Presentation - UNICEF - Children and AIDS

Report
2014 STATISTICAL UPDATE
“Children should be the first to
benefit from our successes in
defeating HIV, and the last to
suffer from our failures.”
Anthony Lake
Executive Director, UNICEF
CHILDREN, ADOLESCENTS AND AIDS
Digital Release, 28 November 2014
Key points [1]
• An AIDS-free generation is within reach, and it starts with
children.
• Globally, more than 1.1 million new HIV infections among
children were averted between 2005 and 2013 but efforts
need be stepped up dramatically to reach 2015 goals.1
• Treatment is not equitable: children and adolescents lag
behind adults on access to antiretroviral therapy (ART).2
1.UNAIDS, 2013 HIV and AIDS estimates, July 2014.
2.UNAIDS, WHO, UNICEF, Global AIDS Response Progress Reporting; and UNAIDS, 2013 HIV and AIDS estimates, July 2014.
Key points [2]
• Adolescents are being left behind.
• AIDS is #1 killer of adolescents in Africa, and #2 globally.3
• Adolescents are the only age group in which AIDS-related
deaths have not decreased.4
• Prevention efforts need to be intensified and targeted to
reach those most at risk; adolescent girls in sub-Saharan
Africa and adolescent key affected populations.
• Stigma and discrimination, along with policy and legal barriers
such as age-of-consent or punitive laws, prevent services from
reaching adolescents.
3. WHO, Health for the world’s adolescents: a second chance in the second decade, World Health Organization, Geneva, 2014.
4. UNICEF analysis of UNAIDS, 2013 HIV and AIDS estimates, July 2014.
Key points [3]
• Improving strategic information is essential to facilitating
better results, especially where data is made available nearly
in real time, and is effectively utilized in planning and
programming.
• We have the knowledge and tools to achieve an AIDS-free
generation.
• Achieving an AIDS-free generation will mean addressing
inequities and reaching the most vulnerable children,
adolescents, and their families.
UPDATE ON THE FIRST DECADE OF A CHILD’S LIFE
“Eliminating new HIV infections among children is an ambitious but achievable
goal. With the support of the Every Woman Every Child movement, an AIDSfree generation can be ours. There is no better investment than the health of
women and children.”
Ban Ki-moon
Secretary-General of the United Nations
1st decade: summary of key figures
1.1m
1.1 million new HIV infections were prevented among children (0–14 years) in
low- and middle-income countries between 2005 and 2013 based on UNAIDS
models.5
240,000
240,000 new HIV infections occurred among children (0–14 years) in low- and
middle-income countries in 2013.5
67%
67% of pregnant women living with HIV in low- and middle-income countries
received the most efficacious antiretroviral medicines to prevent mother-tochild transmission in 2013, compared to 47%** in 2010.6
23%
vs37%
23% of children (0–14 years) living with HIV in low- and middle-income
countries received life-saving ART in 2013 vs 37% of adults.6
5. UNAIDS, 2013 HIV and AIDS estimates, July 2014.
6. UNAIDS, WHO, UNICEF, Global AIDS Response Progress Reporting; and UNAIDS, 2013 HIV and AIDS estimates, July 2014.
** Note: Data from 2005 through 2009 include single-dose nevirapine, a regimen no longer recommended by WHO; thererfore values from 2005-2009 are not directly
comparable to those from 2010-2013.
1.5 million pregnant women living with HIV
2,000,000
1.5 million pregnant women
living with HIV (2013)
1,500,000
1,000,000
500,000
0
1990
1995
2000
Estimated number of pregnant women living with HIV, globally, 1990–2013
Note: The shaded area indicates the uncertainty ranges around the estimates.
Source: UNAIDS 2013 HIV and AIDS estimates, July 2014.
2005
2010
2013
More progress in PMTCT since 2009 than
the previous decade
Estimated number of new HIV infections in children (aged 0–14): global trend, percent decline, and projection, 2001–2015
Source: UNICEF analysis of UNAIDS 2013 HIV and AIDS estimates, July 2014.
Global vertical HIV infection rates
Estimated percentage of HIV-exposed infants who were vertically infected with HIV, 2013
Note: The boundaries and the names shown and the designations used on this map does not imply official endorsement or acceptance by the
United Nations
Source: UNAIDS, 2013 HIV and AIDS estimates, July 2014.
