2007 Aids Epidemic Update
07 AIDS epidemic update
UNAIDS/07.27E / JC1322E (English original, December 2007)
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AIDS epidemic update : December 2007.
“UNAIDS/07.27E / JC1322E”.
1.HIV infections – epidemiology. 2.HIV infections – prevention and control. 3.Acquired immunodeficiency syndrome – epidemiology.
4.Acquired immunodeficiency syndrome – prevention and control. 5.Disease outbreaks. I.UNAIDS. II.World Health Organization. III.Title.
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AIDS epidemic update
December 2007
CONTENTS
Global overview
3
reGional overview
15
Sub-Saharan africa
15
aSia
21
eaStern europe and central aSia
26
caribbean
29
latin america
31
north america, weStern and central europe
33
middle eaSt and north africa
35
oceania
36
mapS
37
Global estimates for adults and children, 2007
38
Adults and children estimated to be living with HIV in 2007
39
Estimated number of adults and children newly infected with HIV during 2007
40
Estimated adult and child deaths from AIDS during 2007
41
biblioGraphY
43
AIDS epidemic update: December 2007
2 0 0 7 A I D S E p I D E m I c u p D A t E | G l o b a l S u m m a r y
Global summary of the AIDS epidemic
December 2007
Number of people living with HIV in 2007
Total
33.2 million [30.6–36.1 million]
Adults
30.8 million [28.2–33.6 million]
Women
15.4 million [13.9–16.6 million]
Children under 15 years 2.5 million [2.2–2.6 million]
People newly infected with HIV in 2007
Total
2.5 million [1.8–4.1 million]
Adults
2.1 million [1.4–3.6 million]
Children under 15 years
420 000 [350 000–540 000]
AIDS deaths in 2007
Total
2.1 million [1.9–2.4 million]
Adults
1.7 million [1.6–2.1 million]
Children under 15 years
330 000 [310 000–380 000]
The ranges around the estimates in this table define the boundaries within which the actual numbers lie,
based on the best available information.
2 0 0 7 A I D S E p I D E m I c u p D A t E | G l o b a l o V E r V I E W
G l o b A l o V e r V I e w
Background
In 2007, advances in the methodology of
propriate to draw conclusions by comparing 2007
estimations of HIV epidemics applied to an
estimates with those published in 2006. However,
expanded range of country data have resulted in
the methodological revisions have been applied
substantial changes in estimates of numbers of
retrospectively to al earlier HIV prevalence data,
persons living with HIV worldwide. However
so that the estimates of incidence, prevalence and
the qualitative interpretation of the severity
mortality from earlier years in the current report
and implications of the pandemic has altered
al ow an assessment of trends over time.
little. The estimated number of persons living
The AIDS epidemic update reports on the latest
with HIV worldwide in 2007 was 33.2 million
developments in the global AIDS epidemic
[30.6–36.1 million], a reduction of 16% compared
and has been published annually since 1998.
with the estimate published in 2006 (39.5 million
The 2007 edition provides the most recent
[34.7–47.1 million]). (UNAIDS/WHO, 2006)
estimates of the epidemic’s scope and human
The single biggest reason for this reduction
toll and explores new trends in the epidem-
was the intensive exercise to assess India’s HIV
ic’s evolution. This is a joint UNAIDS and
epidemic, which resulted in a major revision of
WHO report and the estimates produced by the
that country’s estimates. Important revisions of
UNAIDS/WHO Working Group on Global
estimates elsewhere, particularly in sub-Saharan
HIV/AIDS and STI Surveillance are based on
Africa, also contributed. Of the total difference in methods and parameters that are informed by
the estimates published in 2006 and 2007, 70% are the UNAIDS Reference Group on HIV/AIDS
due to changes in six countries: Angola, India,
Estimates, Modelling and Projections. These
Kenya, mozambique, Nigeria, and Zimbabwe. estimates are also based on work by country
In both Kenya and Zimbabwe, there is
analysts in a series of 11 regional HIV estimates
increasing evidence that a proportion of the
workshops conducted in 2007 by UNAIDS
declines is due to a reduction of the number of
and WHO. The process and methodology used
new infections which is in part due to a reduction by UNAIDS and WHO were reviewed and
in risky behaviours.
endorsed by an International Consultation on
Because estimates of new HIV infections and
AIDS Epidemiological Estimates convened
HIV-associated deaths are derived through math-
jointly by the UNAIDS Secretariat and WHO on
ematical models applied to HIV prevalence
14–15 November 2007 in Geneva.
estimates, new estimates of HIV incidence and
The major elements of methodological improve-
mortality in 2007 also differ substantial y from
ments in 2007 included greater understanding
earlier assessments. It is emphasized that these
of HIV epidemiology through population-based
differences between estimates published in 2006
surveys, extension of sentinel surveillance to more
and those published in 2007 result largely from
sites in relevant countries, and adjustments to
refinements in methodology, rather than trends
mathematical models because of better under-
in the pandemic itself. For this reason, it is inap-
standing of the natural history of untreated HIV
G l o b a l o V E r V I E W | 2 0 0 7 A I D S E p I D E m I c u p D A t E
infection in low- and middle- income countries.
the global prevalence of HIV infection
These adjustments to the methodology used are
(percentage of persons infected with HIV)
explained in more detail in the box “New data
is remaining at the same level, although the
lead to changes in assumptions and improved
global number of persons living with HIV is
estimates.” UNAIDS and WHO will continue
increasing because of ongoing accumulation
to modify their estimates of HIV infections and
of new infections with longer survival times,
AIDS deaths as new scientific data, research and
measured over a continuously growing general
analyses emerge.
population;
there are localized reductions in prevalence in
Several comparisons in this report are made
specific countries;
between HIV estimates derived by the uniform
a reduction in HIV-associated deaths, partly
revised methodology for 2007 and 2001. The year
attributable to the recent scaling up of
2001 was the year of the United Nations General
treatment access; and
Assembly Special Session on HIV/AIDS that first
a reduction in the number of annual new HIV
defined intervention targets, but is also sufficiently
infections globally.
long ago to allow meaningful examination of
Examination of global and regional trends suggests
trends in data subjected to uniform analysis.
the pandemic has formed two broad patterns:
generalized epidemics sustained in the general
Epidemic update 2007—essential
populations of many sub-Saharan African
findings
countries, especially in the southern part of the
continent; and
Every day, over 6800 persons become infected
with HIV and over 5700 persons die from AIDS,
epidemics in the rest of the world that are
mostly because of inadequate access to HIV
primarily concentrated among populations
prevention and treatment services. The HIV
most at risk, such as men who have sex with
pandemic remains the most serious of infectious
men, injecting drug users, sex workers and
disease challenges to public health. Nonetheless,
their sexual partners.
the current epidemiologic assessment has encour-
Sub-Saharan Africa remains the most seriously
aging elements since it suggests:
affected region, with AIDS remaining the leading
cause of death there.
Figure 1
Estimated number of people living with HIV global y,
1990–2007
40
i
l
l
i
o
n
s
M 35
30
Number
25
of people
living with
20
HIV
15
10
5
0 1990 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 2000 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07
Year
This bar indicates the range around the estimate.
2 0 0 7 A I D S E p I D E m I c u p D A t E | G l o b a l o V E r V I E W
Figure 2
Estimated adult (15–49) HIV prevalence (%) globally and in sub-Saharan Africa,
1990–2007
7.0
6.0
5.0
4.0
r
e
v
a
l
e
n
c
e
Sub-Saharan
Africa
p
I
V 3.0
H
% 2.0
1.0
Global
0.0
1990 ‘91 ‘92 ‘93
‘94 ‘95 ‘96
‘97 ‘98 ‘99 2000 ‘01 ‘02
‘03 ‘04 ‘05
‘06 ‘07
Although percentage prevalence has stabilized,
mortality of HIV-infected persons on antiretro-
continuing new infections (even at a reduced rate)
viral treatment. The analyses in this report cannot
contribute to the estimated number of persons
specifical y measure the opposing influences on
living with HIV, 33.2 mil ion [30.6–36.1 mil ion],
HIV prevalence of prevention efforts that reduce
being greater than ever before (Figure 1). HIV
new infections and treatment scale-up that reduces
prevalence tends to reduce slowly over time as
deaths among people with HIV.
new infections decline and through the death
of HIV-infected persons; it can increase through
Global HIV prevalence—the percentage of the
continuing HIV incidence and through reduced
world’s adult population living with HIV—has
Figure 3
Estimated number of adult and child deaths due to AIDS global y,
1990–2007
3.0
i
l
l
i
o
n
s
M 2.5
Number
2.0
of adult
and child
1.5
deaths due
to AIDS
1.0
0.5
0.0 1990 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 2000 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07
Year
This bar indicates the range around the estimate.
G l o b a l o V E r V I E W | 2 0 0 7 A I D S E p I D E m I c u p D A t E
Estimated number of people newly infected with HIV global y,
1990–2007
Upper range
6
Estimate
i
l
l
i
o
n
s
M
Lower range
5
Number of 4
people
newly
3
infected
with HIV
2
1
0
1990 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 2000 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07
Year
Figure 4
been estimated to be level since 2001 (Figure 2).
1990s (Figure 4) at over 3 million new infections
Downward trends in HIV prevalence are occurring per year, and was estimated to be 2.5 million
in a number of countries, where prevention efforts
[1.8–4.1 million] new infections in 2007 of which
aimed at reducing new HIV infections since 2000
over two thirds (68%) occurred in sub-Saharan
and 2001 are showing results. In most of sub-
Africa. This reduction in HIV incidence likely
Saharan Africa, national HIV prevalence has either
reflects natural trends in the epidemic as well as
stabilized or is showing signs of a decline (Figure
the result of prevention programmes resulting in
2). côte d’Ivoire, Kenya and Zimbabwe have
behavioural change in different contexts.
al seen declines in national prevalence, continuing
A final conclusion concerns the quality and nature
earlier trends. In South-East Asia, the epidemics
of strategic information relating to the pandemic
in cambodia, myanmar and thailand al show
and the effects of our programmes. Increased
declines in HIV prevalence.
investments in interventions for HIV prevention,
The estimated number of deaths due to AIDS
treatment and care are showing results but also
in 2007 was 2.1 million [1.9–2.4 million]
greatly increase the complexity of the epidemic
worldwide (Figure 3), of which 76% occurred
and analysis of its trends. The analyses reported
in sub-Saharan Africa. Declines in the past two
here cannot adequately define the impact of
years are partly attributable to the scaling up of
specific interventions or programmes. This will
antiretroviral treatment services. AIDS remains
require special studies in local areas, including
a leading cause of mortality worldwide and the
direct assessments of HIV incidence, mortality,
primary cause of death in sub-Saharan Africa,
programme effectiveness and the burden of HIV
illustrating the tremendous, long-term challenge
infection, disease and death in children.
that lies ahead for provision of treatment services,
As the resources committed to AIDS and other
with the hugely disproportionate impact on sub-
major health problems continue to increase, more
Saharan Africa ever more clear.
emphasis is required to strengthen systems to
HIV incidence (the number of new HIV
col ect and analyse data and to improve the quality
infections in a population per year) is the key
of such data to strategical y guide programming.
parameter that prevention efforts aim to reduce,
Despite the chal enges and limitations inherent in
since newly infected persons contribute to the
data col ection of this nature, the resources made
total number of persons living with HIV; they
available to the global AIDS response have enabled
will progress to disease and death over time; and
the quality of information and our understanding
are a potential source of further transmission.
of the HIV pandemic to be superior to many
Global HIV incidence likely peaked in the late
other global disease estimates.
