The acquired immune deficiency syndrome (AIDS) pandemic is a widespread disease caused by the human immunodeficiency virus (HIV).
Since AIDS was first recognized in 1981, it has led to the deaths of more than 25 million people, making it one of the most destructive diseases in recorded history.
Despite recent improved access to antiretroviral treatment and care in many regions of the world, in 2007 the AIDS pandemic killed an estimated 2.1 million people, including 330,000 children.[1] As of 2009, it is estimated that there are 33.3 million people worldwide living with HIV/AIDS, with 2.6 million new HIV infections per year and 1.8 million annual deaths due to AIDS.[2] This has been attributed to lack of access to antiretroviral treatment in huge areas such as the continent of Africa, where, according to French researcher Olivier Schwartz, less than 10 percent of infected are reported to have access to it.[3]
According to some researchers and institutions the situation is more serious than the UNAIDS figures suggest, the epidemic is accelerating[4] and a second wave is developing (2002 report).[5] It has also been claimed that UNAIDS has historically overstated the AIDS pandemic and that the postulated second wave will not occur.[6]
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The origin of HIV/AIDS has been elucidated by studies of the HIV genome, which indicate that the most common type of HIV (HIV-1) originated in chimpanzees.[7]
The pandemic is not homogeneous within regions, with some countries more afflicted than others. Even at the country level, there are wide variations in infection levels between different areas. The number of people infected with HIV continues to rise in most parts of the world, despite the implementation of prevention strategies, Sub-Saharan Africa being by far the worst-affected region, with an estimated 22.5 million at the end of 2007, 68% of the global total. South and South East Asia have an estimated 12% of the global total.[1]
| World region | Estimated adult prevalence of HIV infection (ages 15–49) |
Estimated adult and child deaths during 2007 |
Adult prevalence (%) |
|---|---|---|---|
| Worldwide | 30.6 million – 36.1 million | 1.9 to 2.4 million | 0.8% |
| Sub-Saharan Africa | 20.9 million – 24.3 million | 1.6 million | 5.0% |
| South and South-East Asia | 3.3 million – 5.1 million | 270,000 | 0.3% |
| Eastern Europe and Central Asia | 1.2 million – 2.1 million | 55,000 | 0.9% |
| Central and South America | 1.4 million – 1.9 million | 58,000 | 0.5% |
| North America | 480,000 – 1.9 million | 21,000 | 0.6% |
| Western and Central Europe | 600,000 – 1.1 million | 12,000 | 0.3% |
| East Asia | 620,000 – 960,000 | 32,000 | 0.1% |
Source: UNAIDS 2007 estimates. The ranges define the boundaries within which the actual numbers lie, based on the best available information.[8]
Sub-Saharan Africa remains the hardest-hit region. HIV infection is becoming endemic in sub-Saharan Africa, which is home to just over 10% of the world’s population but more than 60% of all people infected with HIV. The adult (ages 15–49) HIV prevalence rate is 7.2% (range: 6.6–8.0%) with between 20.9 million and 24.3 million. However, the actual prevalence varies between regions. Presently, Southern Africa is the hardest hit region, with adult prevalence rates exceeding 20% in most countries in the region, and 30% in Swaziland and Botswana.
Eastern Africa also experiences relatively high levels of prevalence with estimates above 10% in some countries, although there are signs that the pandemic is declining in this region. West Africa on the other hand has been much less affected by the pandemic. Several countries reportedly have prevalence rates around 2 to 3%, and no country has rates above 10%. In Nigeria and Côte d'Ivoire, two of the region's most populous countries, between 5 and 7% of adults are reported to carry the virus.
Across Sub-Saharan Africa, more women are infected with HIV than men, with 13 women infected for every 10 infected men. This gender gap continues to grow. Throughout the region, women are being infected with HIV at earlier ages than men. The differences in infection levels between women and men are most pronounced among young people (aged 15–24 years). In this age group, there are 36 women infected with HIV for every 10 men. The widespread prevalence of sexually transmitted diseases, the practice of scarification, unsafe blood transfusions, and the poor state of hygiene and nutrition in some areas may all be facilitating factors in the transmission of HIV-1 (Bentwich et al., 1995).
Mother-to-child transmission is another contributing factor in the transmission of HIV-1 in developing nations. Due to a lack of testing, a shortage in antenatal therapies and through the feeding of contaminated breast milk, 590,000 infants born in developing countries are infected with HIV-1 per year. In 2000, the World Health Organization estimated that 25% of the units of blood transfused in Africa were not tested for HIV, and that 10% of HIV infections in Africa were transmitted via blood.
