The declines in HIV prevalence have occurred amid signs of encouraging changes in sexual behaviour among people 15–24 years old in several countries with generalized epidemics. Survey data from 20 countries in sub-Saharan Africa and the Caribbean provides evidence of these changes (Fig. 2.5).1
Analysis shows that the percentage of young men with multiple partners in the 12 months before the most recent survey decreased signifi cantly in 11 of the 19 countries with data available (including in 4 countries with national adult HIV prevalence exceeding 10% in 2009), and among women it decreased in 6 countries (half of them with HIV prevalence exceeding 10%).
In Rwanda and Zimbabwe, however, the share of young women with multiple partners appears to have increased, and Guyana and Lesotho have a similar trend among young men.
The proportion of young people who said they used a condom the last time they had high-risk sex increased signifi cantly in 7 (for men) and 5 (for women) of the 17 countries with data available. More than half these countries had a national adult HIV prevalence of at least 10% in 2009. However, condom use during high-risk sex appears to have decreased among young men in Uganda and Zimbabwe and among young women in Mali.
The percentage of young men and women who have had sex before age 15 years decreased signifi cantly in 8 of the 18 countries with data available. In 4 of these
1 The analysis is based on survey data in countries in which more than one survey was conducted between 2000 and 2010. If more than two surveys were conducted, only the fi rst and last surveys were analysed.
On average, the surveys were fi ve years apart. UNGASS indicators were used: the percentage of men and women aged 15–24 years who had sex before age 15 years; the percentage of men and women aged 15–24 years who had more than one partner in the past 12 months; and the percentage of men and women aged 15–24 years who had more than one partner in the past 12 months and who used a condom at last sex.
8 countries, the national adult HIV prevalence exceeded 10% in 2009. In contrast, the proportion of young people who had sex before age 15 years increased among men in Guyana, Lesotho and Rwanda, among women in Lesotho and among both men and women in Haiti.
2.1.2 Fewer people are dying from AIDS-related causes …
The annual number of people dying from AIDS-related causes worldwide is steadily decreasing from a peak of 2.2 million [2 100 000–2 500 000] in 2005 to an estimated 1.8 million [1 600 000–1 900 000] in 2010 (Fig. 2.6). AIDS-related mortality began to decline in 2005–2006 in sub-Saharan Africa, South and South-East Asia and the Caribbean and has continued subsequently.
Two signal developments have caused this decline:
fi rst, the increased availability of antiretroviral therapy, as well as care and support, to people living with HIV, especially in sub-Saharan Africa; and second, fewer people newly infected with HIV since the late 1990s.
The effects of antiretroviral therapy are especially evident in sub-Saharan Africa, where an estimated 460 000 (or 30%) fewer people died from AIDS-related causes in 2010 than in 2004, when access to antiretroviral therapy began to be dramatically expanded (Fig. 2.6).
2.1.3 … but the trends vary by region
Not all regions and countries fi t the overall trends, however. The annual number of people newly infected with HIV has risen in the Middle East and North Africa from 43 000 [31 000–57 000] in 2001 to 59 000 [40 000–73 000] in 2010. After slowing drastically in the early 2000s, the HIV incidence in Eastern Europe and Central Asia has been accelerating again since 2008.
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Fig. 2.6 Number of people dying from AIDS-related causes globally, 1990–2010
2.5
1.5
The trends in AIDS-related deaths also differ. For example, in Eastern Europe and Central Asia, the number of people dying from AIDS-related causes increased from 7800 [6000–11 000] in 2001 to 90 000 [74 000–110 000] in 2010. In the same period, AIDS mortality increased by 60% in the Middle East and North Africa (from 22 000 [9700–38 000] to 35 000 [25 000–42 000]) and more than doubled in East Asia (from 24 000 [16 000–45 000] to 56 000 [40 000–76 000]).