2 0 0 7 A I D S E p I D E m I c u p D A t E | G l o b a l o V E r V I E W
Regional summaries
three (68%) adults and nearly 90% of children
Regional data are shown in Table 1. Sub-Saharan
infected with HIV live in this region, and more than
Africa continues to be the region most affected
three in four (76%) AIDS deaths in 2007 occurred
by the AIDS pandemic. More than two out of
there, illustrating the unmet need for antiretroviral
Table 1
Regional HIV and AIDS statistics, 2001 and 2007
Adults and children
Adults and children
Adult prevalence
Adult and child deaths
living with HIV
newly infected with HIV
(%)
due to AIDS
Sub-Saharan Africa
2007
22.5 million
1.7 million
5.0%
1.6 million
[20.9 mil ion–24.3 mil ion] [1.4 mil ion–2.4 mil ion]
[4.6%–5.5%]
[1.5 million–2.0 million]
2001
20.9 million
2.2 million
5.8%
1.4 million
[19.7 mil ion–23.6 mil ion] [1.7 mil ion–2.7 mil ion]
[5.5%–6.6%]
[1.3 million–1.9 million]
Middle East and North Africa
2007
380 000
35 000
0.3%
25 000
[270 000–500 000]
[16 000–65 000]
[0.2%–0.4%]
[20 000–34 000]
2001
300 000
41 000
0.3%
22 000
[220 000–400 000]
[17 000–58 000]
[0.2%–0.4%]
[11 000–39 000]
South and South-East Asia
2007
4.0 million
340 000
0.3%
270 000
[3.3 million–5.1 million]
[180 000–740 000]
[0.2%–0.4%]
[230 000–380 000]
2001
3.5 million
450 000
0.3%
170 000
[2.9 million–4.5 million]
[150 000–800 000]
[0.2%–0.4%]
[120 000–220 000]
East Asia
2007
800 000
92 000
0.1%
32 000
[620 000–960 000]
[21 000–220 000]
[<0.2%]
[28 000–49 000]
2001
420 000
77 000
<0.1%
12 000
[350 000–510 000]
[4900–130 000]
[<0.2%]
[8200–17 000]
Oceania
2007
75 000
14 000
0.4%
1200
[53 000–120 000]
[11 000–26 000]
[0.3%–0.7%]
[<500–2700]
2001
26 000
3800
0.2%
<500
[19 000–39 000]
[3000–5600]
[0.1%–0.3%]
[1100]
Latin America
2007
1.6 million
100 000
0.5%
58 000
[1.4 million–1.9 million]
[47 000–220 000]
[0.4%–0.6%]
[49 000–91 000]
2001
1.3 million
130 000
0.4%
51 000
[1.2 million–1.6 million]
[56 000–220 000]
[0.3%–0.5%]
[44 000–100 000]
Caribbean
2007
230 000
17 000
1.0%
11 000
[210 000–270 000]
[15 000–23 000]
[0.9%–1.2%]
[9800–18 000]
2001
190 000
20 000
1.0%
14 000
[180 000–250 000]
[17 000–25 000]
[0.9%–1.2%]
[13 000–21 000]
Eastern Europe and Central Asia
2007
1.6 million
150 000
0.9%
55 000
[1.2 million–2.1 million]
[70 000–290 000]
[0.7%–1.2%]
[42 000–88 000]
2001
630 000
230 000
0.4%
8000
[490 000–1.1 million]
[98 000–340 000]
[0.3%–0.6%]
[5500–14 000]
Western and Central Europe
2007
760 000
31 000
0.3%
12 000
[600 000–1.1 million]
[19 000–86 000]
[0.2%–0.4%]
[<15 000]
2001
620 000
32 000
0.2%
10 000
[500 000–870 000]
[19 000–76 000]
[0.1%–0.3%]
[<15 000]
North America
2007
1.3 million
46 000
0.6%
21 000
[480 000–1.9 million]
[38 000–68 000]
[0.5%–0.9%]
[18 000–31 000]
2001
1.1 million
44 000
0.6%
21 000
[390 000–1.6 million]
[40 000–63 000]
[0.4%–0.8%]
[18 000–31 000]
TOTAL
2007
33.2 million
2.5 million
0.8%
2.1 million
[30.6 mil ion–36.1 mil ion] [1.8 mil ion–4.1 mil ion]
[0.7%–0.9%]
[1.9 million–2.4 million]
2001
29.0 million
3.2 million
0.8%
1.7 million
[26.9 mil ion–32.4 mil ion] [2.1 mil ion–4.4 mil ion]
[0.7%–0.9%]
[1.6 million–2.3 million]
7
G l o b a l o V E r V I E W | 2 0 0 7 A I D S E p I D E m I c u p D A t E
treatment in Africa. The region’s epidemics,
increase in estimated new infections—from 3800
however, vary significantly in scale, with national
[3000–5600] in 2001 to 14 000 [11 000–26 000]
adult (15–49 years) HIV prevalence ranging
in 2007. In the caribbean, Latin America,
from less than 2% in some countries of the Sahel
the middle East and North Africa, North
to above 15% in most of southern Africa.
America and Western Europe, the numbers of
Southern Africa alone accounted for almost one
new HIV infections in 2007 remained approxi-
third (32%) of all new HIV infections and AIDS
mately stable.
deaths globally in 2007.
These regional incidence figures can mask the
A total of 1.7 mil ion [1.4 mil ion–2.4 mil ion]
fact that the actual number of persons living with
people in sub-Saharan Africa became infected
HIV may be increasing; for instance in Eastern
with HIV in the past year, declining from
Europe, the total number of persons with HIV
2.2 mil ion [1.7 mil ion–2.7 mil ion] new infec-
increased nearly 150% between 2001 and 2007.
tions in 2001.There are currently an estimated
Also in individual countries, such as Viet Nam
22.5 mil ion [20.9 mil ion–24.3 mil ion] people
and Indonesia, the prevalence of HIV is growing.
living with HIV in the region in 2007—compared
with 20.9 mil ion [19.7 mil ion–23.6 mil ion] in
Women living with HIV
2001. In sub-Saharan Africa, adult (15–49 years)
HIV prevalence declined from 5.8% [5.5%–6.6%]
Similar increases occurred in the estimated total
in 2001 to 5.0% [4.6%–5.5%] in 2007. AIDS
numbers of new infections in men and women
continues to be the single largest cause of mortality between 2001 and 2007—the ratio of women
in sub-Saharan Africa (WHO, 2003); of the global
to men remaining stable globally. The estimated
total of 2.1 mil ion [1.9 mil ion–2.4 mil ion]
15.4 million [13.9–16.6 million] women living
adult and child deaths due to AIDS in 2007,
with HIV in 2007 numbered 1.6 million more
1.6 mil ion [1.5 mil ion–2.0 mil ion] occurred
than the 13.8 million [12.7–15.2 million] in 2001.
in sub-Saharan Africa. There are an estimated
For men, the 15.4 million [14.3–17.0 million]
11.4 mil ion [10.5 mil ion–14.6 mil ion] orphans
estimated to be living with HIV in 2007
due to AIDS1 in this region.
compared with 13.7 million [12.6–15.2 million]
in 2001. In sub-Saharan Africa, almost 61%
In addition to the declines in new infections in
of adults living with HIV in 2007 were women,
sub-Saharan Africa between 2001 and 2007, the while in the caribbean that percentage was
estimated annual number of new HIV infections
43% (compared with 37% in 2001) (Figure 5).
decreased in South and South-East Asia from
The proportions of women living with HIV in
450,000 [150 000–800 000] in 2001 to 340 000
Latin America, Asia and Eastern Europe
[180 000–740 000] in 2007, and in Eastern
are slowly growing, as HIV is transmitted to the
Europe from 230,000 [98 000–340 000] in 2001
female partners of men who are likely to have
to 150,000 [70 000–290 000] in 2007. The differ-
been infected through injecting drug use, or
ence in the number of new infections in Eastern
during unprotected paid sex or sex with other
Europe is due mainly to the slower growth of the men. In Eastern Europe and central Asia, it
HIV epidemic in the Russian Federation, the
is estimated that women accounted for 26% of
country with the largest epidemic in that region
adults with HIV in 2007 (compared with 23% in
and where new infections increased steeply in
2001), while in Asia that proportion reached 29%
the late 1990s before peaking in 2001. Annually
in 2007 (compared with 26% in 2001).
reported (rather than estimated) new infections
in the Russian Federation have been growing
again in recent years, but at a lower rate than at
Children (less than 15 years of age)
the turn of the century.
living with HIV
The 92 000 [21 000–220 000] adults and children Globally the number of children living
estimated to be newly infected with HIV in East
with HIV increased from 1.5 million
Asia in 2007 represent an increase of almost
[1.3–1.9 million] in 2001 to 2.5 million
20% over the 77 000 [49 000–130 000] people
[2.2–2.6 million] in 2007. However, estimated
who acquired HIV in 2001. Oceania also saw an
new infections among children declined
1 Orphans (0-17 years) currently living are defined as the estimated number of children aged 0–17 years in 2007 who have lost one or both
parents to AIDS.
2 0 0 7 A I D S E p I D E m I c u p D A t E | G l o b a l o V E r V I E W
Percent of adults (15+) living with HIV who are female 1990–2007
70
Sub-Saharan
60
Africa
GLOBAL
50
40
Caribbean
30
Asia
20
Eastern Europe
& Central Asia
10
Latin America
0
1990 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 2000 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07
Year
Figure 52
from 460 000 [420 000–510 000] in 2001 to
360,000 [350 000–540 000] in 2005, but have
420 000 [390 000–470 000] in 2007. Deaths
now begun to decline to an estimated 330,000
due to AIDS among children had increased
[310 000–380 000] in 2007. Nearly 90% of all
from 330 000 [380 000–560 000] in 2001 to
HIV-positive children live in sub-Saharan Africa.
New DATA leAD To cHANGeS IN ASSumPTIoNS AND ImProVeD eSTImATeS
As part of the continuing process of refining HIV estimations, UNAIDS and WHO regularly update
their estimation methodology with new information, as recommended by the UNAIDS Reference
Group on Estimates, Modelling and Projections, and based on the latest scientific developments.3 In
addition, an International Consultation on AIDS Epidemiological Estimates, convened jointly by the
UNAIDS Secretariat and WHO, was held on 14–15 November 2007 in Geneva, Switzerland to review
the current processes and methodologies used by UNAIDS and WHO to produce HIV estimates at
the country, regional and global level.
The tools that have been developed based on the recommendations of the UNAIDS Reference
Group include the Estimation and Projection Package (EPP), WORKBOOK, and Spectrum. These
tools generate an HIV prevalence curve and project the age-specific demographic impact of AIDS
mortality. The outputs include HIV prevalence over time, number of people living with HIV, new
infections, deaths due to AIDS, orphans and treatment need. Estimates of incidence and mortality
are derived from the estimates of adult HIV prevalence over time—that are in turn based on data
from sentinel surveillance, surveys and special studies.
HIV surveillance systems have expanded and improved considerably in the past few years, most
notably in sub-Saharan Africa and Asia. HIV sentinel surveillance data have improved as the number
of surveillance rounds and their geographical and population coverage has increased. For example
in India the number of sentinel surveillance sites increased to more than 1 100 in 2006 (up from 155
in 1998) and now cover more extensively the most-at-risk populations. In some African countries that
had limited HIV prevalence data in the past (such as Angola, liberia, and Sudan), the recent rounds
of sentinel surveillance have yielded more representative data.
2 The global proportion of women versus men who are infected has remained at approximately 50% since the late 1990s. In this graphic
of proportional rates, even though the proportion of women versus men has been increasing in each region, in most regions, the overall
number of men infected still far outnumbers that of women.
3 The UNAIDS Reference Group on HIV/AIDS Estimates, Modelling and Projections is made up of leading researchers in HIV and AIDS,
epidemiology, demography and related areas. The Reference Group assesses the most recent published and unpublished work drawn from
research studies in different countries. It also reviews advances in the understanding of HIV epidemics, and suggests methods to improve the
quality and accuracy of the estimates.
G l o b a l o V E r V I E W | 2 0 0 7 A I D S E p I D E m I c u p D A t E
Data collected in national population-based surveys have improved the accuracy of HIV and
AIDS estimates. While HIV prevalence from sentinel surveillance will continue to provide valuable
information in terms of the trend in the epidemics, HIV prevalence measured in national population-
based surveys, adjusted for non-response and other biases, provides improved data to estimate the
national prevalence. However, population based surveys in countries with concentrated epidemics
may not include populations that may be at higher risk of HIV infection and other adjustments
should be made. Since 2001, 30 countries in sub-Saharan Africa, Asia and the Caribbean have
conducted national population-based surveys with HIV prevalence measurement, as shown in
Table 2. Results from such population-based surveys have generally indicated lower national HIV
prevalence than extrapolations from sentinel site surveillance.
For the regional and global estimates included in this report, the adult HIV prevalence found
in those surveys has been used to adjust the HIV prevalence in the year of the survey for those
respective countries. For countries with a recent national survey (such as benin, cambodia, central
African republic, Haiti, India, liberia, malawi, mali and Swaziland) this has resulted in lower
estimates compared to those included in the regional and global estimates published in the 2006
AIDS epidemic update.
In addition several new assumptions have been incorporated into the 2007 version of the estimation
software tools, Estimation and Projection Package (EPP) 2007 and Spectrum 3. A major new
assumption concerns countries with generalized HIV epidemics which have not conducted a national
population-based HIV survey. A comparison of HIV prevalence among antenatal clinic attendees and
HIV prevalence from population-based surveys has shown that HIV prevalence among adults in the
latter surveys is approximately 80% of the prevalence among antenatal clinic attendees, in both rural
and urban areas (UNAIDS, 2007). Based on that observation, it was recommended that in countries
with generalized HIV epidemics which have not conducted a national population-based survey, HIV
prevalence data from antenatal clinic attendees should be adjusted downward on average by a
factor of 0.8 (UNAIDS Reference Group on Estimates, Modelling and Projections, 2006). Previously
only the prevalence from antenatal clinics in the rural areas was adjusted.
A second, major assumption relates to the estimation of incidence and mortality. HIV incidence
and mortality due to AIDS are calculated from a combination of HIV prevalence over time and an
assumption regarding the average time a person will survive from HIV infection to death in the
absence of antiretroviral treatment, while allowing for longer survival for people on antiretroviral
treatment (Stover, 2006). In the absence of such treatment, the net median survival time after
infection with HIV is now estimated to be 11 years (UNAIDS Reference Group on Estimates,
Modelling and Projections, 2006), instead of the previously estimated nine years (UNAIDS Reference
Group on Estimates, Modelling and Projections, 2002). This applies to all countries except those
where HIV subtype E accounts for the majority of infections. In the latter countries, the median
net survival time is still under review, but a limited number of studies show estimates of nine years
survival (UNAIDS Reference Group on Estimates, Modelling and Projections, 2006). These new
recommendations are based on recent information provided by longitudinal research studies (Todd
et al., 2007; Marston et al., 2007). For the same level of prevalence, this longer average survival
period has resulted in lower estimates of new infections and deaths due to AIDS.
In addition to the changes in HIV prevalence for some countries that result from adjusting to
country-specific prevalence survey results (see above), other countries have a corrected lower
prevalence because an expansion of their surveillance system has yielded more representative data
(for example, Angola and madagascar). In addition, in some countries with generalized epidemics
that have not conducted a population-based survey, it is the additional adjustment to the antenatal
clinic data from urban areas (see above) that has resulted in a lowering of estimates of national
prevalence, for example in Angola, congo, eritrea, the Gambia, Guinea-bissau, mozambique,
Namibia, Nigeria, Somalia and Sudan.
