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The Global HIV/AIDS Epidemic |
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The HIV/AIDS epidemic has already claimed more than 25 million
lives and another 40 million people are currently estimated to be
living with HIV/AIDS worldwide.1 HIV/AIDS cases have been
reported in all regions of the world, but most people living with
HIV/AIDS (95%) reside in low-and middle-income countries, where
most new HIV infections and AIDS-related deaths occur.1 The
nations of sub-Saharan Africa have been hardest hit; there is also
increasing concern about the next wave of the epidemic, emerging
in parts of Eastern Europe and Asia.2,3 HIV is the leading cause
of death worldwide (among those ages 15–59).4 The epidemic is
considered a threat to the economic well-being, social, and political stability of many nations
Current Global Snapshot1
• There are an estimated 40.3 million people living with HIV/AIDS
worldwide, a greater number than ever before and twice the
number in 1995.
• During 2005, an estimated 4.9 million people became newly
infected with HIV, including approximately 700,000 children
(<15 years old).
• 3.1 million people died of AIDS in 2005.
• Worldwide, most people living with HIV are unaware that they
are infected.
Impact by Region
The major route of HIV transmission worldwide is heterosexual
sex, although risk factors vary within and across populations. In
many regions of the world, men who have sex with men, injection
drug users, and sex workers account for significant proportions of
infections.1 Several regions and countries have been particularly
hard-hit by the HIV/AIDS pandemic (See Figure 1). Even in the
United States, where HIV incidence has been level for more
than a decade, there are increasing numbers of people living
with HIV/AIDS, not everyone has access to care, and HIV/AIDS
prevalence is high among some sub-populations.1,6,7
The most affected regions around the world are:1
• Sub-Saharan Africa. Sub-Saharan Africa has been hardest hit
and is home to 64% (25.8 million) of people living with HIV/AIDS
but only 11–12% of the world’s population.8 Most nations in
this region have generalized HIV/AIDS epidemics—that is, the
national HIV prevalence rate is greater than 1%.9 In several
nations in the region, more than 1 in 5 adults is already estimated
to be HIV positive. South Africa has the highest number of
people living with HIV/AIDS in the world (5.7–6.2 million10).
Swaziland has the highest prevalence rate in the world (more
than 40% among pregnant women). There do appear to be
declines in adult prevalence in some countries in the region.
• Latin America & The Caribbean. More than 2 million people
are estimated to be living with HIV/AIDS in Latin America and the
Caribbean combined, 230,000 of whom were newly infected with
HIV in 2005. Eleven countries in this region have generalized
epidemics, with Haiti’s adult prevalence rate being the highest.
The HIV/AIDS adult prevalence rate in the Caribbean (1.6%) is
second only to sub-Saharan Africa.
• Eastern Europe & Central Asia. An estimated 1.6 million
people are living with HIV/AIDS in this region, which has one
of the fastest growing HIV/AIDS epidemics in the world. It is
heavily concentrated among young people. Driven initially by
injection drug use and increasingly heterosexual transmission,
HIV prevalence has risen sharply over the last several years.
The Russian Federation has the largest number of people
living with HIV/AIDS in the region and is considered part of the
epidemic’s “next” or “second” wave.3
• Asia. An estimated 8.3 million people are living with HIV/AIDS
across South/South-East Asia and East Asia. There are
increasing concerns about the spread of the epidemic in this
region, particularly in China and India, the two most populous
nations in the world. Like Russia, they are considered part of
the epidemic’s “next wave” and despite having relatively low
prevalence rates today, the epidemic could expand significantly
over the next decade without increased intervention. India
already has the second highest number of people estimated to
be living with HIV/AIDS in the world (5.1 million11).
Impact on Women & Young People
• Women comprise an increasing proportion of people living
with HIV/AIDS, rising from 41% of adults in 1997 to almost
half (46%) as of the end of 2005.1,12 Among young people
living with HIV/AIDS, ages 15–24, women outnumber men.
This trend is occurring in most regions of the world, and is
particularly pronounced in sub-Saharan Africa, where women
represent more than half (57%) of all adults living with
HIV/AIDS (See Figure 2).1 Gender inequalities in social and
economic status and in access to prevention and care services
increase women’s vulnerability to HIV. Sexual violence may
also increase women’s risk and women, especially young
women, are biologically more susceptible to HIV infection than
men. The epidemic has multiple effects on women including:
added responsibilities of caring for sick family members; loss
of property if they become widowed and/or infected; and even,
violence when their HIV status is discovered.
