Worldwide statistics commentary

Number of people living with HIV

According to estimates from the UNAIDS 2009 AIDS Epidemic Update, around 31.3 million adults and 2.1 million children were living with HIV at the end of 2008.

Number of people infected during 2008, and the number of deaths

During 2008, some 2.7 million people became infected with the human immunodeficiency virus (HIV), which causes AIDS.
The year also saw 2 million deaths from AIDS - a high global total, despite antiretroviral (ARV) therapy, which reduced AIDS-related deaths among those who received it. The number of deaths probably peaked around 2004, and has since declined only slightly.

How people become infected with HIV

Globally, around 11% of HIV infections are among babies who acquire the virus from their mothers; 10% result from injecting drug use; 5-10% are due to sex between men; and 5-10% occur in healthcare settings. Sex between men and women accounts for the remaining proportion – around two thirds of new infections.

Young people affected by HIV and AIDS

Around half of the people who acquire HIV become infected before they turn 25, and AIDS is the second most common cause of death among 20-24 year olds.¹ By the end of 2007, the epidemic had left behind 15 million AIDS orphans, defined as those aged under 18 who have lost one or both parents to AIDS. These orphans are vulnerable to poverty, exploitation and themselves becoming infected with HIV. They are often forced to leave the education system and find work, and sometimes to care for younger siblings or head a family.
In 2008, around 430,000 children aged 14 or younger became infected with HIV. More than 90% of newly infected children are babies born to women with HIV, who acquire the virus during pregnancy, labour or delivery, or through their mother's breast milk. Over nine-tenths of such transmissions occur in sub-Saharan Africa. Drugs are available to minimise the dangers of mother-to-child HIV transmission, but these are still often not reaching the places where they are most needed.

HIV/AIDS around the world

The overwhelming majority of people with HIV live in the developing world. Sub-Saharan Africa accounts for two-thirds of all infected people. South and South-East Asia has the second highest number of infected people.
The chart on the right shows the distribution of people living with HIV around the world, according to 2008 data.

Higher-income countries

The total number of people living with HIV continues to rise in high-income countries, largely due to widespread access to ARV therapy, which prolongs the lives of HIV+ people. This also increases the pool of HIV-infected people who are able to transmit the virus onwards. It is estimated that 1.4 million people are living with HIV in North America and 850,000 in Western and Central Europe.
In these two regions, AIDS claimed approximately 38,000 lives in 2008. The rate of AIDS-related deaths has been cut substantially through use of ARV medicines. There is mounting evidence that prevention activities in several high-income countries are not keeping pace with the spread of HIV and that in some places they are falling behind. Such shortcomings are most evident where HIV is found mainly among marginalized groups of the population, such as drug users, immigrants and refugees.

Sub-Saharan Africa

The area in Africa south of the Sahara desert, known as sub-Saharan Africa, is by far the worst-affected in the world by the AIDS epidemic. The region has just over 10% of the world's population, but is home to 67% of all people living with HIV. An estimated 1.9 million adults and children became infected with HIV during 2008. This brought the total number of people living with HIV/AIDS in the region to 22.4 million by the end of the year. HIV prevalence varies considerably across this region - ranging from less than 1% in Madagascar to over 25% in Swaziland.
HIV prevalence (the proportion of people living with HIV) appears to have fallen slightly in this region over recent years because the number of new infections is exceeded by the number of deaths each year. However, the total number of people living with HIV is still rising because of overall population growth.
In sub-Saharan Africa, AIDS killed approximately 1.4 million people in 2008. Average survival in the absence of treatment is around 10 years after infection. ARV drugs can dramatically extend survival, allowing many years of healthy life, but these remain unavailable to most Africans.
Unlike women in most other regions in the world, African women are considerably more likely - at least 1.4 times - to be infected with HIV than men. There are a number of reasons why female prevalence is higher than male in this region, including the greater efficiency of male-to-female HIV transmission through sex and the younger age at initial infection for women.