Poor economic conditions (leading to the use of dirty needles in healthcare clinics) and lack of sex education contribute to high rates of infection. In some African countries, 25% or more of the working adult population is HIV-positive. Poor economic conditions caused by slow onset-emergencies, such as drought, or rapid onset natural disasters and conflict can result in young women and girls being forced into using sex as a survival strategy.[10] Worse still, research indicates that as emergencies, such as drought, take their toll and the number of potential 'clients' decreases, women are forced by clients to accept greater risks, such as not using contraceptives.[10]
Former South African President Thabo Mbeki and some of his political allies notably questioned the connection between HIV and AIDS, stating instead that factors such as undernourishment caused AIDS. Critics charge that the AIDS denialist policies of Mbeki's administration impeded the creation of effective programs for distribution of antiretroviral drugs, causing several hundred thousand unnecessary deaths.[11][12] UNAIDS estimates that in 2005 there were 5.5 million people in South Africa infected with HIV — 12.4% of the population. This was an increase of 200,000 people since 2003.
Although HIV infection rates are much lower in Nigeria than in other African countries, the size of Nigeria's population meant that by the end of 2003, there were an estimated 3.6 million people infected. On the other hand, Uganda, Zambia, Senegal, and most recently Botswana have begun intervention and educational measures to slow the spread of HIV, and Uganda has succeeded in actually reducing its HIV infection rate.
HIV/AIDS prevalence in the Middle East and North Africa is around 0.2% (0.1–0.7%), with between 230,000 and 1.4 million people infected. Among young people 15–24 years of age, 0.3% of women [0.1–0.8%] and 0.17% of men [0.1–0.3%] were living with HIV infection by the end of 2004.
The HIV prevalence rate in South and South-East Asia is less than 0.35 percent, with total of 4.2 – 4.7 million adults and children infected. More AIDS deaths (480,000) occur in this region than in any other except sub-Saharan Africa. The geographical size and human diversity of South and South-East Asia have resulted in HIV epidemics differing across the region. The AIDS picture in South Asia is dominated by the epidemic in India. In South and Southeast Asia, the HIV epidemic remains largely concentrated in injecting drug users, men who have sex with men, sex workers, and clients of sex workers and their immediate sexual partners.[13] Migrants, in particular, are vulnerable and 67% of those infected in Bangladesh and 41% in Nepal are migrants returning from India.[13] This is in part due to human trafficking and exploitation, but also because even those migrants who willingly go to India in search of work are often afraid to access state health services due to concerns over their immigration status. [13]
The national HIV prevalence levels in East Asia is 0.1% in the adult (15–49) group. However, due to the large populations of many East Asian nations, this low national HIV prevalence still means that large numbers of people are infected with HIV. The picture in this region is dominated by China. Much of the current spread of HIV in China is through injecting drug use and paid sex. In China, the number was estimated at between 430,000 and 1.5 million by independent researchers, with some estimates going much higher. In the rural areas of China, where large numbers of farmers, especially in Henan province, participated in unclean blood transfusions; estimates of those infected are in the tens of thousands. In Japan, just over half of HIV/AIDS cases are officially recorded as occurring amongst homosexual men, with the remainder occurring amongst heterosexuals and also via drug abuse, in the womb or unknown means.
The Caribbean is the second-most affected region in the world. Among adults aged 15–44, AIDS has become the leading cause of death. The region's adult prevalence rate is 1.6% with national rates ranging from 0.2% to 2.7%.[14] HIV transmission occurs largely through heterosexual intercourse, with two thirds of AIDS cases in this region attributed to this route. Sex between men is also a significant route of transmission, even though it is heavily stigmatised and illegal in many areas. HIV transmission through injecting drug use remains rare, except in Bermuda and Puerto Rico.
In these regions of the American continent, only Guatemala and Honduras have national HIV prevalence of over 1%. In these countries, HIV-infected men outnumber HIV-infected women by roughly 3:1.
The adult prevalence rate in this region is 0.7% with over 1 million people currently infected with HIV. In the United States from 2001–2005, the highest transmission risk behaviors were sex between men (40–49% of new cases) and high risk heterosexual sex (32–35% of new cases).[15] Currently, rates of HIV infection in the US are highest in the eastern and southern regions, with the exception of California. Currently, 35,000–40,000 new infections occur in the USA every year. AIDS is one of the top three causes of death for African American men aged 25–54 and for African American women aged 35–44 years in the United States of America. In the United States, African Americans make up about 48% of the total HIV-positive population and make up more than half of new HIV cases, despite making up only 12% of the population. The main route of transmission for women is through unprotected heterosexual sex. African American women are 19 times more likely to contract HIV than other women.[16] Experts attribute this to "AIDS fatigue" among younger people who have no memory of the worst phase of the epidemic in the 1980s and early 1990s, as well as "condom fatigue" among those who have grown tired of and disillusioned with the unrelenting safer sex message. This trend is of major concern to public health workers.
