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Epidémiologie Mondiale du VIH

Epidémiologie Mondiale du VIH. A global view of HIV infection 38.6 million people [33.4‒46.0 million] living with HIV, 2005. 2.4. 45. 40. 35. 30. 25. 20. 15. 10. 5. 2000. 2001. 2002. 2003. 2004. 0. Estimated number of people living with HIV, 2000 — 2004. Millions. Number

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Epidémiologie Mondiale du VIH

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  1. Epidémiologie Mondiale du VIH

  2. A global view of HIV infection 38.6 million people [33.4‒46.0 million] living with HIV, 2005 2.4

  3. 45 40 35 30 25 20 15 10 5 2000 2001 2002 2003 2004 0 Estimated number of people living with HIV, 2000—2004 Millions Number of people living with HIV This bar indicates the range around the estimate.

  4. Estimated number of people living with HIV and adult HIV prevalence Global HIV epidemic, 1990‒2005* HIV epidemic in sub-Saharan Africa, 1985‒2005* Number of people living with HIV (millions) % HIV prevalence, adult (15‒49) Number of people living with HIV (millions) % HIV prevalence, adult (15‒49) 50 5.0 30 15.0 12.5 25 40 4.0 20 10.0 30 3.0 7.5 15 20 2.0 5.0 10 10 1.0 2.5 5 0 0.0 0 0.0 1990 1995 2000 2005 1985 1990 1995 2000 2005 *Even though the HIV prevalence rates have stabilized in sub-Saharan Africa, the actual number of people infected continues to grow because of population growth. Applying the same prevalence rate to a growing population will result in increasing numbers of people living with HIV. Number of people living with HIV % HIV prevalence, adult (15-49) This bar indicates the range around the estimate 2.2

  5. Regional HIV and AIDS statistics and features, 2003 and 2005 REGION Adults (15+) and children living with HIV Adults (15+) and children newly infected with HIV Adult (15-49) prevalence (%) Adult (15+) and child deaths due to AIDS 2005 2003 2005 2003 2005 2003 2005 2003 Sub-Saharan Africa 24.5 million [21.6‒27.4 million] 23.5 million [20.8‒26.3 million] 2.7 million [2.3‒3.1 million] 2.6 million [2.3‒3.0 million] 6.1 [5.4‒6.8] 6.2 [5.5‒7.0] 2.0 million [1.7‒2.3 million] 1.9 million [1.7‒2.3 million] North Africa and Middle East 440 000 [250 000‒720 000] 380 000 [220 000‒620 000] 64 000 [38 000‒210 000 54 000 [31 000‒150 000 0.2 [0.1‒0.4] 0.2 [0.1‒0.3] 37 000 [20 000‒62 000] 34 000 [18 000‒57 000] Asia 8.3 million [5.7‒12.5 million] 7.6 million [5.2‒11.3 million] 930 000 [620 000‒2.4 million] 860 000 [560 000‒2.3 million] 0.4 [0.3‒0.6] 0.4 [0.2‒0.6] 600 000 [400 000‒850 000] 500 000 [340 000‒710 000] Oceania 78 000 [48 000‒170 000] 66 000 [41 000‒140 000] 7200 [3500‒55 000] 9000 [4300-69 000] 0.3 [0.2‒0.8] 0.3 [0.2‒0.7] 3400 [1900‒5500] 2300 [1300‒3600] Latin America 1.6 million [1.2‒2.4 million] 1.4 million [1.1‒2.0 million] 140 000 [100 000‒420 000] 130 000 [95 000‒310 000] 0.5 [0.4‒1.2] 0.5 [0.4‒0.7] 59 000 [47 000‒76 000] 51 000 [40 000‒67 000] Caribbean 330 000 [240 000‒420 000] 310 000 [230 000‒400 000] 37 000 [26 000‒54 000] 34 000 [24 000‒47 000] 1.6 [1.1‒2.2] 1.5 [1.1‒2.0] 27 000 [19 000‒36 000] 28 000 [19 000‒38 000] Eastern Europe and Central Asia 1.5 million [1.0‒2.3 million] 1.1 million [790 000‒1.7 million] 220 000 [150 000‒650 000] 160 000 [110 000‒440 000] 0.8 [0.6‒1.4] 0.6 [0.4‒1.0] 53 000 [36 000‒75 000] 28 000 [19 000‒39 000] North America, Western and Central Europe 2.0 million [1.4‒2.9 million] 1.8 million [1.3‒2.7 million] 65 000 [52 000‒98 000] 65 000 [52 000‒98 000] 0.5 [0.4‒0.7] 0.5 [0.3‒0.6] 30 000 [24 000‒45 000] 30 000 [24 000‒45 000] TOTAL 38.6 million [33.4‒46.0 million] 36.2 million [31.4‒42.9 million] 4.1 million [3.4‒6.2 million] 3.9 million [3.3‒5.8 million] 1.0 [0.9‒1.2] 1.0 [0.8‒1.2] 2.8 million [2.4‒3.3 million] 2.6 million [2.2‒3.1 million] 2.3

