Abstract
Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH.
| Original language | English (US) |
|---|---|
| Pages (from-to) | e633-e651 |
| Journal | The Lancet HIV |
| Volume | 8 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 2021 |
| Externally published | Yes |
ASJC Scopus subject areas
- Epidemiology
- Immunology
- Infectious Diseases
- Virology
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In: The Lancet HIV, Vol. 8, No. 10, 10.2021, p. e633-e651.
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TY - JOUR
T1 - Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990–2019, for 204 countries and territories
T2 - the Global Burden of Diseases Study 2019
AU - Jahagirdar, Deepa
AU - Walters, Magdalene K.
AU - Novotney, Amanda
AU - Brewer, Edmond D.
AU - Frank, Tahvi D.
AU - Carter, Austin
AU - Biehl, Molly H.
AU - Abbastabar, Hedayat
AU - Abhilash, E. S.
AU - Abu-Gharbieh, Eman
AU - Abu-Raddad, Laith Jamal
AU - Adekanmbi, Victor
AU - Adeyinka, Daniel Adedayo
AU - Adnani, Qorinah Estiningtyas Sakilah
AU - Afzal, Saira
AU - Aghababaei, Soodabeh
AU - Ahinkorah, Bright Opoku
AU - Ahmad, Sajjad
AU - Ahmadi, Keivan
AU - Ahmadi, Sepideh
AU - Ahmadpour, Ehsan
AU - Ahmed, Muktar Beshir
AU - Rashid, Tarik Ahmed
AU - Salih, Yusra Ahmed
AU - Aklilu, Addis
AU - Akram, Tayyaba
AU - Akunna, Chisom Joyqueenet
AU - Al Hamad, Hanadi
AU - Alahdab, Fares
AU - Alanezi, Fahad Mashhour
AU - Aleksandrova, Ekaterina A.
AU - Alene, Kefyalew Addis
AU - Ali, Liaqat
AU - Alipour, Vahid
AU - Almustanyir, Sami
AU - Alvis-Guzman, Nelson
AU - Ameyaw, Edward Kwabena
AU - Amu, Hubert
AU - Andrei, Catalina Liliana
AU - Andrei, Tudorel
AU - Anvari, Davood
AU - Arabloo, Jalal
AU - Aremu, Olatunde
AU - Arulappan, Judie
AU - Atnafu, Desta Debalkie
AU - Quintanilla, Beatriz Paulina Ayala
AU - Ayza, Muluken Altaye
AU - Azari, Samad
AU - Darshan, B. B.
AU - Banach, Maciej
AU - Bärnighausen, Till Winfried
AU - Barra, Fabio
AU - Barrow, Amadou
AU - Basu, Sanjay
AU - Bazargan-Hejazi, Shahrzad
AU - Belay, Habtamu Gebrehana
AU - Berheto, Tezera Moshago
AU - Bezabhe, Woldesellassie Mequanint
AU - Bezabih, Yihienew Mequanint
AU - Bhagavathula, Akshaya Srikanth
AU - Bhardwaj, Nikha
AU - Bhardwaj, Pankaj
AU - Bhattacharyya, Krittika
AU - Bibi, Sadia
AU - Bijani, Ali
AU - Bisignano, Catherine
AU - Bolarinwa, Obasanjo Afolabi
AU - Boloor, Archith
AU - Boltaev, Azizbek A.
AU - Briko, Nikolay Ivanovich
AU - Buonsenso, Danilo
AU - Burkart, Katrin
AU - Butt, Zahid A.
AU - Cao, Chao
AU - Charan, Jaykaran
AU - Chatterjee, Souranshu
AU - Chattu, Soosanna Kumary
AU - Chattu, Vijay Kumar
AU - Choudhari, Sonali Gajanan
AU - Chu, Dinh Toi
AU - Couto, Rosa A.S.
AU - Cowden, Richard G.
AU - Dachew, Berihun Assefa
AU - Dadras, Omid
AU - Dagnew, Amare Belachew
AU - Dahlawi, Saad M.A.
AU - Dai, Xiaochen
AU - Dandona, Lalit
AU - Dandona, Rakhi
AU - das Neves, José
AU - Degenhardt, Louisa
AU - Demeke, Feleke Mekonnen
AU - Desta, Abebaw Alemayehu
AU - Deuba, Keshab
AU - Dhamnetiya, Deepak
AU - Dhungana, Govinda Prasad
AU - Dianatinasab, Mostafa
AU - Diaz, Daniel
AU - Djalalinia, Shirin
AU - Doan, Linh Phuong
AU - Dorostkar, Fariba
AU - Edinur, Hisham Atan
AU - Effiong, Andem
AU - Eftekharzadeh, Sahar
AU - El Sayed Zaki, Maysaa
AU - Elayedath, Rajesh
AU - Elhadi, Muhammed
AU - El-Jaafary, Shaimaa I.
AU - El-Khatib, Ziad
AU - Elsharkawy, Aisha
AU - Endalamaw, Aklilu
AU - Endries, Aman Yesuf
AU - Eskandarieh, Sharareh
AU - Ezeonwumelu, Ifeanyi Jude
AU - Ezzikouri, Sayeh
AU - Farahmand, Mohammad
AU - Faraon, Emerito Jose A.
