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Coll. Antropol. 30 (2006) Suppl. 2: 3–10

Review

The Epidemiology of HIV and AIDS in the World

Aliya Bokazhanova1 and George W. Rutherford1,2
1
Institute for Global Health, University of California, San Francisco, California, USA
2 Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California, USA

ABSTRACT

The worldwide epidemic of HIV continues to expand in many regions of the world, particularly in southern Africa,
South and Southeast Asia, East Asia and Eastern Europe and Central Asia. Estimates are that at the end of 2005 there
were 38.6 million persons living with HIV infection and that 4.1 million new infections and 2.8 million deaths from HIV
occurred during the year. Regionally different patterns predominate from generalized heterosexual epidemics in sub-Sa-
haran Africa and parts of the Caribbean to mixes of epidemics in which transmission among injection drug users, their
sexual partners, commercial sex workers and their partners intersect. Multilateral and bilateral antiretroviral access
campaigns, such as the World Health Organization’s 3 x 5 initiative, have resulted in broader access to live-saving ther-
apy for infected persons in low- and middle-income countries, but several million infected people who are clinically eligi-
ble for antiretroviral therapy remain untreated. The public health challenge worldwide is to keep the uninfected and to
treat and care for those who have already been infected.

Key words: HIV, AIDS, epidemiology, prevalence, Africa, Asia, Europe

Introduction
Since the first description of the acquired immunode- that an infectious inoculum of HIV will infect CD4+ T
ficiency syndrome (AIDS) in 19811, the epidemiology of lymphocytes or a similarly susceptible cell line in a previ-
AIDS and its retroviral causative agent, human immuno- ously uninfected individual depends on a number of
deficiency virus (HIV), has been well described2. AIDS transmission cofactors such as co-infection with another
has come to be viewed not as an isolated syndrome, but sexually transmitted disease (both ulcerative and non-ul-
as the most serious manifestation of a range of clinical cerative), host susceptibility to infection, genetic vari-
and subclinical diseases and conditions caused by HIV. ance in the infectiousness of the particular strain of HIV
HIV infection, in turn, is now viewed not as an infection and temporal variability in the infectiousness of the
of isolated groups of people but as an infection that has host3.
spread worldwide in pandemic proportions. Persons with newly acquired HIV infection have the
highest titers of virus in their blood9, and persons with
high titers in blood are more likely to transmit HIV than
Modes of Transmission those with lower titers. This has been clearly demon-
strated for blood borne and perinatal transmission10, and
HIV is known to be transmitted through sexual con-
there is evidence that at the population level high plasma
tact with an infected partner3; parenterally through di-
or serum viral loads are associated with higher rates of
rect exposure to blood or blood products4,5; and vertically
sexual11 and postnatal12 transmission. The result is that
from an infected mother to her offspring6 (Table 1). The
often it is persons who have recently become infected and
likelihood of HIV transmission is dependent on the prob-
have not had sufficient time to develop measurable anti-
ability of exposure and the probability of infection after
body are the most infectious13. This has led to explosive
exposure7,8. Exposure is dependent on the background
and sustained epidemics when there are high levels of
prevalence of HIV in a population and the frequency and
sexual mixing and partner exchange14,15.
nature of contact with sexual or needle-sharing partners
randomly drawn from the population. The probability

Received for publication November 2, 2006

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TABLE 1
MODES OF HIV TRANSMISSION

Sexual Parenteral Perinatal

• Heterosexual, male to female • Sharing of needles and syringes by • Prenatal
• Heterosexual, female to male injection drug users (heroin, cocaine, • Perinatal during birth
• Homosexual, male to male methamphetamines) • Postnatal from breast milk
• Artificial insemination with • Transfusion of contaminated blood
infected semen • Administration of contaminated
blood products (e.g., Factor VIII)
• Organ transplantation with infected
organs
• Reuse of needles, syringes and intra-
venous tubing in health-care set-
tings
• Occupational injuries
• Bites
Most common forms of transmission are italicized.

