The Global HIV/AIDS Epidemic April 2009

HIV, the virus that causes AIDS, “acquired immunodeficiency • New HIV infections are believed to have peaked in the late 1990s
syndrome,”1 has become one of the world’s most serious health and and declined between 2001 and 2007, from 3 million to 2.7 million.
development challenges. Since the first cases were reported in 1981: The decline is attributable to natural trends in the epidemic and to
• More than 25 million people have died of AIDS worldwide, and another prevention. Still, there were more than 7,000 new HIV infections per
33 million are currently living with HIV/AIDS.1 day in 2007.
• While cases have been reported in all regions of the world, almost • Most new infections are transmitted heterosexually, although risk
all those living with HIV (96%) reside in low- and middle-income factors vary. In some countries, men who have sex with men, injecting
countries, particularly in sub-Saharan Africa.2 drug users, and sex workers are at significant risk.
• Most people living with HIV or at risk for HIV do not have access to • An estimated 8 in 10 people infected with HIV do not know it.4
prevention, care, and treatment, and there is still no cure.3 • HIV has led to a resurgence of tuberculosis (TB), particularly in Africa,
• HIV primarily affects those in their most productive years; more than and TB is a leading cause of death for people with HIV worldwide.5,6
half of new infections are among those under age 25. • Women represent half of all people living with HIV worldwide, and
• The HIV epidemic not only affects the health of individuals, it impacts more than half (59%) in sub-Saharan Africa. Gender inequalities,
households, communities, and the development and economic differential access to services, and sexual violence increase women’s
growth of nations. Many of the countries hardest hit by HIV also vulnerability to HIV, and women, especially younger women, are
suffer from other infectious diseases, food insecurity, and other biologically more susceptible to HIV.
serious problems. • Young people, ages 15–24, account for 45% of new HIV infections
• Despite these challenges, there have been successes and promising (among those 15 and over). In sub-Saharan Africa, the HIV
signs. New global efforts have been mounted to address the epidemic, prevalence rate among young women is nearly 3 times that of their
particularly in the last decade. Prevention has helped to reduce HIV male counterparts.
prevalence rates in a small but growing number of countries and • Globally, there were 2 million children living with HIV in 2007, 370,000
new HIV infections are believed to be on the decline. In addition, new infections among children, and 270,000 AIDS deaths. There are
the number of people with HIV receiving treatment in resource poor approximately 15 million AIDS orphans today (children who have lost
countries has increased 10-fold since 2002, reaching an estimated 3 one or both parents to HIV), most of whom live in sub-Saharan Africa
million by 2007.2 (77%).

Figure 1: Adult HIV/AIDS Prevalence Rate (Ages 15–49), 20071,2 Figure 2: HIV Prevalence & Incidence by Region (Ages 15–49)1,2
Total No. (%) Living Newly Infected Adult Prevalence
Region
with HIV end of 2007 in 2007 Rate, 2007

Global Total 33 million (100%) 2.7 million 0.8%

Sub-Saharan Africa 22.0 million (67%) 1.9 million 5.0%

South/South-East Asia 4.2 million (13%) 330,000 0.3%

Latin America 1.7 million (5%) 140,000 0.5%

Eastern Europe/Central Asia 1.5 million (5%) 110,000 0.8%

North America 1.2 million (4%) 54,000 0.6%

East Asia 740,000 (2%) 52,000 0.1%

<1% (109 countries) Western/Central Europe 730,000 (2%) 27,000 0.3%

1 to <5% (40 countries)
Middle East/North Africa 380,000 (1%) 40,000 0.3%
5 to <10% (6 countries)
>10% (9 countries) Caribbean 230,000 (0.7%) 20,000 1.1%
NA
Oceania 74,000 (0.2%) 13,000 0.4%