  6. Second generation HIV surveillance Objectives • To capture the diversity of the epidemic • To explain changes over time • To build up a more informative picture

  7. Second generation HIV surveillance General concepts • To concentrate data collection in populations most at risk • To compare information on HIV prevalence and on the behaviours that spread it • To make better use of other sources of information (communicable disease surveillance, reproductive health surveys, …) • To tailor the surveillance system to the pattern of the epidemic in the country ( define 3 country profiles) Source: UNAIDS

  8. Données • comportementales • chez les UDI • chez les homosexuels • chez les hétérosexuels • Données de • surveillance : • notification du sida • notification du VIH • - données de prévalence • activités de dépistage • cohortes Dynamique de l’épidémie du VIH perspective = mesurer l’incidence du VIH Autres : données sur les IST

  9. UNAIDS/WHO classification of epidemic states  Low level  Concentrated  Generalised Source: UNAIDS

  10. Low level • Principle: although HIV infection may have existed for many years, it has never spread to significant levels in any sub-population. • Infection is largely confined to individuals with higher risk behaviour: e.g. sex workers, drug injectors, homosexual men. This suggests that networks of risk are rather diffuse (low levels of partner exchange or sharing of drug injecting equipment), or a very recent introduction of the virus. Source: UNAIDS

  11. Concentrated • Principle: HIV has spread rapidly in a defined sub-population, but is not well-established in the general population. • This suggests active networks of risk within the sub-population. The future course of the epidemic is determined by the frequency and nature of links between highly infected sub-populations and the general population. Source: UNAIDS

  12. Generalised • Principle: in generalised epidemics, HIV is firmly established in the general population. • Although sub-populations at high risk may continue to contribute disproportionately to the spread of HIV, sexual networking in the general population is sufficient to sustain an epidemic independent of sub-populations at higher risk of infection. Source: UNAIDS

  13. UNAIDS/WHO classification of epidemic states • Low Level • HIV prevalence has not consistently exceeded 5% in any defined • sub-population • Concentrated • HIV prevalence consistently >5% in at least one defined sub-population • but • <1% in pregnant women in urban areas • Generalised • HIV prevalence consistently >1% • in pregnant women Source: UNAIDS