0
2 0 0 7 A I D S E p I D E m I c u p D A t E | G l o b a l o V E r V I E W
Table 2
Adult (aged 15–49 years) HIV prevalence in countries
which have conducted population-based HIV surveys in recent years
2001 HIV
2003 HIV
2005 HIV
prevalence (%)
prevalence (%)
prevalence (%)
Population-based
reported in 2002
reported in 2004
reported in 2006
Countries
survey prevalence
Report on the
Report on the
Report on the
(%) (year)
global AIDS
global AIDS
global AIDS
epidemic
epidemic
epidemic
Sub-Saharan Africa
Benin
1.2 (2006)
3.6
1.9
1.8
Botswana
25.2 (2004)
38.8
38.0
24.1
Burkina Faso
1.8 (2003)
6.5
4.2
2.0
Burundi
3.6 (2002)
8.3
6.0
3.3
Cameroon
5.5 (2004)
11.8
7.0
5.4
Central African Republic
6.2 (2006)
12.9
13.5
10.7
Chad
3.3 (2005)
3.6
4.8
3.5
Côte d'Ivoire
4.7 (2005)
9.7
7.0
7.1
Equatorial Guinea
3.2 (2004)
3.4
NA
3.2
Ethiopia
1.4 (2005)
6.4
4.4
(0.9–3.5)
Ghana
2.2 (2003)
3.0
3.1
2.3
Guinea
1.5 (2005)
NA
2.8
1.5
Kenya
6.7 (2003)
15.0
6.7
6.1
Lesotho
23.5 (2004)
31.0
29.3
23.2
Malawi
12.7 (2004)
15.0
14.2
14.1
Mali
1.3 (2006)
1.7
1.9
1.7
1.7 (2001)*
Niger
0.7 (2006)
NA
1.2
1.1
0.9 (2002)
Rwanda
3.0 (2005)
8.9
5.1
3.1
Senegal
0.7 (2005)
0.5
0.8
0.9
Sierra Leone
1.5 (2005)
7.0
NA
1.6
South Africa
16.2 (2005)
20.1
20.9
18.8
15.6 (2002)
Swaziland
25.9 (2006–7)
33.4
38.8
33.4
Uganda
7.1 (2004–5)
5.0
4.1
6.7
United Republic of Tanzania
7.0 (2004)
7.8
9.0
6.5
Zambia
15.6 (2001–2)
21.5
16.5
17.0
Zimbabwe
18.1 (2005–6)
33.7
24.6
20.1
Asia
Cambodia
0.6 (2005)
2.7
2.6
1.6
India
0.28 (2005–6)
0.8
0.9
0.9
Latin America
and Caribbean
Dominican Republic
1.0 (2002)
2.5
1.7
1.1
Haiti
2.2 (2005–6)
6.1
5.6
3.8
* includes male 15–59 years.
The change in survival assumption (see above) has resulted in lower estimates of mortality and
incidence in all countries except those where subtype E is dominant. It did not have a major
impact on the timing of the peak of new infections. All of these changes have resulted in improved
estimates of the number of people living with HIV, mortality due to AIDS, and the number of new
HIV infections. Most of the estimates in the current report are lower compared to those published
in previous reports, not just for 2007 but also for past years. Current estimates, therefore, cannot
be compared directly with estimates published in previous reports. Unlike previous reports, which
presented data for the most recent two-year period, this report presents comparative data for 2001
and 2007 which allows for a better assessment of trends. Because surveillance data for the year
G l o b a l o V E r V I E W | 2 0 0 7 A I D S E p I D E m I c u p D A t E
2007 are not yet available for many countries, 2005–2007 estimated trends would be less accurate
than those for the more extended 2001–2007 period.
These and other changes in assumptions based on recent reviews and research data will also have
implications for estimation of the number of people in need of antiretroviral therapy, but these are
not covered in this report.
Significant gaps remain in HIV surveillance systems in some countries, making it difficult to assess
with precision the trends and current status of epidemics in these countries. UNAIDS and WHO will
continue to improve their HIV and AIDS estimates when new surveillance data and new data from
scientific research support such changes.
Recent HIV and sexual behaviour
trends among young people
adult or all-age HIV prevalence. Trends in HIV
prevalence among 15–24-year-olds, therefore, are
In 2001, the United Nations’ Declaration of
believed to reflect trends in HIV incidence.
Commitment on HIV/AIDS outlined a goal of
reducing HIV prevalence by 25% in young
A review of the most recent, available informa-
people (aged 15–24 years) in the most-affected
tion shows that HIV prevalence among young
countries by 2005, in order to monitor progress
pregnant women (15–24 years) attending
in preventing new infections. Determining real
antenatal clinics has declined since 2000/2001
time trends in HIV incidence (and in particular
in 11 of 15 countries with sufficient data (preva-
the impact of prevention programmes on HIV
lence data from three different years) to analyse
incidence) ideally requires longitudinal studies
recent trends among young people in the most-
of large numbers of people. Given the practical
affected countries (see Table 3).
difficulties of conducting such studies, a proxy
In Kenya, HIV prevalence among young
measure has been proposed (HIV prevalence in
pregnant women declined significantly by more
young women aged 15–24 attending antenatal
than 25% in both urban and rural areas, while
clinics).
similar declines were observed in urban areas of
To assess progress towards this goal, countries
côte d’Ivoire, malawi and Zimbabwe, and
in which national prevalence exceeds 3% were
in rural parts of Botswana. Less striking (i.e.
asked by the WHO/UNAIDS Working Group
statistically non-significant) declines in preva-
on Global HIV/AIDS and STI Surveillance to
lence in young pregnant women have occurred
participate in this endeavor in 2006 and again in
in both urban and rural areas of Burkina Faso,
2007. These countries are the 35 listed in Table 3.
Namibia and Swaziland, urban parts of the
Bahamas, Botswana, Burundi and Rwanda,
HIV and sexual behaviour trends among young
and rural parts of the united Republic of
people can offer a window onto recent develop-
tanzania. There was no evidence of a decrease
ments in, and the likely evolution of countries’
in HIV infection levels among young people in
HIV epidemics. Specifically, trends in HIV preva-
mozambique, South Africa or in Zambia.
lence among 15–24-year-old pregnant women, in
whom HIV infections are likely to be relatively
In nine out of the 35 countries, national surveys
recently acquired, are influenced less by mortality
conducted between 1994 and 2006 have
and antiretroviral treatment than are trends in
provided enough comparative data to assess
2
2 0 0 7 A I D S E p I D E m I c u p D A t E | G l o b a l o V E r V I E W
Table 3
2006/2007 Analysis of trends among 15–24-year-olds in high prevalence countries:
HIV prevalence among pregnant women (2000–2006) in sentinel surveillance systems,
and selected sexual behaviours among women and men (1994–2006) from national surveys
Age at sexual
Sex with non-
Condom use during
Analysis in
Prevalence trend*
debut**
regular
Country
sex with non–regular
2006/2007
partner***
partner****
Urban
Rural
Females
Males Females Males Females Males
Angola*
2006
Bahamas
2007
�NS
Benin**
Botswana
2007
�NS
�≥ 25%
Burkina Faso
2007
�NS
�NS
Burundi
2006/2007
�NS
↔
Cameroon*
2006
�
�
�
�
�
�
Central African Republic**
Chad*
2006
�
↔
Congo*
2007
Côte d’Ivoire
2006
�≥ 25%
ID
�
↔
↔
↔
�
�
Democratic Republic of the Congo*
2006
Djibouti**
Ethiopia**
Gabon**
Gambia**
Ghana**
Haiti**
�
�
�
�
�
�
Kenya
2006
�≥ 25%
�≥ 25%
↔
↔
�
�
�
↔
Lesotho*
2006
Liberia**
Malawi#
2006
�≥ 25%
↔
�
�
�
�
�
�
Mozambique‡
2006
↔
↔
�
Namibia
2007
�NS
�NS
Nigeria*
2007
↔
↔
Rwanda
2006
�NS
ND
�
�
�
�
�
�
Sierra Leone*
2007
South Africa§
2006
↔
Sudan*
2007
Swaziland
2007
�NS
�NS
Togo*
2006
�
�
Uganda**
�
↔
�
�
�
↔
United Republic of Tanzania
2006
↔
�NS
↔
�
↔
↔
�
�
Zambia¶
2006
↔
↔
�
↔
↔ ↔
Zimbabwe
2006
�≥ 25%
�NS
↔
↔
�
�
↔ ↔
Notes:
[1] Highlighted cel s indicate positive trends in prevalence or behaviour.
[2] Year of analysis indicates the year in which the analysis was done, and not necessarily the last year of data used in the analysis.
Legend: * Consistent sites used in the analysis of median prevalence by year for a minimum of three years. Significance test based on H : slope=0.
0
Analyses of countries with more than three years of data based on the fol owing number of consistent urban and rural sites: Botswana (10,10), Burundi (3,3), Côte d’Ivoire
(9 urban), Kenya (20,13), Malawi (11,8), Mozambique (5 South, 8 Center, 7 North), Rwanda (6 urban), United Republic of Tanzania (11,8), Zimbabwe (7,6).
** Among 15–19-year-olds, proportion reported having had sex by age 15. Analyses based on DHS, MICS or national surveys conducted between 1995 and 2005.
*** Among 15–24-year-olds, proportion reported having had sex with a non-regular partner in the last year. In South Africa, the proportion among 15–24 year olds reporting
more than one sexual partner in the last 12 months. Analyses based on DHS, and South Africa national surveys conducted between 1995 and 2005.
**** Among 15–24-year-olds, proportion reporting having used condoms the last time they had sex with a non-regular partner. Analyses based on DHS, MICS or national
surveys conducted between 1995 and 2005.
� Statistical y significant increase.
� Statistical y significant decrease.
�≥25% Statistical y significant decrease of more than 25%.
�NS Decrease over time but not statistical y significant.
↔ No evidence of decrease.
*ID Insufficient data, i.e. less than three years of data received for prevalence analysis.
**ND Data not received for prevalence.
# Semi-urban and urban areas were combined in analysis of urban data.
‡ Analysis in Mozambique performed for South, North and Central.
§ No data received in response to working group process; analyses based on data in South Africa surveil ance report.
¶ No data received in response to working group process; analyses based on data reported in Zambia 2005 surveil ance report. Analysis based on urban and rural data combined.
G l o b a l o V E r V I E W | 2 0 0 7 A I D S E p I D E m I c u p D A t E
sexual behaviour trends among young people. In
decreased for men only in côte d'Ivoire and
some of them the trend data indicate significant
Rwanda.
reductions in some forms of sexual behaviour
that place people at risk of exposure to HIV .
Unfortunately, almost two dozen out of the
The proportion of young people who reported
35 countries had insufficient or no data on HIV
having had sex with non-regular partners in
prevalence and/or sexual behaviour trends among
the previous year decreased for both men and
young people – including several countries with
women in Kenya, malawi and Zimbabwe, and
exceptionally high HIV prevalence in southern
for women only in Haiti and Zambia. However, Africa.
the proportion of young men and women having
These behaviour trends among young people
sex with non-regular partners increased in
point to recent, encouraging changes in
cameroon, Rwanda and uganda.
some countries (cameroon, Haiti, Kenya,
There have been striking shifts in condom
Zimbabwe, malawi, Rwanda, togo, united
use during sex with non-regular partners. The
Republic of tanzania and Zambia). Those
proportion of young people who said they
trends, combined with the evidence of signifi-
used condoms the last time they had sex with
cant declines in HIV prevalence among young
a non-regular partner increased for both men
pregnant women in urban and/or rural areas
and women in cameroon, Haiti, malawi and
of five countries (Botswana, côte d’Ivoire,
united Republic of tanzania, and for women
Kenya, malawi and Zimbabwe) suggest that
only in côte d'Ivoire, Kenya, togo, Rwanda
prevention efforts are having an impact in several
and uganda. On the other hand, that proportion
of the most-affected countries.
2 0 0 7 A I D S E p I D E m I c u p D A t E | S u b - S a h a r a n a f r I c a
r e G I o N A l o V e r V I e w
Sub-SAHArAN AFrIcA
Sub-Saharan Africa remains the most affected region in the global AIDS epidemic. More than two thirds (68%)
of all people HIV-positive live in this region where more than three quarters (76%) of all AIDS deaths in 2007
occurred. It is estimated that 1.7 million [1.4 million–2.4 million] people were newly infected with HIV in 2007,
bringing to 22.5 million [20.9 million–24.3 million] the total number of people living with the virus. Unlike
other regions, the majority of people living with HIV in sub-Saharan Africa (61%) are women.
Southern Africa
The scale and trends of the epidemics in the region vary considerably, with southern Africa most seriously affected.
This subregion accounts for 35% of all people living with HIV and almost one third (32%) of all new HIV
infections and AIDS deaths globally in 2007. National adult HIV prevalence exceeded 15% in eight countries
in 2005 (Botswana, Lesotho, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe). While
there is evidence of a significant decline in the national HIV prevalence in Zimbabwe, the epidemics in most of the
rest of the subregion have either reached or are approaching a plateau. Only in Mozambique latest HIV data (in
2005) have shown an increase in prevalence over the previous surveillance period.
Figure 6
Median HIV prevalence among women (15–49 years) attending antenatal clinics
in consistent sites in southern African countries, 1998–2006
45
40
Botswana
35
Lesotho
30
25
Namibia
r
e
v
a
l
e
n
c
e
p
I
V 20
South Africa
H
% 15
Swaziland
10
Zimbabwe
5
0
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
Sources: Various antenatal clinic surveys.
