International figures both good and bad

According to a report released late last year by UNAIDS [1]Joint United Nations Programme on HIV/AIDS. UNAIDS is the main advocate for accelerated, comprehensive and coordinated global action on the epidemic. and WHO, HIV-related deaths fell by 10% in 2008, and since 2001 there has been a 17% decrease in HIV incidence.

In Kenya, treatment scale-up between 2002 and 2007 resulted in a 29% decline in deaths attributable to HIV. And in Botswana where 80% of individuals in need of antiretroviral [2]A medication or other substance which is active against retroviruses such as HIV. therapy are receiving it, the number of people dying because of HIV fell by half between 2003 and 2007.

But we’ve still got a long way to go.

While four million people were receiving antiretroviral drugs at the end of 2008, a total of 33.4 million people were living with HIV. And for every two individuals who started HIV treatment that year, five were newly infected. Prevention is having an impact on new infections, however ‘prevention programming is often off the mark’, says Michel Sidibé, Executive Director of UNAIDS.

In Africa, for example, a common failure is to not focus prevention efforts on key groups such as older heterosexual couples, serodiscordant couples and people with HIV.

Eastern Europe and Central Asia are regions where HIV prevalence is on the rise (up 66% from 2001).

In Asia, the epidemic is steadily expanding through transmission to the sexual partners of injecting drug users, sex workers and their clients, and men who have sex with men.

Bangladesh is transitioning from a low-level
epidemic to a concentrated epidemic among injecting drug users. Ukraine and the Russian Federation are also experiencing severe and growing national epidemics within their injecting drug user communities.

But sub-Saharan Africa remains the region most heavily affected by HIV, accounting for 67% of the world’s HIV infections and 72% of deaths. The number of new infections, however, was approximately 25% lower than in 1995.

In the Caribbean, the region with the highest prevalence outside Africa, it appears that the number of new infections is no longer declining, but has stabilised. The situation is also relatively stable in Latin America, but the report notes that although national epidemics in LatinAmerica are heavily
concentrated among men who have sex with men, injecting drug users and sex workers, only a small fraction of HIV prevention spending in the region supports prevention programmes specifically focused on these populations.

In North America, Western Europe and Central Europe, although HIV incidence has either remained relatively stable or increased slightly in these countries in recent years, epidemiological patterns have evolved considerably.

In particular, there is evidence that the number of new HIV infections among men who have sex with men has increased in the past decade, while rates of new infections among injecting drug users have fallen. The benefits of antiretroviral therapy have been particularly marked in these high-income countries, with an estimated 7.2 million life-years added since 1996.

An estimated 17,444 people, including 12,053 people aged 15 to 49 years, were living with HIV infection in Australia at the end of 2008. Over the past 10 years, the number of new HIV diagnoses in Australia has increased by 38% from 718 in 1999 to 995 in 2008. HIV continues to be transmitted primarily through sexual contact between men, although more women and overseasborn heterosexual people have been diagnosed in recent years.