AIDS Acquired Immune Deficiency Syndrom

HIV and AIDS World, Europe and Poland Dorota Chrominska-Szosland MD, PhD Nofer Institute of Occupational Medicine Lodz-Poland HIV Human Immunodeficiency Virus AIDS Acquired Immune Deficiency Syndrom 1

Adults and children estimated to be living with HIV, 2005 Western & Eastern Europe North America & Central Asia Central Europe 1.3 mln 1.5 mlnm 720 000 East Asia 680 000 Caribbean North Africa & Middle 330 000 East 7South & 440 000 South-East Asia Latin America Sub-Saharan.6 mln 1.6 mln Africa Oceania 24.5 mln 78 000 Total: 38.6 (33.4 46.0) mln Estimated number of people living with HIV globally, 1986 2006 Mllion Number of people living with HIV 50 40 30 20 10 0 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2

Estimated number of people living with HIV globally, 1986 200626 Number of people living with HIV Mllion 45 40 35 30 25 20 15 10 5 Oceania NorthAfrica& MiddleEast Europe & Central Asia Latin America & Caribbean North America & Western Europe Asia Sub-Saharan Africa 0 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 HIV/AIDS CUBA (1) 1983 National AIDS Commitee anihilation all blood products, which were comming not from Cuba ban of blood importation all blood donors on Cuba had to be tested 1984 epidemiologic supervision system for AIDS symptom detection 1985 first AIDS case on Cuba 3

HIV/AIDS CUBA (2) 1986 HIV tests production on Cuba screening for HIV people who later than 1975 were traveling abroad for countries where HIV infections were detected screening for HIV sexual partners infected people (every 3 months through 1 year) 1986 sanatoriums for HIV infected people 1987 first report from Cuba HIV/AIDS CUBA (3) Effective national program against AIDS : intensive education of infected people (6-8 weeks in sanatorium) obligatory HIV tests for pregnant women HIV infected people obliged to give names all sexual partners from last 6 months HIV tests done in all STD (sexual transmited diseases) infected people people encourage to voluntary HIV tests 4

Estimated number of adults and children newly infected with HIV, 2005 Western & Eastern Europe North America & Central Asia Central Europe 22 000 220 000 43 000 East Asia North Africa & Middle 97 000 Caribbean East 37 000 64 000 South & South- East Asia Latin America Sub-Saharan 830 000 140 000 Africa(65%) Oceania 2,7 mln 7 200 Total: 4,1 (3,4 6.2) mln Estimated adult and child deaths from AIDS, 2005 Western & Eastern Europe North America & Central Asia Central Europe 18 000 53 000 12 000 East Asia North Africa & Middle 33 000 Caribbean East 27 000 37 000 South & South-East Asia Latin America Sub-Saharan 560 000 59 000 Africa Oceania 2,0 mln 3 400 Total: 2,8 (2,4 3,3) mln 5

Estimated adult and child deaths from AIDS, 1986 2006 Number of deaths due to AIDS Million 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 Children (<15 years) estimated to be living with HIV, 2005 Western & Eastern Europe North America & Central Asia Central Europe 11 000 69 000 4 000 East Asia North Africa & Middle 6 400 Caribbean East 22 000 31 000 South & South-East Asia Latin America Sub-Saharan 170 000 32 000 Africa Oceania 2,0 mln 3 000 Total: 2,3 (1,7 3,5) mln 6

Estimated number of children (<15 years) newly infected with HIV, 2005 Western & Eastern Europe North America & Central Asia Central Europe 500 23002 200 East Asia North Africa & Middle 2 300 Caribbean East 3 700 6900 South & South-East Asia Latin America Sub-Saharan 44 000 5 000 Africa Oceania 470 000 1 100 Total: 540 000 (420 000 670 000) Estimated deaths in children (<15 years) from AIDS, 2005 Western & Eastern Europe North America & Central Asia Central Europe less 100 12001 less 100 East Asia North Africa & Middle 1 400 Caribbean East 3 100 4 900 South & South- East Asia Latin America Sub-Saharan 29 000 2 900 Africa Oceania 330 000 600 Total: 380 000 (290 000 500 000) 7