AU - Fasanmi, Abidemi Omolara
AU - Ferrero, Simone
AU - Desideri, Lorenzo Ferro
AU - Filip, Irina
AU - Fischer, Florian
AU - Folayan, Morenike Oluwatoyin
AU - Foroutan, Masoud
AU - Fukumoto, Takeshi
AU - Gad, Mohamed M.
AU - Gadanya, Muktar A.
AU - Gaidhane, Abhay Motiramji
AU - Garg, Tushar
AU - Gayesa, Reta Tsegaye
AU - Gebreyohannes, Eyob Alemayehu
AU - Gesesew, Hailay Abrha
AU - Obsa, Abera Getachew
AU - Ghadiri, Keyghobad
AU - Ghashghaee, Ahmad
AU - Gilani, Syed Amir
AU - Ginindza, Themba G.
AU - Glăvan, Ionela Roxana
AU - Glushkova, Ekaterina Vladimirovna
AU - Golechha, Mahaveer
AU - Gugnani, Harish Chander
AU - Gupta, Bhawna
AU - Gupta, Sapna
AU - Gupta, Veer Bala
AU - Gupta, Vivek Kumar
AU - Hamidi, Samer
AU - Handanagic, Senad
AU - Haque, Shafiul
AU - Harapan, Harapan
AU - Hargono, Arief
AU - Hasaballah, Ahmed I.
AU - Hashi, Abdiwahab
AU - Hassan, Shoaib
AU - Hassanipour, Soheil
AU - Hayat, Khezar
AU - Heredia-Pi, Ileana
AU - Hezam, Kamal
AU - Holla, Ramesh
AU - Hoogar, Praveen
AU - Hoque, Mohammad Enamul
AU - Hosseini, Mostafa
AU - Hosseinzadeh, Mehdi
AU - Hsairi, Mohamed
AU - Hussain, Rabia
AU - Ibitoye, Segun Emmanuel
AU - Idrisov, Bulat
AU - Ikuta, Kevin S.
AU - Ilesanmi, Olayinka Stephen
AU - Ilic, Irena M.
AU - Ilic, Milena D.
AU - Irvani, Seyed Sina Naghibi
AU - Islam, M. Mofizul
AU - Ismail, Nahlah Elkudssiah
AU - Itumalla, Ramaiah
AU - Iyamu, Ihoghosa Osamuyi
AU - Jabbarinejad, Roxana
AU - Jain, Vardhmaan
AU - Jayawardena, Ranil
AU - Jha, Ravi Prakash
AU - Joseph, Nitin
AU - Kabir, Ali
AU - Kabir, Zubair
AU - Kalhor, Rohollah
AU - Kaliyadan, Feroze
AU - Kamath, Ashwin
AU - Kanchan, Tanuj
AU - Kandel, Himal
AU - Kassahun, Getinet
AU - Katoto, Patrick D.M.C.
AU - Kayode, Gbenga A.
AU - Kebede, Ermiyas Mulu
AU - Kebede, Hafte Kahsay
AU - Khajuria, Himanshu
AU - Khalid, Nauman
AU - Khan, Ejaz Ahmad
AU - Khan, Gulfaraz
AU - Khatab, Khaled
AU - Kim, Min Seo
AU - Kim, Yun Jin
AU - Kisa, Adnan
AU - Kisa, Sezer
AU - Kochhar, Sonali
AU - Korshunov, Vladimir Andreevich
AU - Koul, Parvaiz A.
AU - Laxminarayana, Sindhura Lakshmi Koulmane
AU - Koyanagi, Ai
AU - Krishan, Kewal
AU - Defo, Barthelemy Kuate
AU - Kumar, G. Anil
AU - Kumar, Manasi
AU - Kumar, Nithin
AU - Kwarteng, Alexander
AU - Lal, Dharmesh Kumar
AU - Landires, Iván
AU - Lasrado, Savita
AU - Lassi, Zohra S.
AU - Lazarus, Jeffrey V.
AU - Lee, Jane Jean Hee
AU - Lee, Yeong Yeh
AU - LeGrand, Kate E.
AU - Lin, Christine
AU - Liu, Xuefeng
AU - Maddison, Emilie R.
AU - El Razek, Hassan Magdy Abd
AU - Mahasha, Phetole Walter
AU - Majeed, Azeem
AU - Makki, Alaa
AU - Malik, Ahmad Azam
AU - Manamo, Wondimu Ayele
AU - Mansournia, Mohammad Ali
AU - Martins-Melo, Francisco Rogerlândio
AU - Masoumi, Seyedeh Zahra
AU - Memish, Ziad A.
AU - Menezes, Ritesh G.
AU - Mengesha, Endalkachew Worku
AU - Merie, Hayimro Edemealem
AU - Mersha, Amanual Getnet
AU - Mestrovic, Tomislav
AU - Meylakhs, Peter
AU - Mheidly, Nour
AU - Miller, Ted R.