Epidemiology are that among 15 to 24 year-old Africans, 1.9% of men

and 4.6% of women are already infected17.
The HIV epidemic is extremely dynamic and has The epidemic in sub-Saharan Africa is not homoge-
grown rapidly since HIV-1 and later HIV-2 entered hu- neous; some countries are much more severely affected
man populations in the 1920s16. Virtually no country in than others18 (Figure 1). In Somalia and Gambia the
the world remains unaffected. Joint United Nations prevalence is around 2% of the adult population, whereas
Programme on HIV/AIDS (UNAIDS) and the World in South Africa and Zambia around 20% of the adult pop-
Health Organization (WHO) estimate that the total ulation is infected. In four southern African countries,
number of people living with HIV was 38.6 million with a the national adult HIV prevalence rate has risen higher
confidence bound of 33.4–46.0 million2. This is an in- than was thought possible and now exceeds 20%. These
crease of 200,000 people since 2004. In 2005, 4.1 million countries are Botswana (24.1%), Lesotho (23.2%), Swazi-
people were estimated to have become newly infected land (33.4%) and Zimbabwe (20.1%). West Africa is rela-
with HIV, and 2.8 million deaths were attributed to the tively less affected by HIV infection, but the prevalence
infection, more of both than in any previous year2. rates in some countries are creeping up. In West Africa
Regionally the HIV epidemic grew in every region in and Central Africa HIV prevalence is estimated to exceed
the World except one – the Caribbean – in 2005 (Table 2). 5% in several countries including Cameroon (5.4%), Cen-
Sub-Saharan Africa remains the most affected region in tral African Republic (10.7%), Côte d’Ivoire (7.1%) and
the world, but there are also rapidly growing epidemics Nigeria (3.9%). HIV infection in Eastern Africa varies be-
in Eastern Europe and Central Asia and in East Asia. tween adult prevalence rates of 2.4% in Eritrea to 6.5%
Earlier epidemics have left a large burden of disease in in Tanzania. In Uganda, a country severely affected by
South and Southeast Asia, Latin America and the high- the HIV epidemic in the 1980s and early 1990s, the coun-
income nations of North America and Western and Cen- trywide prevalence among the adult population is now
tral Europe. The epidemics in Latin America, North 6.7%2.
America and Western and Central Europe show some However, declines in the nationwide prevalence of
signs of stabilizing, but, nonetheless, transmission still HIV among adults appear to be underway in three coun-
occurs in these regions2. tries, Uganda, Kenya and Zambia19–21. Within countries
HIV infection can cluster geographically, particularly in
Incidence and prevalence by region urban and periurban areas. A variety of contextual fac-
Sub-Saharan Africa tors contribute to the spread of the epidemic in these ar-
Sub-Saharan Africa has just over 10 percent of the eas just as surely as do biological factors. Most important
world’s population but is home to 60% of all people living among these are the socioeconomic status of women,
with HIV17. An estimated 24.5 million people were living HIV stigma and inadequate knowledge of HIV transmis-
with HIV in the region at the end of 2005, and approxi- sion and its prevention. Together these factors lead to
mately 2.7 million new infections, or 66% of all new infec- high risk of exposure and, if exposed, high risk of trans-
tions worldwide, occurred there during that year2. Overall mission. These risks are compounded by a hesitancy to
UNAIDS estimates that 6.1% of the adult population is in- seek counseling and testing and, if positive, to seek ther-
fected. Moreover, 50 million Africans have been infected apy because of stigma.
with HIV since the beginning of the epidemic, and more Sub-Saharan Africa is also home to the world’s largest
than 22 million have died2. Eight African countries have pediatric HIV epidemic. Of the 2.3 million children under
more than 1 million people living with HIV, and estimates 15 estimated to be living with HIV infection in 2005, 2.0

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TABLE 2
HIV PREVALENCE, INCIDENCE AND MORALITY BY REGION, 2003 AND 2005

Estimated adult
Prevalent cases Incident cases Mortality
Region prevalence
2003 2005 2003 2005 2003 2005 2003 2005
Sub-Saharan Africa 23 500 24 500 6.2% 6.1% 2 600 2 700 1 900 2 000
South and South-East Asia 7 000 7 600 0.6% 0.6% 840 990 470 560
Latin America 1 400 1 600 0.5% 0.5% 130 140 51 59
Eastern Europe and Central Asia 1 100 1 500 0.6% 0.8% 160 220 28 53
North America 1 200 1 300 0.7% 0.8% 43 43 18 18
East Asia 560 680 0.1% 0.1% 100 140 28 33
Western and Central Europe 680 720 0.3% 0.3% 20 22 12 12
North Africa and Middle East 380 440 0.2% 0.2% 54 64 34 37
Caribbean 310 330 1.5% 1.6% 34 37 28 27
Oceania 66 78 0.3% 0.3% 9 7 2 3
Total 36 200 38 600 1.0% 1.0% 3 900 4 100 2 600 2 800
*Estimates x 1,000. UNAIDS, 2005 and 2006.

