KEY FACTS ON GLOBAL HIV EPIDEMIC AND PROGRESS IN 2010

Report on Global HIV/AIDS Response WHO, UNICEF, UNAIDS Embargoed until 11:30 CET, 30 November 2011 EPIDEMIC OVERVIEW New HIV infections An estimated 2.7 million people worldwide were newly infected with HIV in 2010. An estimated 390 000 children were newly infected with HIV in 2010; 30% fewer than the peak of 560 000 annual new infections in children in 2002 and 2003. Since 2001, annual HIV incidence has fallen in 33 countries, 22 of them in sub-Saharan Africa. However, incidence is accelerating again in Eastern Europe and Central Asia after having slowed in the early 2000s, and new infections are on the rise in the Middle East and North Africa. AIDS-related deaths The number of AIDS-related deaths worldwide is steadily decreasing from a peak of 2.2 million in 2005 to an estimated 1.8 million in 2010. However, between 2001 and 2010, AIDS-related deaths increased more than 11-fold in Eastern Europe and Central Asia (from about 7 800 to 90 000), and more than doubled in East Asia (from 24 000 to 56 000). In the Middle East and North Africa, AIDS-related mortality also increased by 60% (from 22 000 to 35 000). HIV prevalence An estimated 34 million people were living with HIV at the end of 2010. PROGRESS IN THE HEALTH SECTOR RESPONSE HIV treatment, care, and support By the end of 2010, the number of people on antiretroviral treatment (ART) in low- and middle-income countries had reached 6.65 million people, a more than 16-fold increase in seven years. This represents 47% coverage of those in need of ART, up from 39% at the end of 2009. In total, 7.4 million people living with HIV are on ART globally, including those living in high-income countries. The number of children receiving paediatric HIV treatment in low- and middle-income countries has increased from 71 500 in 2005 to 456 000 in 2010. However, estimated coverage is much lower among children (23%) than among adults (51%). ART coverage is higher among women (53%) than men (40%) globally. The number of health facilities providing ART, an indicator of a health system's capacity to deliver treatment, rose from 18 386 in 2009 to 21 641 in 2010 in 109 reporting lowand middle-income countries, representing an 18% increase in one year. Ten low- and middle-income countries, including three countries with generalized epidemics (Botswana, Namibia and Rwanda) and seven countries with concentrated or low-level epidemics (Cambodia, Chile, Croatia, Cuba, Guyana, Nicaragua and Slovakia)

have achieved universal access, commonly understood as providing ART to at least 80% of the people who need it. Among the 22 priority countries for eliminating mother-to-child transmission, five countries reached the goal of providing effective regimens for preventing mother-to-child transmission to 80% of pregnant women living with HIV in need: Botswana, Lesotho, Namibia, South Africa and Swaziland. Eleven countries, including two with generalized epidemics (Botswana and Namibia) and nine with low-level or concentrated epidemics (Belarus, Chile, Ecuador, Guyana, Jamaica, Mexico, Paraguay, Uruguay and Uzbekistan) achieve universal access to paediatric HIV treatment delivering it to over 80% of children in need. Limited data are available on the access to ART for key populations, such as people who inject drugs, sex workers and men who have sex with men. In Eastern Europe and Central Asia, people who inject drugs represent 62% of reported HIV cases but only 22% of those receiving ART. A total of 2.1 million people with tuberculosis were tested for HIV in 2010; 488 000 (23%) were HIV-positive., 46% of people with TB that were found HIV positive are receiving ART. In 2010, an increasing number of countries adopted WHO's new guidelines on isoniazid-preventive therapy (IPT). But coverage for IPT remains low with 12% coverage rate among adults and children newly enrolled in HIV care.

