09

Uniting the World against AIDS

Catherine Hankins
Chief Scientific
Adviser to UNAIDS

UNAIDS
April 8, 2011
 25 years of AIDS
50 People
1 First cases of unusual immune deficiency are identified
living 9 In 1991-1993, HIV prevalence in
young pregnant women in Uganda
Million

among gay men in USA

45 with and in young men in Thailand
2 AIDS defined for the first time 16 begins to decrease, the first major

40 HIV14 15 downturns in the epidemic in

developing countries
3 HIV identified as the cause of AIDS
10 HAART launched
4 In Africa, a heterosexual AIDS epidemic is
35 revealed
5 First HIV antibody test available 11 Scientists develop the first
6 Global Network of People living with 13 treatment regimen to reduce
30 HIV/AIDS (GNP+) (then International mother-to-child transmission of HIV
Steering Committee of People Living 11

25 with HIV/AIDS) founded Children 12 UNAIDS is created

13 Brazil becomes first developing
orphaned
7 WHO launches the Global
Programme on AIDS 10 country to provide ARY through its
public health system
20 by AIDS in
8 AZT is approved for use in USA 9 12 14 The UN General Assembly Special

15 sub- Session on HIV/AIDS. Global Fund

to fight AIDS, Tuberculosis and
Saharan Malaria launched

10
6
7 8 Africa 15 WHO and UNAIDS launch the "3 x 5"
initiative with the goal of reaching 3
5 million people in developing world
5 1 2 3 4 with ART by end 2005
16 Global Coalition on Women and
0 AIDS launched

1980 1985 1990 1995 2000 2005

UNAIDS
April 8, 2011
1.1
 Key statistics (2007 data)

33 million people living with HIV

2 million people died of AIDS
2.7 million new HIV infections – 7,400 every
day
370,000 children newly infected – 1000+
every day
12 million orphans in sub-Saharan Africa

UNAIDS
April 8, 2011
Uniting the world against AIDS
 A global view of HIV infection
33 million people [30–36 million] living with HIV, 2007

UNAIDS
April 8, 2011
 Regional HIV and AIDS statistics and features, 2007
Adults & children Adult Adult & child
Adults & children
newly infected with prevalence deaths due to
living with HIV
HIV (15‒49) [%] AIDS
22.0 million 1.9 million 5.0% 1.5 million
Sub-Saharan Africa [4.6% –
[20.5 – 23.6 million] [1.6 – 2.1 million] [1.3 – 1.7 million]
5.4%]
380 000 40 000 0.3% 27 000
Middle East & North Africa [0.2% –
[280 000 – 510 000] [20 000 – 66 000] [20 000 – 35 000]
0.4%]
4.2 million 330 000 0.3% 340 000
South and South-East Asia [0.2% –
[3.5 – 5.3 million] [150 000 – 590 000] [230 000 – 450 000]
0.4%]
740 000 52 000 0.1% 40 000
East Asia [<0.1% –
[480 000 – 1.1 million] [29 000 – 84 000] [24 000 – 63 000]
0.2%]
1.7 million 140 000 0.5% 63 000
Latin America [0.4% –
[1.5 – 2.1 million] [88 000 – 190 000] [49 000 – 98 000]
0.6%]
230 000 20 000 1.1% 14 000
Caribbean [1.0% –
[210 000 – 270 000] [16 000 – 25 000] [11 000 – 16 000]
1.2%]
Eastern Europe & Central 1.5 million 110 000 0.8% 58 000
Asia [0.6% –
[1.1 – 1.9 million] [67 000 – 180 000] [41 000 – 88 000]
1.1%]
730 000 27 000 0.3% 8000
Western & Central Europe [0.2% –
[580 000 – 1.0 million] [14000 – 49 000] [4800 – 17 000]
0.4%]
1.2 million 54 000 0.6% 23 000
North America [0.4% –
[760 000 – 2.0 million] [9600 – 130 000] [9100 – 55 000]
1.0%]
74 000 13 000 0.4% 1000
Oceania [0.3% –
[66 000 – 93 000] [ 12 000 – 15 000] [<1000 – 1400]
0.5%]
33 million 2.7 million 0.8% 2.0 million
TOTAL [0.7% -
[30 – 36 million] [2.2 – 3.2 million] [1.8 – 2.3 million]
0.9%]
UNAIDS
April 8, 2011 The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available
information.
 Estimated number of people living with HIV and adult HIV prevalence
Global HIV epidemic, 1990–2007; and, HIV epidemic in Sub-Saharan Africa,
1990–2007

