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The Good, the Bad, and the Ugly: Major Study on Global Burden of HIV Released

The Good, the Bad, and the Ugly: Major Study on Global Burden of HIV Released
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Here are the highlights from a study just published in The Lancet HIV, which provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015.

Finding Highlights

♦  Global HIV incidence peaked in 1997, at 3.3 million new infections, decreasing by 4.8% per year to 2005.

♦  Annual incidence has stayed relatively constant at about 2.6 million per year since 2005.

♦  Prevalence of people living with HIV increased rapidly, from 2.4 million in 1985, to 28.0 million in 2000.

♦  From 2000 to 2015, the number of people living with HIV increased by 0.8%per year, reaching 38.8 million in 2015.

♦  Global mortality peaked in 2005, at 1.8 million and subsequently fell by 5.5% per year to 1.2 million in 2015.

♦  The proportion of people living with HIV and receiving ART increased rapidly for both sexes between 2005 and 2015, from 6.4% to 38.6% of men, and from 3.3% to 42.4% of women

Substantial heterogeneity was reported in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections.

Interpretation

Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030.

Discussion

Remarkable progress has been made in curbing the HIV/AIDS epidemic worldwide. HIV incidence reached its peak in 1997, and HIV deaths have been declining since the mid-2000s. However, annual incidence has stayed relatively constant since 2005, after a period of faster decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing, and reached 38·8 million in 2015. At the country level, disparate levels and trends of the epidemic persist. These updated estimates at the global level are similar to those published in the GBD 2013 iteration for deaths; however, our present estimates for incidence and prevalence are lower for 2013 than in GBD 2013.

The unfolding global HIV pandemic has advanced through three phases during which HIV/AIDS mortality has increased from 4·73 per 100 000 in 1995, the 39th-ranked cause of death, to 16·18 per 100 000 in 2015, the 11th-ranked cause of death worldwide. In the initial phase (1981–97), global HIV incidence and the number of people living with HIV increased, followed by huge increases in deaths related to the disease. From 1998 to 2005, incidence declined by 25·4%; however, because of the lag between infection and mortality, the number of deaths caused by HIV increased. In the third phase, mass scale-up of prevention of mother-to-child trans mission and ART, particularly in low-income sub-Saharan Africa, led to a phase of declining HIV mortality, a decade of stagnation in the decline of global incidence rates, and steadily rising prevalence.

These global patterns mask well documented but extraordinary heterogeneity across countries. Epidemics leading to more than 2·5% of the population being infected have happened largely in eastern, southern, and central sub-Saharan Africa. Although death rates and incidence declined in the past decade in many of these countries, they are increasing in many others where prevalence has been lower until now, such as Indonesia and the Philippines. The scale-up of ART, a key driver of the trends, has led to 41% of people living with HIV receiving ART worldwide.

View the full study (PDF) here.

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