  14. HIV prevalence (%) in adults in Africa, 2005 2.5

  15. Burkina Faso 2.5 1.8 (2003) 4.2 2.1 2.0 Decline in urban areas Burundi 4.8 3.6 (2002) 6.0 3.3 3.3 Decline in capital city Cameroon 7.3† 5.5 (2004) 7.0 5.5 5.4 Stable Ghana 3.1 2.2 (2003) 3.1 2.3 2.3 Stable Guinea 4.2 1.5 (2005) 2.8 1.6 1.5 Stable Lesotho 28.4 23.5 (2004) 29.3 23.7 23.2 Stable Rwanda 4.6 3.0 (2005) 5.1 3.8 3.1 Decline in urban areas Senegal 1.9 0.7 (2005) 0.8 0.9 0.9 Stable Sierra Leone 3.0 1.5 (2005) - 1.6 1.6 Stable South Africa 29.5 16.2 (2005) 20.9 18.6 18.8 Increasing UR Tanzania 7.0 7.0 (2004) 9.0 6.6 6.5 Stable Uganda 6.2‡ 7.1 (2004‒5) 4.1 6.8 6.7 Stable Adult (aged 15‒49 years) HIV prevalence (%) in countries in sub-Saharan Africa which have conducted population-based HIV surveys in recent years Median HIV prevalence (%) among women attending antenatal clinics 2003‒2004* Population-based survey prevalence (%) (year) 2003 HIV prevalence (%) reported in 2004 Report on the global epidemic Adjusted 2003 HIV prevalence (%) in current report 2005 HIV prevalence (%) in current report Trend in prevalence Botswana 38.5 25.2 (2004) 38.0 24.0 24.1 Stable Ethiopia 8.5 1.6 (2005)§ 4.4 (1.0‒3.5) (0.9‒3.5) Decline in urban areas * WHO Africa (2005). HIV/AIDS epidemiological surveillance report for the WHO African region, 2005 Update. Harare † Estimate based on country report for 2002 (2003). Ministry of Public Health Cameroon. National HIV sentinel surveillance report 2002. ‡ Estimate based on country report for 2002 (2003). Ministry of Health Uganda. STD/HIV/AIDS surveillance report. STD/AIDS control programme. Kampala § Preliminary result. Additional analysis is ongoing. 2.1

  16. HIV prevalence (%) among pregnant women attending antenatal clinics in sub-Saharan Africa, 1997/98‒2004 Southern Africa Eastern Africa 50 20 Swaziland United Republic of Tanzania 40 15 Zimbabwe 30 Ethiopia 10 Median HIV prevalence (%) Median HIV prevalence (%) 20 Kenya South Africa Mozambique 5 10 0 0 1997‒ 1998 1999‒ 2000 2001 2002 2003 2004 1997‒ 1998 1999‒ 2000 2001 2002 2003 2004 West Africa 20 15 Note: Analysis restricted to consistent surveillance sites for all countries except South Africa (by province) and Swaziland (by region) 10 Median HIV prevalence (%) Côte d'Ivoire Burkina Faso 5 Ghana Senegal 0 1997‒ 1998 1999‒ 2000 2001 2002 2003 2004 Sources: Ministry of Health (Mozambique); Department of Health (South Africa); Ministry of Health and Social Welfare (Swaziland); Ministry of Health and Child Welfare (Zimbabwe); Adapted from Asamoah-Odei, et al. HIV prevalence and trends in sub-Saharan Africa: no decline and large subregional differences. Lancet, 2004 (Ethiopia); Ministry of Health—National AIDS/STD Control Programme (Kenya); Ministry of Health (United Republic of Tanzania); Conseil national de lutte contre le sida et les IST (Burkina Faso); Centers for Disease Control and Prevention (CDC)—GAP—Côte d'Ivoire (Côte d'Ivoire); Ghana Health Service (Ghana); Conseil National de Lutte Contre le SIDA (Senegal). 2.6

  17. HIV prevalence (%) by gender and urban/rural residence, selected sub-Saharan African countries, 2001‒2005 30 15‒49 years old, by gender 20 Women Men % 10 0 30 Women Men 15‒24 years old, by gender 20 % 10 0 30 15‒49 years old, by urban/ rural residence 20 Urban Rural % 10 0 Lesotho South Africa Zambia Kenya Uganda UR Tanzania Burkina Faso Ghana Guinea Senegal South East West Sources: Demographic and Health Survey reports (Lesotho, Zambia, Kenya, Burkina Faso, Ghana, Guinea and Senegal) (2001–2005). Nelson Mandela Foundation (South Africa) (2005). Ministry of Health (Uganda). Tanzania Commission for AIDS (UR Tanzania) (2005). 2.7

  18. Percentage of young people aged 15–24 reporting the use of a condom during sexual intercourse with a non-regular partner, Sub-Saharan Africa, 2001–2005 Benin 2001 Botswana 2001 Countries with date of survey indicated Burkina Faso 2003 Cameroon 2004 Chad 2004 Ghana 2003 Guinea 2005 Kenya 2003 Lesotho 2004 Madagascar 2003 Malawi 2004 Mali 2001 Mozambique 2003 Nigeria 2003 Rwanda 2004 Senegal 2005 United Republic of Tanzania 2003 Uganda 2004 Zambia 2003 0 10 20 30 40 50 60 70 80 90 100 % Female Male Sources: Demographic Health Surveys; HIV/AIDS Indicator Surveys (2001-2005). 3.6