S u b - S a h a r a n a f r I c a | 2 0 0 7 A I D S E p I D E m I c u p D A t E
In Zimbabwe, HIV prevalence among pregnant
HIV prevalence between regions, but there is a
women attending antenatal clinics has declined
significant difference in infection levels between
significantly in the past few years, from 26% in
men and women: 20% of adult men tested HIV-
2002 to 18% in 2006. Among young pregnant
positive, compared to 31% of women (Ministry
women (15–24 years) prevalence declined from
of Health and Social Welfare Swaziland, 2007;
21% to 13% over the same period. Prevalence
Central Statistical Office Swaziland & Macro
is highest among pregnant women attending
International, 2007).
antenatal clinics in mining (26% HIV preva-
HIV prevalence in Lesotho remains high, with
lence) and commercial farming (22% prevalence)
prevalence among antenatal clinic attendees
areas (Ministry of Health and Child Welfare
of 38% in the 25–29-year-age group in 2005
Zimbabwe, 2007).
(Ministry of Health and Social Welfare (Lesotho),
The declining trend observed in Zimbabwe’s
2005). Women account for about 57% of people
surveillance data is supported by several studies
living with HIV. The most recent HIV surveil-
(UNAIDS, 2005; Mahomva et al., 2006; Hargrove lance data show a decline in infection levels
et al., 2005; Mugurungi et al., 2005; Ministry
among young (15–24 years) pregnant women
of Health and Child Welfare Zimbabwe, 2007),
from about 25% in 2003 to 21% in 2005, but the
while declining prevalence among both men
apparent decrease might be due to the addition of
and women has also been observed in rural
new sentinel surveillance sites in the most recent
parts of Manicaland (Gregson et al., 2006).
survey (Ministry of Health and Social Welfare
The trend reflects a combination of very high
(Lesotho), 2005).
mortality and declining HIV incidence, related
Overall, the epidemic in Namibia appears to
in part to behaviour change (UNAIDS, 2005).
have stabilized with one in five women (20%)
There is evidence from eastern Zimbabwe that
attending antenatal clinics testing HIV-positive
more women and men have been avoiding sex
in 2006 (Ministry of Health and Social Services,
with non-regular partners, and that consistent
2007). The relatively stable trend since the mid-
condom use with non-regular partners increased
1990s in HIV prevalence among young pregnant
for women (from 26% in 1998–2000 to 37% in
women (15–24 years), and the rising trend among
2001–2003), though not for men (Gregson et
those in their 30s suggests that prevention efforts
al., 2006). Mathematical modelling also suggests
need to be improved (Ministry of Health and
that the declines in HIV prevalence could not
Social Services, 2007).
be attributed solely to the natural evolution of
Zimbabwe’s AIDS epidemic but are in part due
The decrease in HIV prevalence among pregnant
to behavioural change (Hallet et al., 2006).
women attending antenatal clinics in Botswana in
recent years (from 36% in 2001 to 32% in 2006)
South Africa is the country with the largest
suggests that the epidemic has reached its peak and
number of HIV infections in the world. HIV
could be on the decline. Prevalence is unusual y
prevalence data col ected from the latest round
high even among pregnant teenagers, 18% of
of antenatal clinic surveil ance suggest that HIV
whom tested HIV-positive in 2005. However,
infection levels might be level ing off, with preva-
infection levels among young pregnant women
lence among pregnant women at 30% in 2005 and
have been declining in recent years (Ministry of
29% in 2006 (Department of Health South Africa,
Health Botswana, 2006). Among 15–19-year-old
2007). In addition, the decrease in HIV prevalence
women attending antenatal clinics, prevalence
among young pregnant women (15–24 years)
decreased from 25% to 18% between 2001 and
suggests a possible decline in the annual number
2006, while among their 20–24-year-old counter-
of new infections. The epidemic varies consider-
parts it declined from 39% to 29% over the same
ably between provinces, from 15% in the Western
period (Ministry of Health Botswana, 2006).
Cape to 39% in the province of KwaZulu-Natal.
(Department of Health South Africa, 2007).
The latest HIV data collected at antenatal clinics
in Angola indicate that HIV prevalence among
According to preliminary data from a new
pregnant women did not change much between
population-based survey in Swaziland, aproxi-
2004 and 2005. Median national HIV prevalence
mately one in four (26%) adults (15–49 years) are
was estimated at 2.5% in 2005, compared with
infected with HIV. Both antenatal and popula-
2.4% in 2004 (Ministério da Saúde & CDC
tion-based survey data show little difference in
USA, 2006).
2 0 0 7 A I D S E p I D E m I c u p D A t E | S u b - S a h a r a n a f r I c a
In the other lusophone country of this subregion,
East Africa
mozambique, the epidemic has again started
In most of the countries in East Africa adult HIV
to increase in all three zones after appearing to
prevalence is either stable or has started to decline. The
have stabilized in the early 2000s. HIV preva-
latter trend is most evident in Kenya, where the HIV
lence among women attending antenatal clinics
epidemic has been declining amid evidence of changing
is lowest in the north (average of 9% in 2004),
behaviour. Besides behavioural change, mortality of
but in the central and southern zones prevalence
people infected with HIV several years ago has also
of 20% or more has been found, including in the
contributed to the declines in prevalence.
capital, Maputo, and in Gaza, Inhambane, Manica
and Sofala provinces (where it reached almost
uganda was the first country in sub-Saharan
27% in 2004) (Conselho Nacional de Combate
Africa to register a drop in adult national HIV
ao HIV/SIDA, 2006).
prevalence. The epidemic, however, remains
malawi’s epidemic appears to have stabilized
serious with infection levels highest among
with declines in some local areas and amid some
women (7.5% compared to 5.0% among men)
evidence of behavioural changes that can reduce
and urban residents (10% compared to 5.7%
the risk of acquiring HIV infection (Heaton,
among rural residents) according to a national
Fowler & Palamuleni, 2006). Median HIV
survey conducted in 2004–5 (Ministry of Health
prevalence among pregnant women at sentinel
Uganda & ORC Macro, 2006).
surveil ance sites has remained between 15% and
HIV prevalence started to decrease in Uganda
17% since the turn of the century (National AIDS
in 1992, alongside evidence of substantial
Commission Malawi, 2005).
behaviour change that inhibited the spread of HIV
While there is little sign of a decline in HIV
(Asamoah-Odei, Garcia-Cal eja & Boerma, 2004).
prevalence at the national level in
However, that trend appears to have stabilized in
Zambia, the
the early 2000s. While the decline in HIV preva-
epidemic appears to be declining in some parts
lence observed among pregnant women attending
of the country. The most recent antenatal clinic
antenatal clinics in Kampala and some other urban
surveillance showed HIV prevalence among
areas appears to have persisted through 2005, other
pregnant women to be twice as high in urban
urban and most rural surveil ance sites indicate
as in rural areas (25% versus 12%) (Ministry of
an overal level ing off of prevalence during the
Health, 2005), as did earlier population-based
current decade (Kirungi et al., 2006; Shafer et al.,
survey estimates (23% versus 11%) (Central
2006). Similarly, in a cohort study in a rural area
Statistical Office Zambia et al., 2003). HIV
in southern Uganda, there is evidence that HIV
prevalence has declined among 20–24-year-
prevalence and incidence have level ed off since
old pregnant women in urban areas (where it
about 2000 in both men and women (Shafer et al.,
dropped from 30% in 1994 to 24% in 2004) as
2006). It is important to note that with a popula-
well as among 15–19-year-old pregnant women
tion growing as rapidly as in Uganda (which has
(down from 20% in 1994 to 14% in 2004)
a total fertility rate of 6.7, according to the 2006
(Ministry of Health Zambia, 2005).
Demographic and Health Survey), a stable HIV
The HIV epidemics in the island nations of
incidence rate means that an increasing number of
southern Africa are much smaller. Recent HIV
people acquire HIV each year.
data collected from pregnant women using
The stable HIV trends are occurring alongside
antenatal services in madagascar show national
an apparent recent increase in more sexual risky
HIV prevalence of 0.2%, although prevalence
behaviour. In national population-based surveys
was as high as 1.1% in Sainte Marie and 0.8%
conducted in 1995, 2000, 2004–5, and 2006,
in Morondava (Ministère de la Santé et du
higher risk sex was reported by 12%, 14%, 15%
Planning Familial Madagascar, 2005). Exposure
and 16% of adult women respectively, and by
to non-sterile drug injecting equipment is the
29%, 28%, 37% and 36% of adult men respec-
main risk factor for HIV infection in mauritius,
tively (Kirungi et al., 2006; Ministry of Health
where about three quarters of the HIV infec-
Uganda & ORC Macro, 2006; Uganda Bureau of
tions diagnosed in the first six months of 2004
Statistics & Macro International Inc. 2007). In the
were among injecting drug users (Sulliman &
same surveys, condom use during sex with these
Ameerberg, 2004).
partners was reported by 20%, 39%, 47% and 35%
7
S u b - S a h a r a n a f r I c a | 2 0 0 7 A I D S E p I D E m I c u p D A t E
of women, respectively, and by 35%, 59%, 53% and
Gambela (6%) and Addis Ababa (4.7%) regions
57% of men, respectively, indicating a lack of progress (Central Statistical Agency & ORC Macro,
in the adoption of safer sexual behaviour in recent
2006). Ethiopia’s epidemic stabilized in urban
years. There is an urgent need to revive and adapt the areas in 1996–2000, after which HIV infection
kind of prevention efforts that helped bring Uganda’s
levels declined slowly, notably in parts of the
HIV epidemic under control in the 1990s.
capital, Addis Ababa. In rural Ethiopia, where the
National HIV prevalence in Kenya has decreased
majority of the population resides, the epidemic
from a high of around 14% in the mid-1990s
has remained relatively stable since HIV prevalence
to 5% in 2006 (Ministry of Health Kenya, 2005;
peaked in 1999–2001 (Federal Ministry of Health
National AIDS Control Council Kenya, 2007).
Ethiopia, 2006).
The downward trend was especially profound in
In Eritrea, HIV prevalence among antenatal clinic
the urban sites of Busia, Meru, Nakuru and Thika,
attendees was 2.4% in 2005 and in 2003. HIV prev-
where median prevalence declined from 28% in
alence in 2005 was highest in urban areas (3% versus
1999 to 9% in 2003 among 15–49-year-old women
0.9% in rural areas), and ranged from as high as 7.4%
attending antenatal clinics, and from 29% in 1998 to in the port city of Assab in the far south, to 4.2% in
9% in 2002 among those aged 15–24 years (Hallett
the capital, Asmara, and 3.3% in Massawa, another
et al., 2006).
port city (Ministry of Health Eritrea, 2006).
HIV prevalence has declined also in the united
In Somalia, surveys among women attending
Republic of tanzania. The most recent informa-
antenatal clinics have found HIV prevalence as
tion shows HIV prevalence among antenatal clinic
high as 2.3% in Berbera (WHO, 2005). However,
attendees in Zanzibar ranging from 0.7% in Unguja
due to the conflict situation in the country, sentinel
to 1.4% in Pemba (Salum et al., 2003), while in
surveillance is limited.
mainland Tanzania it was 8.7% among women using
antenatal services in 2003–2004, down from 9.6% in
2001–2002 (Swai et al., 2006). On the mainland, a
West and Central Africa
national population-based HIV survey in 2003–2004
In most of the comparatively smaller epidemics in West
found adult HIV prevalence of 7% in 2003–2004
and Central Africa, adult national HIV prevalence
(Tanzania Commission for AIDS, National Bureau of
has remained stable overall. However, signs of declining
Statistics & and ORC Macro, 2005).
HIV prevalence are evident in an increasing number of
In Burundi, recent HIV surveillance among
countries, notably Côte d’Ivoire, Mali and urban Burkina
women attending antenatal clinics suggests that the
Faso. In these countries, as well as in Benin, there is
declining trend which started in the late 1990s did
evidence of a shift towards safer behaviour.
not continue beyond 2005, when HIV prevalence
started to increase again at most surveillance sites.
Nigeria still has the largest epidemic in this
(Ministère de la Santé Publique du Burundi, 2005).
subregion. The national HIV prevalence among
In Rwanda, antenatal clinic surveillance in 2005
women attending antenatal clinics in Nigeria
showed that 4.1% of pregnant women were HIV-
appears to be stable, but with large variation
positive, with the prevalence highest in Kigali
between different regions and states (Utulu &
(13%), but on average about 5% in other urban
Lawoyin, 2007). State-wide HIV prevalence among
areas and a little over 2% in rural areas. Substantial
pregnant women, for example, ranges from as low
declines in HIV prevalence were observed in
as 1.6% in Ekiti (in the west) to 8% in Akwa Ibom
Rwamagana (from 13% to 4% between 1998 and
(in the south) and 10% in Benue in the south-east
2005) and in Gikondo in the city of Kigali (14% to
(Federal Ministry of Health Nigeria, 2006).