• Teens and young adults, particularly girls and young women,
continue to be at the center of the epidemic. Young people,
ages 15–24 account for approximately half of new adult HIV
infections.13 Most young people living with HIV/AIDS are girls
including approximately three-quarters of HIV-positive young
people in sub-Saharan Africa, and infection rates are several
times higher among young women than young men in many
countries.1
• In 2003, there were an estimated 15 million AIDS orphans
(children who had lost one or both parents to the epidemic);
most (12 million) lived in sub-Saharan Africa.14
The Multi-Sectoral Impact of AIDS
The global HIV pandemic has had a profound, multi-sectoral impact
on the structure of many nations, affecting their development and
economic growth, communities, households, and individuals:5,15
• AIDS has been identified as a serious challenge to development.
High prevalence countries are estimated to be losing 1–2% of
their annual economic growth,14 and the long-term economic
effects may be much higher.4,5 Because HIV/AIDS often hits
working age populations hardest, the workforce of many nations
has been affected, as skilled workers are lost to the epidemic.
The loss of skilled workers in turn affects nations’ ability to
respond to the epidemic.5
• The education sector is also threatened, as AIDS claims the
lives of teachers and contributes to serious teacher shortages
in several African countries. AIDS also weakens the education
sector through its impact on school attendance and enrollment
among children affected by HIV/AIDS.5,14
• Increasing demand for health care services is overwhelming the
public health infrastructure in many developing countries. At the
same time, many countries are losing large numbers of health
care workers to AIDS. In some African countries, it is estimated
that AIDS causes up to one half of all deaths among employees
in the public health sector.5,14
• Many of the nations hardest hit by HIV/AIDS also suffer from
malnutrition, food insecurity, and famine. These challenges are
interrelated with HIV/AIDS, each intensifying and complicating
the effects of the other. 5,14
• The demographic effects of the epidemic are significant, as it
alters the population structures of hard hit countries, affecting
their growth and mortality rates and, ultimately, their age and
sex distributions. Individuals die at prematurely young ages,
during their most productive and reproductive years. One
consequence of this is that there are fewer working age people
to support children and the elderly. And, in some parts of world,
there are disproportionately fewer women compared to men,
due to HIV mortality.4,5,16
• One of the most striking demographic impacts of HIV/AIDS is on
life expectancy, reversing steady gains made in many countries
during the last century. By 2010, life expectancies in several
highly-affected countries could drop to below 40 years, well
below what they would have been without HIV/AIDS and even
below levels they had reached in the pre-AIDS era.4,5,16
The Global Response
The past few years have brought greater attention by the
international community to HIV/AIDS, leading to several
important initiatives including: The United Nations General
Assembly Special Session on HIV/AIDS; The Global Fund
to Fight AIDS, Tuberculosis, and Malaria; The World Health
Organization’s “3x5 Initiative”; and the U.S. “President’s
Emergency Plan for AIDS Relief” (PEPFAR). Affected
country governments and civil society also play critical and
increasing roles in many national responses to the epidemic.
Global funding for HIV/AIDS has also increased over time.
Still, resources fall short of projected need and most people
at risk for HIV and those living with HIV/AIDS do not have
access to prevention, care, and treatment:
• In 2005, global spending on HIV/AIDS was estimated
to reach $8.3 billion, but need is much higher. For
2006, UNAIDS projects that $15 billion will be needed to
effectively respond to the HIV/AIDS epidemic in low- and
middle-income countries; by 2008, this will rise to $22
billion.17
• The lack of resources has limited many nations’ ability
to bring prevention and treatment programs to scale,
and stem the tide of the epidemic. It is estimated that
prevention programs reach fewer than one in five of those
who need them and that only 15% of people with HIV/AIDS
in need of antiretroviral therapy in low and middle income
countries have such access.1,18
• Most funding for HIV/AIDS is expected to come from
international donors, although affected country governments
also have an important role to play. In 2004, major donor
governments committed $3.6 billion to global HIV/AIDS
efforts in developing countries. The U.S. is a key part of
the global response, contributing the highest dollar amount
to HIV/AIDS.19 In its fiscal year (FY) 2005, the U.S.
federal funding commitment for global HIV/AIDS, as part of
PEPFAR, is expected to total $2.7 billion, including funding
for prevention, care, treatment, and research. This also
includes contributions to the Global Fund of $347 million for
FY 2005 and a carry-over of $87.8 million from FY 2004.20
Prepared by Jennifer Kates of the Kaiser Family Foundation (KFF). Additional copies of this publication
(#3030-06) are available on the Kaiser Family Foundation’s website at www.kff.org. |
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Last Updated ( Wednesday, 22 March 2006 )
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