Source: UNAIDS, 2006.
Figure 1.3. HIV epidemic in sub-Saharan Africa, 1985 – 2005.
Eastern Europe
and Asia
Latest estimates show some 8.3 million [5.7 million–12.5 million] people (2.4 million among adult women [1.5 million–3.8 million]) were living with HIV in Asia at the end of 2005—more than two-thirds of them in one country, India. Approximately 650 000 [390 000–1.1 million] people in China were living with HIV in 2005. Injecting drug users (of whom there are at least one million registered in the country) account for almost half (44%) the people living with HIV. The overlapping risks of injecting drug use and unprotected sex feature in several other epidemics in Asia.
The HIV epidemics remain relatively limited in Bangladesh, the Philippines, Indonesia and Pakistan, although each of these countries risks a more serious epidemic if prevention methods are not improved. An especially troubling situation has emerged in the easternmost province of Papua, which borders on Papua New Guinea, where a serious HIV epidemic is underway.
The epidemics in Eastern Europe and central Asia continue to expand. Some 220 000 [150 000–650 000] people were newly infected with HIV in 2005, bringing to about 1.5 million [1.0 million–2.3 million] the number of people living with HIV—a twenty-fold increase in less than a decade. The epidemic’s death toll is rising sharply, too. AIDS killed an estimated 53 000 [36 000–75 000] adults and children in 2005—almost twice as many as in 2003. Increasingly large numbers of women are being infected with HIV.
The majority of people living with HIV in Eastern Europe and central Asia are in two countries: the Ukraine, where the annual number of new HIV diagnoses keeps rising, and the Russian Federation, which has the biggest AIDS epidemic in all of Europe.
Latin America
In Latin America, some 140 000 [100 000–420 000] people were newly infected with HIV in 2005, bringing the number of people living with the virus to 1.6 million [1.2 million–2.4 million] The region’s biggest epidemics are in the countries with the largest populations, notably Brazil, which is home to more than one-third of the people living with HIV in Latin America. The most intense epidemics, however, are underway in the smaller countries of Belize and Honduras, in each of which more than 1.5% or more of adults were living with HIV in 2005.
Oceania
While HIV infection levels remain low across Oceania, Australia’s long-established AIDS epidemic is not dissipating, and Papua New Guinea’s relatively young but already serious epidemic accounts for more than 90% of all HIV infections reported in Oceania to date outside of Australia and New Zealand.
The Caribbean
The Caribbean’s epidemics—and the response of each country to the AIDS epidemic—vary considerably in extent and intensity. HIV infection levels have decreased in urban parts of Haiti and in the Bahamas, and have remained stable in neighbouring Dominican Republic and Barbados. Expanded access to antiretroviral treatment in the Bahamas and Barbados appears to be reducing AIDS deaths, as well. However, such progress has not been enough to undo the Caribbean’s status as the second-most-affected region in the world. AIDS is the leading cause of death among adults (15–44 years) and claimed an estimated 27 000 [18 000–37 000] lives in 2005. (UNAIDS, 2006) Overall, fewer than one in four (23%) persons in need of antiretroviral therapy was receiving it in 2005. National adult HIV prevalence exceeds 2% in Trinidad and Tobago, and 3% in the Bahamas and Haiti.
As the epidemic has spread throughout the Caribbean, the primary mode of sexual transmission has changed from being predominantly homosexual to a mosaic of homosexual, bisexual and heterosexual epidemics. Injecting drug use is responsible for a minority of HIV infections and contributes significantly to the spread of HIV only in Bermuda. The epidemic is also shifting to younger populations—in particular, to young females. Among the 12 territories with a generalised epidemic in the Caribbean, 10 of them are CAREC Member Countries (CMCs). The remaining two countries, Haiti and the Dominican Republic, share the Hispaniola Island, which is the epicentre of the HIV epidemic in the Americas (CSR Supplement, 2003).
Trends (CAREC Surveillance data, 1982–2003)
Data used for this report are based on quarterly reports or year-end summaries submitted by nineteen CMCs. No reports were received from Aruba; combined HIV/AIDS data were received from the Netherlands Antilles. As data for 2004 and 2005 are only available for a small number of countries, this review covers the period from 1982 to 2003.
During the period from1982 to 2003, a cumulative total of 25 854 AIDS cases were reported to CAREC by 19 of its 21 CMCs. The distribution of cases among CMCs was as follows: Jamaica - 31%, Bahamas - 17%, Trinidad and Tobago - 20%, Guyana - 11%, Barbados - 7%, Suriname - 7%, St. Vincent and the Grenadines - 2%, and Bermuda - 2%. The remaining CMCs (except Aruba and the Netherlands Antilles) individually reported less than one percent of the total.