million (90%) lived in sub-Saharan Africa2. Similarly 2.25 billion people between them. In both countries, na-
91% of the 570,000 estimated child deaths and 90% of the tional HIV prevalence is low, 0.1% in China and between
estimated 700,000 new infections in 2005 were in the re- 0.5% and 1.5% in India2.
gion. This is primarily because the predominant mode of
transmission in sub-Saharan Africa is through hetero- East Asia
sexual intercourse, which has led to more than half of the
infected population being female. In fact more than three China has the largest HIV epidemic in East Asia. The
quarters of all HIV-infected women in the world live in latest estimates are that as of the end of 2005, there were
sub-Saharan Africa. approximately 650,000 people currently living with HIV/
AIDS in China. New HIV cases were being transmitted
Asia primarily through injecting drug use and sex22,23. As a
major drug transshipment country with source drugs
Asia has the second largest number of people living
from the »Golden Triangle« area of Southeast Asia,
with HIV/AIDS. Until the late 1980s, no Asian country
China has also become an increasingly important drug
had experienced a major AIDS epidemic, but by the late
consuming market24,25. About half of China’s 1.14 mil-
1990s the disease was well established across the region.
lion documented drug users inject, and many share nee-
UNAIDS reports that in 2005 the total number of people
dles. Injecting with non-sterile needles and syringes has
living with HIV/AIDS in Asia was 8.3 million (confidence
resulted in 42% of cumulatively reported HIV/AIDS cases
limits 5.7–12.5 million)2. The continent includes the
thus far26. The potential for even further spread is un-
world’s most populous countries – China and India –with
derlined by a study that examined drug use practices, in-
cluding injecting drugs and needle sharing, and unpro-
tected sex among drugs users in southwestern China.
More than two-thirds of 833 institutionalized drug users
reported that they frequently injected drugs intrave-
nously or intramuscularly, 78% shared needles, and 73%
had multiple sexual partners27.

South and Southeast Asia

In India by the end of May 2004, the total number of
AIDS cases reported was 109,349 of whom 31,982 were
women28–30. While the Indian HIV/AIDS epidemic is still
largely concentrated in at-risk populations, including sex
workers, injecting drug users, and truck drivers, surveil-
lance data suggest that the epidemic is moving beyond
these groups in some regions into the general population.
In northeastern India along the Myanmar border and in
major cities such as Delhi, Chennai and Mumbai drug in-
Fig. 1. HIV prevalence among adults by country, WHO jecting is also a major source of new infections, and prev-
African Region, December 2003. Source: UNAIDS alence has risen rapidly in injection drug users28,31,32.

