20080729 Global Report Graphics En

Selected events in the global response to the epidemic Millennium Declaration and launch of the Millennium development goals Global Programme on AIDS launched by WHO First International AIDS Conference held in Atlanta, United States

1985 1987

UN General Assembly Special Session on HIV/AIDS (UNGASS) 189 Member States signed the Declaration of Commitment

UN General Assembly Political declaration on Universal Access to Prevention, Treatment, Care and Support G8 commitment to Universal Access to Treatment

Core indicators for monitoring the Declaration of Commitment on HIV/AIDS developed

2000

2001 2002

Millennium Development Goals Universal Access Targets

147 Member States submit UNGASS Country Progress Reports

2005 2006

2008

2010

2015

Midway to Millennium Development Goals

Figure 1.1

2008 Report on the global AIDS epidemic

FIRST OF 2 PARTS:

National indicators for the implementation of the Declaration of Commitment on HIV/AIDS

National Commitment and Action 1 2

Domestic and international AIDS spending by categories and financing sources National Composite Policy Index (Areas covered: gender, workplace programmes, stigma and discrimination, prevention, care and support, human rights, civil society involvement, and monitoring and evaluation)

National Programmes (Blood safety, antiretroviral therapy coverage, prevention of mother-to-child transmission, co-management of TB and HIV treatment, HIV testing, prevention programmes, services for orphans and vulnerable children, and education) National Indicators 3 4 5

Percentage of donated blood units screened for HIV in a quality assured manner Percentage of adults and children with advanced HIV infection receiving antiretroviral therapy Percentage of HIV-positive pregnant women who received antiretrovirals to reduce the risk of mother-to-child transmission 6 Percentage of estimated HIV-positive incident TB cases that received treatment for TB and HIV 7 Percentage of women and men aged 15-49 who received an HIV test in the last 12 months and who know their results 8 Percentage of most-at-risk populations that have received an HIV test in the last 12 months and who know their results 9 Percentage of most-at-risk populations reached with HIV prevention programmes 10 Percentage of orphaned and vulnerable children aged 0–17 whose households received free basic external support in caring for the child 11 Percentage of schools that provided life skills-based HIV education in the last academic year

Table 1a

2008 Report on the global AIDS epidemic

LAST OF 2 PARTS:

National indicators for the implementation of the Declaration of Commitment on HIV/AIDS

Knowledge and Behaviour 12 Current school attendance among orphans and among non-orphans aged 10–14* 13 Percentage of young women and men aged 15–24 who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission* 14 Percentage of most-at-risk populations who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission 15 Percentage of young women and men aged 15–24 who have had sexual intercourse before the age of 15 16 Percentage of women and men aged 15–49 who have had sexual intercourse with more than one partner in the last National Indicators 12 months 17 Percentage of women and men aged 15–49 who had more than one sexual partner in the past 12 months reporting the use of a condom during their last sexual intercourse* 18 Percentage of female and male sex workers reporting the use of a condom with their most recent client 19 Percentage of men reporting the use of a condom the last time they had anal sex with a male partner 20 Percentage of injecting drug users reporting the use of a condom the last time they had sexual intercourse 21 Percentage of injecting drug users reporting the use of sterile injecting equipment the last time they injected

Impact 22 Percentage of young women and men aged 15–24 who are HIV infected* 23 Percentage of most-at-risk populations who are HIV infected 24 Percentage of adults and children with HIV known to be on treatment 12 months after initiation of antiretroviral therapy 25 Percentage of infants born to HIV-infected mothers who are infected * Millennium Development Goals indicator Table 1b

2008 Report on the global AIDS epidemic

Percentage of UN member states reporting by region, 2004–2008 Year of reporting (UN Member States reporting/total number of UN Member States) 2006 (122/191)

2004 (102/189)

2008 (147/192)

100 80 60 % 40 20 0

Caribbean (13)

Latin America (20)

Eastern Europe and Central Asia

SubSaharan Africa

(19)

(47)

South and SouthEast Asia (20)

East Asia (5)

Oceania Western (14) and Central Europe (32)

North America (2)

North Africa and Middle East (20)

(total number of UN Member States in the region) Figure 1.2

Source: UNGASS Country Progress Reports 2008.

2008 Report on the global AIDS epidemic

Percentage of countries with Monitoring and Evaluation components in place, 2005 and 2007 2005

Percentage of countries (%)

100

2007

80 60 40 20 0 One national The Monitoring The Monitoring Monitoring and and Evaluation and Evaluation Evaluation plan plan is endorsed plan has is available by key partners associated budget

Figure 1.3

Source: UNGASS Country Progress Reports 2008.

Funding of Monitoring and Evaluation is secured

A functional National Monitoring and Evaluation unit is present

A central HIV database is present

2008 Report on the global AIDS epidemic

Global trends in monitoring and evaluation system strengthening, 2005 and 2007 2005

basic elements* in place one or more basic elements* missing

2007

no trend data available

* One national monitoring and evaluation plan including budgetary requirements and with funding secured; a functional national monitoring and evaluation unit and/or monitoring and evaluation working group; a central national HIV database.

Figure 1.4

Source: UNGASS Country Reports 2006, 2008.

2008 Report on the global AIDS epidemic

Selected events in tracking the epidemic Guidelines on second generation HIV surveillance Global Programme on AIDS launched by WHO The first HIV antibody test becomes available

1985 1987

First Demographic and Health Surveys with HIV prevalence measurement in Mali and Zambia

First Reference Group on Estimates, Modelling and Projections meeting

1998

As of 2007, 31 countries have conducted populationbased surveys with HIV prevalence measurement

Universal Access Targets

First global series of regional training workshops on estimation methods for national epidemics

2000

2001

2003

2007 2008

UN General Assembly Special Session on HIV/AIDS June 2001/ 189 Member States signed the Declaration of Commitment Figure 2.1

Millennium Development Goals

2010

2015

Midway to Millennium Development Goals

2008 Report on the global AIDS epidemic

A global view of HIV infection 33 million people [30–36 million] living with HIV, 2007

Figure 2.2

2008 Report on the global AIDS epidemic

Analysis of trends among 15–24-year-olds in high prevalence countries

FIRST OF 3 PARTS:

(all countries with national prevalence that exceeded 3% and 4 additional countries in Africa with notable prevalence levels):

HIV prevalence among pregnant women (2000–2007) in sentinel surveillance systems, and selected sexual behaviours among women and men (1990–2007) from national surveys Prevalence trenda

COUNTRY Time period for which prevalence data were available

ANGOLAa BAHAMAS

Females

Males

ID

ID



BENINb

2000–2006

BOTSWANA

2001–2006

BURKINA FASO

2000–2006

Percent of young people (15–19 years) having had sex before age 15b Females

Males

Proportion having sex with more than one partner in the last 12 monthsc

Condom use during last sex among those with more than one partner in the last 12 monthsd

Females

Females

Males

Males

  ↔

* *

↔

*

*







*

↔ *  * * * * * BURUNDI 1999–2004 ↔  [2]* Consistent sites only * NOTES: [1] Highlighted cells indicate positive trends in prevalence or behaviour. were used in the analysis of change in HIV prevalence over time, for a minimum of three years. Significance test based on H0: slope =0

CAMEROONa CENTRAL AFRICAN REPUBLICb CHADa

ID  

ID  

ID

ID

ID

ID

Table 2a

CONGOa

*

*





*



*

*

*



*



*



2008 Report on the global AIDS epidemic

SECOND OF 3 PARTS:

