Report on the 08 global AIDS epidemic Executive summary UNAIDS/08.27E / JC1511E (English original, July 2008) © Joint United Nations Programme on HIV/AIDS (UNAIDS) 2008. All rights reserved. Publications produced by UNAIDS can be obtained from the UNAIDS Content Management Team. Requests for permission to reproduce or translate UNAIDS publications—whether for sale or for noncommercial distribution—should also be addressed to the Content Management Team at the address below, or by fax, at +41 22 791 4187, or e-mail: [email protected]. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of UNAIDS concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. 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ISBN 978 92 9 173 717 8 (NLM classifi cation: WC 503.4) UNAIDS T (+41) 22 791 36 66 [email protected] 20 avenue Appia F (+41) 22 791 48 35 www.unaids.org CH-1211 Geneva 27 Switzerland 2008 Report on the global AIDS epidemic Executive summary 2008 REPORT ON THE GLOBAL AIDS EPIDEMIC | EXECUTIVE SUMMARY The global HIV challenge: assessing national epidemics. A six fold increase in progress, identifying obstacles, financing for HIV programmes in low- and renewing commitment middle-income countries 2001–2007 is beginning to bear fruit, as gains in lowering the number of The 2008 Report on the global AIDS epidemic AIDS deaths and preventing new infections are emerges at the halfway mark between the 2001 apparent in many countries. Progress remains Declaration of Commitment and the 2015 target of uneven, however, and the epidemic’s future is still the Millennium Development Goals to reverse uncertain, underscoring the need for intensified the epidemic by 2015. The launch of this latest action to move towards universal access to HIV report also occurs only two years before the prevention, treatment, care and support. agreed target date for moving as close as possible Reports by 147 countries on national towards universal access to HIV prevention, progress in implementing the 2001 treatment, care, and support. The current junc- Declaration of Commitment on HIV/AIDS ture provides an opportunity to assess the HIV provide the most comprehensive global response and to understand what must be done assessment ever undertaken of the HIV to ensure that nations are on course to achieve response. As Figure 1 illustrates, the number the HIV commitments they have made. of countries reporting on progress in the HIV The report documents considerable prog- response in 2008 is significantly higher than in ress in many countries in addressing their previous reporting rounds. FIGURE 1 Percentage of UN Member States reporting by region, 2004–2008 Year of reporting (UN Member States reporting/total number of UN Member States) 2004 (102/189) 2006 (122/191) 2008 (147/192) 100 80 60 % 40 20 0 Caribbean Latin Eastern Sub - South and East Asia Oceania Western North North (13) America Europe Saharan South - (5) (14) and Central America Africa and (20) and Central Africa East Asia Europe (2) Middle East Asia (19) (47) (20) (32) (20) Source: UNGASS Country Progress Reports 2008. (total number of UN Member States in the region) 3 EXECUTIVE SUMMARY | 2008 REPORT ON THE GLOBAL AIDS EPIDEMIC The indicators on which countries have mented by other data sources, such as household reported are based on the specific time- surveys, civil society reports, and the budgets and bound pledges made by countries at the programme monitoring data of donor govern- 2001 Special Session of the UN General ments, UNAIDS cosponsors, philanthropic Assembly on HIV/AIDS (UNGASS). The foundations, and biomedical research agencies. core UNGASS indicators cover a broad array of variables, such as HIV prevalence among young Civil Society groups have joined their people, aged 15–24, coverage of antiretroviral government counterparts and participated therapy and key HIV-prevention programmes, in this reporting process in unprecedented services to support children orphaned or made numbers, using the opportunity to partici- vulnerable by HIV, and national adoption of pate as a vehicle for public communication recommended HIV policies. Information from on the situation within their country and national progress reports have been supple- to the world. Altogether, more than 700 local Estimated number of people living with HIV and adult HIV prevalence. FIGURE 2 Global HIV epidemic, 1990–2007; and, HIV epidemic in