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However, the majority (85%) of new infection is due to An interesting exception to the rule is Iran, which has
heterosexual transmission, particularly among commer- instituted progressive harm reduction policies to combat
cial sex workers, their clients and the sexual contacts of a rising epidemic among heroin injectors. Iran has his-
their clients33. Although nationwide HIV prevalence rate torically been a major consumer of opium, and as sup-
is low (0.9%), in some parts of the country the epidemic plies from Afghanistan waned earlier in the decade,
has already »generalised«, with more than 1% of women many users switched from smoking opium to injecting
accessing antenatal services in public health institutions heroin with a concomitant rise in HIV, hepatitis B and
testing sero-positive34. There are an estimated 2.3 to 8 hepatitis C43,44.
million female sex workers in India35, and HIV informa-
In Eastern Europe – notably Estonia, Latvia, Lithua-
tion and awareness among sex workers appears to be low,
nia, Moldova, Russia and Ukraine – HIV incidence rates
especially among those working in the streets. Surveys
are among the highest in the world45,46. Today, Russia
carried out in various parts of India in 2001 found that
has the largest HIV epidemic in Europe and accounts for
30% of street-based sex workers did not know that con-
70% of the cases in the Eastern Europe and Central Asia
doms prevent HIV infection, and in some states, such as
region47. By the end of 2004, almost 300,000 cases of HIV
Haryana, fewer than half of all sex workers (brothel- and
have been officially registered in the Russian Federation
street-based) knew that condoms prevent HIV. Large
since the beginning of the epidemic, and this number
proportions of sex workers (42% nationally) also thought
continues to grow47,48. According to the European Center
they could tell whether a client had HIV on the basis of
for the Epidemiological Monitoring of AIDS, in the Rus-
his physical appearance36.
sian Federation more than half of the 33,969 cases newly
Other Southeast Asian countries that have had large reported in 2004 had no transmission category reported;
HIV epidemics or are dangerously close to them are Cam- of the remaining cases, 69% were injection drug users48.
bodia, Thailand, Vietnam, and Indonesia due to an explo- Many analysts date the sudden explosion of HIV to the
sive mix of heroin and commercial sex. For example in fall of the Soviet Union in the early 1990s and the subse-
Haiphong, Vietnam, in 2000 50% of commercial sex work- quent economic and social collapse, which in turn led to
ers reported sex with a male injection drug user, and an unemployment and drug use50,51. By some estimates,
only slightly smaller percentage of male injection drug there could be as many as 3 million injecting drug users
users reported buying sex from a commercial sex work- in the Russian Federation alone and more than 600,000
er2. There is, however, good evidence that the HIV epi- in Ukraine37. Most of these drug users are male and
demic has slowed in Thailand and Cambodia. many are very young; in St. Petersburg, studies found
that 30% of injectors were under 19 years of age, while in
Eastern Europe and Central Asia the Ukraine 20% were still in their teens. In a study of
drug use in the city of Togliatti 56% of drug injectors
Eastern Europe and Central Asia is a region in which
were infected with HIV, and 36% had injected with used
the HIV epidemic continues to grow; the number of peo-
needles and syringes in the last 4 weeks50. The situation
ple living with HIV in this region reached 1.5 million in
and the trajectory are similar in the Ukraine, where the
20052. According to UNAIDS, the total number of newly
national HIV prevalence rate is already higher that 1%37.
reported HIV/AIDS infections in Central Asia grew from
As in Russia the bulk of HIV infection is among injection
88 in 1995 to 6,706 in 2003, with most new infections oc-
drug users52. However, as the epidemic has spread, more
curring in Kazakhstan, Uzbekistan, and Kyrgyzstan37.
women have been infected, and the number of HIV-in-
However, UNAIDS estimates that there were closer to
fected infants has tripled in the last five years53.
50,000 HIV-positive people in the region in 2001, with
20,000 in Kazakhstan alone. Furthermore, the US Cen-
Western and Central Europe
ters for Disease Control and Prevention (CDC) estimated
the regional total to be 90,000 in 2001, with the potential Central Europe in contrast to Eastern Europe has a
to increase to more than 1.6 million in 200538. The explo- much smaller and more stable HIV epidemic. HIV in the
sive growth of HIV in the region has been fueled primar- region is largely concentrated in drug injectors, as in
ily by injection drug use that follows heroin trafficking Russia and the former Soviet republics, and three-quar-
routes from Afghanistan across the region into Europe39. ters of all cases are in Poland and Romania46. Southeast-
This is coupled with reported outbreaks of sexually trans- ern Europe has a more mixed picture. While the preva-
mitted infections, which facilitate HIV transmission. For lence has in general been low54, political instability, the
instance, the United Nations Office on Drugs and Crime wars following the disintegration of Yugoslavia and eco-
estimates indicate that Kazakhstan has around 250,000 nomic depression following the end of the Warsaw Pact
drug users, almost half of whom are injectors40 at a time created an environment in which behavioral and cultural
when the incidence of syphilis increased to 160 cases per shifts, such as injection drug use, commercial sex work
100,000. Knowledge of HIV/AIDS in the country is low and migration, created a situation in which HIV could be
both among high-risk groups and young people; accord- rapidly transmitted55. In addition conditions, such as
ing to a national survey only 15 percent of young people high rates of sexually transmitted diseases, in other
have adequate knowledge of HIV prevention41, and harm countries in southeastern Europe, such as Romania,
reduction initiatives cover only an estimated 8–10% of have the potential to facilitate explosive heterosexual
the injecting-drug-using population42. transmission2. In only a few countries, such as Slovenia

