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AIDS
Who is at Risk of Acquiring or
Transmitting HIV Infection?
Factors that can Facilitate or
Limit Epidemic Sexual HIV
Transmission
Facilitating factors* Protective factors
Other STD, especially Male circumcision – lack
ulcerative STD of penile foreskin
Traumatic sex, “dry” sex Condom use
Acute phase of HIV Potential future factors –
infection (high viral load) Microbicides, vaccines
*Facilitating factors are not co-factors since they are not required for HIV
transmission but can “facilitate” or increase the risk of transmission
The Reproductive
Number (R0) of HIV
7/04/07
Estimated HIV Prevalence in
10,000 Females - 2006
Country Number HIV Transmission
Swaziland >3,000 Primarily heterosexual
Thailand 100 Primarily FSW/Clients & IDU
Russia 75 Primarily IDU
India 50 Focal FSW and IDU
USA 30 Mostly MSM & IDU
Mexico 20 Mostly MSM & IDU
Malaysia 15 Primarily IDU
China 3 IDU and paid plasma donors
Philippines 1 No epidemic HIV spread
Turkey <1 No epidemic HIV spread
Estimated HIV Prevalence and
Incidence – California - 2000
HIV Prevalence HIV Incidence
Population Number Number rate (%) Number rate (%)
MSM 720,000 85,000 12% 5,000 0.7%
IDU 220,000 9,900 4.5% 1,000 0.5%
MSM/IDU 80,000 8,000 10% 500 0.63%
Heterosexual*
Males 5,700,000 2,500 0.044% 150 0.0026%
Females 6,300,000 5,000 0.08% 300 0.0048%
Totals 13,020,000 110,400 0.85% 6,950 0.053%
94
97
87
88
93
Uganda
87
Kenya
93
UNAIDS Report to UNGASS –
May 30, 2006 OVERVIEW OF
THE GLOBAL A I D S EPIDEMIC
“Overall globally, the HIV incidence rate (the
annual number of new HIV infections as a
proportion of previously uninfected persons) is
believed to have peaked in the late 1990s
and to have stabilized subsequently…
…Changes in incidence along with rising AIDS
mortality have caused global HIV prevalence
(the proportion of people living with HIV) to
level off….”
UNAIDS 2006 Estimates of Annual
HIV Incidence and Annual AIDS
Deaths in Selected Regions
Region *HIV *AIDS HIV:Death
Incidence Death Ratio**
Sub-Saharan Africa 2.8 2.1 1.3:1
N Africa & Middle East 0.068 0.036 1.9:1
South & SE Asia 0.86 0.59 1.5:1
East Asia 0.1 0.043 2.3:1
Latin Amer & Caribbean 0.17 0.084 2.0:1
Totals 4 2.85 1.4:1
*Numbers are in millions **When HIV incidence peaks, the ratio of new HIV infections
to AIDS deaths is about 2:1; after 5 years it is 1.5:1; and after 10 years close to 1:1
UN Millennium target
“Have halted by 2015
and begun to reverse
the spread of
HIV/AIDS”
What are the Major Factors
Responsible for Peaking of
Sexual HIV Epidemics?
• Increase of responsible sexual behaviors,
i.e., sexual Abstinence and/or Being faithful
• Increase of consistent Condom use for
risky sex behaviors
• Saturation of infection in those with the
highest sexual risk behaviors
All of the above, but perhaps saturation of
infection may be the most important factor!
Modeling HIV/AIDS in Cambodia
HIV/AIDS # 10 - 2.5%
HIV/AIDS # 8 – 2%
Data source: Version 3 revisions of the Global Burden of Disease (GBD) study.
The Impact of AIDS on the San
Francisco Gay Men’s Chorus
Can You Believe This?
UNAIDS modeled
baseline scenario
UNAIDS’ comprehensive
prevention & treatment
scenario
Estimation and Projection of
HIV Prevalence to 2020
Overestimates and
projections by
UNAIDS & UN Most likely scenario
Population Division
SUB-SAHARAN
AFRICA
SOUTH &
SE ASIA Most likely scenario
****
The AIDS Pandemic argues that
the story of HIV/AIDS has been
distorted by UNAIDS and AIDS
activists in order to support the
myth of the high potential risk of
HIV epidemics spreading into the
general population.
Radcliffe-Oxford, 2007
www.theaidspandemic.com