Global HIV epidemic, 1990–2007 HIV epidemic in Sub-Saharan Africa, 1990–

2007
Number of people % HIV prevalence, Number of people % HIV prevalence,
living with HIV (millions) adult (15–49) living with HIV (millions) adult (15–49)
40 4.0 30 15.0

25 12.0
30 3.0
20
9.0
20 2.0 15
6.0
10
10 1.0
5 3.0

0 0 0 0
1990‘91‘92‘93‘94‘95‘96‘97‘98‘992000‘01‘02‘03‘04‘05‘06
2007 1990‘91‘92‘93‘94‘95‘96‘97‘98‘992000‘01‘02‘03‘04‘05‘06
2007

NOTE: Even though the HIV prevalence

Number of people living with HIV
% HIV prevalence, adult (15–49)
These bars indicate the range around the estimate
stabilized in Sub-Saharan Africa, the actual
number of people infected continues to grow
because of ongoing new infections and
increasing access to antiretroviral therapy.

UNAIDS
April 8, 2011
Percent of adults (15+) living with HIV who are female
1990–2007
70

60 Sub-Saharan Africa

GLOBAL
50
Caribbean
Percent 40
female
Asia
(%) 30
Latin America
20
Eastern Europe
10 & Central Asia

0
1990 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 2000 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 2007

UNAIDS
April 8, 2011
2.4
 Over 7400 new HIV infections a day in 2007

• More than 96% are in low and middle income

countries

• About 1000 are in children under 15 years of age

• About 6300 are in adults aged 15 years and older

of whom:
— almost 50% are among women
— about 45% are among young people (15-24)

UNAIDS
April 8, 2011
 But, we are making progress…

Nearly 4 million people are receiving antiretroviral drugs – more

than tenfold increase from five years before
Fewer people are becoming newly infected with HIV. Estimates
declining from 3 million in 2001 to 2.7 million in 2007.
Fewer people are dying from HIV-related illnesses. Estimates
declining from 2.2 million in 2005 to 2.0 million in 2007.
The total number of people living with HIV is increasing due to
ongoing new infections, persons alive as a result of treatment, and
population growth.
USD 14 billion was spent on AIDS last year

UNAIDS
April 8, 2011
Uniting the world against AIDS
Who is funding the AIDS response?
Resource Availability for HIV 2005-2008
$13,765
14,000

12,000 $11,322

10,000
$8,835
$7,918
US$ million

8,000

6,000

4,000

2,000

0
2005 2006 2007 2008

Domestic (Public and Private)*** Bilateral ODA*

Multilateral ODA* Philanthropic sector**
UNAIDS
April 8, 2011
About UNAIDS

UNAIDS is an innovative joint venture

of the United Nations, bringing
together the efforts and resources of
the UNAIDS Secretariat and ten UN
system organizations to respond to
AIDS.
The Secretariat is based in Geneva,
Switzerland and works on the ground
in more than 80 countries.

UNAIDS/S.NOORANI
UNAIDS
April 8, 2011
About UNAIDS
• Established in 1994 by an ECOSOC resolution, launched in January
1996
• Innovative joint venture, combining the efforts and resources of the
Secretariat and ten UN system organizations (Cosponsors) to respond
to AIDS
• Guided by a Programme Coordinating Board, consisting of:
 Representatives of 22 governments from all geographic regions
 the UNAIDS Cosponsors
 Five representatives of NGOs from all geographic regions, including
associations of people living with HIV

UNAIDS
April 8, 2011
Our Cosponsors

 UNHCR
 UNICEF
 WFP
 UNDP
 UNFPA
 UNODC
 ILO
 UNESCO
 WHO
 WORLD BANK

UNAIDS
April 8, 2011
UNAIDS five focus areas
1. Mobilizing leadership and
advocacy for effective action on
the epidemic
2. Providing strategic information
and policies to guide efforts for
the AIDS response worldwide
3. Tracking, monitoring and
evaluation of the epidemic and
the response
4. Engaging civil society and
developing partnerships

UNAIDS/L.TAYLOR
5. Mobilizing resources to support
an effective response

UNAIDS
April 8, 2011
Global AIDS M&E Team (GAMET

Incidence by Modes of Transmission

(76,315) (74,263) (91,546) (118,279) (11,381) (23,269) (N)
100

80
Percent
new 60
infections
40

20

0
Kenya Zambia Uganda Mozambique Swaziland Lesotho

Other Partners of clients of female sex workers Clients of female sex workers Injecting drug users
Men having sex with men Casual heterosexual sex Partners (Casual heterosexual sex)
Low risk heterosexual
Sources: Draft results from Know your Epidemic project
Our goals
Through the 2001 Declaration of
Commitment on HIV/AIDS and the
Millennium Development Goals, the
world has a set of commitments,
actions and goals to stop and reverse
the spread of HIV.
UNAIDS
April 8, 2011
Millennium development goals
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower
women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other
diseases
7. Ensure environmental sustainability
8. Develop a global partnership for
development
 Universal access to HIV prevention,
treatment, care and support
 3 by 5: the WHO/UNAIDS-led initiative to place 3
million people in low and middle-income countries on
antiretroviral treatment by the end of 2005

 Universal Access (2010):

a signpost on the road to….

