Doing the Right Thing

Karen A. Stanecki XV International AIDS Conference

Trends in global adult HIV prevalence

0

10

20

30

40

50

1991 1993 1995 1997 1999 2001 2003

Million

s

Estimated number of people living with HIV

Global Report 2002

Global Report 2004

0

1

2

3

4

5

1991 1993 1995 1997 1999 2001 2003

Million

s

GlobalSub-Saharan Africa

New infections

GlobalSub-Saharan Africa

Deaths due to AIDS

Steadily rising annual HIV infections and AIDS deaths

Rising HIV infection among injecting drug users,

followed by rising infection among sex workers

% HIV positive

0

10

20

30

40

50

60

70

80

90

100

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

IDU (Jakarta, Indonesia)

Sex workers (Jakarta, Indonesia)

IDU (Guangxi, China)

Sex workers (Guangxi, China)

IDU (Hanoi, Vietnam)

Sex workers (Hanoi, Vietnam)

0 10 20 30 40 50 60 70 80 90 100

Central Bangladesh

Sichuan, China*

Delhi, India

Surabaya, Indonesia

Katmandhu Valley, Nepal

Bangkok, Thailand**

Hanoi, Vietnam

Unprotected commercial sex Commercial sex with a condom

Source: Behavioural surveillance reports

High proportions of men who inject drugs are also clients of

sex workers

%

Condom use,Female sex workers

HIV prevalence, female sex workers

0

20

40

60

80

100

1995 1997 1999 2001 2003

%

Source: Cambodia National Center for HIV/AIDS Dermatology and STDs, Ministry of Health

Increasing condom use and decreasing HIV infections in

Cambodia

Used needle after other

injector last time

Used needle after other

injector in the last week

Reported STI symptom past year*

Sought medical treatment for

STI**

Per

cen

t

Participated in needle exchange

Did not participate

51

59

72

90

38

1621

17

0

10

20

30

40

50

60

70

80

90

100

Needle-exchange programmes promote healthy sexual behaviour

and safe injection

Source: National behavioural surveillance data

* of sexually active respondents; ** of respondents reporting STIs

Bangladesh

Asia’s HIV prevention successes have three features in common

1. They recognize and target the behaviors that are causing most new infections

2. They use the most effective interventions that directly reduce the risk of HIV transmission

3. They provide the services to the population at greatest risk of HIV exposure

63 000

115 000

200 000

8 500

110 000

0 50 000 100 000 150 000 200 000 250 000

Men and womenneeding

antiretrovirals

Prisoners needingprevention services

High-risk MSM needing

condoms and lubricant

Drug injectors needing

needles and condoms

Sex workers needingcondoms and STI

services

Source: Based on national estimates of people at risk for HIV, Ministry of Health , Indonesia

Treatment is critical, and HIV prevention services remain a major

priorityin Indonesia

Adult prevalence %

15.0% − 39.0%5.0% − 15.0%1.0% − 5.0%0.5% − 1.0%0.1% − 0.5%0.0% − 0.1%not available

HIV prevalence in adults, end 200338 million people [range: 35-42 million] living with HIV as of end 2003

HIV prevalence among 15−24-year-oldsin selected sub-Saharan African countries,

2001−2003

0

5

10

15

20

Niger

(2002)

Mali

(2001)

Burundi

(2002)

Kenya

(2003)

Zambia

(2001-2002)

South Africa(2003)

Zimbabwe

(2001-2002)

% H

IV p

revale

nce

Men Women

2004 Report on the Global AIDS Epidemic (Fig 7)

And the more people have access to effective prevention,the fewer people will be

in need of treatment.

It’s about human rights

Every person in need must haveaccess to HIV treatment.