In North America and in Western and Central Europe, the number of people dying from AIDS-related causes began to decline soon after antiretroviral therapy was introduced in 1996. The number of deaths attributed to AIDS in Latin America has declined since its peak in 2001–2003 but appears to have levelled off since 2008.1
2.1.4 As treatment expands, the number of people living with HIV is rising
UNAIDS estimates that 34 million [31 600 000–
35 200 000] people were living with HIV globally at the end of 2010 versus 28.6 million [26 700 000–
30 900 000] in 2001 – a 17% increase (Fig. 2.7). This refl ects the high numbers of people newly infected with HIV along with signifi cantly expanded access to antiretroviral therapy, which has helped to reduce the number of people dying from AIDS-related causes, especially since 2004–2005 (Table 2.1).
2.1.5 Half the people living with HIV are women Globally, women constituted half (50% [48–53%]) the adults (15 years and older) living with HIV in 2010, according to UNAIDS estimates (Fig. 2.8). That proportion has shifted very little in the past 15 years. The burden of HIV on women, however, varies considerably by region and is heaviest in sub-Saharan Africa. In that region, 1.4 times more adult women than men were living with HIV in 2010. Women comprised 59%
[56–63%] of the adults living with HIV in sub-Saharan Africa in 2010, as they have for most of the past decade.
1 Mexico is now included in the HIV estimates for Latin America. These latest estimates therefore supersede those published in the past by UNAIDS (including estimates for previous years).
The Caribbean is the only other region where women outnumber men among adults living with HIV; they comprised 53% [47–61%] of the adults living with HIV in 2010 (this pattern largely results from the fact that women outnumber men in Haiti, which has the greatest epidemic in the Caribbean). Two regions have experienced slight increases in the proportion of women among people living with HIV in the past decade or more: Latin America (35% [29–41%] in 2010 versus 32% [26–41%] in 2001) and North America and Western and Central Europe (26% [23–33%] in 2010 versus 25% in 2001 [22–28%]). Elsewhere the proportion has hardly shifted, including in Asia (34%
[30–37%] to 35% [30–38%]), Eastern Europe and Central Asia (34% [28–40%] to 35% [30–40%]), the Middle East and North Africa (45% [24–57%] to 45% [31–50%]) and Oceania (44% [37–55%] to 44%
[39–51%]).
2.1.6 Positive developments among children As access to services for preventing the mother-to-child transmission of HIV increased, the annual number of children acquiring HIV infection stabilized in the early 2000s before decreasing steeply in the past few years (Fig. 2.9). An estimated 390 000 [340 000–450 000]
children were newly infected with HIV in 2010, 30%
fewer than the peak of 560 000 [500 000–630 000]
children newly infected annually in 2002 and 2003. The number of children (younger than 15 years) living with HIV globally has levelled off in the past few years and totaled 3.4 million [3 000 000–3 800 000] in 2010;
more than 90% were living in sub-Saharan Africa.2
Deaths among children younger than 15 years are declining. The estimated 250 000 [220 000–290 000]
children who died from AIDS-related illnesses in 2010 were 20% fewer than the estimated 320 000 [280 000–360 000] who died in 2005. This trend refl ects the steady expansion of services to prevent HIV from being transmitted to infants and, to a lesser degree, the slow expansion of access to treatment for children.
2 This is higher than previous estimates because of improvements made to the estimation models, including improved assumptions about the survival of children living with HIV and the effects on their survival of the timing of their infection (see Box 2.4).
Millions 4
2 1 0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Fig. 2.7 Number of people newly infected with HIV globally, 1990–2010
3
40%
30%
20%
10%
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Fig. 2.8 Percentage of adults (15+ years) living with HIV who are female, by geographical region, 1990–2010
60%
50%
Sub-Saharan Africa Caribbean Global
Middle East and North Africa Oceania
Latin America Asia
Eastern Europe and Central Asia
Western and Central Europe and North America 70%
Millions
4 3 2 1 0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Fig. 2.9 Number of children 0–14 years old living with HIV globally, 1990–2010
Box 2.1