AIDS Alert International
CDC's global AIDS outlook gives preview of WHO report
Prevalence declines in some hot spots
Africa remains the hardest hit of the worldwide HIV/AIDS pandemic, accounting for 64 percent of all people living with HIV/AIDS, while only having 10 percent of the world's population, an expert says.
"But there is some good news as far as looking at trends in HIV prevalence, and there have been some declines in countries such as Kenya, Zimbabwe, urban areas of Burkina Faso, and Uganda," says Theresa Diaz Vargas, MD, MPH, branch chief for epidemiology and strategic information branch of the division of global AIDS at the Centers for Disease Control and Prevention (CDC) of Atlanta, GA.
The CDC's report about the global HIV/AIDS pandemic, published in the Morbidity and Mortality Weekly Report (MMWR) in August, 2006, notes that while HIV incidence and HIV-related sexual risk behaviors have decreased in those countries, AIDS death rates continue to rise.1
"When looking at these declines, we're looking at a national level, so it represents all of the collective activities that are occurring in the country," Vargas says. "It's hard to say whether it was a specific program or activity or something else going on that has caused the decline."
However, there is evidence, especially in Kenya, of declines in the initiation of sexual intercourse, and there is evidence of a decrease in the number of sex partners, as well as an increase in condom use, Vargas notes.
"But as I said before, we're looking at national data, the collective measure of everything going on in the country," she adds. "So if things like mortality have increased and, subsequently, people have died and that results in lower prevalence, or if people are migrating out of the country, then we can't say these are evidence of a decline in HIV infection."
Even data on death rates are not precise
"There is evidence of increasing mortality because of more people being HIV infected over time," Vargas says. "But these are only estimates based on HIV prevalence; we don't have good vital statistics."
The MMWR report states that in Asia the adult HIV prevalence is lower than in sub-Saharan Africa, and that the epidemic primarily is the result of high-risk behaviors among injection drug users, men who have sex with men (MSM), and sex workers.1
"For the Asian region, despite HIV being in that area for a long time, it seems to have concentrated in high-risk populations such as MSM, IDUs, and commercial sex workers, and so it's important that prevention activities are geared towards those groups that are more at risk," Vargas says.
The vast majority of the 8.3 million people who are infected with HIV in Asia live in India, which accounts for 5.7 million infected, and about 80 percent of the HIV infections in India are from heterosexual contact.1
In both India and Thailand, there is evidence of HIV prevalence declining among some populations. In India, some recent data from four states shows a decline among young pregnant women from 2000 to 2004, and in Thailand, HIV prevalence among pregnant women has been cut in half between 1995 and 2003.1
The same trend, however, cannot be seen among Thailand's MSM population, which showed an increase from 17 percent HIV prevalence in 2003 to 28 percent in 2005.1
"The good news is we've dramatically increased the number of people in treatment around the world," Vargas notes. "The number of people who have received antiretroviral treatment increased from 400,000 in December, 2003, to 1.3 million by December, 2005."
A large proportion of that increase is due to the President's Emergency Plan For HIV/AIDS Relief (PEPFAR) initiatives that have supported more than 550,000 people on antiretroviral treatment in 15 countries, Vargas says.
"Most of these countries are in Africa, with two in the Caribbean -- Haiti and Guyana -- and Vietnam in Asia," Vargas says.
Other global initiatives that have improved access to ART are the Five Initiative and the Global Fund, Vargas says.
As HIV-infected people globally live longer because of antiretroviral treatment, it will be very important to study whether prevention services and programs work to keep HIV infection rates from rising, Vargas says.
"From my understanding, there is going to be funding directly toward that from PEPFAR and, I assume, other organizations, but I don't have the specifics," Vargas says.
Reference:
- The Global HIV/AIDS Pandemic, 2006. MMWR. 2006;55:841-872.
Estimated percentage of adult population• living with HIV infection, by country — worldwide, 2005••
Africa remains the hardest hit of the worldwide HIV/AIDS pandemic, accounting for 64 percent of all people living with HIV/AIDS, while only having 10 percent of the world's population, an expert says.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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