The Global State of HIV/AIDS. Presented By: Siobhan K. Young, MPH PhD Candidate at UNC Chapel Hill

Transcription

1 The Global State of HIV/AIDS Presented By: Siobhan K. Young, MPH PhD Candidate at UNC Chapel Hill

2 Outline HIV/AIDS 101 Origin of AIDS State of the Epidemic HIV/AIDS in Sub-Saharan Africa Anti-Retroviral Therapy HIV& AIDS are Not Stand Alone Diseases Nutrition & HIV/AIDS Global Impact of HIV/AIDS What Can We Do?

3 HIV/AIDS 101

4 What is HIV? HIV is a virus that attacks the body s immune system. HIV enters they body and over time, breaks down the immune system. When the immune system can no longer protect the body from infections, a person has AIDS.

5 Natural History of HIV Infection w/o Tx HIV RNA load Clinically CD4 latent lymphocytes period Infection with HIV 6 24 weeks (?) years 2 3 years Clinical symptoms

6 How Is HIV Transmitted?

7 Sources of HIV Infection by Region

8 The Status of the Epidemic

9 Global Summary of the HIV/AIDS Epidemic, December 2007 Number of people living with HIV in 2007 Total Adults Women Children under 15 years 33.2 million [ million] 30.8 million [ million] 15.4 million [ million] 2.5 million [ million] People newly infected with HIV in 2007 AIDS deaths in 2007 Total 2.5 million [ million] Adults 2.1 million [ million] Children under 15 years [ ] Total 2.1 million [ million] Adults 1.7 million [ million] Children under 15 years [ ]

10 Adults & Children Estimated to be Living with HIV, 2007 North America 1.3 million [ million] Caribbean [ ] Latin America 1.6 million [ million] Western & Eastern Europe Central Europe & Central Asia [ million] Middle East & North Africa [ ] Sub-Saharan Africa 22.5 million [ million] 1.6 million [ million] East Asia [ ] South & South-East Asia 4.0 million [3.3 Oceania 5.1 million] [ ] Total: 33.2 ( ) million

11 Estimated Number of Adults & Children Newly Infected with HIV, 2007 North America [ ] Caribbean [ ] Latin America [ ] Western & Eastern Europe Central Europe & Central Asia [ ] Middle East & North Africa [ ] Sub-Saharan Africa 1.7 million [ million] [ ] East Asia [ ] South & South-East Asia [ Oceania ] [ ] Total: 2.5 ( ) million

12 Over 6,800 new HIV infections Occurred EVERYDAY in 2007 More than 96% are in low and middle income countries About 1,200 are in children under 15 years of age About 5,800 are in adults aged 15 years and older of whom: about 40% are among young people (15-24)

13 Where Did AIDS Come From?

14 Lentivirus What Type of Virus is HIV? Found in a number of different animals, including cats, sheep, horses and cattle. However, the most interesting lentivirus in terms of the investigation into the origins of HIV is the Simian Immunodeficiency Virus (SIV) that affects monkeys. It is now generally accepted that HIV is a descendant of a Simian Immunodeficiency Virus because certain strains of SIVs bear a very close resemblance to HIV-1 and HIV-2, the two types of HIV.

15 Microbes Flourish In the Wake of Human Development Small pox, TB, and anthrax probably jumped from cattle to humans during the process of domestication Influenza evolved from pig and chicken diseases Common cold from horse disease Measles & rabies from dog disease More recent developments in farming have marked the possible spread of West Nile & Avian Flu

16 What Caused the Epidemic to Spread Globally so Suddenly? Travel Blood Industry Drug Use

17 The Epidemics in Sub-Saharan Africa

18 How Did HIV Spread in Africa? Adult HIV prevalence (%) in Africa 20%-30% 10%-20% 5%-10% 1%-5% 0%-1% data unavailable

19 Adult HIV Prevalence in Africa Source : UNAIDS, 2006

20 Why are HIV Rates so much Higher in Sub-Saharan Africa?

21 Ecological Model for HIV Risk in Southern Africa Condom Usage, Circumcision, HSV-2/GUD, Viral Load, Acute Infection, Age of Coital Debut, Marriage, ARV Status Individual Risks for HIV Infection Widening Risk Contexts for HIV Infection Beyrer & Baral, 2006

22 Sexual Mixing What matters is not the # of partners, but who those partners were. For example, perhaps Africans were more susceptible to HIV because of sexual mixing between high-risk groups, such as prostitutes, miners, truck drivers, and others. Seemed to be the key in the early 1990s. But then, the epidemic began to spread teachers, shop owners, government ministers. Everyone was AT RISK!

23 Concurrency Theory Figure courtesy of the University of Chicago Press. From the American Journal of Sociology, Vol. 100, No. 1. "Chains of affection: The structure of adolescent romantic and sexual networks," Bearman PS, Moody J, Stovel K.

24 Why are Women at Higher Risk? In Africa, infection rates among young women are at least twice the rates among young men In certain regions, adolescent women are as much as 6x more likely than men to be infected

25 Biological Reasons Women are at Higher Risk than Men, Globally The risk of becoming HIV infected during unprotected sex is 2 to 4 times greater for a woman than for a man Male-to-female transmission is more likely During vaginal intercourse a woman has a larger surface area of her genital tract exposed to her partner's sexual secretions than does a man HIV concentration is generally higher in a man's semen than in a woman's sexual secretions

26 Biological Reasons Adolescents are at Higher Risk than Adult Women, Globally Adolescent women are at even greater risk than adult women The vagina and cervix of young women are less mature and are less resistant to HIV Changes in the reproductive tract during puberty make the tissue more susceptible to penetration by HIV Hormonal changes associated with the menstrual cycle often are accompanied by a thinning of the mucus plug, the protective sealant covering the cervix Such thinning can allow HIV to pass more easily Young women produce only scant vaginal secretions, providing little barrier to HIV transmission

27 ARV Therapy

28 ARVs Don t Cure HIV, So What Do They Do? These drugs can: slow the spread of HIV in the body, keep virus levels in the blood low, and help prevent AIDS-related infections.

29 ARV Therapy: Global Need, June % of the total unmet need (Number of people in millions) Unmet need Receiving ARV therapy Sub-Saharan Africa Latin America and the Caribbean East, South and South-East Asia Europe and Central Asia North Africa and the Middle East

30 Children's Access to HIV Tx, June 2008 Africa Median: 8% Latin America Median: 8% Asia Median: 5 %

31 ARV Therapy: Summary For every person put on ART, 6 new HIV infections Failure to reach children and pregnant women Lack of human resources, lab support, and health infrastructure High mortality (5-15%) in the first year of ART Malnutrition & Co-morbidities

32 HIV & AIDS are NOT Stand Alone Dx s HIV+ individuals are more susceptible to Malaria and TB because their immune systems are weaker!

33 Unmet Need for Dual Treatment of TB in People Living with HIV, by Region, Unmet need Treated Number Number Latin Eastern America Europe & Central Asia East Asia CaribbeanOceania Middle East & North Africa Western & Central Europe 0 GLOBAL (76) Sub- Saharan Africa (22) South & South- East Asia (8) Latin America (14) Eastern Europe & Central Asia (12) East Asia (2) CaribbeanOceania (10) (2) Middle East & North Africa (3) Western & Central Europe (3) 5.8 Source: UNGASS Country Progress Reports 2008.

34 Nutrition & HIV/AIDS

35 AIDS & Famine

36 Global Impact of HIV Negative economic impact on countries Overwhelmed healthcare systems Decreasing life expectancy and quality of life Deteriorating child survival rates Increasing numbers of orphans Famine

37 What Can We Do? QuickTime and a TIFF (Uncompressed) decompressor are needed to see this picture. QuickTime and a TIFF (Uncompressed) decompressor are needed to see this picture. Join AIDS.gov to promote this important day!

38 What Can We Do? Roots & Shoots, a program of the Jane Goodall Institute, is a powerful, youthdriven, global network of more than 8,000 groups in almost 100 countries. Together, youth of all ages are taking action to improve our world through service learning projects that promote care and concern for animals, the environment and the human community.

39 THANK YOU! QuickTime and a TIFF (Uncompressed) decompressor are needed to see this picture.