8%) (Ministère de la santé du Rwanda, 2005). The
In Benin, sentinel surveys among pregnant women
declines in HIV prevalence among pregnant women attending antenatal clinics indicate a relatively
in urban areas in Rwanda were strongest in the late
stable national epidemic, with HIV prevalence
1990s and infection levels appeared to have stabi-
having remained around 2% since 2003. According
lized subsequently (Kayirangwa et al., 2006).
to the 2006 Demographic and Health Survey, 1.2%
In Ethiopia, the 2005 Demographic and Health
of adults nationally was infected with HIV, and
Survey estimated national adult HIV prevalence
prevalence among women (1.5%) was almost twice
to be 1.4%, with infection levels highest in the
as high as among men (0.8%) (Institut National de
2 0 0 7 A I D S E p I D E m I c u p D A t E | S u b - S a h a r a n a f r I c a
HIV prevalence from national population-based surveys in countries
in West and Central Africa, 2003–2007
Mali
Niger
Chad
Senegal
Gambia
Burkina
Guinea-Bissau
Faso
Guinea
Benin Nigeria
Côte
Sierra Leone
d’Ivoire
Central African
Liberia
Ghana
Republic
Cameroon
Togo
Adult HIV prevalence %
Equatorial Guinea
Democratic
Gabon Congo
6.0 – 8.0%
Republic of
the Congo
4.0 – <6.0%
2.0 – <4.0%
0 – <2.0%
No available data
Sources: (Central African Republic) [1] Institut Centrafricain de la Statistique et des Études Économiques et Sociales; [2] United Nations
Population Fund; [3] MEASURE DHS, Macro International Inc. Enquête de sérologie VIH en République Centrafricaine, 2006.
(Cameroon) [1] Institut National de la Statistique, Ministère de la Planification de la Programmation du Développement et de
l’Aménagement du Territoire; [2] ORC Macro. Enquête Démographique et de Santé. Cameroun 2004. (Côte d'Ivoire) [1] Project
RETRO-CI, Institut National de la Statistique, Ministère de la Lutte contre le Sida; [2] ORC Macro. Enquête sur les Indicateurs du Sida.
Côte d’Ivoire 2005. (Chad) [1] Institut National de la Statistique, des Études Économiques et Démographiques; [2] ORC Macro.
Enquête Démographique et de Santé. Tchad 2004. (Equatorial Guinea) Programa Nacional de Lucha Contra el SIDA, Proyecto Centro
de Referencia para el Control de Endemias en Guinea Ecuatorial. Informe Final de la Encuesta de Seroprevalencia del VIH en Guinea
Ecuatorial 2004. (Ghana) [1] Ghana Statistical Service; [2] Noguchi Memorial Institute for Medical Research; [3] ORC Macro. Ghana
Demographic and Health Survey 2003. (Burkina Faso) [1] Institut National de la Statistique et de la Démographie; [2] ORC MacroBurkina
Faso Enquête Démographique et de Santé 2003. (Liberia) [1] Liberia Institute of Statistics and Geo-Information Services; [2] Ministry of
Health and Social Welfare; [3] National AIDS Control Program; [4] MEASURE DHS, Macro International. Liberia Demographic and Health
Survey 2007. (Guinea) [1] Direction Nationale de la Statistique; [2] ORC Macro. Démographique et de Santé Guinée 2005. (Sierra Leone)
[1] Nimba Research and Consulting Company; [2] Statistics Sierra Leone; [3] Ministry of Health and Sanitation; [4] National HIV/AIDS
Secretariat. National Population Based HIV Seroprevalence Survey of Sierra Leone 2005. (Mali) [1] Cellule de Planification et de
Statistique, Ministère de la Santé; [2] Direction Nationale de la Statistique et de l’Informatique, Ministère du Plan et de l’Aménagement
du Territoire; [3] MEASURE DHS. Enquête Démographique et de Santé EDSM-IV, Mali 2006. Rapport Préliminaire. (Benin) [1] Institut
National de la Statistique et de l’Analyse Économique; [2] Programme National de Lutte contre le Sida; [3] Demographic and Health
Surveys, Macro International, Inc. Enquête Démographique et de Santé (EDSB-III) Bénin 2006. Rapport Préliminaire. (Niger) [1] Institut
National de la Statistique, Ministère de l’Économie et des Finances; [2] Macro International Inc. Enquête Démographique et de Santé et
à Indicateurs Multiples 2006. (Senegal) [1] Ministère de la Santé et de la Prévention Médicale Centre de Recherche pour le Dévelop-
pement Humain; [2] ORC Macro. Enquête Démographique et de Santé Sénégal 2005.
Figure 7
la Statistique et de l’Analyse Economique &
The most recent data for mali, collected during
ORC Macro, 2007).
a 2006 Demographic and Health Survey, also
indicate a possible decline in the epidemic. Adult
HIV prevalence in togo is among the highest in
national HIV prevalence was estimated at 1.2%
West Africa: prevalence among pregnant women
in 2006 (Ministère de la Santé du Mali & ORC
tested for HIV at antenatal clinics in 2006 was
Macro, 2007), lower than that recorded in a
4.2%, showing a decline in national infection
similar survey in 2001, when adult national HIV
levels. (In 2003, 4.8% of antenatal clinic attendees
prevalence was estimated at 1.7% (2% among
tested HIV-positive; this fell to 4.6% in 2004.)
women and 1.3% among men) (Cellule de
(Ministère de la Santé du Togo, 2007 & 2006).
Planification et de Statistique du Ministère de
la Santé et al., 2002). Here also, mortality would
The HIV epidemic in Burkina Faso continues
be a contributing factor to the decline in preva-
to decline in urban areas. Among young pregnant
lence. Among pregnant women attending public
women attending antenatal clinics in urban
antenatal clinics, prevalence was 3.4% in 2005,
areas, HIV prevalence fell by half in 2001–2003
similar to prevalence in previous years (Ministère
(to a little below 2%) (Présidence du Faso,
de la Santé du Mali, 2005).
2005; Institut National de la Statistique et de la
Median HIV prevalence among women attending
Démographie & ORC Macro, 2004).
antenatal clinics in Ghana has ranged between
S u b - S a h a r a n a f r I c a | 2 0 0 7 A I D S E p I D E m I c u p D A t E
2.3% and 3.6% between 2000 and 2006.
In chad, a national population based survey found
(Ministry of Health Ghana, 2007).
that 3.3% of adults were living with HIV in 2005.
In côte d’Ivoire, the national adult HIV preva-
The epidemic appears to be concentrated mainly
lence as obtained from the latest Demographic
in urban areas where average HIV prevalence was
and Health Survey was estimated to be 4.7%
7%, more than three times higher than in rural
(Institut National de la Statistique et Ministère
areas (Institut National de la Statistique, des Etudes
de la Lutte contre le Sida Côte d’Ivoire & ORC
Economiques et Démographiques et Programme
Macro, 2006). HIV surveillance among pregnant
National de Lutte Contre le Sida, 2006).
women indicates that prevalence is declining, at
least in urban areas, where prevalence fell from
HIV prevalence is considerably lower in neigh-
10% in 2001 to 6.9% in 2005 (Ministère de
bouring Niger where a 2006 Demographic and
la Santé et de l’Hygiène Publique de la Côte
Health Survey estimated that 0.7% of adults were
d’Ivoire et al., 2007).
infected with HIV. Prevalence was highest in
the Agadez and Diffa regions, at 1.6% and 1.7%,
In Senegal, HIV prevalence in the general
respectively (Institut National de la Statistique du
population was 0.7% in 2005 (Ndiaye & Ayad,
Niger & Macro International Inc., 2007).
2006). However, most HIV transmission is still
estimated to be associated with unprotected paid
In cameroon, a national population-based
sex: in Ziguinchor, for example, HIV prevalence
survey in 2004 showed large geographic variation
as high as 30% has been found among female sex in prevalence, from 1.7% in the North and 2.0%
workers (Gomes do Espirito Santo & Etheredge,
in the Extreme North, to substantially higher
2005).
levels of infection in the capital Yaoundé (8.3%)
Prevalence of HIV-1 among pregnant women
and the south-west (8%), east (8.6%) and north-
in the Gambia increased from 0.7% to 1.0%
west (8.7%) provinces (Institut National de la
between 1994 and 2000, while prevalence of
Statistique & ORC Macro, 2005). Surveillance
HIV-2 decreased from 1.0% to 0.8% in the same
among pregnant women has not been conducted
period (van der Loeff et al., 2003).
in recent years, making it difficult to assess trends
HIV prevalence in Guinea does not vary much
in the epidemic.
across the country, and appears to have peaked
In the Democratic Republic of the congo
at 2.1% in the capital, Conakry, according to
HIV prevalence among antenatal clinic attendees
a national population-based survey in 2005
has remained relatively stable in the capital,
(Direction Nationale de la Statistique & ORC
Kinshasa (between 3.8% in 1995 and 4.2% in
Macro, 2006).
2005), but prevalence has risen in the country’s
In Liberia, preliminary results from the 2007
second-largest city, Lubumbashi (from 4.7% to
Demographic and Health survey show adult
6.6% between 1997 and 2005), as well as in
(15–49 years) national HIV prevalence of 1.5%,
Mikalayi (from 0.6% to 2.2% between 1999
with infection levels varying from 2.5% in urban
and 2005) (Kayembe et al., 2007). Prevalence is
areas to 0.8% in rural areas. Adult prevalence was
also high in the cities of Matadi, Kisangani and
highest in the Monrovia region, at 2.6% (Liberia
Mbandaka (where 6% of women using antenatal
Institute of Statistics and Geo-Information
services were HIV-positive in 2005), as well as in
Services & Macro International, 2007).
Tshikapa (where prevalence was 8%) (Programme
In Sierra Leone, the country’s second round of
National de Lutte contre le SIDA, 2005).
national sentinel surveillance showed HIV preva-
lence of 4.1% among pregnant women attending
Adult national HIV prevalence in the central
(mostly urban) antenatal clinics in 2006.
African Republic is among the highest in all
Compared to the HIV prevalence of 3% among
of West and Central Africa, and was estimated
pregnant women in a similar survey in 2003, the
at 6.2% in a 2006 national population-based
latest data suggest that the epidemic in Sierra
survey (Ministère de l’Economie, du Plan et de
Leone might be growing (Ministry of Health
la Coopération internationale de la République
and Sanitation Sierra Leone, 2007). A 2005
centrafricaine, 2007). Nationally, prevalence
population-based survey found national adult
among women was almost twice as high as among
prevalence of 1.5% (National AIDS Secretariat &
men (7.8% versus 4.3%), and there is considerable
Nimba Research Consultancy, 2005).
regional variation in HIV prevalence.
20
2 0 0 7 A I D S E p I D E m I c u p D A t E | A s i A
ASIA
In Asia, national HIV prevalence is highest in South-East Asia, with wide variation in epidemic trends between
different countries. While the epidemics in Cambodia, Myanmar and Thailand all show declines in HIV preva-
lence, those in Indonesia (especially in the Papua province) and Viet Nam are growing. Although the proportion
of people living with HIV in India is lower than previously estimated, its epidemic continues to affect large
numbers of people. Overall in Asia, an estimated 4.9 million [3.7 million–6.7 million] people were living with
HIV in 2007, including the 440 000 [210 000–1.0 million] people who became newly infected in the past
year. Approximately 300 000 [250 000–470 000] died from AIDS-related illnesses in 2007.
Although HIV infections have been reported in
work is an important factor in the HIV epidemic
each of china’s provinces, most of the people
in China. Increasing numbers of women are
living with HIV in China are believed to be
injecting drugs and in some places as many as half
in Henan, Guangdong, Guangxi, Xinjiang and
of those also sell sex. Many male injecting drug
Yunnan provinces (Ministry of Health China,
users also buy sex, often without using condoms.
2006). It is estimated that just under half of
(Hesketh et al., 2006).
all people living with HIV in China in 2006
New, more accurate estimates of HIV indicate
were infected during injecting drug uses with
that approximately 2.5 million (2 million–3.1
contaminated equipment, while a similar propor-
million) people in India were living with HIV
tion acquired the virus during unprotected sex
in 2006, with national adult HIV prevalence of
(Ministry of Health China, 2006; Lu et al., 2006).
0.36%. Although the proportion of people living
Although the epidemic is still dominated by
with HIV is lower than previously estimated,
injecting drug use, recent data indicate an
India’s epidemic continues to affect large
emerging epidemic among men who have sex
numbers of people.
with men in the main cities and it is estimated
The revised estimates are based on an expanded
that as many as 7% of HIV infections could be
and improved surveillance system, and the use
attributed to unsafe sex between men (Lu et al.
of more robust and enhanced methodology. The
2006). Studies have found HIV prevalence among inclusion of the results of the recent national
men who have sex with men ranging from 1.5%
household survey (the National Family Health
in Shanghai (Choi et al., 2007), 1.7% in the south Survey 3, conducted in 2005–2006) in the esti-
(Tao et al., 2004; Zhu et al., 2005), and 3.1%–
mation process contributed significantly to the
4.6% in Beijing (Choi et al., 2003; Ma et al.,
revised estimates. Over 100 000 people were
2006). The overlap of injecting drug use and sex
tested for HIV in the survey which was the first
21
A s i A | 2 0 0 7 A I D S E p I D E m I c u p D A t E
Estimated adult HIV prevalence (15–49 years), by state, India 2006
national population based survey to include a
prevalence varies and the epidemic tends to be
component on HIV (NFHS-3, 2007).
concentrated in certain districts (NACO, 2005a;
Estimated adult HIV
In addition, India has expanded its HIV sentinel
World Bank, 2005). Reported adult HIV preva-
prevalence %
Jammu
surveillance system in recent years and the
lence in six states included in the recent national
and Kashmir
number of surveillance sites increased from 155
population-based survey (NFHS-3, 2007) varied
1.0 – 2.0%
in 1998 to 1120 in 2006. Data from pregnant
from 0.07% in Uttar Pradesh, to 0.34% in Tamil
0.5 – <1.0%
women attending antenatal clinics, people
Nadu, 0.62% in Maharashtra, 0.69% in Karnataka,
0.2 – <0.5%
attending sexually transmitted infections clinics
0.97% in Andhra Pradesh, and 1.13% in Manipur.
Himachal Pradesh
0 – <0.2%
and population groups that are at a higher risk of
Prevalence in all other states together was 0.13%.