Sub-Saharan Africa, 1990–2007 Number of people Global % HIV prevalence, living with HIV (millions) adult (15-49) 40 4.0% 30 3.0% 20 2.0% 10 1.0% 0 0.0% Number of people 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 living with HIV Number of people Sub-Saharan Africa % HIV prevalence, living with HIV (millions) adult (15-49) % HIV prevalence, adult (15-49) 30 15% These bars 25 12% indicate the range around the estimate 20 9.0% 15 6.0% 10 3.0% 5 0 0.0% 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Note: Even though the HIV prevalence stabilized in sub-Saharan Africa, the actual number of people infected continues to grow because of ongoing new infections and increasing access to antiretroviral therapy. 4 2008 REPORT ON THE GLOBAL AIDS EPIDEMIC | EXECUTIVE SUMMARY nongovernmental organizations (represented by tions each year and the beneficial effects of many more individuals) served as key informants more widely available antiretroviral therapy. Sub- on the National Composite Policy Index, which Saharan Africa remains most heavily affected tracks national progress in implementing sound by HIV, accounting for 67% of all people living HIV policy frameworks and strategies. with HIV and for 72% of AIDS deaths in 2007. The HIV response is critical to progress The global epidemic is stabilizing but at across the breadth of the global develop- an unacceptably high level. Globally, there ment agenda. Success in addressing HIV will were an estimated 33 million [30 million— accelerate progress in achieving virtually all of 36 million] people living with HIV in 2007 the Millennium Development Goals. Satisfying (Figure 3). The annual number of new the many political commitments made on HIV HIV infections declined from 3.0 million will require greater leadership, building on [2.6 million—3.5 million] in 2001 to 2.7 million recent successes by taking account of lessons [2.2 million—3.2 million] in 2007. learnt, enhanced financial resources, improved The rate of new HIV infections has coordination of effort, and effective action to fallen in several countries, although address societal determinants of HIV risk and globally these favourable trends are at vulnerability. least partially offset by increases in new infections in other countries. In sub-Saharan Status of the global HIV epidemic Africa, most national epidemics have stabilized or begun to decline (Figure 4). However new The global percentage of people living information from Kenya suggests that in 2007, with HIV has stabilized since 2000 HIV prevalence ranged between 7.1% and (Figures 2 and 3). However, the overall number 8.5%—compared with the 2003 estimate of of people living with HIV has increased as a 6.7%. Outside of Africa, infections are on the result of the ongoing number of new infec- rise in a number of countries. A global view of HIV infection, 2007 FIGURE 3 33 million people [30 – 36 million] living with HIV, 2007 Adult prevalence (%) 15.0% – 28.0% 5.0% – <15.0% 1.0% – <5.0% 0.5% – <1.0% 0.1% – <0.5% <0.1% No data available 5 EXECUTIVE SUMMARY | 2008 REPORT ON THE GLOBAL AIDS EPIDEMIC HIV prevalence (%) among pregnant women attending antenatal clinics FIGURE 4 in sub-Saharan Africa, 1997–2007 Southern Africa 50 Botswana 40 Lesotho Mozambique 30 Namibia 20 South Africa Median HIV prevalence (%) Swaziland 10 Zimbabwe 0 1997- 1999- 2001 2002 2003 2004 2005 2006 2007 1998 2000 Eastern Africa 20 15 Ethiopia 10 Kenya 5 Median HIV prevalence (%) 0 1997- 1999- 2001 2002 2003 2004 2005 2006 2007 1998 2000 West Africa 20 15 Burkina Faso Côte d'Ivoire 10 Ghana Senegal Median HIV prevalence (%) 5 0 1997- 1999- 2001 2002 2003 2004 2005 2006 2007 1998 2000 Note: Analysis restricted to consistent surveillance sites for all countries except South Africa (by province) and Swaziland (by region). Source: National surveillance reports and UNAIDS/WHO/UNICEF, Epidemiological Fact Sheets on HIV and AIDS. July 2008. 6 2008 REPORT ON THE GLOBAL AIDS EPIDEMIC | EXECUTIVE SUMMARY HIV prevalence (%) among 15–24 years old, by sex, FIGURE 5 selected countries, 2005–2007 Swaziland South Africa Zimbabwe Central African Republic Uganda Female Chad Male Côte d'Ivoire Sierra Leone Rwanda Haiti Guinea Ethiopia Benin Mali DR Congo Niger Dominican Republic Senegal Cambodia India 0 5 10 15 20 25 % HIV prevalence Source: Demographic and Health Surveys and other national population-based surveys with HIV testing.