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					UNAIDS / WHO 2008 REPORT ON THE
      GLOBAL AIDS EPIDEMIC

             Eastern and Southern Africa trends and themes

Mark Stirling, Director Eastern and Southern Africa Regional Support Team




                                                                        2008 Report on the
                                                                        global AIDS epidemic
     A global view of HIV infection
33 million people [30–36 million] living with HIV, 2007




                                                          2008 Report on the
                                                          global AIDS epidemic
    Regional HIV and AIDS statistics and features, 2007
                                                    Adults & children                   Adults & children     Adult prevalence                                     Adult & child
                                                     living with HIV                  newly infected with HIV   (15‒49) [%]                                     deaths due to AIDS

Sub-Saharan Africa                                             22.0 million                            1.9 million                              5.0%                   1.5 million
                                                            [20.5 – 23.6 million]                    [1.3 – 2.4 million]                [4.6% – 5.4%]               [1.3 – 1.7 million]

Middle East & North Africa                                           380 000                                 40 000                             0.3%                        27 000
                                                           [280 000 – 510 000]                      [18 000 – 69 000]                   [0.2% – 0.4%]               [20 000 – 35 000]

South and South-East Asia                                        4.2 million                                330 000                             0.3%                      340 000
                                                              [3.5 – 5.3 million]                  [76 000 – 680 000]                   [0.2% – 0.4%]             [230 000 – 450 000]

East Asia                                                            740 000                                 51 000                             0.1%                        40 000
                                                         [480 000 – 1.1 million]                    [27 000 – 86 000]                 [<0.1% – 0.2%]                [24 000 – 63 000]

Latin America                                                    1.7 million                                110 000                             0.5%                        63 000
                                                              [1.5 – 2.1 million]                  [37 000 – 200 000]                   [0.4% – 0.6%]               [49 000 – 98 000]

Caribbean                                                            230 000                                 20 000                             1.1%                        14 000
                                                           [210 000 – 270 000]                      [14 000 – 27 000]                   [1.0% – 1.2%]               [11 000 – 16 000]

Eastern Europe & Central Asia                                    1.5 million                                110 000                             0.8%                        58 000
                                                              [1.1 – 1.9 million]                  [53 000 – 200 000]                   [0.6% – 1.1%]               [41 000 – 88 000]

Western & Central Europe                                             730 000                                 27 000                             0.3%                           8000
                                                         [580 000 – 1.0 million]                      [3200 – 69 000]                   [0.2% – 0.4%]                 [4800 – 17 000]

North America                                                    1.2 million                                 54 000                             0.6%                        23 000
                                                         [760 000 – 2.0 million]                     [7600 – 130 000]                   [0.4% – 1.0%]                 [9100 – 55 000]

Oceania                                                                74 000                                13 000                             0.4%                           1000
                                                              [66 000 – 93 000]                    [ 12 000 – 15 000]                   [0.3% – 0.5%]                 [<1000 – 1400]
                                                                 33 million                           2.7 million                              0.8%                  2.0 million
TOTAL
                                                             [30 – 36 million]                   [1.6 – 3.9 million]                  [0.7% - 0.9%]               [1.8 – 2.3 million]

            The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information.              2008 Report on the
                                                                                                                                                                           global AIDS epidemic
Trends in estimated number of people living with HIV and adult HIV prevalence
 Global HIV epidemic, 1990–2007; and, HIV epidemic in Sub-Saharan Africa, 1990–2007


               Global HIV epidemic, 1990–2007                                                  HIV epidemic in Sub-Saharan Africa, 1990–2007

Number of people                                                 % HIV prevalence,           Number of people                                                  % HIV prevalence,
living with HIV (millions)                                       adult (15–49)               living with HIV (millions)                                        adult (15–49)
     40                                                                                4.0         30                                                                                15.0

                                                                                                   25                                                                                12.0
     30                                                                                3.0
                                                                                                   20
                                                                                                                                                                                      9.0
     20                                                                                2.0         15
                                                                                                                                                                                      6.0
                                                                                                   10
     10                                                                                1.0
                                                                                                    5                                                                                 3.0

      0                                                                                0            0                                                                                 0
          1990 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 2000 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 2007                    1990 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 2000 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 2007