AU - Mirica, Andreea
AU - Moazen, Babak
AU - Mohammad, Yousef
AU - Mohammadi, Mokhtar
AU - Mohammed, Arif
AU - Mohammed, Salahuddin
AU - Mohammed, Shafiu
AU - Moitra, Modhurima
AU - Mokdad, Ali H.
AU - Molokhia, Mariam
AU - Moni, Mohammad Ali
AU - Moradi, Ghobad
AU - Moradi, Yousef
AU - Mpundu-Kaambwa, Christine
AU - Mubarik, Sumaira
AU - Munro, Sandra B.
AU - Mwanri, Lillian
AU - Nachega, Jean B.
AU - Nagarajan, Ahamarshan Jayaraman
AU - Narayana, Aparna Ichalangod
AU - Naveed, Muhammad
AU - Nayak, Biswa Prakash
AU - Nduaguba, Sabina O.
AU - Kandel, Sandhya Neupane
AU - Nguefack-Tsague, Georges
AU - Nguyen, Trang Huyen
AU - Nixon, Molly R.
AU - Nnaji, Chukwudi A.
AU - Noubiap, Jean Jacques
AU - Nuñez-Samudio, Virginia
AU - Nyirenda, Thomas Elliot
AU - Oghenetega, Onome Bright
AU - Olagunju, Andrew T.
AU - Olakunde, Babayemi Oluwaseun
AU - Owopetu, Oluwatomi Funbi
AU - Mahesh, P. A.
AU - Padubidri, Jagadish Rao
AU - Pakhale, Smita
AU - Parekh, Tarang
AU - Kan, Fatemeh Pashazadeh
AU - Pawar, Shrikant
AU - Pepito, Veincent Christian Filipino
AU - Peprah, Emmanuel K.
AU - Pinheiro, Marina
AU - Pokhrel, Khem Narayan
AU - Polibin, Roman V.
AU - Pollok, Richard Charles G.
AU - Postma, Maarten J.
AU - Syed, Zahiruddin Quazi
AU - Radfar, Amir
AU - Radhakrishnan, Raghu Anekal
AU - Rahim, Fakher
AU - Rahimi-Movaghar, Vafa
AU - Rahimzadeh, Shadi
AU - Rahman, Mosiur
AU - Rahmani, Amir Masoud
AU - Ram, Pradhum
AU - Ranabhat, Chhabi Lal
AU - Ranasinghe, Priyanga
AU - Rao, Chythra R.
AU - Rao, Sowmya J.
AU - Rathi, Priya
AU - Rawaf, David Laith
AU - Rawaf, Salman
AU - Regassa, Lemma Demissie
AU - ur Rehman, Inayat
AU - Renzaho, Andre M.N.
AU - Rezaei, Nima
AU - Rezahosseini, Omid
AU - Rezai, Mohammad Sadegh
AU - Rezapour, Aziz
AU - Ripon, Rezaul Karim
AU - Rodrigues, Voilet
AU - Roshchin, Denis O.
AU - Rwegerera, Godfrey M.
AU - Saeed, Umar
AU - Moghaddam, Sahar Saeedi
AU - Sagar, Rajesh
AU - Saif-Ur-Rahman, K. M.
AU - Salem, Marwa Rashad
AU - Samaei, Mehrnoosh
AU - Samy, Abdallah M.
AU - Santric-Milicevic, Milena M.
AU - Saroshe, Satish
AU - Sathian, Brijesh
AU - Satpathy, Maheswar
AU - Sawhney, Monika
AU - Schutte, Aletta Elisabeth
AU - Seylani, Allen
AU - Shaikh, Masood Ali
AU - Shaka, Mohammed Feyisso
AU - Shamshad, Hina
AU - Shamsizadeh, Morteza
AU - Shannawaz, Mohammed
AU - Shetty, Adithi
AU - Shin, Jae Il
AU - Shivakumar, K. M.
AU - Singh, Jasvinder A.
AU - Skryabin, Valentin Yurievich
AU - Skryabina, Anna Aleksandrovna
AU - Somayaji, Ranjani
AU - Soshnikov, Sergey
AU - Spurlock, Emma Elizabeth
AU - Stein, Dan J.
AU - Sufiyan, Mu'awiyyah Babale
AU - Tadbiri, Hooman
AU - Tadesse, Birkneh Tilahun
AU - Tadesse, Eyayou Girma
AU - Tamiru, Animut Tagele
AU - Tarkang, Elvis Enowbeyang
AU - Taveira, Nuno
AU - Tekalegn, Yohannes
AU - Tesfay, Fisaha Haile
AU - Tessema, Gizachew Assefa
AU - Thapar, Rekha
AU - Tovani-Palone, Marcos Roberto
AU - Traini, Eugenio
AU - Tran, Bach Xuan
AU - Tsai, Alexander C.
AU - Tusa, Biruk Shalmeno
AU - Ullah, Saif
AU - Umeokonkwo, Chukwuma David
AU - Unnikrishnan, Bhaskaran
AU - Tahbaz, Sahel Valadan
AU - Villafañe, Jorge Hugo
AU - