

Cameroon

Chad

Côte d'Ivoire

Mali

Niger

Tanzania

TogoHaiti

Bolivia

Guatem

alaPeru

living with one or both parents both parents dead

Source: Demographic and Health Surveys, Macro International, USA, and UNICEF, 2000

Pro

po

rtio

n o

f c

hil

dre

n i

n s

ch

oo

l (%

)

00001-E-60– 27 June 2000

Proportion of girls and boys aged 15-19 Proportion of girls and boys aged 15-19 who do not know how to protect themselves fromwho do not know how to protect themselves from

HIV, surveys in selected countries, 1994-1998HIV, surveys in selected countries, 1994-1998

0

10

20

30

40

50

60

70

80

90

100

Bangla

desh

Moza

mbiq

ue

Niger

Chad

Tanza

nia

Comoro

s

Mal

i

Bolivia

Peru

Camer

oon

Nicar

agua

Kenya

Zambia

Cote d

'Ivoire

Zimbab

we

Uganda

Brazil

Pro

po

rtio

n w

ho

do

no

t kn

ow

girls

boys

Source: Demographic and Health Surveys, Macro International, USA, and UNICEF

00001-E-61– 27 June 2000

Proportion of 15 to 19 year-old girls married, proportion Proportion of 15 to 19 year-old girls married, proportion reporting ever having had sex, and adult HIV prevalence reporting ever having had sex, and adult HIV prevalence

rate, surveys in selected countries, 1996-1998rate, surveys in selected countries, 1996-1998

0

10

20

30

40

50

60

70

80

Philippin

es 1

998

Indones

ia 1

997

Bolivia

199

8

Sénég

al 1

997

Nicar

agua

1998

Kenya

199

8

Chad 1

996-

97

Zambia

199

6

Togo 199

8

Niger

199

8

Camer

oon 199

8

Moza

mbiq

ue 19

97

married

ever had sex

adult HIV prevalence rate

Source: Demographic and Health Surveys, Macro International, USA

Per

cen

tag

e

00001-E-62– 27 June 2000

HIV prevalence rates among pregnant women andHIV prevalence rates among pregnant women andamong all adults aged 15-49among all adults aged 15-49

Source: Sentinel surveillance data from antenatal clinics and population-based studies, selected African countries, 1990-1998

0

5

10

15

20

25

30

35

Lusaka,Zambia

94-96

Mposhi,Zambia

94-96

Mwanza,Tanzania 90-91

Rakai,Uganda 90

Rakai,Uganda

91

Rakai,Uganda 92

Kisumu,Kenya 98

pregnant women all adults

HIV

pre

vale

nc

e (%

)

00001-E-63– 27 June 2000

Learning from success stories: Programmes that work



00001-E-64– 27 June 2000

Prevalence of sexually transmitted diseasesamong sex workers, Dakar, Senegal,

1991 and 1996

0

10

20

30

40

50

Trichomonas vaginalis

Chlamydia trachomatis

Neisseria gonorrhoeae

Syphilis

STD prevalence (%) 1991

1996

Source: National AIDS Programme, Senegal

00001-E-65– 27 June 2000

Proportion of men reporting casual sex in the Proportion of men reporting casual sex in the past year and condom use with their last non-regular past year and condom use with their last non-regular

partner, Tamil Nadu, India, 1996 to 1998partner, Tamil Nadu, India, 1996 to 1998

0

10

20

30

40

50

60

70

1996 1997 1998

%

casual sex, truckers

casual sex, factory workers

condom use, truckers

condom use, factory workers

Source: AIDS Prevention and Control Project, Tamil Nadu, India, 1999

00001-E-66– 27 June 2000

Trend in HIV prevalence in 21 year old military Trend in HIV prevalence in 21 year old military conscripts in Thailandconscripts in Thailand

Source: Armed Forces Research Institute of Medical Sciences, Thailand

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

HIV

pre

vale

nc

e (%

)H

IV p

reva

len

ce

(%)

00

55

00001-E-67– 27 June 2000

Annual number of deaths due to AIDS, Annual number of deaths due to AIDS, Canada, 1990 to 1999Canada, 1990 to 1999

0

200

400

600

800

1000

1200

1400

1600

90 91 92 93 94 95 96 97 98 99

Nu

mb

er o

f A

IDS

de

ath

s

Source: Health Canada, HIV and AIDS in Canada. Surveillance Report to December 31, 1999