Eastern Europe and Central Asia

The AIDS epidemic in Eastern Europe and Central Asia is rapidly expanding. Some 110,000 people were infected with HIV in 2008, bringing the total number of people living with the virus to around 1.5 million. Only a small proportion of HIV+ people in these areas can hope to receive ARV medication, so the AIDS death rate - which was around 87,000 in 2008 - is higher than it might otherwise be.
Worst affected are the Russian Federation, Ukraine, and the Baltic states (Estonia, Latvia, and Lithuania), but HIV continues to spread in Belarus, Moldova and Kazakhstan, while more recent epidemics are now evident in Kyrgyzstan and Uzbekistan. It is now estimated that around 940,000 people are living with HIV in the Russian Federation.

Asia

Until recently it was thought that India was home to around 5.7 million people living with HIV - more than any other country in the world. In July 2007 this estimate was revised to between 2 million and 3.1 million, based on better data including the results of a national household survey.
Because of the major revision of the Indian estimate, the number of people living with HIV in the whole of Asia is now thought to be substantially less than the figure published by UNAIDS in late 2006. The current estimate is around 4.7 million.
National adult prevalence is still under 1% in the majority of this region's countries. However some Asian countries are very large and national averages may obscure serious epidemics in some smaller provinces and states. Although national adult HIV prevalence in India, for example, is below 1%, some states have an estimated prevalence well above this level. Other countries with large numbers of people living with HIV include China (700,000), Thailand (610,000) and Viet Nam (290,000).

North Africa and the Middle East

The notion that this region has sidestepped the global epidemic - perhaps due to strict rules governing sexual behaviour - is not supported by the latest estimates, which indicate that 35,000 people acquired an HIV infection in 2008, bringing the total number of people living with HIV/AIDS in the Middle East and North Africa to an estimated 310,000. AIDS killed a further 20,000 people in 2008.

Latin America and the Caribbean

An estimated 2.24 million people are living with HIV in Latin America and the Caribbean, including the estimated 190,000 who became infected during 2008. Around 89,000 people died of AIDS in the same year.
All the main modes of transmission exist in most countries, along with significant levels of risky behaviour - such as early sexual debut, unprotected sex with multiple partners and the use of unclean drug-injecting equipment. The largest HIV epidemic is in Brazil, where around 730,000 people are living with the virus, though the death rate has fallen due to widespread access to treatment. Adult HIV prevalence in five countries is more than 2% - higher than anywhere else outside sub-Saharan Africa.

The future

Future projections of the extent of the HIV/AIDS epidemic cannot be made with any precision; what happens next will depend on what action is taken. In some scenarios, governments and societies mount a very vigorous and wide-ranging response which recognises AIDS as much more than just a health issue, and so HIV prevalence eventually decreases; in other projections, good intentions fail to deliver anything more than short-term and fractured responses in the worst-affected countries, and the number of people living with HIV soars.²
Although there are promising signs that the epidemic is in retreat, the World Health Organization predicts that AIDS will remain a leading cause of death worldwide for decades to come.³
Minimising the impact of HIV will require massive responses at the national and international level:

• People need to challenge the myths and misconceptions about human sexuality that translate into dangerous sexual practices.
• Work and legislation is needed to reduce prejudice felt by HIV+ people around the world and the discrimination that prevents people from "coming out" as being HIV positive.
• HIV prevention initiatives need to be increased, people across the world need to be made aware of the dangers, the risks, and the ways they can protect themselves.
• Condom promotion and supply needs to be increased, and the appropriate sexual health education needs to be provided to young people before they reach an age where they become sexually active.
• Medication and support needs to be provided to people who are already HIV+, so that they can live longer and more productive lives, support their families, and avoid transmitting the virus onwards.
• Support and care needs to be provided for those children who have already been orphaned by AIDS, so that they can grow up safely, without experiencing poverty, exploitation, and themselves falling prey to HIV.