Analysis of trends among 15–24-year-olds in high prevalence countries

(all countries with national prevalence that exceeded 3% and 4 additional countries in Africa with notable prevalence levels):

HIV prevalence among pregnant women (2000–2007) in sentinel surveillance systems, and selected sexual behaviours among women and men (1990–2007) from national surveys Prevalence trenda

COUNTRY Time period for which prevalence data were available

Females

Males

DJIBOUTIb

 

 

ETHIOPIAb

 

 

GABONb

 

 

GAMBIAb

 

 

Percent of young people (15–19 years) having had sex before age 15b Females

*

Males

*

Proportion having sex with more than one partner in the last 12 monthsc

Condom use during last sex among those with more than one partner in the last 12 monthsd

Females

Females

*

Males

*

Males



b GHANA   NOTES: [1] Highlighted cells indicate positive trends in prevalence or behaviour. [2]* Consistent  sites only were the analysis ↔ of change in↔ HIV prevalence * used in * * over time, for

a minimum of three years. Significance test based on H0: slope =0

HAITIb

 

KENYA LESOTHO Table LIBERIA 2b b

2000–2005 a

 

*

2003–2007

* 

↔  

 

*

*







*

↔

↔

*

*



* 2008 Report on the global AIDS epidemic

Analysis of trends among 15–24-year-olds in high prevalence countries

LAST OF 3 PARTS:

(all countries with national prevalence that exceeded 3% and 4 additional countries in Africa with notable prevalence levels):

HIV prevalence among pregnant women (2000–2007) in sentinel surveillance systems, and selected sexual behaviours among women and men (1990–2007) from national surveys Prevalence trenda

COUNTRY Time period for which prevalence data were available

NIGERIAa RWANDA

Females

  1998–2003

Females

Males

Proportion having sex with more than one partner in the last 12 monthsc

Condom use during last sex among those with more than one partner in the last 12 monthsd

Females

Females

Males

Males

  ND



SIERRA LEONEa SOUTH AFRICAg

Males

Percent of young people (15–19 years) having had sex before age 15b

ID

*

*



*

↔

ID ↔

2000–2006

*

NOTES: [1] Highlighted cells indicate positive trends in prevalence or behaviour. [2]* Consistent sites only were used in the analysis of change in HIV prevalence over time, for

a SUDAN a minimum of three years. Significance test based on H0: slope =0

SWAZILAND

 

2002–2006



 



TOGOa

 

 

UGANDAb

 

 

*



↔

↔

*



↔

*

*

*

*

Table 2c

UNITED REPUBLIC OF TANZANIA

2000–2006

↔

*

2008 Report on the global AIDS epidemic

*

Estimated number of people living with HIV and adult HIV prevalence Global HIV epidemic, 1990–2007; and, HIV epidemic in Sub-Saharan Africa, 1990–2007 Global HIV epidemic, 1990–2007 Number of people living with HIV (millions)

HIV epidemic in Sub-Saharan Africa, 1990–2007

% HIV prevalence, adult (15–49)

40

4.0

30

3.0

20

2.0

10

1.0

Number of people living with HIV (millions)

% HIV prevalence, adult (15–49)

30

15.0

25

12.0

20

9.0

15 6.0

10

3.0

5 0

1990 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 2000 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 2007

0

0

1990 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 2000 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 2007

Number of people living with HIV % HIV prevalence, adult (15–49) These bars indicate the range around the estimate

Figure 2.3

0

NOTE: Even though the HIV prevalence stabilized in Sub-Saharan Africa, the actual number of people infected continues to grow because of ongoing new infections and increasing access to antiretroviral therapy.

2008 Report on the global AIDS epidemic

Percent of adults (15+) living with HIV who are female 1990–2007 70 Sub-Saharan Africa

60

GLOBAL

50 Percent female (%)

Caribbean

40

Asia

30

Latin America

20

Eastern Europe & Central Asia

10 0 1990 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 2000 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 2007

Figure 2.4

2008 Report on the global AIDS epidemic

Millions

Children living with HIV globally, 1990–2007 2.5 2.0 1.5 1.0 0.5 0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Year This bar indicates the range around the estimate

Figure 2.5

2008 Report on the global AIDS epidemic

New HIV infections among children, 1990–2007 600 000 500 000 400 000 300 000 200 000 100 000 0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Year This bar indicates the range around the estimate

Figure 2.6

2008 Report on the global AIDS epidemic

Child deaths due to AIDS, 1990–2007 500 000 400 000 300 000 200 000 100 000 0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Year This bar indicates the range around the estimate

Figure 2.7

2008 Report on the global AIDS epidemic

HIV prevalence (%) in adults (15–49) in Africa, 2007

Figure 2.8

2008 Report on the global AIDS epidemic

HIV prevalence (%) among pregnant women attending antenatal clinics in sub-Saharan Africa, 1997–2007 Median HIV prevalence (%)

Southern Africa 50

Botswana Lesotho Mozambique Namibia South Africa Swaziland Zimbabwe

40 30 20 10 0

1997– 1999– 2001 2002 2003 2004 2005 2006 2007 1998 2000

Figure 2.9

West Africa

20 15

Ethiopia

10 5 0

Kenya 1997– 1999– 2001 2002 2003 2004 2005 2006 2007 1998 2000

Median HIV prevalence (%)

Median HIV prevalence (%)

Eastern Africa

NOTE: Analysis restricted to consistent surveillance sites for all countries except South Africa (by province) and Swaziland (by region)

20 15

Burkina Faso Côte d'Ivoire Ghana Senegal

10 5 0

1997– 1999– 2001 2002 2003 2004 2005 2006 2007 1998 2000

Source: National surveillance reports and UNAIDS/WHO/UNICEF, Epidemiological Fact Sheets on HIV and AIDS.  July 2008.

2008 Report on the global AIDS epidemic

HIV prevalence (%) among 15–24 years old, by sex, selected countries, 2005–2007 Swaziland South Africa Zimbabwe Central African Republic Uganda Chad Côte d'Ivoire Sierra Leone Rwanda Haiti Guinea Ethiopia Benin Mali DR Congo Niger Dominican Republic Senegal Cambodia India

Female Male

0 Figure 2.10

5

10 15 % HIV prevalence

Source: Demographic and Health Surveys and other national population-based surveys with HIV testing.

20

25 2008 Report on the global AIDS epidemic

Life expectancy at birth, selected regions, 1950–1955 to 2005–2010 90 Western Europe

80

Asia

Years

70

Southern Africa Western Africa

60

Eastern Africa 50

Central Africa

40 30 1950– 1955– 1960– 1965– 1970– 1975– 1980– 1985– 1990– 1995– 2000– 2005– 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010

Figure 2.11

Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2006 Revision, http://esa.un.org/unpp

2008 Report on the global AIDS epidemic

Changes in population structure: Ghana and Lesotho 1950

Ghana

100+

Male

2007 Female

Male

Female

Age

80 60 40 20 0

10

5

0 Percentage

5

10

10

5

1950

Lesotho

100+

Male

0 Percentage

5

10

2007 Female

Male

Female

Age

80 60 40 20 0

Figure 2.12

10

5

0 Percentage

5

10

10

5

0 Percentage

5

10

Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2006 Revision, http://esa.un.org/unpp

2008 Report on the global AIDS epidemic

HIV prevalence (%) in adults (15–49) in Asia, 2007

Figure 2.13

2008 Report on the global AIDS epidemic

FIRST OF 3 PARTS:

HIV prevalence among injecting drug users, men having sex with men, and female sex workers in Pakistan, 2004–2007 Injecting drug users 60 51.3

50 40 30 19.6

16.5

Figure 2.14a

Larkana Faisalabad Rawalpindi Sukker Hyderabad Sargodha

Source: Ministry of Health Pakistan. HIV Second Generation Surveillance in Pakistan, National Report Rounds I and II.

