Global Overview

          According to estimates from UNIAIDS (United Nations Program on HIV/AIDS) & WHO (World Health Origination), the global HIV/AIDS epidemic has killed more than 3 Million people in 2003, and an estimated 5 million acquired HIV bringing the number of people living with the virus around the world to 40 Million.

      In Sub-Saharan Africa, HIV Prevalence has remained relatively steady (generally at high levels) for the past several years across much of the region. This is due to the fact that high levels of New HIV infections are persisting and are now matched with very high levels of AIDS mortality. The Epidemic remains rampant. How long this will last will depend on the vigor, scale and effectiveness of prevention, treatment and care programs.

   Although Basic Knowledge of HIV/AIDS has increased among young people in recent years, it is still disturbingly low in many countries, especially among young women.

In the 33 states which have a history of confidential HIV reporting, an estimated 174,396 people were living with HIV that had not progressed to AIDS. According to the number of AIDS cases reported to the CDC, these 33 areas represent approximately 43% of the US epidemic. The total number of people living with HIV (not AIDS) in the USA must therefore be much higher.

Estimated numbers of persons living with HIV (not AIDS) or with AIDS at the end of 2003, by USA area of residence

Around half of all people diagnosed with AIDS were probably infected with HIV through male-to-male sexual contact, while people exposed through heterosexual contact comprise around 16% of the total. However, since the beginning of the epidemic, the number of heterosexual infections has increased dramatically. According to CDC estimates, heterosexual contact led to about one third of new AIDS diagnoses and one third of new HIV diagnoses in 2003.

More than 18% of all adults and adolescents diagnosed with AIDS have been female. Among new AIDS diagnoses in 2003, and among new HIV diagnoses, this proportion was 27%.

Of the estimated 9,419 children under 13 years of age who have been diagnosed with AIDS, 8,749 (93%) were infected with HIV through mother-to-child transmission.

Estimated adult and adolescent HIV diagnoses in 2003 by exposure category

Estimated adult and adolescent AIDS diagnoses by exposure category

 Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report 2003, (Vol. 15).
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National HIV prevalence (the proportion of the population who are living with HIV) is now estimated to be at least 1% in Belize, Guyana, Honduras and Suriname. However, in most countries HIV infection is not generalized but is highly concentrated in populations at particular risk. Despite a national prevalence below 1%, Brazil (by far the region's most populous country) accounts for perhaps 40% of people living with HIV in Latin America. In some Brazilian cities, more than 60% of drug users are HIV positive.

The 48 countries which have national HIV reporting systems have reported 571,648 HIV diagnoses. This is certainly a severe understatement of the total number of infections. UNAIDS estimates that more than 2 million people were living with HIV in Europe at the end of December 2004¹ .

Across the continent, HIV infections through heterosexual contact are increasing steadily and women account for a rising proportion of HIV diagnoses.

Surveillance data reflects the diversity of the HIV & AIDS situation in Europe. Most statistics are presented in three geographic areas: the West, the Centre and the East.

Western Europe

A cumulative total of 195,964 HIV infections had been reported in 20 countries of Western Europe by the end of 2003. This considerably understates the true figure because not all prevalent HIV infections have been diagnosed or reported. This is partly because many people do not know that they are infected. More significantly, the three countries with the most extensive epidemics either do not yet have national HIV reporting systems (Spain), do not report from all regions (Italy) or started reporting only in 2003 (France). National HIV reporting started at different dates in different countries, without systematic retrospective reporting of infections diagnosed in previous years.

Of the 18,030 people with newly diagnosed HIV which the West reported in 2003,

• 58% probably acquired HIV through heterosexual contact
• 30% were homo/bisexual men
• 11% were injecting drug users
• 37% were female
• 29% were less than 30 years old.

Heterosexual contact has been the most frequent transmission mode in the West since 1999. It is responsible for the largest proportion of diagnosed HIV infections in every country except Germany and the Netherlands, in which men who have sex with men form the largest transmission group. Heterosexual transmission predominates even in Portugal, which has a particularly severe epidemic among injecting drug users.

Trends in HIV incidence may be examined in countries which have a history of reporting. For 16 of the 23 countries in the West, HIV reporting data are available at least since 1998. In these countries, the number of newly diagnosed HIV infections rose slowly between 1998 and 2001, before increasing substantially by 26% between 2001 and 2002. This rise continued with a 9% increase in 2003.

In the 16 aforementioned countries, the number of people infected with HIV through heterosexual contact has been continually rising. Following several years of decline, the number of diagnoses among homo/bisexual men increased significantly in 2002 and remained at a similar level in 2003. In contrast, the number of cases among injecting drug users has been falling since 1998.

There has been a sharp rise in the number of cases reported in the UK. This country accounted for nearly a third of all new HIV infections reported in the West in 2001 and 2002. In 2003, the United Kingdom reported 39% of all new cases.

AIDS statistics have been as geographically varied in the West as in Europe as a whole. In 2003, the highest rates of AIDS diagnoses were reported by Portugal (81.3 per million population), Spain (33.2), Switzerland (31.0) and Italy (30.6). Each of Spain, France and Italy has reported more than 50,000 AIDS cases since the beginning of the epidemic.

An estimated 6,496 AIDS cases were diagnosed in the West in 2003. After several years of decline since the introduction and widespread use of combination antiretroviral treatment, AIDS incidence seems to be reaching a plateau in many countries. The apparent drop from an estimated 8,779 cases in 2002 is probably largely due to the inability to adjust data from Spain for reporting delays (see Notes, below) and to incomplete reporting from France and the Netherlands.

In the age of widely available antiretroviral therapy, AIDS mortality has continued to decrease. There were an estimated 2,525 deaths in 2003.

As new diagnoses outnumber deaths, the number of people living with AIDS continues to increase. Given that 260,573 people had been diagnosed with AIDS and 149,960 of these were known to have died, it has been estimated that 110,000 people in the West were living with AIDS at the end of 2003.

Central Europe

A total of 1,440 HIV infections and an estimated 559 AIDS cases were diagnosed in the Centre in 2003.

Central Europe has been relatively spared by the epidemic, with the incidence of both AIDS cases and newly diagnosed HIV infections remaining low. However, this region accounts for the largest proportion of paediatric AIDS cases following an outbreak of infection among young children in hospitals in Romania around 1990.

Eastern Europe

By the end of 2003, a cumulative total of 354,641 HIV diagnoses had been reported by the 15 countries of the former Soviet Union. The Russian Federation accounted for 76% of these cases. These reports represent just a small fraction of the real epidemic. According to UNAIDS, 1.4 million people were living with HIV in Eastern Europe and Central Asia at the end of 2004.

After increasing steeply for several years, the number of new HIV diagnoses peaked in 2001 at over 100,000. There then followed annual declines of 36% in 2002 and 15% in 2003. This fall was due to a sharp drop in the number of cases amongs