Chandigarh
No available data
exposure to HIV are included in the surveillance.
An earlier analysis of sentinel surveillance data
Punjab
Uttaranchal
also showed that HIV prevalence in southern
Prevalence trends in India vary greatly between
Haryana
states overall was about five times higher than in
states and regions. Even in the four southern
Delhi
Arunac nor
hal ther
Pran
d states
esh in 2000–2004 (Kumar R et al.,
states (Andhra Pradesh, Karnataka, Maharashtra
Sikkim
2006). However, pockets of high HIV prevalence
Ut and
tar Tamil Nadu) where the large majority
(mainly among population groups at high risk
Rajasthan
Pr of
ad people
esh
living with HIV are residing, HIV
Assam
of exposure to HIV) have also been identified in
Bihar
Nagaland
Meghalaya
Manipur
Jharkand
Gujarat
Madhya
West
Tripura
Pradesh
Mizoram
Bengal
Chhatisgarh
Orissa
Daman
Figure 8
and Diu
Maharashtra
Dadra and
Nagar Haveli
Andhra
Pradesh
Trends in HIV prevalence among
pregnant women in consistent sites,
Goa
selected states in India, 2003–2006
Karnataka
) 2.20
Pondicherry
Tamil
1.
1 5
Kerala Nadu
r
e
v
a
l
e
n
c
e
(
%
1.
1 0
p
Lakshadweep
I
V
0.
0 5
i
a
n
H
e
d
M 0.
0 0
20
2 0
0 3
20
2 0
0 4
20
2 0
0 5
20
2 0
0 6
Year
Selected States (Number of consistent sites)
Andhra Pradesh (43)
Tamil Nadu (52)
Karnataka (53)
Bihar (6)
Maharashtra (70)
Uttar Pradesh (16)
Gujarat (8)
Madhya Pradesh (13)
Source: National AIDS Control Organization, 2007.
22
2 0 0 7 A I D S E p I D E m I c u p D A t E | a S I a
states where overall prevalence is generally low,
to 26% in March 2005 (Emmanuel, Archibal &
warning against complacency.
Altaf, 2006), while other studies have found that
HIV prevalence among injecting drug users has
Data from the expanded 2006 sentinel surveil-
reached 24% in Quetta (along the border with
lance show stable or declining prevalence among
Afghanistan) (Achakzai, Kassi & Kasi, 2007),
pregnant women in Tamil Nadu, Maharashtra,
12% in Sargodha, nearly 10% in Faisalabad (Nai
Karnataka, and Andhra Pradesh, but high HIV
Zindagi and Associates, 2006) and 8% in Larkana
prevalence among sex workers, and rising HIV
(Abbasi, 2006). HIV prevalence remains low in
prevalence among injecting drug users and men
other populations at higher risk of infection.
who have sex with men in a few states. Outside
Among female sex workers in Karachi, HIV prev-
of the north-east of the country, where the use of alence in 2005 was 2% while it was below 1%
contaminated drug injecting equipment is a key
in Lahore and Rawalpindi (Ministry of Health
risk factor, HIV appears to be spreading mainly as Pakistan, 2005; National AIDS Control Program
a result of unprotected sex between sex workers
Pakistan, 2005).
and their clients, and their respective other
sex partners (Kumar et al., 2005). Prevention
The estimated number of people living with HIV
programmes focusing on sex workers show some
in Viet Nam has more than doubled between
success and HIV prevalence is on the decline
2000 and 2005 from 120 000 to 260 000
among sex workers in areas that have been the
(Ministry of Health Viet Nam, 2005). The main
focus of targeted prevention efforts, especially in
risk factors associated with HIV infection are the
Tamil Nadu and other southern states. However,
use of contaminated injecting equipment and
prevention efforts are often complicated by the
unprotected sex with non-regular partners or sex
varied nature of commercial sex. (Char, Piller &
workers (Tuang et al., 2007). Among injecting
Shirke, 2003).
drug users in Viet Nam, prevalence increased
from 9% in 1996 to about 34% in 2005 (Ministry
In pakistan, HIV prevalence is increasing among
of Health Viet Nam, 2006 & 2005). As the
injecting drug users. One study in Karachi
epidemic evolves, increasing numbers of women
showed an increase in HIV prevalence among
are acquiring HIV from males who were infected
injecting drug users from under 1% in early 2004
during unsafe paid sex and injecting drug use, as
Figure 9
HIV prevalence among pregnant women in Viet Nam, 1994–2005
0.40
0.30
r
e
v
a
l
e
n
c
e
0.20
p
I
V
H
%
0.10
0.00
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Source: Ministry of Health, Sentinel Surveillance Survey Data.
2
a S I a | 2 0 0 7 A I D S E p I D E m I c u p D A t E
HIV prevalence among the general population in Cambodia, 1995–2006
3.0
)
Total
Urban
Rural
2.0
r
e
v
a
l
e
n
c
e
(
%
p
I
V 1.0
u
l
t
H
d
A
0.0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year
Source: National Center for HIV/AIDS, Dermatology and STDs (NCHADS).
Figure 10
seen by the increase over time in the prevalence
In Papua province (bordering Papua New
among pregnant women attending antenatal
Guinea) the epidemic is more serious with
clinics (see Figure 9). In 2006, an estimated one
unprotected sex being the main mode of trans-
third of people living with HIV were women
mission. In a province-wide population-based
(Viet Nam Commission for Population et al.,
survey in Papua in 2006, adult HIV prevalence
2006). However, the majority of HIV infections
was estimated at 2.4%, and reached 3.2% in the
are still directly or indirectly linked to injecting
remote highlands and 2.9% in less-accessible
drug use.
lowland areas. Among 15–24-year-olds, HIV
prevalence was 3% (Ministry of Health Indonesia
The HIV epidemic in Indonesia is among the
& Statistics Indonesia, 2007).
fastest growing in Asia. The majority of HIV
In cambodia there is evidence that well-focused
infections are estimated to occur through the use
and sustained prevention efforts can help reverse
of contaminated injecting equipment, unpro-
an HIV epidemic. Nationally, HIV prevalence
tected paid sex and, to a lesser extent, unprotected has fallen to an estimated 0.9% among the adult
sex between men. (Ministry of Health Indonesia
(15–49 years) population in 2006, down from
& Statistics Indonesia, 2006). When surveyed in
a peak of 2% in 1998 (National Center for
2005, more than 40% of injecting drug users in
HIV/AIDS, Dermatology and STIs, 2007).
Jakarta tested HIV-positive (WHO & Ministry
The number of new annual HIV infections in
of Health Indonesia, 2007), and about 13% in
thailand continues to decline, although the
West Java (Ministry of Health Indonesia, 2006).
decline in HIV prevalence has been slowing in
In addition, many injecting drug users also buy
recent years as more people are receiving antiret-
or sell sex (Ministry of Health Indonesia &
roviral therapy. The patterns of HIV transmission
Statistics Indonesia, 2006). In 2005, approximately
in Thailand have changed over time, with the
one quarter of injecting drug users in Bandung,
virus spreading increasingly to persons considered
Jakarta and Medan said they had had unprotected
to be at lower risk. More than four in 10 (43%)
paid sex in the previous year (Ministry of Health
new infections in 2005 were among women, the
Indonesia & Statistics Indonesia, 2006).
majority of whom probably acquired HIV from
2
2 0 0 7 A I D S E p I D E m I c u p D A t E | a S I a
HIV prevalence among various groups in Myanmar, 1992–2006
80
Commercial sex
workers
60
Injecting drug users
r
e
v
a
l
e
n
c
e
p 40
Sexual y transmitted
I
V
infection clinic male
H
attendees
% 20
0
1992
1994
1996
1998
2000
2002
2004
2006
Year
3
Antenatal clinic
attendees
2
New military recruits
r
e
v
a
l
e
n
c
e
p
I
V
H 1
%
0
1992
1994
1996
1998
2000
2002
2004
2006
Year
Source: Progress of HIV Epidemic in Myanmar, International Congress on AIDS in Asia & the Pacific. Colombo,
Sri Lanka, August 2007.
Figure 11
husbands or partners who had been infected
from 17% in 2003 to 28% in 2005) (van
either during unsafe paid sex or through injecting Griensven, 2006).
drug use (WHO, 2007).
The epidemic in myanmar is also showing
Despite the overall achievements in reversing
signs of a decline, with HIV prevalence among
the HIV epidemic in Thailand, prevalence
pregnant women at antenatal clinics having
among injecting drug users has remained high
dropped from 2.2% in 2000 to 1.5% in 2006
over the past 15 years, ranging between 30%
(National AIDS Programme Myanmar, 2006).
and 50% (WHO, 2007). Similarly, recent studies Despite the overall decline in prevalence, the
show increasing HIV prevalence among among
elevated prevalence of HIV among key popula-
men who have sex with men (e.g. in Bangkok
tions at higher risk is of concern (see Figure 11).
2
E a S t E r n E u r o p E a n d c E n t r a l a S I a | 2 0 0 7 A I D S E p I D E m I c u p D A t E
eASTerN euroPe AND ceNTrAl ASIA
An estimated 150 000 people [70 000–290 000] people were newly infected with HIV in 2007 bringing
the number of people living with HIV in Eastern Europe and Central Asia to 1.6 million [1.2 million–
2.1 million] compared to 630 000 [490 000–1.1 million] in 2001, a 150% increase over that time period.
Nearly 90% of newly reported HIV diagnoses in this region in 2006 were from two countries: the Russian
Federation (66%) and Ukraine (21%). Elsewhere, the annual numbers of newly reported HIV diagnoses
are also rising in Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, the Republic of Moldova, Tajikistan and
Uzbekistan (which now has the largest epidemic in Central Asia). Of the new HIV cases reported in 2006
in Eastern Europe and Central Asia for which there was information on the mode of transmission, nearly two
thirds (62%) were attributed to injecting drug use and more than one third (37%) were ascribed to unprotected
heterosexual intercourse.
The HIV epidemic in the Russian Federation
Overall, women comprised about 44% of newly
continues to grow, although not as rapidly as
registered HIV cases in 2006 (Russian Federal
in the late 1990s. The annual number of newly
AIDS Centre, 2007). National HIV prevalence
registered HIV cases declined between 2001
among pregnant women was 0.4% in 2005
and 2003 (from a peak of 87 000 to 34 000),
and 2006 (Ladnaya, 2007), although prevalence
but has subsequently started to increase again. In
of 1% or more has been recorded in some
2006, 39 000 new HIV diagnoses were officially
areas, including Saint Petersburg and Orenburg
recorded, bringing the total number of HIV cases
(Lazutkina, 2007; Volkova, 2007).
registered in the Russian Federation to about
370 000 (AIDS Foundation East-West, 2007;
In ukraine, annual HIV diagnoses have more
EuroHIV, 2007). Those officially documented
than doubled since 2001, reaching 16 094 in
HIV cases represent only those persons who
2006 and exceeding 8700 in the first six months
have been in direct contact with the Russian
of 2007 (Ministry of Health of Ukraine, 2007).
Federation’s HIV reporting system.
South-eastern Ukraine continues to be the
Injecting drug use remains the main mode of
most affected area, especial y the regions of
HIV transmission in the Russian Federation.
Dnipropetrovsk, Donetsk, Mikolaiv and Odessa,
Of the newly registered HIV cases in 2006 where as wel as the Autonomous Republic of Crimea.
the mode of transmission was known, two thirds
These regions, together with the capital city Kiev,
(66%) were due to injecting drug use and about
represent more than 70% of al registered cases of
one third (32%) to unprotected heterosexual
HIV currently in Ukraine (Ministry of Health of
intercourse (Ladnaya, 2007). The latter propor-
Ukraine, 2007). In recent HIV sentinel surveys in
tion, though, has been increasing steadily since
six cities in 2007, HIV prevalence among injecting
the late 1990s, especially in areas with compara-
drug users ranged from 10% in Lugansk to 13% in
tively mature epidemics. Less than 1% of newly
Kiev, and 89% in Krivoi Rog (Ukrainian Institute
registered HIV cases in 2006 were attributed to
for Social Research et al., 2007). HIV prevalence
unsafe sex between men. (EuroHIV, 2007)
among sex workers ranged from 4% in Kiev to
2
2 0 0 7 A I D S E p I D E m I c u p D A t E | E a S t E r n E u r o p E a n d c E n t r a l a S I a
HIV infection in Ukrainian regions*, 2007
Volyn
Chernigiv
Rivne
Sumy
Zhytomyr
Kyiv
Lviv
Kharkiv
Poltava
Ternopil
Khmel-
nytskiy
Luhansk
Iv-Frank.
Cherkasy
Vinnytsia
Zakarpatska
Kirovograd
Chernivtsi
Dnipropetrovsk
Donetsk
Mykolaiv
Zaporizhia
Odessa
Kherson
Number of
registered cases
< 1000
1000 – 3999
AR Crimea
4000 – 8999
> 9000
* Data on number of officially registered cases of HIV infection currently under medical care at
the regional level in Ukraine as of 01 July 2007.
Source: Ukrainian AIDS Centre, 2007.
Figure 12
24% in Donetsk and 27% in Mikolayev (Booth,
HIV prevalence found in this population: 34% in
Kwiatkowski & Brewster, 2006; Ministry of Health Zhlobine, 31% in Minsk, 23% in Soligorsk, 20%
of Ukraine, 2007).
in Rechitza and 17% in Gomel (WHO, 2006a).
