: The Global Fund

HIV situation in the world

Every day, over 7,500 people -- nearly half of them women -- are newly infected with HIV, the virus that causes AIDS. As of the end of 2006, the Joint United Nations Program on HIV/AIDS (UNAIDS) estimated that some 40 million adults are living with HIV/AIDS, including over 37.2 million males and almost 17.7 million females. Heterosexual transmission accounts for more than 75% of all HIV infections world-wide. Today, the HIV virus is transmitted in all countries and, by the year 2015, UNAIDS projects that 60 million people will have been infected. It is also estimated that over 30 million AIDS cases in adults and children have occurred world-wide since the epidemic began. UNAIDS foresees that this cumulative total will triple by the year 2007 over 5 million adults and children are estimated to have died from AIDS so far.

The Poor and Marginalized

Poverty is one of the most powerful driving forces behind the spread of AIDS. More than 90% of the more than 30.1 million people alive today with the virus live in a developing country.

Young People

Among both men and women, the hardest hit group is young people. UNAIDS estimates that half of all infections to date have been in 15-24 year-olds. In some countries, 60% of all new infections are among 15-24 year-olds, with a female to male ratio of 2 to 1 among 15-19 year-olds. The belief that sex and AIDS education may encourage sexual activity in young people, is a powerful barrier to the introduction of HlV-prevention programs. Yet, there is no evidence to suggest that sex education in schools leads to earlier or increased sexual activity. On the contrary, a number of studies have shown that sex education increases the adoption of safer sexual practices and tends to lead young people to postpone sex.

Women

Women are increasingly becoming infected with HIV and at a significantly younger age than men. As of late 2006, almost 17.000.000 women had been infected with HIV since the start of the epidemic. By the year 2017, over 28.000.000 women are expected to have been infected and 6.000.000 of them to have died. Why are girls and young women particularly vulnerable to HIV infection? Women are biologically, epidemiologically and socially more vulnerable. For example, women tend to marry or have sex with men older than themselves, who may have had more sexual partners and hence be more likely to have become infected. In some relationships or cultural environments, it is almost impossible for women to insist on protecting themselves against the virus, through mutual fidelity or condom use. In other cultures, men expect sex with any women receiving their financial support.

Infants and Children

As infections in women rise, so do infections in the infants born to them. Overall, about one-third of babies born to HIV-infected mothers become infected themselves. Parental transmission can occur during pregnancy, during delivery and through breast- feeding. To date, about 1.500.000 children have been infected with HIV, of whom more than 500.000 have already developed AIDS. In addition, UNAIDS estimates that by the end of this century, AIDS will rob almost 5.000.000 children of one or both parents.

AIDS by Region

Southern and Southeast Asia -The extensive spread of HIV in South and Southeast Asia began in the mid-1980s, but its progression has been very rapid. What is happening in Africa now could be dwarfed by the Asian epidemic. As of the end of 2006, UNAIDS estimated that over 7,8 000.000 people were living with HIV/AIDS in this region. While India and Thailand account or the majority of infections, rapid HIV spread into specific populations in other counties of the region has also been noted. For the region's adults, the predominant modes of transmission are unprotected heterosexual intercourse and needle sharing. In some Asian countries, a large proportion of sex outside marriage is not "casual sex" but "commercial sex." One study found that 44% of Thai men had their first sexual experience with a commercial sex worker (prostitute) at an average age of about 18 years. In India, an indication of the population's vulnerability to HIV can be found in the millions of sexually transmitted diseases (STDS) occurring each year. The AIDS epidemic in Southern and Southeast Asia gained an early foothold among injecting drug users. Today, the virus is spreading rapidly in and around the area known as the Golden Triangle, where most of the world's opium and heroin are produced. Apart from unprotected sex and drug injection, contaminated blood transfusions also contribute to the epidemic in parts of the region.

Eastern Europe and Central Asia -In Eastern Europe and Central Asia, it is estimated that more than 1.7000.000 adults are thought to be infected with HIV/AIDS. While this can still be called low prevalence, this is likely to rise given that the region has many ingredients of rapid HIV spread -- economic crisis, rising unemployment, crumbling health systems, ethnic and religious conflicts, the displacement of civilian populations, as well as people on the move in search of economic opportunities.

North Africa and the Middle East -The few studies which are available regarding this region suggest that the extensive spread of HIV began in some parts of the Middle East in the late 1980's. As of the end of 2006, UNAIDS estimates that over 460.000 people are living with HIV/AIDS in this region.

Latin America and the Caribbean -In Latin America and the Caribbean, over 1,950,000 adults are living with HIV/AIDS. Rates of infection are rising in Honduras and in other Central American countries and in the Caribbean. Since the mid 1980s, there has been increasing heterosexual transmission, principally among bisexual men and their female sex partners, and among female sex workers and their clients. This is especially true where heterosexual transmission is spurred by a high prevalence of STDS and other genital tract infections, and by social and economic conditions that favor unprotected sex with many partners (e.g. prostitution). Transmission through drug injecting is also on the rise. In Argentina, for example, HIV prevalence among injecting drug users ranges from 30% to 50%, and in Brazil form 20% to 60%.

North America and Western Europe -In this region, over 1,200,000 adults are living with HIV/AIDS, including more than 750,000 in the USA alone. The people predominantly affected to date have been homosexual or bisexual men and injecting drug users, together with their sex partners. However, the transmission of HIV through heterosexual intercourse is on the rise, with especially notable increases in urban populations who have high rates of injecting drug use or STDS. The USA has by far the highest reported number of AIDS cases in the industrialized world. The proportion of AIDS cases attributable to sexual transmission between men decreased from 75% to just over 50% of the cases between 1985 and 1992. However, by 1992, the proportion of cases due to drug injecting had risen to 25%. In the US, HIV infection is increasingly a disease of poverty and exclusion, with disproportionately high rates among black men and women. Since the epidemic started, as far back as the late 1970s, AIDS has become the leading cause of death among adults under age 45 in many US and Western European cities. In Western Europe today, about 450,000 people are living with HIV/AIDS . There is some evidence that HIV prevalence has stabilized in Northern European countries such as Belgium, Germany, the Netherlands, Sweden and the United Kingdom. Switzerland has reported reductions in the HIV/AIDS cases. However, the situation is less encouraging in countries such as Spain and Italy.

Sub-Saharan Africa -With more than 12,900,000 HIV-infected adults today,sub-Saharan Africa is the region hardest hit. Heterosexual transmission has predominated since the outset, and currently, the number of women infected outnumbers men by 6 to 5. More than 6,000,000 women of childbearing age have been infected and UNAIDS believes that as many as 1,000,000 children may already have been infected prior to, or during birth, or through breast-feeding. In a number of countries in the region, the spread of HIV/AIDS has been spurred by population movements due to situations of conflict or poverty. Another contributory factor appears to have been the frequent presence of other sexually transmitted diseases (STDs) which, if left untreated, increase the risk of HIV infection. The lower status of women in a number of cultures has also contributed to the rapid spread. Recent data suggest that the epidemic is continuing to evolve, particularly in Western and Southern Africa. However, there is also some evidence of a stabilization in HIV infection rates in certain areas of East and Central Africa. In one rural district of southwest Uganda, the percentage of those aged 13 and above acquiring HIV infection each year declined from 7.5% in 1989-1990 to 4.5% in 1993. This is attributed to success in changing sexual behavior. To date, sub-Saharan Africa has lost more than 3,000,000 people to AIDS.