 Millennium Development Goals (2015):

to halt and reverse the HIV epidemic
Principles for the coordination of
national AIDS responses

The Three Ones: Ownership, Alignment and Mutual

Accountability
One agreed AIDS action framework that provides the
basis for coordinating the work of all partners;
One national AIDS authority, with a broad-based
multisectoral mandate;
One agreed country-level monitoring and evaluation
system.

UNAIDS
April 8, 2011
Prioritization
•We can prevent mothers from dying and
babies from becoming infected with HIV.

•We can ensure that people living

with HIV receive treatment.

•We can prevent people living with

HIV from dying of tuberculosis.

•We can protect drug users from

becoming infected with HIV.

UNAIDS/S.NOORANI
UNAIDS
April 8, 2011
Prioritization (continued)
•We can remove punitive laws,
policies, practices, stigma and
discrimination that block effective
responses to AIDS.

•We can stop violence against women

and girls.

• We can empower young people to

protect themselves from HIV.

•We can enhance social protection for

people affected by HIV.

UNAIDS
April 8, 2011
Impact of the Economic Crisis
on the response to AIDS
 The crisis is affecting both advanced and
developing countries
 Financial conditions facing developing
countries have deteriorated sharply, and
the crisis will have long-term
implications for them
 The challenge is to protect or expand
critical expenditures in the social sector –
safety nets, human development and
infrastructure
 There is a strong need to expand
assistance to developing countries to
protect these expenditures and prevent the
erosion of progress in reducing poverty

UNAIDS
April 8, 2011
 What are the direct impact – early
warning signals

Information collected in late March 2009 from 69 countries

(in which 3.4 million people are under treatment) shows
that:
In 12% of the surveyed countries, the crisis
is already affecting treatment programmes.

In 32% of the countries—home to 61% of

those under antiretroviral treatment—an
impact is expected this year.

UNAIDS
April 8, 2011
 The risks of reduced treatment
Increased mortality and morbidity Unnecessary death
and disease (including increased tuberculosis) due to AIDS
Greater transmission risks as people off treatment
become more infectious
Higher financial costs Interruptions of treatment make
treatment failure more likely, requiring use of costly second-
line regimen drugs
Increased burden on health systems. More HIV-related
illnesses, and pressure on health services at a time when
their budgets are being cut
Reversal of economic and social gains. Consequences
for households, and costs to businesses and public
agencies.
UNAIDS
April 8, 2011
 Additional threats to sustaining antiretroviral treatment
coverage and increasing access to effective regimens

• HIV prevention using antiretroviral drugs

• Double standard regimens in the global south and global north

• Late diagnosis incurs high mortality in first 3 months of treatment

(300x that of the general population)
 Need to invest in testing and counselling and reduce stigma
and discrimination – know your status
 Possible changes in CD4 count level for treatment initiation

UNAIDS
April 8, 2011
 Prevention Strategies
(those using antiretroviral drugs in red)

Prior to Point of
After infection
exposure transmission

• Structural • Male and female • Prevention for

interventions condoms (FC1 & Positives
FC2)
• Behaviour change • Therapeutic
• PMTCT (mother- Vaccines
• Male circumcision
to-child)
• Preventive • Treatment of
• Post exposure infected partner
Vaccines
prophylaxis (PEP)
• Pre-exposure • Microbicides
prophylaxis
(PREP) • Diaphragm,
cervical barriers
UNAIDS
• HSV2 suppression
April 8, 2011
UNAIDS
April 8, 2011

Egger, 2007
 Currently, the
median CD4
count at ART
initiation is well
below 200 in
Africa and
South/South-
east Asia.

Raising the
eligibility
criteria will not
affect numbers
on treatment
unless potential
patients are
identified
earlier and
access to
treatment
expands.
Source: Matthias Egger, Outcomes of Antiretroviral Treatment
in Resource Limited and Industrialized Countries, CROI 2007
UNAIDS
April 8, 2011
www.unaids.org
Any questions?

UNAIDS/L.TAYLOR
UNAIDS
April 8, 2011