00001-E-68– 27 June 2000

Proportion of sex workers and sex workers’ clients Proportion of sex workers and sex workers’ clients always using condoms with commercialalways using condoms with commercial

partners, Cambodia, 1997 to 1999partners, Cambodia, 1997 to 1999

0

10

20

30

40

50

60

70

80

90

1997 1998 1999

Pro

po

rtio

n r

epo

rtin

g c

on

sist

ent

con

do

m u

se (

%)

brothel-based sex workers

military/police

motorbike taxi drivers

beer promotion women

Source: National AIDS Programme, Cambodia, and Family Health International, 2000

00001-E-69– 27 June 2000Source: National STD/AIDS Control Programmes, Senegal and Uganda Armed Forces Research Institute of Medical Sciences, Thailand

00

55

1010

1515

2020

2525

3030

89 90 91 92 93 94 95 96 97 98 99

HIV

pre

vale

nc

e (%

)H

IV p

reva

len

ce

(%)

Kampala, <20 year old ANC

Thailand, 21 year old military conscripts

Dakar, all ages ANC

Trends in HIV prevalence in selected populations Trends in HIV prevalence in selected populations in Kampala, Uganda; Dakar, Senegal; and Thailand;in Kampala, Uganda; Dakar, Senegal; and Thailand;

1989 to 19991989 to 1999

00001-E-70– 27 June 2000

Condom use for casual sex in the past six months,Condom use for casual sex in the past six months,17 to 30 year-olds, Switzerland, 1987 to 199717 to 30 year-olds, Switzerland, 1987 to 1997

0

20

40

60

80

100

never sometimes always

Source: University Institute of Social and Preventive Medicine, Lausanne, Switzerland, 1999

87 88 89 90 91 92 93 94 95 96 97

Per

cen

tag

e

00001-E-71– 27 June 2000

Condom use for casual sex, by age, selectedCondom use for casual sex, by age, selectedLatin American and Caribbean countries, 1996-1997Latin American and Caribbean countries, 1996-1997

0

10

20

30

40

50

60

70

80

15-19 20-29 30-39 40-49

Age group (years)

Pro

po

rtio

n r

epo

rtin

g c

on

do

m u

se

wit

hth

eir

mo

st r

ecen

t n

on

-reg

ula

r p

artn

er (

%)

Chile

Costa Rica

Cuba

Dominican Republic

Source: National AIDS Programmes

00001-E-72– 27 June 2000

EXTRA SLIDES



00001-E-73– 27 June 2000

Annual number of reported HIV infections in the Annual number of reported HIV infections in the UK, by mode of transmission, 1983 to 1999UK, by mode of transmission, 1983 to 1999

0

500

1000

1500

2000

2500

83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99

Nu

mb

er o

f d

iag

no

ses

Heterosexual MSM + MSM/IDU

Source: PHLS Communicable Disease Surveillance Centre UK, July 2000

00001-E-74– 27 June 2000

Number of AIDS patients, AIDS deaths and patients Number of AIDS patients, AIDS deaths and patients on antiretroviral therapy among men who have sex with on antiretroviral therapy among men who have sex with

men (MSM), San Francisco, USA, 1980 to 1998men (MSM), San Francisco, USA, 1980 to 1998

0

1000

2000

3000

4000

5000

6000

7000

8000

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98

MSM taking antiretroviral drugsMSM taking antiretroviral drugs

AIDS deaths among MSMAIDS deaths among MSM

MSM with AIDSMSM with AIDS

Source: San Francisco Department of Public Health (California), USA, 1999

00001-E-75– 27 June 2000

35

21

26

46

12

7

4

117

57

103

69

7

19

17

14.8

7.8

1.5

15.0

14.0

2.0

21.5

14.9

15.2

2.1

26.3

147.3

5.2

12.2

150.0 100.0 50.0 0.0 50.0 100.0 150.0

AustraliaAustralia

BelgiumBelgium

CanadaCanada

DenmarkDenmark

FinlandFinland

GermanyGermany

JapanJapan

LuxembourgLuxembourg

NetherlandsNetherlands

NorwayNorway

SwedenSweden

SwitzerlandSwitzerland

UKUK

USAUSA

1998 HIV/AIDS ODA in US$ million HIV/AIDS ODA in US$ per US$ million 1998 GNP

HIV/AIDS ODA in 1998: HIV/AIDS ODA in 1998: Total amount obligated, in US$ million Total amount obligated, in US$ million

and per US$ million of donor country’s GNPand per US$ million of donor country’s GNP

trends in the epidemic over time

Documents