Almost 90% of new HIV infections in
children in sub-Saharan Africa
Latin America and
Caribbean
2,300
East Asia and Pacific
1%
8,200
3%
South Asia
14,000
6%
West and Central Africa
92,000
38%
Middle East and North Industrialzed
Africa
countries
1,800
<500
1%
<1%
CEE/CIS
<1,000
<1%
Eastern and Southern
Africa
120,000
51%
Total: 240,000 (100%)
Estimated number and percentage of new HIV infections among children aged 0–14 globally, by UNICEF region, 2013
Source: UNAIDS 2013 HIV and AIDS estimates, July 2014.
Good progress for many countries
…even more needed by 2015
< 30% decline
30-49% decline
≥ 50% decline
Global plan priority countries and
respective 2015 targets
Number of new HIV infections among children Percentage decline in new HIV infections among
(0-14 years)
children (0-14 years)
2009 (baseline) 2013 (latest) 2015 (target) Achieved (2009–2013) Required (2013–2015)
7,400
Malawi
23,000
2,300
67%
69%
8,300
Ethiopia
20,000
2,000
57%
77%
9,000
Zimbabwe
21,000
2,100
57%
77%
<500
Botswana
<1,000
<100
57%
77%
Namibia
2,400
1,100
<500
57%
77%
Mozambique
27,000
12,000
2,700
57%
77%
South Africa
33,000
16,000
3,300
52%
79%
Ghana
4,800
2,400
<500
50%
80%
Burundi
2,600
1,300
<500
49%
80%
United Republic of Tanzania
31,000
16,000
3,100
49%
81%
Uganda
30,000
16,000
3,000
47%
81%
Swaziland
1,900
1,100
<200
46%
81%
Côte d'Ivoire
8,200
4,900
<1,000
40%
83%
Kenya
21,000
13,000
2,100
38%
84%
Zambia
19,000
12,000
1,900
37%
84%
Cameroon
14,000
9,500
1,400
32%
85%
Democratic Republic of the Congo
10,000
7,400
1,000
27%
86%
Chad
4,900
3,700
<500
25%
87%
Lesotho
4,400
3,400
<500
23%
87%
India
17,000
13,000
1,700
22%
87%
Nigeria
63,000
4,400
51,000
6,300
19%
88%
4,000
<500
10%
89%
Angola
Country progress in reducing new HIV infections among children aged 0–14 in 22 Global Plan priority countries, 2009–2013
Source: UNICEF analysis of UNAIDS, 2013 HIV and AIDS estimates, July 2014.
67% of pregnant women living with
HIV received PMTCT in 2013
>95%
100%
93%
90%
80%
78%
2005*
2009*
2010
2011
2012
2013
67%
70%
68%
60%
50%
42%
39%
40%
30%
17%
16%
20%
10%
0%
Eastern and
Southern
Africa
West and
Central Africa
Middle East
and North
Africa
East Asia and
Pacific
South Asia
Latin America
and Caribbean
CEE/CIS
All low- and
21 African
middle-income Global Plan
countries
countries
Estimated percentage of pregnant women living with HIV receiving the most effective antiretroviral medicines for PMTCT, in UNICEF
regions, all low- and middle-income countries and the 21 African Global Plan priority countries, 2005–2013
Source: UNAIDS, UNICEF and WHO, 2005-2013 Global AIDS Response Progress Reporting, and UNAIDS, 2013 HIV and AIDS estimates, July 2014.
*Note: Data from 2005 through 2009 include single-dose nevirapine, a regimen no longer recommended by WHO; thererfore values from
2005-2009 are not directly comparable to those from 2010-2013.
New infections among children rapidly declining
as PMTCT coverage increases
600,000
1
Maternal ARVs for PMTCT
New HIV infections in
children (0-4)
0.8
0.7
400,000
67%
62%
56%
300,000
48%
0.6
0.5
47%
0.4
40%
200,000
0.3
31%
0.2
22%
100,000
PMTCT coverage (%)
New HIV infections (#)
500,000
0.9
0.1
14%
0
0
2001
2002
2003
2004
2005*
2006*
2007*
2008*
2009*
2010
2011
2012
2013
Estimated number of new HIV infections among children (aged 0–14) and coverage of antiretroviral medicines for PMTCT in all low- and
middle-income countries 2001–2013
Source: UNAIDS, UNICEF and WHO, 2005-2013 Global AIDS Response Progress Reporting, and UNAIDS, 2013 HIV and AIDS estimates, July 2014.