Recent research has revealed the extent of the
Newly reported HIV cases in the Republic of
previously hidden epidemic among men who
moldova have more than doubled since 2003,
have sex with men in Ukraine. A study in four
to 621 in 2006 (EuroHIV, 2007). More than half
cities found HIV prevalence ranging from 4%
(59%) of HIV infections reported in 2006 were
in the capital Kiev to 23% in the city of Odessa.
attributed to unprotected sexual transmission
Among the HIV-positive men in this study, only
(EuroHIV, 2007).
34% reported condom use the last time they had
Increasing numbers of new HIV cases are being
sex with a male partner (Ukrainian Institute for
reported in each of the Caucasian republics. In
Social Research et al., 2007).
Georgia, more than half (60%) of the 1156
The HIV epidemic in Belarus may have stabi-
registered HIV cases to date were reported in
lized, with the annual number of newly reported
the past three years (2004–2006), and the annual
HIV diagnoses varying only slightly since 2003
number of newly registered HIV infections has
(between 713 and 778) (EuroHIV, 2007). Most
risen each year (EuroHIV, 2007).
new HIV infections are being reported in and
Similar patterns are evident in Armenia’s smaller
around the capital, Minsk, and in the provinces
epidemic (EuroHIV, 2007), where most reported
of Brest and Vitebsk (Ministry of Health Belarus,
HIV infections have been among injecting drug
2007). Here, too, the epidemic is largely concen-
users (almost all of them men). HIV prevalence of
trated among injecting drug users, with a high
about 9% was found among injecting drug users,
27
E a S t E r n E u r o p E a n d c E n t r a l a S I a | 2 0 0 7 A I D S E p I D E m I c u p D A t E
whereas prevalence of less than 2% was found
uted in part to expanded HIV testing (including
among female sex workers (Armenian National
testing in correctional settings, among most-
AIDS Foundation, 2006).
at-risk groups and among pregnant women),
although a nosocomial HIV outbreak infecting
Almost half (47%) of all HIV infections docu-
more than 130 children in the south of the
mented in Azerbaijan’s relatively recent
country was reported in 2006 (AIDS Center
epidemic were reported in 2005–2006 (EuroHIV,
of the South-Kazakhstan Oblast, 2007). In a
2007). Almost half of the HIV cases registered
2005 study in Temirtau 17% of injecting drug
by 2006 were in the capital, Baku, where 13% of
users were HIV-positive (Ministry of Health
injecting drug users tested HIV-positive in a 2003 Kazakhstan et al., 2005). Sentinel surveillance in
survey (WHO, 2006b). In addition, high preva-
23 towns and cities across the country in 2005
lence of HIV (9%) and other sexually transmitted
indicated that a little more than 3% of injecting
infections (9% syphilis and 63% chlamydia) has
drug users nationally were infected with HIV
been found among female sex workers, among
(Republic Centre for AIDS Prevention and
whom condom use appears to be infrequent
Control, 2005).
(WHO, 2006b).
In tajikistan, HIV prevalence among injecting
In uzbekistan, which now has the largest
drug users increased from 16% in 2005 to 24%
epidemic in Central Asia, the number of newly
in 2006 in the cities of Dushanbe and Khujand.
reported HIV diagnoses rose exponentially
Also of concern is the sudden rise in prevalence
between 1999 and 2003, from 28 to 1836. Since
among sex workers in those same cities (from
then, the number of newly reported HIV infec-
0.7% to 3.7% over the same period) (Ministry of
tions has grown at a slower pace, and reached
Health Tajikistan, 2007).
2205 in 2006 (EuroHIV, 2007). Almost one in
three (30%) injecting drug users tested HIV-
In Kyrgyzstan, the HIV epidemic is also concen-
positive in a study in Tashkent between 2003 and
trated largely among injecting drug users. Sentinel
2004 (Sanchez et al., 2006).
surveys in Bishkek and Osh found HIV prevalence
of 0.8% among injecting drug users, 3.5% among
In Kazakhstan, newly registered HIV cases
prisoners,1.3% among female sex workers and
increased from 699 in 2004 to 1745 in 2006
1% among men who have sex with men in 2006
(EuroHIV, 2007). The increase can be attrib-
(Ministry of Health Kyrgyzstan, 2007).
2
2 0 0 7 A I D S E p I D E m I c u p D A t E | c a r I b b E a n
cArIbbeAN
Adult HIV prevalence in the Caribbean is estimated at 1.0% [0.9%–1.2%] in 2007. Prevalence in this region
is highest in the Dominican Republic and Haiti, which together account for nearly three quarters of the 230 000
[210 000–270 000] people living with HIV in the Caribbean , including the 17 000 [15 000–23 000] who
were newly infected in 2007. An estimated 11 000 [9800–18 000] people in the Caribbean died of AIDS in
this year and AIDS remains one of the leading causes of death among persons aged 25 to 44 years.
The primary mode of HIV transmission in this
(Gaillard et al., 2006). However, results of sentinel
region is sexual intercourse, with unprotected
surveillance among pregnant women in 2006
sex between sex workers and clients a significant
show a stabilization in HIV prevalence (Ministère
factor in the transmission of HIV. Among female
de la Santé Publique et de la Population, 2007).
sex workers, HIV prevalence of 3.5% has been
A national population-based survey estimated
found in the Dominican Republic, 9% in
adult national prevalence at 2.2% in 2005
Jamaica and 31% in Guyana (Gupta et al., 2006; (Cayemittes et al., 2006). The declining trend is
Secretaria de Estado de Salud Pública y Asistencia
largely related to decreasing infection levels in the
Social de República Dominica, 2005b; PAHO,
capital, Port-au-Prince, and other cities, where
2007; Gebre et al., 2006; Allen et al., 2006).
HIV prevalence among 15–44-year-old women
fell from 5.5% to 3% between 2000 and 2005.
Unsafe injecting drug use is responsible for
Modelling of the epidemic indicates that besides
a minority of HIV infections, and contrib-
mortality, protective behaviour changes were at
utes significantly to the spread of HIV only in
least partly responsible for those declines (Gaillard
Bermuda and Puerto Rico. Unsafe sex between
et al., 2006). Behavioural surveys have shown a
men is a significant factor in this region but is
20% drop in the mean number of sexual partners
largely hidden because of associated stigma. Little
between 1994 and 2000, while condom use
research has been conducted in the Caribbean
increased, especially during sex with non-regular
among men who have sex with men, but the
partners (Cayemittes et al., 2006; Hallet et al.,
available data suggest that about 12% of reported
2006; Gaillard et al., 2006
HIV infections are the result of unsafe sex
between men (Caribbean Commission on Health
The HIV epidemic in the Dominican
and Development, 2005; Inciardi, Syvertsen &
Republic appears to have stabilized (see Figure
Surratt, 2005).
13) (Secretaria de Estado de Salud Pública y
Asistencia Social de República Dominica, 2007).
Haiti still accounts for the largest HIV burden
As in most other countries of the Caribbean,
in the Caribbean. Among pregnant women
commercial sex is a key factor in the epidemic.
attending antenatal clinics, HIV prevalence
One study found that condom use increased from
declined from 5.9% in 1996 to 3.1% in 2004
75% to 94% in 12 months among sex workers
2
c a r I b b E a n | 2 0 0 7 A I D S E p I D E m I c u p D A t E
HIV prevalence among pregnant women in the Dominican Republic, 1991–2005
La Romana
Puerto Plata
San Vicente de Paul (Duarte)
Nuestra Señora de la Altagracia
H. Alejandro Cabral (San Juan)
7.0
6.0
5.0
4.0
r
e
v
a
l
e
n
c
e
p
3.0
I
V
H
%
2.0
1.0
0.0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Source: Ministry of Health surveillance reports, 1991–2006.
Figure 13
who participated in a community solidarity
The latest antenatal clinic survey shows HIV
prevention project in the capital, Santo Domingo
prevalence of 1.6% among pregnant women.
(Kerrigan et al., 2006).
This is lower than the 2.3% prevalence found in
a similar survey in 2004, but due to methodo-
The HIV epidemics in Jamaica, the Bahamas,
logical differences, comparing the two sets of data
and trinidad and tobago have also been stable
should be done with caution. (Ministry of Health
over recent years (Ministry of Health Jamaica,
Guyana, 2007).
2007; Ministry of Health The Bahamas, 2006;
PAHO & WHO, 2006; Ministry of Health
In contrast to the rest of the region, injecting
Trinidad and Tobago, 2007).
drug use is the key factor in HIV transmission
in Bermuda and Puerto Rico. Very high HIV
In Barbados, the number of persons newly
prevalence is still being found among injecting
diagnosed with HIV each year has remained
drug users in Puerto Rico, where the rate of HIV
relatively stable since the late 1990s (Ministry of
infection (26 per 100 000) is twice that of the
Health Barbados, 2007).
United States mainland and where more than
HIV transmission in Guyana, is occurring
two thirds of HIV infections have been among
primarily through unprotected sexual intercourse.
men (AIDS Action, 2007).
0
2 0 0 7 A I D S E p I D E m I c u p D A t E | l a t I n a m E r I c a
lATIN AmerIcA
The HIV epidemics in Latin America remain generally stable, and HIV transmission continues to occur among
populations at higher risk of exposure, including sex workers and men who have sex with men. The estimated
number of new HIV infections in Latin America in 2007 was 100 000 [47 000–220 000], bringing to
1.6 million [1.4 million–1.9 million] the total number of people living with HIV in this region. An estimated
58 000 [49 000–91 000] people died of AIDS in the past year.
Unprotected sex between men is an important factor in the epidemics of Bolivia, Chile, Ecuador and Peru in South
America, as well as in several Central American countries, including El Salvador, Guatemala, Honduras, Mexico,
Nicaragua and Panama.
About one third of all people living with HIV
found among men who have sex with men.
in Latin America reside in Brazil. In 2005, an
Injecting drug use as well as the use of non-
estimated 620 000 [370 000–1 million] people
sterile injecting equipment, once an important
were living with HIV. Although initially concen-
risk factor in the epidemic, has decreased in the
trated primarily among men who have sex
last decade. It was estimated that injecting drug
with men, the epidemic subsequently spread
use accounted for only about 5% of new HIV
to injecting drug users and eventually into the
infections in the capital of Buenos Aires between
general population, with increasing numbers
2003 and 2005 (Cohen, 2006).
of women becoming infected (Dourado et al.,
The HIV epidemic in uruguay is concentrated
2007). It is estimated that a large proportion of
largely in and around the capital, Montevideo
infections among women can be attributed to
(where more than three quarters of all AIDS
the behaviour of their male sexual partners (Silva
cases have been reported), and in the Canelones,
& Barone, 2006). However, unprotected sex
Maldonado and Rivera districts. Unprotected
between men remains an important factor, and
sex (mostly heterosexual) accounts for approxi-
is estimated to account for about half of all HIV
mately two thirds of reported HIV cases. In
infections that are sexually transmitted in Brazil.
addition, unsafe sex between men and the use
HIV prevalence among injecting drug users in
of non-sterile injecting drug equipment account
Brazil has declined in some cities as a result of
for substantial proportions of HIV infections
harm-reduction programmes, changing from
(Montano et al., 2005; National AIDS Program
injecting to inhaling drugs, and mortality among
Uruguay, 2007; IDES et al., 2005).
drug users (UNAIDS & WHO, 2006).
In paraguay the epidemic is concentrated
In recent years, unprotected sex has become the
mainly in the capital city (Asunción), the
main route of HIV transmission in Argentina
department of Central, as well as in some areas
(Cohen, 2006), with an estimated four in five
bordering Argentina and Brazil (National AIDS
new HIV diagnoses in 2005 attributed to unpro-
Program Paraguay, 2007). The majority of people
tected sexual intercourse (mainly heterosexual)
living with HIV at the end of 2005 were men.
(National AIDS Programme Argentina, 2005).
HIV prevalence among pregnant women nation-
However, as in several other South American
ally was 0.3% in 2005 (National AIDS Program
countries, the highest HIV prevalence has been
Paraguay, 2006).
l a t I n a m E r I c a | 2 0 0 7 A I D S E p I D E m I c u p D A t E
In Bolivia, chile, colombia, Ecuador and
low prevalence of 0.2% in Nicaragua and Panama
peru, HIV infections continue to be concen-
(Soto et al., 2007)
trated among men who have sex with men
(Martínez, Elea & Chiu, 2006; Ministerio de
Recent HIV sentinel surveys have provided more
Salud y Deportes, ONUSIDA, 2007a,b).
information on the epidemic in Honduras,
where HIV transmission occurs mainly during
National HIV prevalence in Peru is estimated
unsafe paid sex and unprotected sex between
to be low and concentrated in specific popula-
men (Ministry of Health Honduras, 2006).
tions. Prevalence among men who have sex with
However, there is evidence of declining preva-
men remained between 18% and 22% in various
lence and consistent condom use among these
studies conducted between 1996 and 2002
population groups (Secretaria de Salud de
(Sanchez et al., 2007; Ministerio de Salud del
Honduras et al., 2007a,b). Preliminary findings
Peru, 2006).
from a 2006 study show HIV prevalence of
Against the background of widespread homo-
5.7% among men who have sex with men in
phobia, high HIV prevalence has been found
Tegucigalpa (down from 8.2% in 2001 and 10%
among men who have sex with men in several
in 1998) and 9.7% in San Pedro Sula (down from
Central American countries, including Belize,
16% in 2001) (Secretaria de Salud de Honduras
costa Rica, El Salvador, Guatemala,
et al., 2007b). A sharp decline in HIV preva-
Nicaragua and panama. Compared with HIV
lence among female sex workers has also been
prevalence in the adult general population, research observed in three cities in Honduras (see graph).
in 2002 suggested that infection levels among
Consistent condom use during the previous
men who have sex with men were seven times
30 days was high in all three cities (>80% in
higher in Honduras, 10 times higher in Guatemala
Tegucigalpa and San Pedro Sula, and 98% in
and Panama, 22 times higher in El Salvador and
La Ceiba with paying clients, and 87% or more
38 times higher in Nicaragua (Soto et al., 2007).
with non-regular partners), which suggests
High levels of HIV prevalence have also been
that condom promotion and other prevention
found among female sex workers in Honduras
efforts have been successful (Secretaria de Salud
(10%), Guatemala (4%) and El Salvador (3%), but
Honduras, 2007a).