In the United States in particular, a new wave of infection is being blamed on the use of methamphetamine, known as crystal meth. Research presented at the 12th Annual Retrovirus Conference in Boston in February 2005 concluded that using crystal meth or cocaine is the biggest single risk factor for becoming HIV+ among US gay men, contributing 29% of the overall risk of becoming positive and 28% of the overall risk of being the receptive partner in anal sex.[17] In addition, several renowned clinical psychologists now cite methamphetamine as the biggest problem facing gay men today, including Michael Majeski, who believes meth is the catalyst for at least 80% of seroconversions currently occurring across the United States, and Tony Zimbardi, who calls methamphetamine the number one cause of HIV transmission, and says that high rates of new HIV infection are not being found among non-crystal users. In addition, various HIV and STD clinics across the United States report anecdotal evidence that 75% of new HIV seroconversions they deal with are methamphetamine-related; indeed, in Los Angeles, methamphetamine is regarded as the main cause of HIV seroconversion among gay men in their late thirties.[17] The First National Conference on Methamphetamine, HIV and Hepatitis took place in Salt Lake City in August 2005.
In Canada, nearly 60,000 people were living with HIV/AIDS in 2005.[18] The HIV-positive population continues to increase in Canada, with the greatest increases amongst aboriginal Canadians.[19]
As in Western Europe, the death rate from AIDS in North America fell sharply with the introduction of combination AIDS therapies (HAART).
There is also growing concern about a rapidly growing epidemic in Eastern Europe and Central Asia, where an estimated 0.99–2.3 million people were infected in December 2005, though the adult (15–49) prevalence rate is low (0.9%). The rate of HIV infections began to grow rapidly from the mid-1990s, due to social and economic collapse, increased levels of intravenous drug use and increased numbers of prostitutes. By 2004 the number of reported cases in Russia was over 257,000, according to the World Health Organization, up from 15,000 in 1995 and 190,000 in 2002; some estimates claim the real number is up to five times higher, over 1 million. There are predictions that the infection rate in Russia will continue to rise quickly, since education there about AIDS is almost non-existent. Ukraine and Estonia also had growing numbers of infected people, with estimates of 500,000 and 3,700 respectively in 2004. The epidemic is still in its early stages in this region, which means that prevention strategies may be able to halt and reverse this epidemic. However, transmission of HIV is increasing through sexual contact and drug use among the young (<30 years). Indeed, over 80% of current infections occur in this region in people less than 30 years of age.
In most countries of Western Europe, AIDS cases have fallen to levels not seen since the original outbreak; many attribute this trend to aggressive educational campaigns, screening of blood transfusions and increased use of condoms. Also, the death rate from AIDS in Western Europe has fallen sharply, as new AIDS therapies have proven to be an effective (though expensive) means of suppressing HIV.
In this area, the routes of transmission of HIV is diverse, including paid sex, injecting drug use, mother to child, male with male sex and heterosexual sex. However, many new infections in this region occur through contact with HIV-infected individuals from other regions. The adult (15–49) prevalence in this region is 0.3% with between 570,000 and 890,000 people currently infected with HIV infection. Due to the availability of antiretroviral therapy, AIDS deaths have stayed low since the lows of the late 1990s. However, in some countries, a large share of HIV infections remain undiagnosed and there is worrying evidence of antiretroviral drug resistance among some newly HIV-infected individuals in this region.
There is a very large range of national situations regarding AIDS and HIV in this region. This is due, in part, to the large distances between the islands of Oceania. The wide range of development in the region also plays an important role. The prevalence is estimated at between 0.2% and 0.7%, with between 45,000 and 120,000 adults and children currently infected with HIV.
Papua New Guinea has one of the most serious AIDS epidemics in the region. According to UNAIDS, HIV cases in the country have been increasing at a rate of 30 percent annually since 1997, and the country's HIV prevalence rate in late 2006 was 1.3%.[20]
In June 2001, the United Nations held a Special General Assembly to intensify international action to fight the HIV/AIDS epidemic as a global health issue, and to mobilize the resources needed towards this aim, labelling the situation a "global crisis".[21]
Regarding the social effects of the HIV/AIDS pandemic, some sociologists suggest that AIDS has caused a "profound re-medicalization of sexuality".[22][23]
Social factors also influence HIV/AIDS. A 2003 study states that HIV and AIDS are less prevalent in Muslim populations and speculates that this may be due to the effect of several Islamic tenets, such as the avoidance of extramarital affairs and the "benefits arising from circumcision".[24]
There are numerous initiatives and campaigns which have been used to curb the spread of HIV, such as the Abstinence, be faithful, use a condom or ABC campaign, in Africa and other parts of the world.
One of the greatest problems many countries with high prevalence face is "HIV fatigue", where populations are not interested in hearing more about a disease they hear about constantly. In order to address this, novel approaches are often required. In 2011, the Botswana Ministry of Education will be introducing new HIV/AIDS educational technology for schools. The TeachAIDS prevention education software, developed at Stanford University, will be distributed to every primary, secondary, and tertiary educational institution in the country, reaching all learners from 6 to 24 years of age nationwide.[25]
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