UNAIDS report suggests global progress against HIV - but there are exceptions

Michael Carter
Published: 30 July 2008

New HIV infections and deaths fell in 2007, according to the 2008 Report on the Global AIDS Epidemic released by UNAIDS. The report also showed that rates of condom use are increasing amongst young people in some parts of the world, as is the age of sexual debut.

UNAIDS now estimates that there are 33.2 million people living with HIV worldwide. The total number of new HIV infections in 2007 is estimated to be 2.5 million, down from a peak of 3 million in 2001.

But although the number of new infections fell in many countries with generalised HIV epidemics, UNAIDS is warning “the AIDS epidemic is not over in any part of the world.”

There was good news with evidence of expanding access to antiretroviral therapy, with 3 million people receiving anti-HIV drugs in 2007. There is now near-universal treatment access in a number of low- and middle-income countries including Botswana and Brazil. In other countries there have been massive increases in the proportion of HIV-positive patients receiving treatment, with access to antiretroviral therapy in Namibia increasing from 1% in 2003 to 87% in 2007.

Although HIV-related mortality fell compared to the year before, there were an estimated 2.1 million deaths in 2007.

And increases in the number of new HIV infections were observed in many countries including China, Indonesia, Vietnam, Kenya, Russia and the Ukraine. UNAIDS also cautioned that there were signs that rates of HIV infections were increasing in countries with older HIV epidemics – such as the UK.

HIV in Africa

Sub-Saharan Africa continues to be the world region hardest-hit by HIV. UNAIDS estimates that there are a total of 22.5 million HIV infections in this region, with 1.7 million of these occurring in 2007. However, this represented an estimated fall of 500,000 compared to 2001, and adult HIV prevalence is thought to have declined from 5.8% in 2001 to 5% last year.

There are still significant numbers of HIV-related deaths in the region, however, with 1.6 million AIDS deaths in 2007 compared to 1.4 million seven years ago.

Some data suggest that the pace of the HIV epidemic in the region is slowing. Prevalence amongst pregnant women in both rural and urban areas of Kenya fell by 25%, with similar declines observed in Cote d’Ivoire, Malawi, Zimbabwe and rural Botswana. There was also encouraging evidence suggesting that HIV risk activities were decreasing amongst young people in some countries, such as Kenya, Malawi and Zimbabwe. But the proportion of young men and women reporting non-regular sexual partners in Cameroon, Rwanda and Uganda increased.

Controversially, however, UNAIDS does not acknowledge the importance of concurrent sexual relationships to the epidemiology of HIV in the region, saying the evidence is `unclear`.

In a widely circulated email to the the editor of The Lancet, the writer and researcher Helen Epstein strongly criticised UNAIDS' decision not to recommend the reduction of concurrency as a target for prevention activity, and accused the agency of ignoring `abundant supporting evidence` for the hypothesis that concurrent sexual partnerships - where a man or woman may have two regular sexual partners simultaneously, often for long periods of time - is partially responsible for the very high HIV prevalence seen in southern Africa.

"Concurrency does not explain everything about AIDS in Africa, nor does it imply a simple solution, but the evidence for it is much clearer than UNAIDS would like to admit and understanding it is crucial if we are to come to grips with the issues of prevention and gender relations which every one of us knows are central to the epidemic," she wrote.

South and South-East Asia

Overall HIV prevalence in this region has remained stable between 2001 and 2007 at 0.3%. A total of 4 million individuals are infected with HIV in the region, an increase of 500,000 since 2001. UNAIDS estimates that there were 340,000 new HIV infections and 270,000 AIDS deaths in South and South-East Asia in 2007.

East Asia

The number of HIV infections in East Asia has almost doubled since 2001 from 420,000 to 800,000. Unlike many other regions of the world, the number of new infections was higher in 2007 (92,000) compared to 2001 (77,000). A total of 32,000 individuals in the region are thought to have died because of HIV last year.

Latin America

Overall HIV prevalence has remained stable in Latin America at approximately 0.5%. There were 100,000 new infections in the region in 2007, a fall of 30,000 compared to 2001. The epidemic in the region remains focused on high-risk groups such as sex workers and men who have sex with men. Although access to antiretroviral therapy is increasing in many Latin American countries, the number of HIV-related deaths increased from 51,000 in 2001 to 58,000 last year.

The Caribbean

Of the 230,000 HIV cases in the Caribbean, three-quarters are located in just two countries – the Dominican Republic and Haiti. A total of 17,000 individuals in the region were newly diagnosed with HIV in 2007, a slight fall compared to 2001. HIV-related mortality in the region fell from 14,000 in 2001 to 11,000 last year.

Eastern Europe and Central Asia

HIV prevalence in this region more than doubled from 0.4% in 2001 to 0.9% in 2007, with the total number of infections increasing from 630,00 to 1.6 million. Although, the number of new infections fell substantially in 2007 compared to 2001 (150,00 vs, 230,000) the number of HIV-related deaths increased from just 8000 in 2001 to 55,000 last year.

Russia and the Ukraine alone account for 90%of new HIV infections in this region.

Western and Central Europe and North America

Although the total number of people with HIV in these regions is increasing, this is due in part to the improved prognosis of antiretroviral-treated individuals. Nevertheless, there were slight increases in the numbers of new HIV infections in 2007 in both Europe and North America. Although antiretroviral therapy is widely used in these regions, 12,000 people died of HIV-related illnesses in Europe and 21,000 in North America.

Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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