                                                                                                                                       NOTE: Even though the HIV prevalence stabilized
                                                                        Number of people living with HIV                               in Sub-Saharan Africa, the actual number of people
                                                                                                                                       infected continues to grow because of ongoing new
                                                                        % HIV prevalence, adult (15–49)                                infections and increasing access to antiretroviral
                                                                                                                                       therapy.
                                                                        These bars indicate the range around the estimate


                                                                                                                                                                       2008 Report on the
                                                                                                                                                                       global AIDS epidemic
Southern Africa
Nine Southern Africa countries account for 35 per cent of all HIV infections and 38 per cent
of AIDS deaths in 2007 (Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa,
Swaziland, Zambia and Zimbabwe)

South Africa continues to have the largest epidemic of any country with an estimated 5.7
million people living with HIV.

Among 15-24 year olds in South Africa women and girls account for more than 90 per cent
of new infections.

Swaziland has the world’s highest national adult HIV prevalence of 26 per cent.

In Mozambique the epidemic continues to grow with some provinces exceeding 20 per
cent prevalence and infections among young people increasing across the country.


                                                                                  2008 Report on the
                                                                                  global AIDS epidemic
Southern Africa
Compared to previous years the South African epidemic does appear to have stabilized as
have the epidemics in Malawi and Zambia.

Reductions in HIV prevalence were notable in Zimbabwe and Botswana.

In Zimbabwe HIV prevalence among pregnant women attending antenatal clinics fell from
26 per cent in 2002 to 18 per cent in 2006.

In Botswana figures for pregnant 15-19 year-olds dropped from 25 per cent HIV prevalence
in 2001 to 18 per cent in 2006.




                                                                            2008 Report on the
                                                                            global AIDS epidemic
Eastern Africa
Many of the national HIV epidemics of East Africa appear to be receding or have stabilized
at around 5 per cent adult prevalence.

For example Uganda’s adult prevalence appears to have stabilized at around 5.4 per cent
but signs of resurgence in sexual risk taking could trigger a further growth in the epidemic.

However Kenya reported an HIV prevalence of between 7.1 per cent and 8.5 per cent this
year compared with the 2003 estimate of 6.7 per cent.




                                                                                 2008 Report on the
                                                                                 global AIDS epidemic
HIV prevalence (%) among 15–24 years old, by sex,
          selected countries, 2005–2007
                 Swaziland
                South Africa
                 Zimbabwe
   Central African Republic
                    Uganda
                                                            Female
                       Chad
                Côte d'Ivoire                               Male
               Sierra Leone
                    Rwanda
                         Haiti
                     Guinea
                    Ethiopia
                      Benin
                         Mali
                 DR Congo
                       Niger
      Dominican Republic
                    Senegal
                 Cambodia
                        India
                                 0   5    10         15       20     25
                                         % HIV prevalence
                                                                          2008 Report on the
                                                                          global AIDS epidemic
Need to continue improving access to treatment
Nearly 3 million people were receiving antiretroviral treatment in low and middle income
countries at the end of 2007

Increases in treatment coverage have been extraordinary in many countries for example
Namibia, where treatment coverage was only 6 per cent in 2003 and 57 per cent on 2007.

Botswana has achieved one of the world’s highest coverage rates of HIV treatment,
delivering drugs in 2007 to more than 90 per cent of those who need them.

Treatment and prevention must go hand in hand




                                                                              2008 Report on the
                                                                              global AIDS epidemic
Need unprecedented scale-up of HIV Prevention
Heterosexual intercourse is the main driver of the epidemic in the region with women and girls most
affected - the following priorities to improve the region’s AIDS responses:

Increased social mobilization with the strong involvement of males, that addresses multiple and
concurrent partnerships, age-disparate/intergenerational sex and transactional sex

Scaling up public health interventions that include adolescent friendly health services, the
acceleration of programmes that prevent mother to child transmission of HIV and the expansion of
male circumcision services

Structural interventions that keep girls in school, increase women’s economic independence and
recognize women’s property and inheritance rights

Improved Surveillance and Monitoring through greater investment in tools and capacities to
monitor the effects and the evolution of the HIV epidemic

Further research on the structural drivers of the epidemic including the relationship between alcohol
and HIV risk as well as HIV prevention efforts targeting sero-discordant couples
                                                                                       2008 Report on the
                                                                                       global AIDS epidemic