*Note: Data from 2005 through 2009 include single-dose nevirapine, a regimen no longer recommended by WHO; thererfore values from 20052009 are not comparable to those from 2010-2013
Transition to treatment for pregnant women
living with HIV - too slow
100%
Maternal ARVs for PMTCT
90%
Maternal ART
80%
Coverage (%)
70%
67%
60%
62%
56%
50%
48%
40%
47%
40%
30%
20%
10%
33%
31%
25%
22%
18%
14%
13%
0%
2005*
2006*
1%
3%
9%
2007*
2008*
2009*
2010
2011
2012
2013
Estimated percentage of pregnant women living with HIV receiving antiretroviral medicines (ARVs) for PMTCT or receiving antiretroviral
therapy (ART), in all low- and middle-income countries, 2005–2013
Source: (ARVS) – UNAIDS, UNICEF and WHO, 2005-2013 Global AIDS Response Progress Reporting; and (ART) – UNAIDS, 2013 HIV and AIDS
estimates, July 2014.
*Note: Data from 2005 through 2009 include single-dose nevirapine, a regimen no longer recommended by WHO; thererfore values from 20052009 are not directly comparable to those from 2010-2013.
Increased ART access for children living with HIV
is critical for their survival
350,000
1
Paediatric ART
coverage
300,000
Child AIDS deaths
0.8
0.7
0.6
200,000
0.5
150,000
0.4
ART coverage (%)
AIDS deaths (#)
250,000
0.9
0.3
100,000
50,000
0
2001
2002
2003
2004
2005
2006
6%
8%
10%
2007
2008
2009
13%
17%
19%
23%
0.2
0.1
0
2010
2011
2012
2013
Estimated number of AIDS-related deaths and ART coverage among children (aged 0–14) in all low- and middle-income countries, 2001–2013
Source: UNAIDS, UNICEF and WHO, 2005-2013 Global AIDS Response Progress Reporting, and UNAIDS, 2013 HIV and AIDS estimates, July 2014.
Note: The coverage estimate is based on the estimated unrounded number of all children living with HIV receiving ART. UNAIDS recommends
using the denominator of all adults and children living with HIV and not just those eligible for ART based on 2013 WHO eligibility HIV treatment
criteria.
Treatment is not currently equitable:
children lag behind adults
100%
90%
80%
70%
60%
50%
40%
30%
37%
20%
23%
10%
0%
All adults (aged 15+)
Children (aged 0–14)
Percentage of adults (aged 15+) and children (aged 0–14) living with HIV receiving antiretroviral therapy, global, 2013
Note: The coverage estimate is based on the estimated unrounded number of all adults and children living with HIV receiving ART. UNAIDS recommends
using the denominator of all adults and children living with HIV and not just those eligible for ART based on 2013 WHO eligibility HIV treatment criteria.
Source: UNAIDS, UNICEF and WHO, 2005-2013 Global AIDS Response Progress Reporting, and UNAIDS, 2013 HIV and AIDS estimates, July 2014.
Children not benefitting from
ART as much as adults
100%
Adults (aged 15+)
84%
Chad
5%
Nigeria
12%
6%
Cameroon
India
Ghana
8%
Percentage of adults (aged 15+) and children (aged 0–14) living with HIV receiving ART, 22 Global Plan priority countries, 2013
Source: UNAIDS, UNICEF and WHO, 2013 Global AIDS Response Progress Reporting and UNAIDS, 2013 HIV and AIDS estimates, July 2014.
Note: The coverage estimate is based on the estimated unrounded number of all children living with HIV receiving ART. UNAIDS recommends
using the denominator of all adults and children living with HIV and not just those eligible for ART based on 2013 WHO eligibility HIV
treatment criteria.