Current Global Snapshot • Sub-Saharan Africa. Sub-Saharan Africa, the hardest hit region, is
According to the latest global estimates from UNAIDS and WHO:1,2 home to two-thirds (67%) of people living with HIV but only 11–12%
of the world’s population. Most children with HIV live in this region
• There were 33 million people living with HIV in 2007, up from 29.5
(90%). Almost all of the region’s nations have generalized HIV
million in 2001, the result of continuing new infections, people living
epidemics—that is, their national HIV prevalence rate is greater than
longer with HIV, and general population growth.
1%. In 9 countries, more than 10% of adults are estimated to be
• The global prevalence rate (the percent of people ages 15–49 who HIV-positive. South Africa has the highest number of people living
are infected) has leveled since 2000 and was 0.8% in 2007. with HIV in the world (5.7 million), and almost one in five South African
• 2 million people died of AIDS in 2007, up from 1.7 million in 2001, but adults is HIV-positive. Swaziland has the highest prevalence rate in
deaths are now declining due in part to antiretroviral treatment (ART) the world (26.1%). Recent data offer promising signs, with national
scale-up. HIV is a leading cause of death worldwide and the number HIV prevalence stabilizing or even declining in several countries in
one cause of death in Africa. the region.
• L atin America & The Caribbean. Nearly 2 million people are for HIV/AIDS under PEPFAR, including Global Fund contributions,
estimated to be living with HIV in Latin America and the Caribbean was $5.8 billion in FY 2008, and is estimated to be $6.3 billion in FY
combined, including 160,000 newly infected in 2007. The Caribbean 2009.12
itself, with an adult HIV prevalence rate of 1.1%, is the second hardest • Today, there are multiple federal departments, agencies, and
hit region in the world after sub-Saharan Africa. Ten countries in Latin programs that address the global epidemic, and the U.S. government
America and the Caribbean have generalized epidemics, with the is the single largest donor to international HIV efforts in the world,
Bahamas having the region’s highest prevalence rate (3.0%), and including the largest donor to the Global Fund.13
Brazil the greatest number of people living with the disease (730,000).
• Eastern Europe & Central Asia. An estimated 1.5 million people Figure 3: U.S. Government Funding for Global HIV/AIDS
are living with HIV in this region, up from 650,000 in 2001 (a 130% Through PEPFAR, Bilateral and Global Fund Contributions,
increase). The epidemic is driven primarily by injecting drug use, FY 2004–200912
although heterosexual transmission also plays an important role.
Estonia, the Russian Federation, and Ukraine have the highest In Billions $6.3
prevalence rates in the region, and Russia has the region’s highest $5.8
number of people living with HIV (940,000).
• A sia. Nearly 5 million people are living with HIV across $4.4

