HIV EPIDEMIOLOGY. An update on global and national statistics. Dr Diarmuid Nugent SpR HIV/GU Medicine

Transcription

1 HIV EPIDEMIOLOGY An update on global and national statistics Dr Diarmuid Nugent SpR HIV/GU Medicine

2 IMPORTANT DISCLAIMER This presentation contains medical and pharmaceutical news, and data, supplied for general information purposes only. The materials contained within this presentation do not constitute medical or pharmaceutical advice, which should only be sought from your own medical and pharmaceutical advisers. We are not responsible for any mistakes or deficiencies. The material displayed within this presentation is provided without any guarantees, conditions or warranties as to its accuracy. If you need medical advice or are planning to change anything relating to your healthcare or treatment please speak to your nurse or doctor before.

3 HIV epidemiology An update on global and national statistics Dr Diarmuid Nugent SpR HIV/GU Medicine

4 The basics 35 million people living with HIV worldwide New infections are declining 2.1 million in million in 2001 (down by 38%) AIDS related deaths are declining 1.5 million in 2013, down 35% since % of people living with HIV know their status New HIV infections in children reduced by 58% since ,000 incident infections in children in 2013 Record numbers of individuals on ART (12.9 million) 63% not on ART in 2013 vs 90% in 2006

5 The global scale

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7 Sub-Saharan Africa 71% of global total of those living with HIV 58% women ART available to approx 4/10 86% of people who know their status are on ART New infections falling in every country except Uganda and Angola since % fall in AIDS related deaths since 2005 South Africa 48%, Rwanda 76%, Eritrea 67%, Botswana 58%, Ethiopia 63%, Kenya 60% Success directly due to expansion of availability of ART Statistics mask differences between countries

8 ART access

9 South Africa & Nigeria Together account for 38% of those living with HIV in sub-sarahan Africa South Africa 2.6 Million now on ART Increased coverage from 1/10 in 2010 to 4/10 in % reduction in deaths due to advanced HIV Nigeria 2/10 have access to ART No reduction in deaths due to advanced HIV

10 Prevalence varies at sub-national levels

11 Zooming in on the epidemic

12 Zooming in on the epidemic

13 Young women

14 Young women HIV prevalence and incidence unacceptably high in young women aged 15-24, especially in Sub- Saharan Africa Earlier sexual debut Gender based violence Less able to negotiate condom use Lack of access to information and education May not have final say related to their own healthcare

15 People who inject drugs Globally HIV prevalence of around 13% Account for 30% new infections outside SSA Fuelling novel epidemics in Eastern Europe and Central Asia: Russia, Ukraine, Uzbekistan 4% accessing ART National figures mask wide local variations Prevalence of 56.4% and 48.8% in Jakarta and Subraya, Indonesia Rapid spread: Cebu had negligible rates in 2009 to 52.4% in 2013 Need for opioid substitution and needle exchange programmes Edinburgh vs Glasgow in early 1980s

16 Men who have sex with men Disproportionate burden of HIV infection across all nations Hidden epidemics in countries with in which same sex activity is stigmatised or criminalised Massive disincentives to testing and accessing care Emergent epidemics in late 2000s in Poland, Czech Republic and Hungary Not a homogenous group

17 USA: Dual stigma of race and sexuality

18 The UK: PHE Annual Report Estimated 107,800 people living with HIV in 2013 Approximately 1 in 4 unaware of diagnosis 43,500 MSM of whom 16% unaware 6000 new diagnoses (6250 in 2012) Decline in late diagnoses Decline in new diagnoses except in young MSM aged (8.7%) in (16%) in 2013

19 UK outcomes 95% retention in care at 12 months 90% prescribed ART 90% in whom ART prescribed achieved viral suppression <200 copies Positive Voices patient survey report high levels of satisfaction

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22 People living with HIV in W Europe & N America

23 AIDS-related deaths in W Europe & N America

24 Conclusions Lack of knowledge of HIV status is the major barrier to defeating the epidemic Targeted geographical approach to testing and service provision Targeted demographic approach Wider social context to reduce stigma and promote equality of access Abolition of punitive sanctions for at risk populations

25 References 1. The Gap Report; UNAIDS Gap_report_en.pdf 2. The resurgent global HIV epidemic in men who have sex with men (MSM); Professor Kevin Fenton, BHIVA Autumn Conference HIV in the United Kingdom: 2014 Report; Public Health England 4. Centers for Disease Control and Prevention: Vital Signs: HIV Prevention through care and treatment United States; m