Figure 14
HIV prevalence in female sex workers in various cities in Honduras, 1996–2006
16
14
1996
1998
2001
2006
12
10
8
r
e
v
a
l
e
n
c
e
p
I
V
6
H
%
4
2
0
Tegucigalpa
San Pedro Sula
La Ceiba
Source: Secretaria de salud de Honduras et al. (2007). Estudio Centroamericano de vigilancia de comportamiento
sexual y prevalencia de VIH/ITS en poblaciones vulnerables: Trabajadoras Sexuales. Agosto. Tegucigalpa, Secretaria
de salud de Honduras.
2
2 0 0 7 A I D S E p I D E m I c u p D A t E | n o r t h a m E r I c a , W E S t E r n a n d c E n t r a l E u r o p E
NorTH AmerIcA, weSTerN AND ceNTrAl euroPe
In these regions, the total number of people living with HIV is increasing. This increase is due mainly to the life-
prolonging effects of antiretroviral therapy and an increase in the number of new HIV diagnoses in Western Europe
since 2002, combined with a relatively stable number of new HIV infections each year in North America. Overall,
approximately 2.1 million [1.1 million–3.0 million] people in North America, Western and Central Europe were
living with HIV in 2007, including the 78 000 [19 000–86 000] who acquired HIV in the past year. In the
context of widespread access to effective antiretroviral treatment, comparatively few people died of AIDS—32 000
[20 000–84 000] in 2007.
The united States of America is one of
about 14% of the population, accounted for
the countries with the largest number of HIV
18% of new diagnoses (US Centers for Disease
infections in the world. Based on data from
Control and Prevention, 2007b).
the 33 states and four dependent territories
with long-term, confidential name-based HIV
After levelling off in the mid-1990s, the estimated
reporting, men accounted for most of the HIV or
total number of people living with HIV in
AIDS diagnoses (74%) among adults and adoles-
canada started to increase again in the late
cents in the country in 2005. More than half
1990s, mainly because of the life-prolonging
of all newly diagnosed HIV infections (53%) in
effects of antiretroviral treatment. The annual
2005 were among men who have sex with men.
number of newly reported HIV infections stayed
Persons exposed to HIV through heterosexual
about the same during that period, ranging
intercourse with a non-regular partner accounted
between 2495 and 2538 per year (Public Health
for just under one third (32%) of newly diagnosed Agency of Canada, 2006).
HIV infections and AIDS cases, while about 18%
Unprotected sex between men continues to
occurred among injecting drug users (US Centers
account for the largest proportion of new HIV
for Disease Control and Prevention, 2007a).
infections (45% in 2005 compared with 42% in
Racial and ethnic minorities continue to
2002) (Boulos et al., 2006).
be disproportionately affected by the HIV
An estimated 37% of new HIV infections in
epidemic in the United States. Although African
2005 were attributed to unprotected heterosexual
Americans represent about 13% of the popula-
intercourse, with a substantial proportion among
tion (US Census Bureau, 2006) they accounted
people born in countries where HIV is endemic
for 48% of new HIV or AIDS diagnoses in 2005. (mainly sub-Saharan Africa and the Caribbean).
AIDS was the fourth leading cause of death
among African Americans aged 25–44 years in
Heterosexually acquired HIV infections, most
the United States in 2004 (Anderson, Mosher &
of which were among immigrants and migrants,
Chandra, 2006; US Centers for Disease Control
accounted for the largest proportion (42%) of
and Prevention, 2006). Hispanics, who comprise
new HIV diagnoses in Western Europe in
n o r t h a m E r I c a , W E S t E r n a n d c E n t r a l E u r o p E | 2 0 0 7 A I D S E p I D E m I c u p D A t E
2006. A little under one third (29%) of newly
HIV in this region is transmitted mainly through
diagnosed HIV infections were attributable
unsafe sex and, to a much lesser extent (except in
to unsafe sex between men, and only 6% to
countries such as Portugal and Spain), through the
injecting drug use (EuroHIV, 2007).
use of contaminated equipment by injecting drug
The HIV epidemics in
users. Most heterosexual y transmitted HIV cases
Spain, Italy, France
and the united Kingdom, continue to be
originate in countries with high HIV prevalence
the largest in Western and Central Europe. The
and within that group, more than 50% of new
annual number of newly diagnosed HIV infec-
HIV diagnoses are in women (EuroHIV, 2007).
tions has more than doubled in the United
Two divergent epidemic trends have been
Kingdom, from 4152 in 2001 to 8925 in 2006
observed in Western Europe. While the number
(EuroHIV, 2007). The increase in HIV diagnoses
of new HIV diagnoses attributed to unsafe sex
reported in the united Kingdom is mainly due
between men nearly doubled between 1999 and
to sustained levels of newly acquired infections
2006 (from 2538 to 5016), those attributed to
among men who have sex with men, an increase
injecting drug use declined in the same period
in diagnoses among heterosexual men and
(from 661 to 581).
women who acquired their infection in a high-
prevalence country (mainly sub-Saharan Africa
In Central Europe, the number of newly
and the Caribbean), and improved reporting
diagnosed HIV infections in 2006 surpassed 100
due to expanding HIV testing services. (Health
in only three countries: poland (750), turkey
Protection Agency, 2007; EuroHIV, 2007).
(290) and Romania (180). Elsewhere, the
epidemics are comparatively small and only in
In Western Europe (excluding the United
Hungary, montenegro and Serbia more than
Kingdom), the number of annual reported new
1000 HIV infections in total have been reported
HIV diagnoses almost tripled between 1999 and
since the epidemic began (EuroHIV, 2007).
2005 (from 7497 to 19 476), but declined signifi-
cantly in 2006 (to 16 316). The largest number
Injecting drug use is the most-reported mode
of diagnoses were reported in France (where
of HIV transmission in the three Baltic states
routine reporting only started in 2003 and where
(Estonia, Latvia, and Lithuania) where the
5750 HIV infections were newly diagnosed in
epidemics appear to have stabilized (Hamers, 2006;
2006), Germany (2718) and portugal (2162). In EuroHIV, 2007). However, Estonia continues
Spain and Italy, only certain regions contribute to
to have the highest rate of newly reported HIV
the reporting system. Elsewhere, the number of
diagnoses (504 per one mil ion population) and
diagnoses is smaller, and new infections in 2006
the highest estimated adult national HIV preva-
exceeded 1000 only in the Netherlands (1017)
lence (1.3% [0.6%–4.3%] in 2005) in al of Europe
(EuroHIV, 2007).
(UNAIDS, 2006; EuroHIV, 2007).
2 0 0 7 A I D S E p I D E m I c u p D A t E | m I d d l E E a S t a n d n o r t h a f r I c a
mIDDle eAST AND NorTH AFrIcA
Despite recent improvements in some countries, epidemiological surveillance in this region remains limited
(Obermeyer, 2006). Nevertheless, using available HIV information it is estimated that 35 000 [16 000–65 000]
people acquired HIV in 2007, bringing to 380 000 [270 000–500 000] the total number of people living with
HIV in the region. As a result of AIDS-related illnesses, an estimated 25 000 [20 000–34 000] people died in
2007.
Reported numbers of HIV cases in the region
While unprotected paid sex is a key factor in the
remain small. Most HIV infections are occurring
HIV epidemics throughout the region, exposure
in men and in urban areas, with the exception of
to contaminated drug injecting equipment is the
the Sudan, the country with the highest preva-
main route of HIV transmission in Afghanistan,
lence in the region, where unsafe heterosexual
the Islamic Republic of Iran, the Libyan
intercourse is the most important risk factor for
Arab Jamahiriya and tunisia, and contributes
HIV infection.
to the epidemics of Algeria, morocco and the
Syrian Arab Republic.
o c E a n I a | 2 0 0 7 A I D S E p I D E m I c u p D A t E
oceANIA
An estimated 14 000 [11 000–26 000] people acquired HIV in Oceania in 2007, bringing to 75 000
[53 000–120 000] the number of people living with the virus in this region.
Over 70% of those persons reside in papua
during the 1990s, new HIV diagnoses have
New Guinea, where the epidemic is still
increased by 41% between 2000 and 2005,
expanding, although at slightly lower levels than
(National Centre in HIV Epidemiology and
previously believed. The majority of reported
Clinical Research, 2006), together with an
HIV infections to date have been in rural areas,
increase in unsafe sex among men who have sex
where more than 80% of the population lives
with men. (Prestage et al., 2006).
(National AIDS Council Secretariat Papua New
In New Zealand the main factor for acquiring
Guinea, 2007). Unsafe heterosexual intercourse
HIV inside the country remains unsafe sex
is estimated to be the main mode of HIV trans-
between men. However, the number of people
mission.
diagnosed with HIV who report being infected
In Australia, HIV continues to be transmitted
though unsafe heterosexual intercourse is on the
mainly through unprotected sex between men
rise, with the majority of infections occurring
(National Centre in HIV Epidemiology and
outside the country, primarily in Asia and
Clinical Research, 2007). While concerted
sub-Saharan Africa (Ministry of Health New
prevention efforts controlled the epidemic
Zealand, 2007).
2 0 0 7 A I D S E p I D E m I c u p D A t E | m a p S
Maps
Global estimates for adults and children, 2007
Adults and children estimated to be living with HIV in 2007
estimated number of adults and children newly infected with HIV during 2007
estimated adult and child deaths from AIDS during 2007
7
m a p S | 2 0 0 7 A I D S E p I D E m I c u p D A t E
Global estimates for adults and children,
2007
People living with HIV ............... 33.2 million [30.6–36.1 million]
New HIV infections in 2007 ............ 2.5 million [1.8–4.1 million]
Deaths due to AIDS in 2007 ............. 2.1 million [1.9–2.4 million]
The ranges around the estimates in this table define the boundaries within which the actual numbers lie,
based on the best available information.
2 0 0 7 A I D S E p I D E m I c u p D A t E | m a p S
adults and children estimated to be livinG
with hiv in 2007
Eastern Europe
and Central Asia
Western and
1.6 million
Central Europe
[1.2–2.1 million]
North America
760 000
1.3 million
[600 000–1.1 million]
East Asia
[480 000–1.9 million]
800 000
[620 000–960 000]
Middle East
Caribbean
and North Africa
South and
230 000
380 000
South-East Asia
[210 000–270 000]
[270 000–500 000]
4.0 million
[3.3–5.1 million]
Latin America
Sub-Saharan
1.6 million
Africa
[1.4–1.9 million]
22.5 million
[20.9–24.3 million]
Oceania
75 000
[53 000–120 000]
Total: 33.2 (30.6–36.1) million
m a p S | 2 0 0 7 A I D S E p I D E m I c u p D A t E
estimated number of adults and children
newly infected with hiv durinG 2007
Eastern Europe
and Central Asia
Western and
150 000
Central Europe
[70 000–290 000]
North America
31 000
46 000
[19 000–86 000]
East Asia
[38 000–68 000]
92 000
[21 000–220 000]
Middle East
Caribbean
and North Africa
South and
17 000
35 000
South-East Asia
[15 000–23 000]
[16 000–65 000]
340 000
[180 000–740 000]
Latin America
Sub-Saharan
100 000
Africa
[47 000–220 000]
1.7 million
[1.4–2.4 million]
Oceania
14 000
[11 000–26 000]
Total: 2.5 (1.8–4.1) million
0
2 0 0 7 A I D S E p I D E m I c u p D A t E | m a p S
estimated adult and child deaths from
aids durinG 2007
Eastern Europe
and Central Asia
Western and
55 000
Central Europe
[42 000–88 000]
North America
12 000
21 000
[<15 000]
East Asia
[18 000–31 000]
32 000
[28 000–49 000]
Middle East
Caribbean
and North Africa
South and
11 000
25 000
South-East Asia
[9800–18 000]
[20 000–34 000]
270 000
[230 000–380 000]
Latin America
Sub-Saharan
58 000
Africa
[49 000–91 000]
1.6 million
[1.5–2.0 million]
Oceania
1 200
[<500–2700]
Total: 2.1 (1.9–2.4) million
2 0 0 7 A I D S E p I D E m I c u p D A t E | b I b l I o G r a p h y
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2 0 0 7 A I D S E p I D E m I c u p D A t E | n o t E S
n o t E S | 2 0 0 7 A I D S E p I D E m I c u p D A t E
UNAIDS, the Joint United Nations Programme on HIV/AIDS, brings together the efforts and resources
of ten UN system organizations to the global AIDS response. Cosponsors include UNHCR, UNICEF,
WFP, UNDP, UNFPA, UNODC, ILO, UNESCO, WHO and the World Bank. Based in Geneva, the UNAIDS
secretariat works on the ground in more than 80 countries worldwide.
The annual AIDS epidemic update reports on
the latest developments in the global AIDS
epidemic. With maps and regional summaries,
the 2007 edition provides the most recent
estimates of the epidemic’s scope and human
toll and explores new trends in the epidemic’s
evolution.
uNAIDS
t (+41) 22 791 36 66
www.unaids.org
20 AVeNue APPIA
f (+41) 22 791 48 35
cH-1211 GeNeVA 27
SwItZerlAND
