UNAIDS today released new global estimates on the scale of the AIDS pandemic, and reported that approximately 39.5 million people are living with HIV in 2006, 2.6 million more than in 2004.
Two-thirds live in sub-Saharan Africa, and one-third of all people living with HIV globally live in southern Africa. One third of all global AIDS deaths in 2006 occurred in southern Africa.
4.3 million adults and children are estimated to have become infected with HIV in 2006 alone (compared with 3.9 million in 2004).Young people aged 15-24 accounted for 40% of new infections in 2006.
The epidemic continues to grow fastest in Eastern Europe and Central Asia – 270,000 new infections in 2006 compared to 170,000 in 2004 – a 70% increase. Two-thirds of infections are due to shared injecting equipment.
One million people throughout sub-Saharan Africa were estimated to be receiving ARVs in June 2006 – just under a quarter of those who need them.
Southern Africa
Although declines in prevalence have been reported from Zimbabwe, we should be cautious about these figures, warns UNAIDS. They do not reflect a region-wide trend. In Botswana HIV prevalence among pregnant women aged 30-34 is still on the rise, even though it has fallen somewhat in women aged 16-24. In Swaziland one in three adults is now living with HIV. 59% of those living with HIV in sub-Saharan Africa are women.
The death rate in women aged 25-34 increased fivefold in South Africa between 1997 and 2004, compared with a doubling in males aged 30-44. Women are becoming infected earlier and so dying younger.
Although delays in first sexual activity have been reported from some countries in southern Africa, the impact of the epidemic on young women is dire. In Lesotho less than 10% are HIV-positive at ages 18-19; by the age of 24, 40% are HIV-positive. In South Africa HIV prevalence is around 14-16% in young pregnant women aged 15-19 and 28-31% in pregnant women aged 20-24.
Young women in South Africa are four times more likely to be infected than men (17% prevalence in 15-24s compared to 4.4% among young men).
East Africa
Stabilising or declining prevalence is being reported in East Africa, but the report warns of increases in HIV incidence since 2000 in Uganda at the same time as increased reports of multiple casual partners and erratic condom use in national household surveys.
Asia
8.6 million people are now estimated to be living with HIV in Asia, 5.7 million of these in India. 960,000 became infected in 2006 and 630,000 died of AIDS in 2006.
Antiretroviral therapy is reaching 235,000 people in Asia – only 16% of those who need it.
Around 650,000 people are living with HIV in China. Half the new infections that occurred in 2005 were a result of unprotected sex.
Needle exchange programmes in China are beginning to produce results, with reductions in needle sharing reported by drug users. But China still needs to do more, particularly in relation to overcoming opposition to needle exchange at local level.
Although needle exchange in China is resulting in a reduction in needle-sharing, condom use is very low among drug users, illustrating the need for targeted and integrated interventions.
HIV is continuing to spread rapidly between men who have sex with men in China, India and South East Asia but few national AIDS programmes adequately address this group.
The Indian epidemic appears to be stablising or declining in the south but growing modestly in the north. There are significant regional differences in risk factors, with injecting drug use most prominent near the north-eastern border with Myanmar. Harm reduction programmes in India are an essential step to limiting the scale of the epidemic, already one of the world’s largest.
West Africa
The epidemic in West Africa continues to be less severe, with national prevalence rates below 4%. However, research has recently found high levels of HIV among men who have sex with men in Senegal (22%), among prison populations in Ghana (19%), and commercial sex workers in Senegal (30%), highlighting the importance of targeted interventions for high-risk groups in the African setting. Injecting drug use is also being noted as a significant route of new infections in sub-Saharan Africa for the first time.
HIV and sexual behaviour trends among young people
UNGASS 2001 set a target of a 25% reduction in prevalence by 2005 among young people.
HIV prevalence in this group has declined in 8 of 11 countries in southern and eastern Africa with sufficient data (no evidence of decline in South Africa, Zambia, Mozambique).
Behavioural data are mixed – improvements across the board in Kenya, improved rates of condom use in South Africa, Tanzania and Uganda, but increases in high-risk activities among sub-groups in some countries eg Cameroon.
The strongest evidence of behaviour change among young people is coming from East Africa. Behaviour change among this group will influence the future course of the epidemic worldwide, says UNAIDS.