8%
Democratic Republic
of the Congo
15% 14%
11%
Uganda
South Africa
21% 20%
22%
Côte d'Ivoire
16%
12%
Swaziland
Ethiopia
Malawi
Zimbabwe
Namibia
Zambia
0%
22%
9%
29% 27%
25% 24%
30%
24%
Burundi
27%
31%
Mozambique
33%
20%
33%
42%
Angola
46%
45%
42% 41% 40%
38% 36% 36%
United Republic of
Tanzania
40%
44%
Lesotho
69% 55% 52%
51% 51% 50% 49%
48%
Kenya
60%
Children (aged 0–14)
Botswana
ART coverage (%)
80%
Less than 1 in 4 children living with HIV receiving
ART in 2013
>95%
100%
90%
2007
2009
2011
2012
2013
80%
70%
60%
51%
50%
38%
40%
30%
30%
27%
23%
20%
22%
15%
10%
10%
0%
Eastern and
Southern
Africa
West and
Central Africa
Middle East
and North
Africa
East Asia and
Pacific
South Asia
Latin America
and Caribbean
CEE/CIS
All low- and
21 African
middle-income Global Plan
countries
countries
Estimated percentage of children living with HIV receiving antiretroviral therapy, in UNICEF regions, all low- and middle-income countries and the 21
African Global Plan priority countries, 2007–2013
Source: UNAIDS, UNICEF and WHO, 2007–2013 Global AIDS Response Progress Reporting, and UNAIDS, 2013 HIV and AIDS estimates, July 2014.
Note: The coverage estimate is based on the estimated unrounded number of all children living with HIV receiving ART. UNAIDS recommends using the
denominator of all adults and children living with HIV and not just those eligible for ART based on 2013 WHO eligibility HIV treatment criteria.
Only 37% of infants tested in time
…progress is too slow
100%
90%
2010
2011
2012
2013
80%
80%
70%
60%
50%
49%
43%
37%
40%
30%
39%
25%
19%
20%
10%
10%
4%
0%
Eastern and
Southern
Africa
West and
Central Africa
Middle East
and North
Africa
East Asia and
Pacific
South Asia
Latin America
and Caribbean
CEE/CIS
All low- and
21 African
middle-income Global Plan
countries
countries
Estimated percentage of infants born to women living with HIV receiving a virological test by two months of age, in UNICEF regions, all low- and
middle-income countries and the 21 African Global Plan priority countries, 2010–2013
Source: UNAIDS, UNICEF and WHO, 2005–2013 Global AIDS Response Progress Reporting, and UNAIDS, 2013 HIV and AIDS estimates, July 2014.
Cotrimoxazole coverage for children
remains low at 37%
99%
100%
90%
2010
2011
2012
2013
80%
70%
60%
50%
48%
47%
37%
40%
38%
30%
20%
19%
18%
Middle East
and North
Africa
East Asia and
Pacific
13%
17%
10%
0%
Eastern and
Southern
Africa
West and
Central Africa
South Asia
Latin America
and Caribbean
CEE/CIS
All low- and
21 African
middle-income Global Plan
countries
countries
Estimated percentage of infants born to women living with HIV receiving cotrimoxazole, in UNICEF regions, all low- and middle-income countries and
the 21 African Global Plan priority countries, 2010–2013
Source: UNAIDS, UNICEF and WHO, 2005–2013 Global AIDS Response Progress Reporting, and UNAIDS, 2013 HIV and AIDS estimates, July 2014.
UPDATE ON THE SECOND DECADE OF A CHILD’S LIFE
“We cannot run away from adolescents. HIV is the leading cause of adolescent
mortality in Africa – especially among young women. This is a moral
injustice. I am calling on young people to lead the new ‘All In’ initiative,
alongside UNICEF and UNAIDS, to end the adolescent AIDS epidemic.”
Michel Sidibé
Executive Director, UNAIDS
2nd decade: summary of key figures
#1 #2
#1 killer of adolescents in Africa and #2 worldwide, is AIDS.7
and
2.1m
64%
1.2bn
2.1 million adolescents (10–19 years) were living with HIV in 2013
more than 80% of whom live in sub-Saharan Africa, and many of
whom still do not know their HIV status.8
64% of the 250,000 new HIV infections among older adolescents
(15–19 years) were among girls in 2013.8
1.2 billion adolescents; the largest generation in history.9
7. WHO, Health for the world’s adolescents: a second chance in the second decade, World Health Organization, Geneva, 2014.
8. UNICEF analysis of UNAIDS, 2013 HIV and AIDS estimates, July 2014.
9. United Nations Population Division, 2014.
Adolescents living with HIV is a global issue
Estimated number of adolescents
(aged 10-19) living with HIV, 2013
Estimated adolescents living with HIV globally in 2013
Note: The boundaries and the names shown and the designations used on this map does not imply official endorsement or acceptance by the
United Nations
Source: UNAIDS, 2013 HIV and AIDS estimates, July 2014.