Prevention of mother-to-child transmission of HIV Progress in preventing mother-to-child transmission of HIV (PMTCT) has driven the recent global commitment, and global plan agreed at the UN High-Level Meeting in June 2011, to eliminate new HIV infections among children by 2015. In 2010, 48% of pregnant women living with HIV in low- and middle-income countries (716 500 of 1.49 million) received effective antiretroviral regimens excluding single dose nevirapine. An estimated 35% of pregnant women in need living with HIV in low- and middle-income countries received an HIV test in 2010, up from 7% in 2005. Between 2009 and 2010, coverage of antiretroviral (ARV) prophylaxis to the estimated 1.48 million infants born to mothers living with HIV increased from 32% to 42%. In 65 low- and middle-income countries providing data, 28% of infants were reported to have been tested for HIV within two months of their birth, versus 6% in 54 reporting countries in 2009. Prevention in the health sector More than 550 000 men were circumcised for HIV prevention in priority countries in subSaharan Africa in 2010. The availability and safety of blood and blood products for transfusion remain a concern. In low-income countries with available data, only 53% of blood donations were screened in a quality-assured manner in 2008. In 2010, there were approximately 3.2 million 15 24 year-old young people living with HIV. Of this 64% were women. In certain regions, prevalence levels in this group are disproportionately higher than among their male peers. For example, in sub-Saharan Africa, 71% of 15 24 year-olds living with HIV were women and 29% were men. Knowledge of HIV status More than 95 million HIV tests were performed in 2010 in 119 low- and middle-income countries, representing an increase from 67 million tests reported in 100 countries in 2009. The reported number of health facilities providing HIV testing and counselling services reached
131 000 in 2010 (in 119 countries), up from 30 300 in 2007 (in 78 countries).

Services for key populations An analysis of data in low- and middle-income countries found that men who have sex with men are 19.3 times more likely to be living with HIV than the general population showing HIV prevalence rates up to 33%. Coverage of harm reduction programmes for people who inject drugs remained limited in 2010. Among 107 reporting countries, 42 had needle and syringe programmes and 37 offered opioid substitution therapy.

BEYOND 2011: TREATMENT GAINS AMID FUNDING UNCERTAINTIES A 2011 study indicates that investments in ART programmes are having a significant impact on economic activity and labour force productivity, with gains expected to reach up to US $34 billion and 18.5 million life years in low- and middle-income countries by 2020. This more than offsets the costs of ART programmes. As a result of new evidence that early ART initiation significantly reduces AIDS-related illness and death, as of late 2010, 88 out of 93 reporting countries were following the new WHO recommendations to initiate ART for all patients with CD4 counts of or below 350 cells/mm3. The Treatment 2.0 initiative, launched by UNAIDS and WHO in 2010, is continuing the drive innovation and efficiency in key areas, such as simplified and more affordable diagnostics and treatment regimens, and integrated, decentralized HIV service delivery. Examples of these efficiency gains in countries include: In South Africa, a new tendering strategy, aimed at increasing competition between drug manufacturers and reducing treatment costs, has resulted in a 53% reduction overall in the cost of antiretrovirals and estimated savings of US$ 685 million over a two-year period. In Uganda, the use of simplified fixed-dose combination ARVs for children, as opposed to costly and less convenient syrups and single-drug formulations, has risen from 17% to 100% of those in need in the past two years, and enabled savings of US$ 2 million. In Mozambique, after the introduction of CD4 testing devices at selected primary health care clinics, the median time taken for CD4 staging was reduced from 27.5 days to one, and the number of patients lost to follow up prior to initiation of ART fell from 64% to 33%. In Malawi, as a result of shifting treatment delivery from hospitals to health centres and from clinical officers to nurses, patients in Thyolo district now start treatment within 3 weeks of diagnosis as opposed to 3 months. HIV testing and counselling services have also been transferred from nurses to trained assistants. After years of significant increases, international funding for HIV programmes fell in 2010 in the wake of the global financial crisis. Current annual funding is estimated to be US$16 billion, well below the US$2224 billion needed annually by 2015 for a comprehensive, effective global response to HIV, according to UNAIDS' Investment Framework. WHO is working with Member States to optimize HIV treatment, prevention and diagnostics, and improve integration and efficiencies of HIV programmes. In May of this year, the World Health Assembly adopted the new Global Health Sector Strategy on HIV/AIDS, 2011 2015 with a view to eliminating new infections in infants, reducing new infections in young people by 50%, reducing AIDS-related deaths by 35%, and reducing tuberculosis-related deaths by 50%. For more information on WHO's HIV programme, please visit, www.who.int/hiv