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and Croatia, are the substantial numbers of cases among data indicate that interventions to reduce risky behavior
men who have sex with men48, 56. Additionally in Croatia, and practices need to be intensified and to be targeted at
merchant seamen, in many ways analogous to truck driv- older, as well as younger, men who have sex with men60.
ers, appear to have high risk for acquiring HIV infection In Italy and Spain, HIV incidence is estimated to have
sexually and have exposures in hyper-endemic parts of increased much more rapidly among injection drug users
the world as a result of their voyages57. This pattern has than among other transmission groups, reaching over 15
also been seen in commercial fisherman in Cambodia and per 100 000 population towards the end of the 1980s61.
Thailand58,59. HIV diagnoses among injection drug users have dropped
In Western Europe more than half a million people steeply in the 1990s in Spain after methadone treatment
are living with HIV, and that number continues to grow2. and needle-exchange projects were introduced. However,
There are in essence three separate epidemics occurring high HIV prevalence is still found among injection drug
in Western Europe – one among men who have sex with users in parts of Spain, such as Catalonia2. Italy has a
men, one among injection drug users and one among het- similarly prominent epidemic among injection drug us-
erosexuals. While there is good evidence that rates of ers, with almost 60% of AIDS cases reported among
transmission among men who have sex with men and in- injectors48 but also has experienced localized outbreaks
jection drug users declined by the late 1980s, by early in of sexually transmitted diseases reflecting a new rise in
2000 an increase in cases among heterosexuals began to high-risk sexual behavior. As a consequence, HIV is be-
appear46. Data from 11 countries which have provided in- ing spread sexually. For instance in Rome new HIV infec-
dividual HIV data since 1998 (Belgium, Denmark, Fin- tions in a sexually transmitted disease clinic have in-
land, Germany, Greece, Iceland, Luxembourg, Norway, creased dramatically in the period 2000–2003 compared
Sweden, Switzerland, United Kingdom), indicate that to 1996–199962.
the rise in diagnoses of infections among heterosexuals is
North America
largely due to an increasing number of cases among per-
sons originating from countries with generalized HIV ep- UNAIDS estimates that there were 1.3 million people
idemics: from 30% of heterosexual infections in 1998 to living with HIV in North America at the end of 2005 and
53% in 2003, over 90% of which were in migrants from that the number of new infections (43,000) far outpaces
sub-Saharan Africa48. In Germany, the number of new the number of deaths (18,000). As opposed to less devel-
HIV diagnoses increased in 2002 among heterosexuals oped countries, this is because HIV/AIDS survival has in-
originating from countries with generalized HIV epidem- creased markedly in the region as the direct result of
ics, most of who were believed to have been infected in highly active antiretroviral therapy2.
their countries of origin. In Sweden, more than 80% of In the United States of America an estimated 40,000
reported HIV infections acquired through heterosexual people have been infected with HIV each year during the
contact were probably acquired abroad. In Belgium, 73% past decade2. As in Western Europe, men who have sex
of HIV infections ever diagnosed in heterosexually in- with men, injection drug users and high-risk heterosexu-
fected people were in non-Belgian individuals – mostly als all have experienced high rates of HIV infection.
from Africa48. To determine when, where, and how HIV However, unlike Europe there has been significant trans-
transmission has occurred is often difficult and further mission of HIV from injection drug users to non-user het-
hindered where language or cultural barriers exist. Most erosexuals. This has been especially pronounced among
HIV-infected migrants are unaware of their HIV status persons of African descent in the United States who com-
and are diagnosed only when they become symptomatic prise about 12.5% of the country’s population. Currently
or during pregnancy. Their reasons for migration to about half of newly reported HIV infections in recent
Western Europe are economic or political and not con- years have been among African Americans63, and Afri-
nected with seeking HIV treatment, although this may can-American women are almost three times as likely to
sometimes happen47. be infected as women of European descent2.
Despite the increase of new HIV diagnoses in those Sex between men is the most common route of HIV
infected through heterosexual contact, injection drug us- infection in both the United States and Canada, account-
ers and men who have sex with men remain the most af- ing for 63% of newly diagnosed HIV infections in the
fected groups in Western Europe. Recent studies con- United States in 20032, but African Americans are also
ducted among men who have sex with men in England, disproportionately represented among men who have sex
Wales and Northern Ireland has found that contrary to with men. Analyzing data from 11 states, a recent Cen-
general expectations, recent HIV infections have been ters for Disease Control and Prevention study found that
occurring at similar rates in men of all age groups be- 34% of HIV-positive African-American men said they had
tween 20 and 44 years. The general opinion has been sex with both women and men. However, only a small
continuing HIV transmission is principally due to youn- proportion of HIV-positive African-American women re-
ger men who have sex with men less aware of the safe sex ported knowing that their partners also had sex with
message of the late 1980s and early 1990s and, as a re- men64.
sult, adopting high-risk behaviors and practices. In most The HIV epidemic in Canada is more of a hybrid be-
years, however, incidence has been highest either in tween the Western European epidemic, with substantial
those aged 35–44 years or those aged 25–34 years. These numbers of cases among immigrants from countries with