  19. Impact of AIDS on life expectancy in five African countries, 1970–2010 70 65 60 Botswana 55 South Africa Life expectancy at birth (years) 50 45 Swaziland 40 35 Zambia 30 Zimbabwe 25 20 1970–1975 1980–1985 1990–1995 2000–2005 1975–1980 1985–1990 1995–2000 2005–2010 Source: United Nations Population Division (2004). World Population Prospects: The 2004 Revision, database. 4.1

  20. TB notification rate in 20 African countries* versus HIV prevalence in sub-Saharan Africa, 1990–2004 200 8 180 7 160 6 140 5 % Adult HIV prevalence (15-49) 120 TB notification rate per 100,000 population 100 4 80 3 60 HIV prevalence 2 40 TB notification rate 1 20 0 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 • Consistently reporting each year: Algeria, Angola, Botswana, Cameroon, Comoros, Congo, Côte d'Ivoire, Democratic Republic of Congo, Ghana, Guinea, Kenya, Malawi, Mauritius, Mozambique, Nigeria, Senegal, South Africa, Uganda, United Republic of Tanzania, Zimbabwe Sources: World Health Organization (2006), Global TB database; UNAIDS (2006) 4.5

  21. Impact of three scenarios on HIV infection in sub-Saharan Africa, 2003–2020 5.0 4.0 Number of new HIV infections (millions) 3.0 2.0 1.0 0.0 2003 2005 2010 2015 2020 Year Baseline Treatment-centered Prevention-centered Comprehensive response Source: Salomon JA et al. (2005). Integrating HIV prevention and treatment: from slogans to impact 6.1

  22. Impact of AIDS-related deaths in sub-Saharan Africa, 2003–2020 3.0 2.5 Number of AIDS- related deaths (millions) 2.0 1.5 1.0 0.5 0.0 2003 2005 2010 2015 2020 Year Baseline Treatment-centered Prevention-centered Comprehensive response Source: Salomon JA et al. (2005). Integrating HIV prevention and treatment: from slogans to impact 6.2

  23. HIV prevalence (%) in adults in Asia and Oceania, 2005 2.8

  24. 1985 < 5 % High Risk Group > 5 % High Risk Group > 1 % Antenatal Women

  25. 1993 <5% High Risk Group > 5% High Risk Group >1%Antenatal Women

  26. 1998 < 5 % High Risk Group > 5 % High Risk Group > 1 % Antenatal Women

  27. 2004 <5% High Risk Group > 5% High Risk Group >1%Antenatal Women 8 M HIV+ I M new Infections 0.5 M deaths

  28. HIV prevalence (%) trends in India among injecting drug users and pregnant women, selected areas, India, 1998–2004* 15.0 12.0 Delhi Injecting drug users 9.0 Mizoram % 6.0 3.0 West Bengal 0.0 1998 1999 2000 2001 2002 2003 2004 1998 1999 2000 2001 2002 2003 2004 Madhya Pradesh 1.5 1.2 Antenatal clinic attendees Mizoram 0.9 % Uttar Prahesh 0.6 0.3 West Bengal 0.0 5.0 Andhra Pradesh 4.0 Antenatal Clinic attendees Karnataka 3.0 % 2.0 Maharashtra *Data from consistent surveillance sites only. 1.0 Tamil Nadu 0.0 1998 1999 2000 2001 2002 2003 2004 2.9

  29. HIV prevalence trends among pregnant women in major cities in Cambodia, Myanmar and Thailand, 1990–2004 5.0 % HIV prevalence 4.0 3.0 2.0 1.0 1990 1992 1994 1996 1998 2000 2002 2004 1991 1993 1995 1997 1999 2001 2003 0.0 Phnom Penh Mandalay and Yangon Bangkok Sources: Cambodia National Center for HIV/AIDS, Dermatology and STDs (Phnom Penh); Myanmar Ministry of Health (Mandalay and Yangon); Thailand Ministry of Public Health (Bangkok), 2005. 2.10