Over 11 000 new HIV infections a day in 2005 More than 95% are in low and middle income countries About 1500 are in children under 15 years of age About 1500 are in children under 15 years of age About 10 000 are in adults aged 15 years and older of whom: almost 50% are among women over 40% are among young people (15-24) 25 years of AIDS Million 50 45 40 35 30 25 20 15 10 5 1 First cases of unusual immune deficiency are identified among gay men in USA, and a new deadly disease noticed 2 Acquired Immune Deficiency Syndrome (AIDS) is defined for the first time 3 The Human Immune Deficiency Virus (HIV) is identified as the cause of AIDS 4 In Africa, a heterosexual AIDS epidemic is revealed 5 The first HIV antibody test becomes 6 Global available Network of People living with HIV/AIDS (GNP+) (then International Steering Committee of People Living with HIV/AIDS) founded 7 The World Health Organisation launches the Global Programme on 10 AIDS 8 The first therapy for AIDS zidovudine, or AZT -- is 9 approved for use in the USA 1 2 3 4 5 6 7 8 0 1980 1985 1990 1995 2000 2005 11 12 13 People living with HIV 14 15 16 Children orphaned by AIDS in sub- Saharan Africa 9 In 1991-1993, HIV prevalence in young pregnant women in Uganda and in young men in Thailand begins to decrease, the first major downturns in the epidemic in developing countries 10 Highly Active Antiretroviral Treatment launched 11 Scientists develop the first treatment regimen to reduce motherto-child transmission of HIV 12 UNAIDS is created 13 Brazil becomes the first developing country to provide antiretroviral therapy through its public health system 14 The UN General Assembly Special Session on HIV/AIDS. Global Fund to fight AIDS, Tuberculosis and Malaria launched 15 WHO and UNAIDS launch the "3 x 5" initiative with the goal of reaching 3 million people in developing world with ART by 2005 16 Global Coalition on Women and AIDS launched 1.1 8

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HIV/AIDS ROMANIA The beginning of 90-ies 1094 HIV infections in children The reason: giving small amount of infected blood (5-10 ml) for immunity raising insufficient equipment sterilization 50% of children died within 2 years Till 2002-12 559 HIV/AIDS cases 9 936 cases in children; 2 358 died from AIDS 14

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HIV and AIDS in Poland 1985 February 2007 Adult and children infected 10 10696 Persons infected due to to intravenous drug using 5 396 AIDS cases 1 884 AIDS deaths --847 38

HIV/AIDS epidemiological situation in Poland in the years 1986-2005 AIDS cases AIDS cases deaths due to AIDS HIV infections HIV infections registered in Poland in the years 1985 2005 by age no data 39

HIV in Poland Average annual rates of HIV infections reported at the National Institute of Hygiene as newly detected in the years 2001-2005 (by voivodeships) Number of infected (100 000) AIDS in Poland Average annual rates of AIDS reported at the National Institute of Hygiene detected in the years 2001-2005 (by voivodeships) Morbidity of diseaser (100 000) 40

Average rates of HIV infections recorded in 2005 by voivodeships (per 1000 000 inhabitants) POLAND POLSKA Dolnośląskie Pomorskie Warm-Mazurskie Łódzkie Opolskie Mazowieckie Sląskie Kujawsko-Pomorskie Kujaw-Pomorskie Zachodniopomorskie Małopolskie Podlaskie Lubelskie Podkarpackie Wielkopolskie Świętokrzyskie 1,21 1,4 1,52 1,16 1,09 0,94 0,83 0,67 0,6 0,57 0,53 0,31 1,72 4,19 2,38 2,69 1,94 0 1 2 3 4 5 Possible ways of AIDS transmission in the years 2001-2005 41

HIV infections in Poland in the years 1985 2005 by age brak danych 4 >50 4 40-49 9 30-39 25 20-29 50 <20 8 0 10 20 30 40 50 Years 2001 The HIV epidemiological situation in voivodeship lodzkie: 2001-2005 Total 50 HIV infections Incidence rate 1,9 Intravenous drug users(%) 48,0 2002 52 2,0 36,5 2003 73 2,8 41,1 2004 61 2,3 44,3 2005 39 1,5 38,5 42

Years 2001 The AIDS epidemiological situation in voivodeship lodzkie: 2001-2005 Total 5 AIDS Incidence rate 0,19 Deaths 2 2002 8 0,31 6 2003 6 0,23 3 2004 12 0,46 7 2005 20 0,77 3 43