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generalized epidemics, and the United States’ epidemic, Guyana and Trinidad and Tobago; and greater than 3%
with cases among men who have sex with men, injection in Haiti2. Higher prevalence rates are found only in
drug users and ethnic and racial minorities2. sub-Saharan Africa, making the Caribbean the second-
most affected region in the world. More than half of in-
Latin America fected adults are women2.
The number of people living with HIV in Latin Amer- According to U.S. Agency for International Devel-
ica has risen to an estimated 1.8 million2. A few countries opment68, AIDS is the leading cause of death among 15 to
in Latin America, such as Honduras, and some areas in 44-year-olds in the region; patients with AIDS occupy 25
Brazil have reached prevalence rates above 1% in preg- percent of all hospital beds in the region. Late diagnosis
nant women and can be considered to have generalized is common, and few people receive treatment, even for
epidemics65. The dominant mode of transmission varies opportunistic infection. HIV is transmitted primarily
from country to country, but men who have sex with men through sexual contact (64% among heterosexuals, 11%
and injection drug users are the predominant groups among men who have sex with men) amplified by pov-
that have been affected by HIV in most Latin American erty, unemployment and gender inequality2.
countries. Commercial sex work, especially in Central
America and along the West Coast of South America, has
also been an important amplifier of the epidemic2. In
Central America and Brazil, heterosexual transmission Antiretroviral Therapy
beyond commercial sex work plays an increasing and im-
portant role for HIV dissemination65. As the incidence of HIV has increased worldwide, so
In Latin America, men who have sex with men may have the incidence and prevalence of AIDS and the other
not identify themselves as »gay« and frequently have sex advanced clinical stages of HIV infection. We know from
with women. In Brazil, 11% of the participants in a sex- high- and middle-income countries that effective anti-
ual practices survey in Fortaleza considered themselves retroviral therapy can lead to increased survival for indi-
to be bisexual. The same survey found that a 23% of men vidual patients and decreased mortality rates at the pop-
who have sex with men had at least one heterosexual ulation level69–71. Today, more resources are available for
contact during the previous year. Furthermore, two- the fight against HIV than ever before, but at the global
-thirds of men who had unprotected sex with their fe- level our treatment efforts have not yet been fully real-
male partners also had unprotected anal sex with their ized. Worldwide in 2005, more people died from AIDS
male partners66. Similar patterns have been reported in than in any previous year2.
the Dominican Republic, where sexual contact between The World Health Organization launched an anti-
bisexual men and women is common. retroviral treatment initiative in 2003 to treat 3 million
Injection drug users are the second group that can act of the 6 million people living in low- and middle-income
as a bridge for HIV infection to the general population. countries who were clinically eligible for antiretroviral
In Brazil 21% of AIDS cases are injection drug users, and therapy72. This initiative, termed 3 x 5 because of the tar-
38% of AIDS cases in women resulted from sexual infecti- get of 3 million people under therapy by 2005, has led to
on from injection-drug-using partners or drug use them- more than a doubling of antiretroviral therapy to around
selves. In the Southern Cone of South America, the pre- 1 million patients by June 2005. Moreover, to date, 14 of
ferred drug of injection is cocaine, and a band of HIV target countries are providing antiretroviral therapy to
infection among cocaine injectors stretches along cocaine at least 50 per cent of those who need it, consistent with
trafficking routes from Bolivia and Paraguay to the At- the »3 by 5« target, including a remarkable 80% or more
lantic coastal ports of Argentina, Brazil and Uruguay67. coverage in Brazil, Argentina, Chile and Cuba2.
Colombia also has a high risk from injecting practices. The current momentum to expand treatment access
The country is currently considered to be one of the most in sub-Saharan Africa and Asia, where the burden of dis-
important producers of opium by-products, ranking fo- ease is greatest, is especially encouraging. Approximately
urth after Myanmar, Laos and Afghanistan67. However, 500,000 people in the region are receiving treatment, a
sex between men is the predominant mode of transmis- three-fold increased in one year from 2003 to 2004. Prog-
sion. HIV prevalence of 20% was recently reported ress in Asia, the region with the second highest need for
among men who have sex with men in Bogotá, while an- treatment, has also been significant, with the number of
other survey in the same city found consistently low con- people receiving treatment increasing nearly three-fold
dom use in this group2. –from 55 000 to 155 000 – during this same period. In
Eastern Europe and Central Asia, the number of people
Caribbean
on treatment has almost doubled from 11 000 to 20 000
At the end of 2005, an estimated 330,000 people were people. Available data and trends suggest that the goal of
living with HIV and AIDS in the Caribbean. Some 30,000 providing antiretroviral therapy to 3 million people by
people were newly infected during 2005, and there were the end of 2005 was not fully met, but UNAIDS reports
27,000 deaths due to AIDS. Estimated adult prevalence that as the result of antiretroviral access efforts that be-
is greater than 1% in Barbados, the Dominican Republic, gan in 2003, between 250,000 and 350,000 deaths were
Jamaica and Suriname; greater than 2% in the Bahamas, averted in 20052.