  30. 120 000 105 000 90 000 75 000 60 000 45 000 30 000 15 000 0 Increase in reported HIV cases in the Russian Federation and Ukraine, 1987–2005 Reported HIV cases in the Russian Federation Reported HIV cases in Ukraine 400 000 Russian Federation 350 000 Newly reported cases 300 000 Cumulative (previous years) 250 000 Ukraine 200 000 Newly reported cases 150 000 Cumulative (previous years) 100 000 50 000 0 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 Sources: Russian Federal AIDS Centre; Ukranian AIDS Centre and Ministry of Health of Ukraine 2.12

  31. Drivers of the epidemic: familiar pattern in countries 90% SW Spouse 5% IDU 5% 50% Spouse SW 15% IDU 20% MTCT 15% 70% IDU SW 26 % Source: Thai Working Group on HIV/AIDS Projections, 2001

  32. Sub-population? MSM General population Men with have sex with men EuroHIV

  33. Sub-population? IDU Injecting Drug Users General population EuroHIV

  34. Sub-population? STI General population Persons with others sexually transmitted infection EuroHIV

  35. Sub-population? General population Prostitutes EuroHIV

  36. Sub-population? General population Migrants EuroHIV

  37. Sub-population : - size? - behaviour? - links? IDU MSM STI General population Prostitutes Migrants ? EuroHIV

  38. Trend in HIV prevalence in 21-year-old military conscripts in Thailand: 1989-1999 5 4 3 HIV prevalence (%) 2 1 0 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 Source: Armed Forces Research Institute of Medical Sciences, Thailand

  39. HIV prevalence (%) in adults in Latin America and the Caribbean, 2005 2.13

  40. Argentina Ecuador Quito Buenos Aires Provinces (7 cities) Guayaquil Bolivia La Paz Other city ports (4) Paraguay Asunción and 4 other cities Santa Cruz Peru Border cities with Argentina Lima Chile 0.0 Santiago Provinces Colombia Uruguay Bogotá Montevideo Border cities with Brazil 0 5 10 15 20 25 30 Venezuela 0.0 % HIV prevalence Isla Margarita 0 5 10 15 20 25 30 % HIV prevalence Female sex workers Men who have sex with men HIV prevalence (%) among female sex workers and men who have sex with men in Latin America, 1999–2002 Source: Montano SM et al., JAIDS (2005). 2.14

  41. Distribution by region of the funding required for treatment and care Latin America/Caribbean: 17% Eastern Europe: 7% North Africa/Middle East: 1% Africa: 55% South/South-East Asia: 4% East Asia/Pacific: 16% Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries. 10.6

  42. www.unaids.org www. eurohiv.org www.invs.sante.fr

  43. 25 years of AIDS People living with HIV 50 1 First cases of unusual immune deficiency are identified among gay men in USA, and a new deadly disease noticed 9 In 1991-1993, HIV prevalence in young pregnant women in Uganda and in young men in Thailand begins to decrease, the first major downturns in the epidemic in developing countries 45 Million 2 Acquired Immune Deficiency Syndrome (AIDS) is defined for the first time 40 3 The Human Immune Deficiency Virus (HIV) is identified as the cause of AIDS 10 Highly Active Antiretroviral Treatment launched 35 4 In Africa, a heterosexual AIDS epidemic is revealed 11 Scientists develop the first treatment regimen to reduce mother-to-child transmission of HIV 5 The first HIV antibody test becomes available 30 6 Global Network of People living with HIV/AIDS (GNP+) (then International Steering Committee of People Living with HIV/AIDS) founded 11 Children orphaned by AIDS in sub-Saharan Africa 12 UNAIDS is created 25 13 Brazil becomes the first developing country to provide antiretroviral therapy through its public health system 7 The World Health Organisation launches the Global Programme on AIDS 20 8 The first therapy for AIDS – zidovudine, or AZT -- is approved for use in the USA 14 The UN General Assembly Special Session on HIV/AIDS. Global Fund to fight AIDS, Tuberculosis and Malaria launched 15 12 10 15 WHO and UNAIDS launch the "3 x 5" initiative with the goal of reaching 3 million people in developing world with ART by 2005 5 9 1 2 4 6 8 5 13 14 15 16 7 10 3 16 Global Coalition on Women and AIDS launched 0 2005 1980 1985 1990 1995 2000 1.1

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