Marked differences in HIV between
females and males emerge during adolescence
55%
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Female
1–4
5–9
10–14
15–19
20–24
55%
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Male
25–29
30–34
35–39
40–44
45–49
Female
<5
5-14
15-19
20-24
Botswana (2013)
55%
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Female
<5
15–19
20–24
25–29
Uganda (2011)
25-29
30-34
35-39
40-44
45-49
South Africa (2012)
55%
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Male
30–34
Male
35–39
40–44
45–49
Female
<5
5-9
10-14
15-19
20-24
Male
25-29
30-34
Kenya (2012)
HIV prevalence by age group in Botswana (2013), Kenya (2012), South Africa (2012) and Uganda (2011)
Source: Botswana AIDS Impact Survey, 2013; Kenya AIDS Indicator Survey (AIS), 2012; South African National HIV Prevalence,
Incidence, Behaviour and Communication Survey, 2012; and Uganda AIDS Indicator Survey (AIS), 2011.
35-39
40-44
45-49
Almost two-thirds of adolescents
living with HIV are in Eastern & Southern Africa
Industrialized
Countries
East Asia and
2%
Pacific
4%
CEE/CIS
1%
Middle East and
North Africa
1%
Latin America and
Caribbean
4%
South Asia
6%
West and Central
Africa
19%
Eastern and
Southern Africa
64%
Estimated percentage of adolescents aged 10–19 living with HIV globally, by UNICEF region, 2013
Source: UNAIDS 2013 HIV and AIDS estimates, July 2014.
Nearly half of all adolescents living with HIV are
in just six countries
South Africa
15%
Rest of the World
21%
Nigeria
8%
Côte d'Ivoire 2%
Total: 2.1
million
Cameroon 2%
Indonesia 2%
United Republic of Tanzania
7%
Zambia
4%
Malawi
4%
Kenya
7%
Mozambique
5%
Zimbabwe
5%
Ethiopia
7%
Uganda
5%
India
6%
Estimated percentage of adolescents aged 10–19 living with HIV in 14 selected high burden countries, 2013.
Source: UNAIDS 2013 HIV and AIDS estimates, July 2014.
AIDS-related deaths are declining rapidly for all age
groups . . . except adolescents
250,000
Children aged 0–4
Children aged 5–9
Adolescents aged 10-19
Young people aged 20–24
200,000
150,000
100,000
50,000
0
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Estimated number of AIDS-related deaths among children aged 0–9, adolescents aged 10–19 and young people aged 20–24,
2001–2013
Source: UNICEF analysis of UNAIDS 2013 HIV and AIDS estimates, July 2014.
2013
Infections among infants decreasing more
rapidly than adolescents and young people
700,000
Children aged 0–14
600,000
Adolescents aged 15–19
Young people aged 20–24
500,000
400,000
300,000
200,000
100,000
0
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Estimated number of new HIV infections among children (aged 0–14), adolescents (aged 15–19) and young people (aged 20–24),
2001–2013
Source: UNAIDS, 2013 HIV and AIDS estimates, July 2014.
2013
Access to testing is a challenge
…most adolescents don’t know their HIV status
Percentage of adolescent and young males and females (aged 15-19 and 20-24) who have been tested for HIV in the last 12
months and received the results of the most recent test, select sub-Saharan African countries, 2010-2014
Source: UNICEF global HIV and AIDS databases based on MICS, DHS, AIS and other nationally representative household surveys,
2010-2014.
17.7 million children orphaned by AIDS
20,000,000
Eastern and Southern Africa
West and Central Africa
East Asia and the Pacific
Latin America and the Caribbean
South Asia
CEE/CIS
18,000,000
16,000,000
14,000,000
12,000,000
10,000,000
8,000,000
6,000,000
4,000,000
2,000,000
0
1990
1995
2000
2005
2010
Estimated number of children (aged 0-17) who have lost one or both parents to an AIDS-related cause, by UNICEF region,
1990–2013
Source: UNICEF analysis of UNAIDS 2013 HIV and AIDS estimates, July 2014.
2013
Acknowledgements
UNICEF
Amaya Gillespie
Chiho Suzuki
Eduard Eduardo
Lisa Walmsely
Natalie Bailey
Priscilla Idele
Tyler Porth
Vivian Lopez
UNAIDS
Mary Mahy
Juliana Daher
WHO
Awandha Mamahit
Chika Hayashi
Michel Beusenberg
Web:
www.childrenandaids.org
Email:
[email protected]
Twitter: @unicef_aids

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