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Conclusions care of persons who have progressed to AIDS and the less
severe clinical stages of the infection. To achieve these
The incidence and prevalence of HIV infection are in- goals, however, will require a redoubling of scientific ef-
creasing worldwide, and the complexity of the pandemic forts to further refine antiretroviral therapies and care
is increasing with them. As we approach the 25th anni- models; to develop a safe, effective and inexpensive vac-
versary of the first report of AIDS, the need for primary cine; and to renew our collective commitment to the be-
prevention of HIV infection is ever more clear, crystal- havior changes that have already led to decreasing inci-
lized by the sobering reality of the depth and breadth of dence in several parts of the world.
the pandemic. The need is also clear for treatment and

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G. W. Rutherford

Institute for Global Health, University of California, San Francisco, 50 Beale Street, Suite 1200,
San Francisco, 94105 California, USA
e-mail: [email protected]

EPIDEMIOLOGIJA HIV-INFEKCIJE I AIDS-A U SVIJETU

SA@ETAK

Svjetska epidemija zaraze HIV-om nastavlja se {iriti u mnogim dijelovima svijeta, osobito u ju`noj Africi, ju`noj i
jugoisto~noj Aziji, isto~noj Aziji i isto~noj Europi i sredi{njoj Aziji. Procjenjuje se da je krajem 2005. `ivjelo 38,6 milijuna
osoba zara`enih HIV-om i da je bilo 4,1 milijuna novih infekcija i 2,8 milijuna umrlih te godine. Postoje regionalne
razlike od op}e heteroseksualne epidemije u supsaharskoj Africi i dijelova Kariba do mije{ane epidemija u kojoj se
preklapa prijenos me|u korisnicima droga, njihovim seksualnim partnerima, seksualnim radnicama i njihovim part-
nerima. Multilateralni i bilateralni programi provo|enja antiretrovirusnog lije~enja poput incijative 3 x 5 Svjetske
zdravstvene organizacije, rezultirali su ve}om dostupno{}u `ivotno-spa{avaju}eg lije~enja osoba zara`enih HIV-om u
slabo ili srednje razvijenim zemljama, ali vi{e milijuna zara`enih koje bi prema klini~kim mjerilima trebalo lije~iti
ostaju nelije~eni. Svjetski javnozdravstveni izazov jest zadr`ati nezara`ene nezara`enim i lije~iti sve one koji jesu za-
ra`eni.

10

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