Lahore

10 9.5 2.2

7

3.7

0.5

5 2 00 6

0

4

6

5

200

5 200

200

6 200

6

6 200

200

6

5 200

Karachi

200

6

5

2 00

2 00

2 00

4

0

0

6.5

200

0.5

200

5.3

200

9

10

6

13 13.3

5

20

200

23

29.8

200

27

4 200 5 200 6

30

200

%

Quetta Peshawar

2008 Report on the global AIDS epidemic

SECOND OF 3 PARTS:

HIV prevalence among injecting drug users, men having sex with men, and female sex workers in Pakistan, 2004–2007 Men having sex with men 20

Male sex workers

16

14.0

*Cities with single or multiple years 0% HIV prevalence: Sukker (MSW: 2005, 2006); Hyderabad (MSW: 2005); Rawalpindi (MSW & Hijras: 2004, 2005, 2006); Lahore (MSW: 2004, 2005, 2006); and, Quetta (MSW: 2004, 2005, 2006)

200 2005 6

6 2 00 6

200

2 00 4 2 00 5 200 6 200 4 2 00 5 200 6

Karachi

2.5

2.0 0

5

0

0

Figure 2.14b

2.5

0

0.5 0.5

Sukker Hyderabad Larkana Faislabad

1 0

0

0.5

0

0.5

0

0

0.5

0

Sargodha Lahore Quetta

Source: Ministry of Health Pakistan. HIV Second Generation Surveillance in Pakistan, National Report Rounds I and II.

0

0.9

0

0.9

2 00 2 00 5 7 200 2006 7

1.7

200 2005 6 200 5 200 6

2 1.5

200 2 0 04 5 200 6

4 4.5

200

4

200 2 00 4 5 200 6

7.5

8

200 2005 6 200 2005 6

12 %

Hijras

Peshawar

2008 Report on the global AIDS epidemic

LAST OF 3 PARTS:

HIV prevalence among injecting drug users, men having sex with men, and female sex workers in Pakistan, 2004–2007 Female sex workers 5 *Cities with single or multiple years 0% HIV prevalence: Larkana (2006); Faisalabad (2005, 2006); Sargodha (2005, 2006); Rawalpindi (2004, 2005, 2006); and Peshawar (2005, 2006)

4 3 %

2 1

0.7 0

0

0.3

0

0

0.3

0.7

0.5 0

0

Figure 2.14c

Hyderabad

Source: Ministry of Health Pakistan. HIV Second Generation Surveillance in Pakistan, National Report Rounds I and II.

5

6 200

Lahore

200

5 200

4 200

6 2 00

6 200

Sukker

5

5 200

Karachi

200

6 200

5 200

2 00

4

0 Quetta

2008 Report on the global AIDS epidemic

Projected total number of HIV infections in various population groups, in Jakarta, Indonesia, 2000–2020 IDUs with HIV

Wives of IDU with HIV

Other heterosexuals infected with HIV in a chain originating with IDU

Number of HIV infections

200 000 160 000 120 000 80 000 40 000 0

Figure 2.15

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Source: Asian Epidemic Model projections using Jakarta data.

2008 Report on the global AIDS epidemic

HIV prevalence (%) in adults (15–49) in Eastern Europe and Central Asia, 2007

Figure 2.16

2008 Report on the global AIDS epidemic

HIV prevalence (%) in adults (15–49) in the Caribbean, 2007

Figure 2.17

2008 Report on the global AIDS epidemic

HIV prevalence (%) in adults (15–49) in Latin America, 2007

Figure 2.18

2008 Report on the global AIDS epidemic

HIV prevalence (%) in adults (15–49) in North America, Western and Central Europe, 2007

Figure 2.19

2008 Report on the global AIDS epidemic

HIV infections newly diagnosed in injecting drug users and men who have sex with men, by country, and year of report, 2002–2006 3000

Men having sex with men

Canada

2000

France Germany

1000 0

Italy Netherlands

2002

2003

2004

2005

2006

Switzerland United Kingdom

600

Injecting drug users

400 200 0

Figure 2.20

2002

2003

2004

2005

2006

Sources: (1) Public Health Agency of Canada. HIV and AIDS in Canada. Selected Surveillance Tables to June 30, 2007. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, 2007. (2) Epidemiologisches Bulletin (5. Oktober 2007/Sonderausgabe B aktuelle daten und informationen zu infektionskrankheiten und public health). (3) The UK Collaborative Group for HIV and STI Surveillance Testing Times. HIV and other Sexually Transmitted Infections in the United Kingdom: 2007. London: Health Protection Agency, Centre for Infections. November 2007. (4) EuroHIV. HIV/AIDS Surveillance in Europe. End-year report 2006. Saint-Maurice: Institut de veille sanitaire, 2007. No. 75. (5) EuroHIV. HIV/AIDS Surveillance in Europe. Mid-year report 2007. Saint-Maurice: Institut de Veille Sanitaire, 2007. No. 76.

2008 Report on the global AIDS epidemic

HIV prevalence (%) in adults (15–49) in Middle East and North Africa, 2007

Figure 2.21

2008 Report on the global AIDS epidemic

HIV prevalence (%) in adults (15–49) in Oceania, 2007

Figure 2.22

2008 Report on the global AIDS epidemic

Annual diagnoses of HIV infection and AIDS in Australia 1981–2006 HIV diagnoses

AIDS diagnoses

Number of diagnoses

2400 2000 1600 1200 800 400 0

1981

1986

1991

1996

2001

2006

Year

Figure 2.23

Source: National Centre in HIV Epidemiology and Clinical Research, 2007. Data available at http://www.nchecr.unsw.edu.au/NCHECRweb.nsf/resources/SurvRep07/$file/ASR2007.pdf

2008 Report on the global AIDS epidemic

Selected events related to social determinants of the HIV epidemic UN General Assembly “Declaration of Commitment on HIV/AIDS” recognises human rights as essential element in the global response

Paris meeting establishing the Greater Involvement of People with AIDS (GIPA) principle

Establishment of UN Secretary General’s Task Force on Women, Girls and AIDS

Creation of the Global Coalition on Women and AIDS

3rd international consultation on HIV and Human Rights makes first call for universal access to prevention, treatment care and support

1994

2001 2002

1st Global Parliamentary Meeting on AIDS calls for rights-based response to the epidemic and end to HIVrelated travel restrictions Tools for measuring gender inequitable norms and HIV related stigma established

Universal Access Targets

Over 100 country and regional consultations identified stigma, discrimination and gender inequality as major barriers to universal access

2003 2004 2005

2007 2008

UN General Assembly Special Session on HIV/AIDS June 2001/ 189 Member States signed the Declaration of Commitment Figure 3.1

Millennium Development Goals

2010

2015

Midway to Millennium Development Goals

2008 Report on the global AIDS epidemic

Percentage of countries in regions reporting that women are addressed as a specific component of their multisectoral HIV strategy with a specific HIV budget for their activities

Percentage of countries (%)

100

Women are addressed as a specific component of multisectoral HIV strategy

80 60

Women are addressed as a specific component of multisectoral HIV strategy with a budget

40 20 0

North Caribbean South (12) and America (1) SouthEast Asia

SubSaharan Africa (41)

(13)

Oceania (7)

Latin America

Middle East

(19)

(4)

Eastern Europe and Central Asia

East Asia (3)

Western and Central Europe (14)

(16)

(Number of countries reporting) Figure 3.2

Source: UNGASS Country Progress Reports 2008.

