Morbidity and Mortality Weekly Report Weekly / Vol. 64 / No. 46 November 27, 2015 Lower Levels of Antiretroviral World AIDS Day — Therapy Enrollment Among Men December 1, 2015 with HIV Compared with Women — World AIDS Day, observed on December 1, draws atten- 12 Countries, 2002–2013 tion to the current status of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) Andrew F. Auld, MBChB1; Ray W. Shiraishi, PhD1; Francisco Mbofana, MD2; Aleny Couto, MD2; Ernest Benny Fetogang, PhD3; Shenaaz epidemic worldwide. This year’s theme is World AIDS El-Halabi, MPH3; Refeletswe Lebelonyane, MD3; Pilatwe Tlhagiso 2015: The Time to Act is Now. Pilatwe, MSc3; Ndapewa Hamunime, MD4; Velephi Okello, MD5; The first cases of AIDS were reported more than 30 years Tsitsi Mutasa-Apollo, MBChB6; Owen Mugurungi, MD6; Joseph 6 6 7 ago, in the June 5, 1981 issue of MMWR. At the end of Murungu, MD ; Janet Dzangare, MSc ; Gideon Kwesigabo, MD ; Fred Wabwire-Mangen, MD8; Modest Mulenga, MD9; Sebastian Hachizovu, 2014, approximately 36.9 million persons worldwide were MBChB9; Virginie Ettiegne-Traore, MD10; Fayama Mohamed, MSAE11; living with HIV infection (1). Although AIDS-related Adebobola Bashorun, MD12; Do Thi Nhan, MD13; Nguyen Huu Hai, deaths have decreased by 42% since 2004, an estimated MD13; Tran Huu Quang, MSc14; Joelle Deas Van Onacker, MD15; Kesner Francois, MD15; Ermane G. Robin, MD15; Gracia Desforges, 1.2 million persons died from AIDS in 2014 (1). MD15; Mansour Farahani, MD16; Harrison Kamiru, DrPH17; Harriet Global efforts, including the U.S. President’s Emergency Nuwagaba-Biribonwoha, MBChB17; Peter Ehrenkranz, MD18; Julie A. Plan for AIDS Relief (in which CDC is a principal Denison, PhD19; Olivier Koole, MD20; Sharon Tsui, MPH19; Kwasi Torpey, PhD21; Ya Diul Mukadi, MD22; Eric van Praag, MD23; Joris agency), have resulted in approximately 13.5 million Menten, MSc20; Timothy D. Mastro, MD24; Carol Dukes Hamilton, persons in low- and middle-income countries receiving MD24; Oseni Omomo Abiri, MPH25; Mark Griswold, MSc26; Edna antiretroviral therapy (ART) for HIV infection in 2014 Pierre, MD26; Carla Xavier, MSc27; Charity Alfredo, MD27; Kebba 27 28 29 (2). Globally, approximately 15 million persons are on Jobarteh, MD ; Mpho Letebele, MD ; Simon Agolory, MD ; Andrew L. Baughman, PhD29; Gram Mutandi, MBChB29; ART (1). An estimated 1.2 million persons in the United Peter Preko, MD25; Caroline Ryan, MD30; Trong Ao, ScD30; Elizabeth States and Puerto Rico are living with HIV infection (3) Gonese, MPH31; Amy Herman-Roloff, PhD31; Kunomboa A. Ekra, MD32; and approximately 50,000 persons become infected with HIV each year (4). References INSIDE 1. Joint United Nations Programme on HIV/AIDS. How AIDS 1287 Scale-up of HIV Viral Load Monitoring — changed everything. MDG6: 15 years, 15 lessons of hope from the Seven Sub-Saharan African Countries AIDS response. Geneva, Switzerland: Joint United Nations 1291 Vital Signs: Estimated Percentages and Numbers Programme on HIV/AIDS; 2015. Available at http://www.unaids. org/sites/default/files/media_asset/MDG6Report_en.pdf. of Adults with Indications for Preexposure 2. World Health Organization. HIV/AIDS fact sheet no. 360. Geneva, Prophylaxis to Prevent HIV Acquisition — Switzerland: World Health Organization; 2015. Available at http:// United States, 2015 www.who.int/mediacentre/factsheets/fs360/en/. 1296 Vital Signs: Increased Medicaid Prescriptions for 3. CDC. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and Preexposure Prophylaxis Against HIV infection — 6 dependent areas, 2013. HIV surveillance supplemental report; New York, 2012–2015 2015:20(2). Available at http://www.cdc.gov/hiv/pdf/library/reports/ 1303 QuickStats surveillance/cdc-hiv-surveillancereport_vol20_no2.pdf. 4. Estimated HIV incidence in the United States, 2007–2010. HIV surveillance supplemental report; 2012:17(4). Available at http:// Continuing Education examination available at www.cdc.gov/hiv/pdf/statistics_hssr_vol_17_no_4.pdf. http://www.cdc.gov/mmwr/cme/conted_info.html#weekly. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report Joseph S. Kouakou, MD32; Solomon Odafe, MD33; Dennis Onotu, estimates for the female-to-male ratio among HIV-infected 33 33 33 MD ; Ibrahim Dalhatu, MD ; Henry H. Debem ; Duc B. Nguyen, adults by 23%–83%. In six African countries and Haiti, MD34; Le Ngoc Yen, MD34; Abu S. Abdul-Quader, PhD34; Valerie Pelletier, MD35; Seymour G. Williams, MD36; Stephanie Behel, MPH1; the ratio of women to men among new adult ART enrollees George Bicego, PhD1; Mahesh Swaminathan, MD1; E. Kainne Dokubo, increased more sharply over time than the estimated UNAIDS 1 37 16 MD ; Georgette Adjorlolo-Johnson, MD ; Richard Marlink, MD ; female-to-male ratio among adults with HIV in the general David Lowrance, MD38; Thomas Spira, MD1; Robert Colebunders, MD20; David Bangsberg, MD39; Aaron Zee, MPH1; Jonathan Kaplan, population. Increased ART coverage among men is needed MD1; Tedd V. Ellerbrock, MD1 to decrease their morbidity and mortality and to reduce HIV incidence among their sexual partners. Reaching more men Equitable access to antiretroviral therapy (ART) for men and with HIV testing and linkage-to-care services and adoption of women with human immunodeficiency virus (HIV) infection test-and-treat ART eligibility guidelines (i.e., regular testing is a principle endorsed by most countries and funding bod- of adults, and offering treatment to all infected persons with ies, including the U.S. President’s Emergency Plan for AIDS ART, regardless of CD4 cell test results) could reduce gender (acquired immunodeficiency syndrome) Relief (PEPFAR) (1). inequity in ART coverage. To evaluate gender equity in ART access among adults (defined Three approaches to sampling and analysis were employed for this report as persons aged ≥15 years), 765,087 adult ART in the 12 studied countries (Table). In Botswana, Haiti, patient medical records from 12 countries in five geographic Mozambique, and Namibia, where large, centralized, electronic regions* were analyzed to estimate the ratio of women to ART patient monitoring systems are employed, all available men among new ART enrollees for each calendar year during data from 2002–2013 were analyzed. In each of these coun- 2002–2013. This annual ratio was compared with estimates tries, 67%–100% of all ART patients and 58%–100% of all from the Joint United Nations Programme on HIV/AIDS ART facilities were captured in the electronic system. In Côte † (UNAIDS) of the ratio of HIV-infected adult women to men d’Ivoire, Nigeria, Swaziland, Vietnam, and Zimbabwe, nation- in the general population. In all 10 African countries and Haiti, ally representative samples of ART facilities were selected, the most recent estimates of the ratio of adult women to men with probability of selection proportional to size. In Tanzania, among new ART enrollees significantly exceeded the UNAIDS Uganda, and Zambia, health facilities were purposively selected by investigators to represent the range of ART facilities in each * East Africa: Tanzania, Uganda; Southern Africa: Botswana, Mozambique, country and ensure that the study remained feasible. Among Namibia, Swaziland, Zambia, Zimbabwe; West Africa: Côte d’Ivoire, Nigeria; Caribbean: Haiti; Southeast Asia: Vietnam. the eight sample-based surveys, a sample frame of study-eligible † Additional information available at http://aidsinfo.unaids.org/. ART patients was created at each selected facility, and simple The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30329-4027. Suggested citation: [Author names; first three, then et al., if more than six.] [Report title]. MMWR Morb Mortal Wkly Rep 2015;64:[inclusive page numbers]. Centers for Disease Control and Prevention Thomas R. Frieden, MD, MPH, Director Harold W. Jaffe, MD, MA, Associate Director for Science Joanne Cono, MD, ScM, Director, Office of Science Quality Chesley L. Richards, MD, MPH, Deputy Director for Public Health Scientific Services Michael F. Iademarco, MD, MPH, Director, Center for Surveillance, Epidemiology, and Laboratory Services MMWR Editorial and Production Staff (Weekly) Sonja A. Rasmussen, MD, MS, Editor-in-Chief Martha F. Boyd, Lead Visual Information Specialist Charlotte K. Kent, PhD, MPH, Executive Editor Maureen A. Leahy, Julia C. Martinroe, Jacqueline Gindler, MD, Editor Stephen R. Spriggs, Moua Yang, Teresa F. Rutledge, Managing Editor Visual Information Specialists Douglas W. Weatherwax, Lead Technical Writer-Editor Quang M. Doan, MBA, Phyllis H. King, Soumya Dunworth, PhD, Teresa M. Hood, MS, Teresa C. Moreland, Terraye M. Starr, Technical Writer-Editors Information Technology Specialists MMWR Editorial Board Timothy F. Jones, MD, Chairman William E. Halperin, MD, DrPH, MPH Jeff Niederdeppe, PhD Matthew L. Boulton, MD, MPH King K. Holmes, MD, PhD Patricia Quinlisk, MD, MPH Virginia A. Caine, MD Robin Ikeda, MD, MPH Patrick L. Remington, MD, MPH Katherine Lyon Daniel, PhD Rima F. Khabbaz, MD Carlos Roig, MS, MA Jonathan E. Fielding, MD, MPH, MBA Phyllis Meadows, PhD, MSN, RN William L. Roper, MD, MPH David W. Fleming, MD Jewel Mullen, MD, MPH, MPA William Schaffner, MD 1282 MMWR / November 27, 2015 / Vol. 64 / No. 46 US Department of Health and Human Services/Centers