South/South-East Asia and East Asia. While HIV prevalence $3.2

appears to be declining in Cambodia, Myanmar, and Thailand, it is $2.6
on the rise in Indonesia, Pakistan, and Viet Nam. The region is also $2.2
home to the two most populous nations in the world—China and
India—and even relatively low prevalence rates translate into large
numbers of people.
2004 2005 2006 2007 2008 2009
Prevention and Treatment
Numerous prevention interventions exist to combat HIV, and new tools,
such as microbicides and vaccines, are currently being researched.8 The Global Response to HIV/AIDS
• Effective prevention strategies include behavior change programs, Global efforts to combat HIV began in the first decade of the epidemic,
condoms, HIV testing, blood supply safety, harm reduction efforts for with the creation of the WHO’s Global Programme on AIDS in 1987,
injecting drug users, and male circumcision.8 but did not increase until recently. UNAIDS formed in 1996 to help
• Experts recommend that prevention be based on “knowing your galvanize worldwide attention to and funding for AIDS. More recent
epidemic,” that is, tailoring prevention to the local context and initiatives include:
epidemiology, and using a combination of prevention strategies, • In 2000, all nations agreed to global HIV targets to halt and begin
bringing programs to scale, and sustaining efforts over time.1,8 to reverse the spread of HIV by 2015, as part of the UN Millennium
• Access to prevention, however, remains limited; only one in five of Development Goals (MDGs), and the World Bank launched its Multi-
those at risk have access to needed services.9 Country AIDS Program (MAP).
HIV treatment includes the use of combination antiretroviral therapy to • In 2001, a United Nations General Assembly Special Session on
attack the virus itself, and medications to prevent and treat the many HIV/AIDS (UNGASS) was convened and the Global Fund was
opportunistic infections that can occur when the immune system is created. More recently, in 2006, UNAIDS launched a Universal
compromised by HIV.3 Access Campaign to reach universal treatment access by 2010.
• Combination ART, first introduced in 1996, has led to dramatic • The role of affected country governments and civil society has also
reductions in morbidity and mortality, and access has increased in been critical to the response.
recent years, rising from about a quarter million in 2002 to nearly 3 • As a result of increased efforts, total global spending on HIV rose
million in 2007 (31% of those in need).3 from $300 million in 1996 to $13.7 billion in 2008. Most funding has
• The greatest increase was in Sub-Saharan Africa, where the number come from international donors who, in 2007, committed $6.6 billion
of people receiving ART surpassed 2 million in 2007.3 to address HIV in developing countries.14 Hard hit countries have
also provided significant resources to address their epidemics. The
• The share of pregnant women receiving ART for the prevention of Global Fund has disbursed over $4 billion to more than 110 countries
mother-to-child transmission of HIV increased from 10% in 2004 for HIV efforts to date,15 and the private sector, including foundations
to 33% in 2007. Access to ART among children has also risen and corporations, also plays a major role, particularly the Bill &
significantly, although they have less access than adults.3 Melinda Gates Foundation which has committed $2.3 billion for HIV
• Despite these successes, more than two-thirds of those in need of to date, with additional funding provided to the Global Fund.16
ART still have not received it.2 • Despite these increases, resource needs are still estimated to be
The U.S. Government Response much higher ($19.8 billion in 2009, rising to $25.1 billion in 2010),
The U.S. first provided funding to address the global HIV epidemic in leaving a significant gap.17
1986. U.S. efforts and funding increased slowly over time, intensifying ––––––––––––––––––––––––––––––
relatively recently. Key initiatives include: 1
 NAIDS/WHO. 2008 Report on the Global AIDS Epidemic; 2008.
U
2
UNAIDS/WHO. Core Slides: Global Summary of the HIV and AIDS Epidemic; 2008.
• In 1999, President Clinton announced the Leadership and Investment 3
WHO. Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector;
in Fighting an Epidemic (LIFE) Initiative to address HIV in 14 African June 2008.
countries and in India. 4
WHO. HIV Testing and Counseling: www.who.int/hiv/topics/vct/en/.
5
WHO. Tuberculosis: www.who.int/mediacentre/factsheets/fs104/en/index.html.
• In 2002, President Bush announced the International Mother and 6
UNAIDS. Tuberculosis and HIV [website]; 2008.
Child HIV Prevention Initiative focused on 12 African and 2 Caribbean 7
Population Reference Bureau. 2007 World Population Data Sheet; 2007.
8
Global HIV Prevention Working Group. Behavior Change for HIV Prevention: (Re) Considerations
countries. for the 21st Century, August 2008.
• The passage of the President’s Emergency Plan for AIDS Relief UNAIDS. HIV prevention [website]; 2008.
9
10
U.S. Congress. P.L. 108-25; May 27, 2003.
(PEPFAR) in 2003 brought significant new attention and funding to 11
PEPFAR. About PEPFAR [website]; 2009.
address the global epidemic, as well as TB and malaria.10 PEPFAR 12
KFF analysis of data from OMB and OGAC.
authorized up to $15 billion over 5-years, primarily for 15 hard hit KFF. U.S. Federal Funding for HIV/AIDS: The FY 2009 Budget Request; April 2008.
13
14
KFF/UNAIDS. Financing the Response to AIDS in Low- and Middle-Income Countries:
“focus countries”, and multilateral support to the Global Fund to Fight International Assistance from the G8, European Commission and Other Donor Governments,
AIDS, Tuberculosis and Malaria (Global Fund), an independent, 2007, Chartpack; July 2008.
international financing institution which in turn provides grants to The Global Fund to Fight AIDS, Tuberculosis and Malaria: www.theglobalfund.org/programs/
15

search/?search=3&lang=en.
countries to address HIV/AIDS. 16
Personal communication, Bill & Melinda Gates Foundation; February 2009.
• In 2008, PEPFAR was reauthorized for an additional 5-year period
17
UNAIDS. What Countries Need: Investments needed for 2010 Targets; February 2009.

and up to $48 billion to combat HIV, TB, and malaria.11 Funding This publication (#3030-13) is available on the Kaiser Family Foundation’s website at www.kff.org.