2008 Report on the global AIDS epidemic

Percentage of countries (by region) reporting policies in place to ensure equal access to HIV prevention, treatment, care, and support for women and men

Percentage of countries (%)

100 80 60 40 20 0

Caribbean Middle (12) East (4)

Oceania (7)

SubSaharan Africa

Europe (30)

South Asia

Latin America

East Asia

(13)

(19)

(3)

(41) (Number of countries reporting)

Figure 3.3

Source: UNGASS Country Progress Reports 2008.

2008 Report on the global AIDS epidemic

Index of policies related to women’s vulnerability to HIV Sub-Saharan Africa East Asia South and South-East Asia Caribbean Middle East Oceania Latin America Eastern Europe and Central Asia 0

2

4

6

8

10

12

14

Scale of (0–14)

Figure 3.4

Source: UNGASS Country Progress Reports 2008.

2008 Report on the global AIDS epidemic

Percentage of countries (by region) reporting programmes designed to change societal attitudes of stigmatization associated with HIV and/or using indicators for reduction of HIV-related stigma and discrimination Countries reporting programmes designed to change societal attitudes of stigmatization associated with HIV and AIDS

Percentage of countries (%)

100 80 60 40 20 0

Caribbean (12)

East Asia (3)

South and SouthEast Asia

North America (1)

(13)

SubLatin Saharan America (19) Africa (41)

Oceania Western (7) and Central Europe (13)

Eastern Europe and Central Asia

Middle East (4)

Countries reporting using performance indicators or benchmarks for reduction of HV-related stigma and discrimination

(16)

(Number of countries reporting) Figure 3.5

Source: UNGASS Country Progress Reports 2008.

2008 Report on the global AIDS epidemic

Percentage of countries (by region) reporting legal protections against discrimination and relevant mechanisms Report laws or regulations protecting people living with HIV against discrimination

Percentage of countries (%)

100 80 60 40 20 0

East Asia

North America

(3)

(1)

Eastern Europe and Central Asia

Latin America (19)

(16)

Oceania (7)

SubSaharan Africa (41)

South and SouthEast Asia

Caribbean Middle (12) East (4)

Western and Central Europe

Report mechanisms to report, document and address cases of discrimination against people living with HIV and/or most-atrisk populations

(13)

(13)

(Number of countries reporting)

Figure 3.6

Source: UNGASS Country Progress Reports 2008.

2008 Report on the global AIDS epidemic

Median percentage of population reached with HIV prevention services within the specified legal environment 100 Countries reporting having nondiscrimination laws/regulations with protection for this population

80

Median percentage of population reached with HIV prevention services (UNGASS indicator 9)

60

Countries reporting NOT having nondiscrimination laws/regulations with protection for this population

40

20

0

Sex workers (N=42)

Figure 3.7

Source: UNGASS Country Progress Reports 2008.

Injecting drug users (N=17)

Men having sex with men (N=28) 2008 Report on the global AIDS epidemic

HIV Prevalence by wealth status: men

100 80

WEALTH QUINTILE 1

2

3

4

5

60 HIV prevalence (%) 40 20 0 Burkina Faso

Figure 3.8

Ghana

Cameroon

Uganda

Kenya

UR Tanzania

Malawi

Source: Mishra V, Bignami-Van Assche S, Greener R, Vaessen M, Hong R, Ghys P, Boerma T, Van Assche A,Khan S, Rutstein S, “HIV infection does not disproportionately affect the poorer in sub-Saharan Africa”, 2007,AIDS, Vol 21 Supplement 7, November 2007.

Lesotho

2008 Report on the global AIDS epidemic

Selected events related to HIV prevention Gay community responses organized in many developed countries

UN General Assembly Declaration of Commitment: prevention is the mainstay of the AIDS response

Universal Access to Prevention endorsed by UN General Assembly

Prevention of Mother to Child Transmission (PMTCT) found to be effective in resource-poor settings and recommended for implementation globally

First Male circumcision trial, Orange Farm, South Africa

Needle exchange programmes to reduce HIV transmission begin in Britain, Australia, Netherlands

Global comprehensive prevention policy established

Thailand introduces 100% condom use programme nationally

1982–83 1986

1991

1998

2001

34% of HIV-positive pregnant women are receiving antiretrovirals for PMTCT

Universal Access Targets

40% of young males and 36% of young females have accurate knowledge about HIV prevention

2005 2006

UN General Assembly Special Session on HIV/AIDS June 2001/ 189 Member States signed the Declaration of Commitment Figure 4.1

Millennium Development Goals

Treatment Action Campaign in South Africa supports mass marches for prevention

2008

2010

2015

Midway to Millennium Development Goals

2008 Report on the global AIDS epidemic

Namibia: HIV related knowledge and behaviour in the general population, 2000–2006 80 2000

70

2006

60 50 (%) 40 30 20 10 0

Female

Male

Tested for HIV in last 12 months (15–49 year olds)

Figure 4.2

Female

Male

Comprehensive knowledge (15–24 year olds)

Source: Namibia Country Progress Report 2008.

Female

Male

Female

Male

Sex before age 15 Sex with >1 partner (15–24 year olds) in last 12 months (15–49 year olds)

Female

Male

Condom use (15–49 year olds)

2008 Report on the global AIDS epidemic

Comprehensive knowledge of HIV among young people (ages 15–24), 1999–2007 100

2010 Target

2005 Target 80 60

Male

%

Female

40 20 0

1999–2003

2004–2007

2010

Year

Figure 4.3

Source: MEASURE DHS (2008)

2008 Report on the global AIDS epidemic

Comprehensive knowledge of HIV among young people, by type of question 100 Males

Females

80 60

(%) correct

40 20 0

All 5 questions are correct

Having only one faithful partner can protect against HIV

Condoms can A healthy Mosquitos do prevent HIV looking person not transmit can have HIV HIV

Sharing food does not transmit HIV

QUESTION Figure 4.4

Source: UNGASS Country Progress Reports 2008.

2008 Report on the global AIDS epidemic

Percentage of countries with AIDS education as part of the school curriculum Primary curriculum

Secondary curriculum

Teacher training

100 80 Percentage 60 of countries (%) 40 20 0

North America (1)

Sub- Caribbean Latin (12) Saharan America (19) Africa (41)

Oceania Western (7) and Central Europe (14)

(Number of countries reporting)

Figure 4.5

Source: UNGASS Country Progress Reports 2008.

Eastern Europe and Central Asia (16)

East Asia (3)

South and SouthEast Asia

North Africa and Middle East (4)

(13)

2008 Report on the global AIDS epidemic

Percentage of young people who have first sex before age 15, by sex Male

Female

20

15

% 10

5

0

1998-2002

2003-2007 Year

Figure 4.6

Source: Measure DHS.

2008 Report on the global AIDS epidemic

US$ Millions

Annual investment in preventive HIV vaccine research and development by source between 2000 and 2006 800 Multilaterals

700

Other Public Sector

600

Europe

500

US

400 300 200 100 0

2000

2001

2002

2003

2004

2005

2006

Year Figure 4.7

Source: HIV Vaccines and Microbicides Resource Tracking Working Group, 2007.