The first case of AIDS in the CMCs was recorded in Jamaica in 1982, and the general trend since then has been an increasing one, from 669 cases in 1990 to 2 638 cases in 2003 [as shown in Figure 1.3]. Incomplete reports from some relatively large countries (for example, Barbados, Belize and Suriname) were mainly responsible for the decrease in 2000-2002.
The rate of the spread of HIV (and subsequently AIDS) shows a variety of trends in the different member countries. This is the result of a number of factors, including the stage of the epidemic in each country, the primary mode(s) of transmission, the strength of the HIV/AIDS control programme and the availability of antiretroviral drugs. In Jamaica, the trend has been a steadily increasing one, from one case in 1982 to 70 cases in 1990, to a high of 1070 cases in 2003. Trinidad and Tobago and the Bahamas, which reported higher numbers than Jamaica in 1990-1993, have shown a slower rate of increase, with indications of a plateau in 1996/97 and subsequent declines. Antigua and Barbuda, Dominca, Grenada and St. Lucia have all reported fewer than 20 cases per year, while Anguilla, Montserrat, the British Virgin Islands, the Cayman Islands and St. Kitts and Nevis have individually reported fewer than 10 cases per year.
Trends (CAREC Surveillance data, 1982 – 2003), continued
Figure 1.3. Reported (confirmed) cases of AIDS by year, CAREC member countries, 1982-2005.
During the period under review, the HIV/AIDS epidemic in the Caribbean changed from occurring mostly in males, to a male-to-female ratio of 1:1.4 in 2003. In the year 1985, out of 138 total AIDS cases reported by CMCs, 28 (20%) were in females. In the year 1990, out of 669 total AIDS cases reported by CMCs, 211 (32%) were in females. As shown in Figure 1.4, on the next page, in 2003, of 2 638 total reported AIDS cases, 1 102 (42%) were in females.
Trends (CAREC Surveillance data, 1982 – 2003), continued
Figure 1.4. Reported AIDS cases in the Caribbean region, 1982-2003.
Source: AIDS reports from CMCs, accessed from the CAREC Reporting Tool for AIDS at: http://carec.net/index.html on 11th May 2006
Trends (CAREC Surveillance data, 1982 – 2003), continued
Table 1.1 shows the age distribution of reported AIDS cases for the years 1985, 1990, 1995, 2000 and 2003. The 20-49 year age group is the most affected, accounting for over 65% of cases annually.
Table 1.1: Reported AIDS cases by age group in 1985, 1990, 1995, 2000 and 2003.
-
Age (years)
|
1985
|
1990
|
1995
|
2000
|
2003
|
≤ 1
|
8
|
21
|
33
|
32
|
20
|
1-4
|
9
|
14
|
36
|
106
|
56
|
5-14
|
1
|
6
|
14
|
38
|
34
|
15-19
|
3
|
13
|
21
|
29
|
30
|
20-24
|
14
|
74
|
128
|
128
|
150
|
25-29
|
28
|
110
|
234
|
279
|
290
|
30-34
|
27
|
120
|
312
|
309
|
404
|
35-39
|
16
|
87
|
256
|
338
|
383
|
40-44
|
8
|
57
|
192
|
245
|
321
|
45-49
|
1
|
46
|
129
|
220
|
234
|
≥ 50
|
10
|
64
|
201
|
284
|
366
|
Unknown
|
11
|
57
|
24
|
222
|
350
|
Total
|
136
|
669
|
1580
|
2230
|
2638
|
Source: AIDS reports from CMCs, accessed from the CAREC Reporting Tool for AIDS at: http://carec.net/index.html on 11th May 2006.
Although heterosexual transmission of HIV has been steadily increasing over the years and is the major mode of transmission, other routes, like MSM (men having sex with men) and MTCT (mother-to-child transmission) have also been consistently responsible for a significant number of AIDS cases. However, unlike in some other parts of the world (like North America and Europe), HIV transmission due to intravenous drug use is not responsible for a large number of AIDS cases in the CMCs.
While there is under-reporting, there is cautious optimism that the AIDS epidemic in some CMCs has reached or is reaching a plateau.
For more detailed AIDS data, please visit CAREC Reporting Tool for AIDS at: http://carec.net/index.html
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