2008 Report on the global AIDS epidemic

Country reporting on prevention services for populations most at risk, 2005 and 2007 Countries reporting on IDUs

Countries reporting on sex workers Countries reporting on MSM

Figure 4.8

Source: UNGASS Country Progress Reports 2008.

2008 Report on the global AIDS epidemic

Percentage of countries reporting laws, regulations or policies that present obstacles to effective HIV services for most-at-risk populations Injecting drug users

Men having sex with men

Sex workers

100 80 Percentage 60 of countries (%) 40 20 0

North America (1)

South and SouthEast Asia (13)

Figure 4.9

Eastern North Western Europe Africa and and and Middle Central Central East Europe (4) (13) Asia (16)

Source: UNGASS Country Progress Reports 2008.

Latin America

East Asia

(19)

(3)

Sub- Caribbean Oceania (12) (7) Saharan Africa (41)

(Number of countries reporting) 2008 Report on the global AIDS epidemic

Percentage of most-at-risk populations reached with HIV prevention programmes, 2005–2007 100 90 80 70 60

60.4%*

(39 countries)

46.1%**

% Median 50

(15 countries)

40.1%*

(27 countries)

40 30 20 10 0

Figure 4.10

Sex workers

Source: UNGASS Country Progress Reports 2008.

Injecting drug users

Men having sex with men

* Percentage of sex workers and men having sex with men reported knowing where they can receive an HIV test and that they were given condoms. ** Percentage of injecting drug users who reported knowing where they could receive an HIV test and be provided with condoms and sterile injecting needles and syringes.

2008 Report on the global AIDS epidemic

Percent change in condom use at last sex, among those with more than one partner in the last 12 months, by sex

20% Percent change from previous survey (%)

10% 0%

am N ero am on ib C ia ot e Pe d'I ru voi re U ga n R da w a Za nda m b G ia ui n C ea ol o Bu mb rk ia i U na R F Ta as Be nz o ni an n ia D om G inic ha an n M a Re al pu aw bl C ic i ha d Zi m b M abw al i e Ke ny H a ai ti Ethiopia Ar m en ia

30%

C

40%

Male

N ig er

Female

-10% -20% -30%

Figure 4.11

Source: Measure DHS 2008.

2008 Report on the global AIDS epidemic

Condom use at last sex, among those with more than one partner in the last 12 months, in three high-burden countries 50% Uganda Female

40%

Uganda Male Zambia Female

30%

Zambia Male UR Tanzania Female UR Tanzania Male

20%

10%

0%

Figure 4.12

1995–1996

Source: Measure DHS 2008.

1999–2001

2004–2007 2008 Report on the global AIDS epidemic

Number and percentage of HIV-positive pregnant women receiving antiretroviral prophylaxis, 2004–2007 40

600 000

35

500 000

30 Number of HIV-positive pregnant women receiving anti-retrovirals

400 000

25

300 000

20

% of HIV-positive pregnant women receiving anti-retrovirals

15

200 000

10 100 000

5

0

0 2004

2005

2006

2007

Year

Figure 4.13

Source: UNAIDS, UNICEF & WHO, 2008; data provided by countries.

2008 Report on the global AIDS epidemic

Percentage of HIV-positive pregnant women receiving antiretroviral prophylaxis, 2007

Figure 4.14

Source: UNAIDS, UNICEF & WHO, 2008; data provided by countries.

2008 Report on the global AIDS epidemic

Selected events related to the treatment of AIDS First Global Fund Grants awarded for treatment World Bank MAP II includes ART in developing countries Introduction of HAART

1996

Accelerating Access Initiative launched by UN/ industry partnership

UN General Assembly Political Declaration on Universal Access to Prevention, Treatment care and support

Universal Access Targets

WHO launches 3 x 5 initiative G8 Declaration for Universal Access to treatment

2000 2001 2002 2003

2005 2006

UN General Assembly Special Session on HIV/AIDS June 2001/ 189 Member States signed the Declaration of Commitment Figure 5.1

Millennium Development Goals

3 million people on treatment in developing countries

2008

2010

2015

Midway to Millennium Development Goals

2008 Report on the global AIDS epidemic

Millions

Number of people receiving antiretroviral drugs in low- and middle-income countries, 2002−2007 3.0 2.8 2.6 2.4 2.2 2.0 1.8 1.6 1.4 1.2 1.0 0.8 0.6 0.4 0.2 0.0

North Africa and the Middle East Eastern Europe and Central Asia East, South and South-East Asia Latin America and the Caribbean Sub-Saharan Africa

end2002

end2003

end2004

end2005

end2006

end2007

Year Figure 5.2

Source: Data provided by UNAIDS & WHO, 2008.

2008 Report on the global AIDS epidemic

Millions

Estimated number of adult and child deaths due to AIDS globally, 1990–2007 3.0 2.5 2.0 1.5 1.0 0.5 0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Year This bar indicates the range around the estimate

Figure 5.3

2008 Report on the global AIDS epidemic

Scale up of antiretroviral coverage over time select group of generalized and concentrated epidemic countries, 2004 to 2007 Percent Coverage (%)

100 2004

2005

2006

2007

80 60 40 20 0

a c e canc d la m ia ia ya apuea lawi pia nda ubli ia oire tho eria u n da land o a b n ib a q n i Afri bli o e P in a a ep an 'Iv il io m a ig et N Ang m b s ai z g a h K u z w a u M t N e a h Z i U R an e d R N L E G T am tral Rep V d z t Sw T w ite of Cô Mo Cen Ne Un

Figure 5.4

Source: UNGASS Country Progress Reports 2008.

2008 Report on the global AIDS epidemic

Comparison of antiretroviral therapy coverage in 2007 between males and females (for countries with reported data on the number of people on treatment for both sexes separately) 80%

Male

Female

60% 40%

0%

Countries with generalized epidemics

Barbados Cambodia El Salvador Brazil Philippines Senegal Morocco Chile Belize Mauritania Kazakhstan China Bolivia Paraguay Belarus Niger India Ukraine Somalia Pakistan

20% Botswana Rwanda Papua New Guinea Burkina Faso Zambia Haiti Gabon Kenya Malawi Swaziland Cote d'Ivoire Lesotho South Africa Ethiopia Cameroon Burundi Guinea Mozambique Togo Guinea-Bissau Central African Rep Zimbabwe Congo Ghana Chad

Percent Coverage (%)

100%

Countries with concentrated or low epidemics

NOTE: Coverage estimates are based on applying the ratio of number of males and number of females receiving antiretroviral therapy to the final projected value of all people receiving antiretroviral therapy as of December 2007. This provides December 2007 estimates of number of males and females receiving antiretroviral therapy that are then divided by the estimated number of males and females in need of antiretroviral treatment respectively. Figure 5.5

Source: Data from UNAIDS and WHO, 2008

2008 Report on the global AIDS epidemic

Relationship between tuberculosis notification rate and HIV prevalence in Zimbabwe, 1990–2006 500

18

450

16

400

14

350

12

TB notification rate

300

10

(per 100 000 population)

250

8 TB notification rate

200 150

(new and relapse), rate per 100 000 population

100

HIV prevalence in all (%)

50 1985

Figure 5.6

1990

1995

2000

Source: WHO Global TB control report 2008 (WHO, 2008a); UNAIDS HIV prevalence estimates.

2005

% HIV prevalence in all ages

6 4 2 0 2010

2008 Report on the global AIDS epidemic

Percentage of incident tuberculosis cases in people living with HIV receiving both antiretroviral and anti-tuberculosis medications, 2007 100 80 60 % 40 20 0

North Africa and Middle East

Oceania (2)

SubGLOBAL Caribbean Latin (76) (10) Saharan America (14) Africa (22)

(3) (Number of countries reporting)

Figure 5.7

Source: UNGASS data provided by countries, 2008.

Eastern Europe and Central Asia

South and SouthEast Asia (8)

East Asia (12)

Western and Central Europe (3)

(12) (Note: No data from North America)

2008 Report on the global AIDS epidemic

Unmet need for dual treatment of incident tuberculosis cases in people living with HIV, by region, 2007 Unmet need

Treated

1 000 000

10 000 8000

Number

Number

800 000

600 000

400 000

6000 4000 2000 0

200 000

0

GLOBAL (76)

(Number of countries reporting)

Latin Eastern America Europe & Central Asia

South SubLatin Eastern Saharan & South- America Europe & East Africa (14) Central Asia (22) Asia (8)

(12)

East Asia (2)

East Asia

Caribbean Oceania

Caribbean Oceania (10)

(2)

Middle East & North Africa

Western & Central Europe

Middle East & North Africa

Western & Central Europe (3)

(3)

Note: No data from North America Figure 5.8

Source: UNGASS Country Progress Reports 2008.

2008 Report on the global AIDS epidemic

Treatment outcomes for HIV-positive and HIV-negative tuberculosis patients, 2005 cohort 100 Not evaluated

80

Transferred Defaulted

60

Failed

40

Died Completed

20 0

Cured

HIV+ (6113)

HIV(148 570)

Smear-positive (data from 47 countries)

HIV+ (8100)

HIV(132 984)

Smear-negative and extrapulmonary

HIV+ (2577)

HIV(34 863)

Re-treatment (data from 25 countries)

(data from 42 countries)

Figure 5.9

Source: WHO Global tuberculosis control: surveillance, planning, financing. World Health Organization, Geneva.

2008 Report on the global AIDS epidemic

HIV testing for tuberculosis patients, all countries, 2006 14

800 12%

700

12

600

10

8.5%

500

Number of TB cases tested (thousands)

8

400 6

300

4.0% 3.2%

4

200 100

Percentage of notified TB cases tested

2

0.5%

0

0 2002

2003

2004

2005

2006

(9, 37%)

(92, 53%)

(84, 61%)

(118, 83%)

(112, 90%)

Note: Numbers under bars represent the number of countries reporting data followed by the percentage of total estimated HIV-positive tuberculosis cases accounted for by reporting countries

Year

Figure 5.10

Source: WHO, 2008a.

2008 Report on the global AIDS epidemic

Percentage of countries reporting laws, regulations or policies that present obstacles to services for injecting drug users 100 80 Percentage of countries (%)

60 40 20 0

North America (1)

Eastern South Europe and and SouthEast Asia Central (13) Asia

Middle East (4)

Western and Central Europe

Latin America

East Asia

(19)

(3)

Sub- Caribbean Oceania (12) (7) Saharan Africa (41)

(13)

(16) (Number of countries reporting)

Figure 5.11

Source: UNGASS Country Progress Reports 2008.

2008 Report on the global AIDS epidemic

Percentage of countries by income status reporting a policy of free services for antiretroviral treatment 100 80 Percentage of countries (%)

60 40 20 0

Figure 5.12

Low income (42)

Source: UNGASS Country Progress Reports 2008.

Lower middle income (39)

Upper middle income (31)

High income (16)

2008 Report on the global AIDS epidemic

Selected events related to mitigating the impact of AIDS UNICEF first International Conference on AIDS orphans

Anglo American introduces policy to make antiretroviral therapy available for HIV positive employees

Children on the Brink: Strategies to Support HIV/AIDS," published by USAID includes the most comprehensive global estimates of the effects of HIV/AIDS on the world's children

1991

1997

“Unite for Children, Unite Against AIDS” campaign launched by UNICEF and partners

2003

2005

UN General Assembly Special Session on HIV/AIDS June 2001/ 189 Member States signed the Declaration of Commitment Figure 6.1

Universal Access Targets

In Mexico, the Universal Antiretroviral Therapy access was guaranteed by the newly implemented “Seguro Popular” for the informal sector along with the social insurance schemes for the formal sector

2001 2002

Millennium Development Goals

2008

2010

2015

Midway to Millennium Development Goals

2008 Report on the global AIDS epidemic

Estimated number of children under 18 orphaned by AIDS in sub-Saharan Africa (1990–2007) Millions

12 10 8 6 4 2 0 1990

Figure 6.2

Source: UNAIDS/WHO, 2008

1995

2000

2002

2003

2004

2005

2006

2007

2008 Report on the global AIDS epidemic

Ratio of school attendance among orphans to non-orphans in countries with HIV prevalence greater than 5% Côte d'Ivoire UR Tanzania Zambia Namibia Central African Republic Swaziland Malawi Uganda Zimbabwe Lesotho Kenya Cameroon Gabon South Africa Mozambique 0.0

UNGASS 2007 UNGASS 2005 UNGASS 2003

0.2

0.4

0.6

0.8

1.0

1.2

1.4

Proportion of school attendance, orphans/non-orphans Figure 6.3

Source: UNGASS Country Progress Reports 2008.

2008 Report on the global AIDS epidemic

Support to orphans and vulnerable children as reported by countries with adult HIV prevalence ≥5 % (2005 estimates) COUNTRY Population based survey data

OVC TOTAL1

COVERAGE in 2007 (n=10)  

Botswana

Not reported

Not reported

Not reported

Cameroon Central African Republic

412 Not reported

4,431 Not reported

9% 7%

Gabon

259

2,637

10%

Kenya

Not reported

Not reported

17% 2

Lesotho

Not reported

Not reported

Not reported

Malawi

Not reported

Not reported

19%

882

5,343

17%

1,472

3,576

41%

Uganda

569

5,321

11%

Zambia

578

3,671

16%

1,972

6,322

31%

34,161     37,250 1,057,900 471,315 2,928,143

4,970     420,943 1,577,200 930,000 1,566,465

15%     9% 67% 51% 53%

Namibia Swaziland

Zimbabwe

Population adjusted average   Programme based data Côte d'Ivoire South Africa United Republic of Tanzania Population adjusted average Table 6.1

OVC SUPPORTED    

Source: UNGASS Country Progress Reports 2008.

1

Total number of OVC as reported by countries.

2

Information based on survey implemented by PEPFAR in Kenya on OVC support in 2007, source: Kenya UNGASS country report 2008.

2008 Report on the global AIDS epidemic

Orphans due to AIDS in Sub-Saharan Africa, from 2006 projected to 2015 Millions

16 14 12 10 8 6

AIDS orphans_base

4

AIDS orphans scaled phase-up

2

AIDS orphans UA2010

0 2006

Figure 6.4

2007

Source: UNICEF, UNAIDS, WHO, 2008.

2008

2009

2010

2011

2012

2013

2014

2015

2008 Report on the global AIDS epidemic

HIV-Related Labour Costs SECTOR

COUNTRY

NUMBER OF ESTIMATED COST PER AGGREGATE WORKERS HIV AIDS DEATHS ANNUAL COSTS IN SECTOR PREVALENCE OR RETIREMENT (% of Labour Cost) (% of Adult Population)

Retail Agribusiness

Manufacturing

Media Utility Mining Tourism

Table 6.2

South Africa South Africa Uganda Kenya Zambia South Africa Uganda Ethiopia Ethiopia South Africa South Africa South Africa Botswana Zambia

500 700 500 22,000 1,200 1,300 300 1,500 1,300 3,600 >25,000 600 500 350

10.50 23.70 5.60 10.00 28.50 14.00 14.40 5.30 6.20 10.20 11.70 23.60 29.00 36.80

Source: Piot P et al. (2007). Squaring the Circle: AIDS, Poverty, and Human Development.

(Multiple of Annual Compensation) 0.7 1.1 1.9 1.1 0.9 1.2 1.2 0.9 0.8 1.3 4.7 1.4 4.4 3.6

0.50 0.70 1.20 1.00 1.30 1.10 1.90 0.60 0.60 1.30 2.20 2.40 8.40 10.80

2008 Report on the global AIDS epidemic

Percentage of countries with sectors included in the national AIDS strategy and earmarked budgets Military/police Sector included

Labour Health

Earmarked budget present

Transportation Agriculture Minerals and energy Trade and industry Tourism Public works 0

20

40

60

80

100

Percentage of countries (%), N=126

Figure 6.5

Source: UNGASS Country Progress Reports 2008.

2008 Report on the global AIDS epidemic

US$ Billion

Estimated total annual resources available for HIV, 2000–2007, and projected financial resources required by 2010 if current scale up continues (US$ billion)* Resources available for HIV services

20

Current trend

15

10.0

10

8.3

8.9

6.1 5.0

5

3.2 1.4

1.6

0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Figure A

* This represents the projected trend in resource needs if the current rate of scaleup of services is maintained constant 2008 Report on the global AIDS epidemic

Spending in programmes specifically directed to the populations most at risk for HIV as a percentage of total prevention spending by type of epidemic—public and international Funds, 2006 25% Harm reduction programs and IDUs Programs for men having sex with men

20%

Programs for sex workers and their clients 8.6%

15%

10%

2.8% 4.7%

5%

0%

8.0%

3.3% 1.8%

Low

Concentrated

0.0% 0.1% 0.5%

Generalized

TYPE OF EPIDEMIC Figure B

Source: UNGASS Country Progress Reports 2008.

2008 Report on the global AIDS epidemic

Per capita HIV expenditures from domestic public sources in low- and middle-income countries, 2004–2007 14 (12.01)

12 US$

10

(9.89)

Sub-Saharan Africa Upper middle income countries Rest of the world Upper middle income countries

8

Sub-Saharan Africa Low and lower middle income countries

6 4 (2.04)

2

(1.17) (0.63)

(1.15)

0

(0.14)

(0.20)

2004

2005

2006

Rest of the world Low and lower middle income countries

2007

Year Figure C

Source: UNGASS Country Progress Reports 2008.

2008 Report on the global AIDS epidemic

Public domestic expenditures, Malawi (US$ millions)

US$ Million

20

18.3

15 10.7

10 4.5

5

5.4

3.1

0 2001

Figure D

2002

2003

2004

2005

2008 Report on the global AIDS epidemic

Annual domestic spending: top 20 countries (US$ 2.73 billion) UNGASS reports, latest data available (US$ million) DOMESTIC PUBLIC EXPENDITURE PER CAPITA (US$)

DOMESTIC PUBLIC EXPENDITURE (US$ Millions)

Brazil* South Africa Russian Federation Mexico Thailand Argentina Botswana China UR Tanzania Australia Colombia Japan Zimbabwe Turkey Chile Poland Angola Cuba Iran Ukraine 80 Figure E

60

40

20

0

200

400

600

* Partial data 2008 Report on the global AIDS epidemic

HIV expenditures by finance sources and income level 2007, or latest data available Per capita (US$):

$3.32

$0.26

$2.54

$8.31

100 International

80

Public 60 %

40 20 0

Figure F

Low income

Lower middle income

Upper middle income

High income: non-OECD 2008 Report on the global AIDS epidemic

Resources available to HIV-related programmes by source and bilateral disbursements, 2006

(US$ Billions)

Total Resource availability for HIV-related programmes in 2006 (US$ Billions)

Bilateral disbursements to HIV-related programmes in 2006

10 9 8

EC (0.5%)

7

UN (2%)

6

GFATM (7%)

5

Foundations (11%)

4 3 2

Bilaterals (33%) Domestic Public and Private (46%)

1

Other DAC country members 1% Belgium 1% Spain 1% Norway 2% Australia 2% Germany 2% Canada 2% Sweden 3% Netherlands 3% Ireland 3% United Kingdom 9% United States 71%

0

Total resources available: US$8.9 Billion

Percentage out of the total bilateral disbursements Total Bilateral disbursements 2006: US$ 2.9 Billion

The organizational disbursements are different than commitments or obligations, as well as different from in-country expenditures Figure G

Sources: UNAIDS analysis based on OECD/DAC online database (last visited on May 6, 2008), Resource availability UNAIDS 2005, Funders Concerned About AIDS (FCAA), European HIV/AIDS Funders Group (EFG) for Philanthropic sector

2008 Report on the global AIDS epidemic

Disbursements for HIV per US$ 1 Million GDP, 2006 Netherlands

521

Sweden

462

Ireland

408

United Kingdom

328

United States

120

France

93

Germany

60

Canada

50

Japan

24

Italy

4

0

Figure H

100

200

300 US$

400

500

600

Sources: UNAIDS and Kaiser Family Foundation analysis, June 2007; Global Fund to Fight AIDS, Tuberculosis and Malaria online data query May 2007; International Monetary Fund, World Economic Outlook Database, April 2007.

2008 Report on the global AIDS epidemic

US$ Billion

Annual resources available 2000–2007 and funding gap between projected financial resources if current scale-up continues and a phased scale-up scenario to reach universal access between 2010 and 2015 (US$ billion) 45

Resources available for HIV services

40

Resource Needs: if current scale-up continues

35

Resource Needs for phased scale-up to Universal Access

30 25 20 15 10 5 0

Figure I

8.3 5.0 1.4

1.6

8.9

10.0

6.1

3.2

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2008 Report on the global AIDS epidemic

Total annual resources available for AIDS 1986–2007 US$ million

10 billion

10 000 8.9 billion

9000

Signing of Declaration of Commitment on HIV/AIDS, UNGASS

8000

8.3 billion

7000 6000

World Bank MAP launch

5000 4000 3000 2000

UNAIDS

Less than US$ 1 million

1000 59

212

257

Gates Foundation

292

PEPFAR 1623

Global Fund

0 1986 1987

1990 1991 1992 1993

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Notes: [1] 1986-2000 figures are for international funds only; [2] Domestic funds are included from 2001 onwards [i] 1996-2005 data: Extracted from 2006 Report on the Global AIDS Epidemic (UNAIDS, 2006); [ii] 1986-1993 data: Mann.&. Tarantola, 1996

Figure 7.1

Source: UNAIDS & WHO unpublished estimates, 2007

2008 Report on the global AIDS epidemic

Comparison of 2005 and 2007 percentage coverage of antiretroviral therapy for people with advanced HIV and percentage coverage of antiretroviral drugs for HIV positive pregnant women by region Antiretroviral Therapy 100

2005

2007

Prevention of Mother to Child Transmission 2005

2007

Percent (%)

80 60 40 20 0 Sub-Saharan Africa

Figure 7.2

Source: UNAIDS/UNICEF/WHO.

Latin America and the Caribbean

East, South and South-East Asia

EasternEurope and Central Asia

North Africa and the Middle East

GLOBAL

2008 Report on the global AIDS epidemic

Percent Coverage of Antiretrovirals for Prevention of Mother-to-Child Transmission Breakdown by Quartiles (N=63) Less than 25% Coverage (36 Countries): Angola, Burkina Faso, Burundi, Cameroon, Chad, China, Colombia, Congo (Republic of the), Côte d'Ivoire, Democratic Republic of the Congo, El Salvador, Eritrea, Ethiopia, Gabon, Ghana, Guatemala, Guinea, Guinea-Bissau, Haiti, India, Indonesia, Iran (Islamic Republic of), Liberia, Madagascar, Malaysia, Mali, Nepal, Nigeria, Pakistan, Papua New Guinea, Senegal, Sierra Leone, Somalia, Togo, Venezuela, Viet Nam

25% to 49% Coverage (16 Countries): Benin, Cambodia, Central African Republic, Dominican Republic, Gambia, Honduras, Lesotho, Malawi, Mozambique, Myanmar, Niger, Peru, Uganda, United Republic of Tanzania, Zambia, Zimbabwe

50% to 75% Coverage (7 Countries): Brazil, Kenya, Namibia, Rwanda, South Africa, Swaziland, Ukraine Greater than 75% Coverage (4 Countries): Argentina, Botswana, Russian Federation, Thailand

All values are based on need estimates using UNAIDS/WHO methodology. Includes all countries for which number of HIV pregnant women receiving ARVs was reported for 2007, except countries for which UNAIDS/WHO need estimates are not available, or with need estimates less than 500. Table 7.1

2008 Report on the global AIDS epidemic

Percent Coverage of Antiretroviral Therapy for Adults and Children with Advanced HIV Breakdown by Quartiles (N=106) Less than 25% Coverage (45 Countries): Algeria, Armenia, Azerbaijan, Bangladesh, Belarus, Bolivia, Burundi, Central African Republic, Chad, China, Congo (Republic of the). Democratic Republic of the Congo, Djibouti, Egypt, Eritrea, Gambia, Ghana, Guinea-Bissau, Hungary, Indonesia, Iran (Islamic Republic of), Kazakhstan, Kyrgyzstan, Liberia, Lithuania, Madagascar, Mauritania, Mauritius, Mozambique, Myanmar, Nepal, Niger, Pakistan, Paraguay, Russian Federation, Serbia, Sierra Leone, Somalia, Sri Lanka, Sudan, Tajikistan, Togo, Ukraine, Uzbekistan, Zimbabwe

25% to 49% Coverage (40 Countries): Angola, Bahamas, Belize, Benin, Burkina Faso, Cameroon, Cote d'Ivoire, Dominican Republic, Ecuador, Equatorial Guinea, Estonia, Ethiopia, Gabon, Guatemala, Guinea, Guyana, Haiti, Honduras, Jamaica, Kenya, Lebanon, Lesotho, Malawi, Malaysia, Mali, Morocco, Nicaragua, Nigeria, Papua New Guinea, Peru, Philippines, Poland, South Africa, Suriname, Swaziland, Uganda, United Republic of Tanzania, Venezuela, Viet Nam, Zambia

50% to 75% Coverage (14 Countries): Argentina, Barbados, Cambodia, Czech Republic, El Salvador, Moldova, Netherlands, Panama, Romania, Rwanda, Senegal, Thailand, Trinidad and Tobago, Uruguay

Greater than 75% Coverage (7 Countries): Botswana, Brazil, Chile, Costa Rica, Cuba, Lao People's Democratic Republic, Namibia All values are based on need estimates using UNAIDS/WHO methodology. Includes all countries for which number of adults and children on ART was reported for 2007, except countries for which UNAIDS/WHO need estimates are not available, or with need estimates less than 500. Table 7.2

2008 Report on the global AIDS epidemic

Annual AIDS deaths comparing projected current rate of scale up and the phased scale-up strategy to reach universal access between 2010 and 2015 3.0 2.5 2.0 Number of AIDS deaths (Millions)

Current Scale-Up

1.5

Phased Scale-Up

1.0 0.5 0 2006

Figure 7.3

Source: UNAIDS, 2008.

2009

2012

2015

2008 Report on the global AIDS epidemic

US$ Millions

Prevention

Treatment and Care

200 160

US$ Millions

HIV spending on prevention, treatment, and care, Mexico, 1995–2005 (US$ millions) 25 20 15

120

10

80 5

40

0

0

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

2001

2003

2005

Prevention – selected components Programs for sex workers and their clients Programs for men having sex with men Blood safety Figure 7.4

Source: Personal communication with Centro Nacional para la Prevención y control del SIDA (CENSIDA), Ministry of Health, Mexico (2008).

2008 Report on the global AIDS epidemic

Resources needed in 2010 using a phased scale-up strategy towards universal access* US$ Billions

14 Program Support

12

Orphans and Vulnerable Children

10

Treatment and Care

8

Prevention

6 4

* Estimates in 138 low- and middle-income countries for implementing the most effective programmatic services as determined by data derived from national efforts to “know and act on your epidemic”

2 0

Low Level (50)

Concentrated (44)

Generalized and Hyperendemic (44)

TYPE OF EPIDEMIC Figure 7.5

Source: UNAIDS, 2008.

2008 Report on the global AIDS epidemic

Prevention, care and treatment expenditures from public and international funding sources— Mozambique, 2004–2006, US$ millions 40 US$ Millions

35

Care and Treatment

30

Prevention

25 20 15 10 5 0 2004

2005

2006

Year Figure 7.6

Source: UNGASS Country Progress Reports 2008.

2008 Report on the global AIDS epidemic

Countries reporting quality implementation of the national AIDS strategy

Percentage of countries (%)

100 Quality national strategy*

Quality national strategy*

80 60 40 20 0

North America (1)

South and SouthEast Asia

Caribbean Eastern (12) Europe and Central Asia

(13)

(Number of countries reporting) (N=130)

Figure 7.7

Source: UNGASS Country Progress Reports 2008.

(16)

Middle East And North Africa

Oceania (7)

Latin America (19)

SubWestern Saharan and Africa Central (41) Europe

East Asia (3)

(14)

(4) * One national multisectoral strategy and operational plan with goals, targets, costing, and identified funding per programmatic area, and a monitoring and evaluation framework. 2008 Report on the global AIDS epidemic

Country progress in improving the implementation quality of the “Three Ones”: one national strategic framework, one national AIDS authority, and one national monitoring and evaluation system* 50 quality implementation of 2 components

40 Number of countries

quality implementation of all 3 components

30 * Quality implementation refers to: 1 One national multisectoral strategy and operational plan with goals, targets, costing, and identified funding per programmatic area, and a monitoring and evaluation framework; 2 One national coordinating body with terms of reference, a defined membership, an action plan, a functional secretariat, and regular meetings; 3 One national M&E plan which is costed and for which funding is secured, a functional national monitoring and evaluation unit or technical working group, and central national database with AIDS data.

20 10

0

Figure 7.8

2005 (N=94)**

Source: UNGASS Country Progress Reports 2008.

2007 (N=129)**

** Only countries that have all three or two of the three components in place are displayed; other countries have only one or none of the components in place, or did not report. 2008 Report on the global AIDS epidemic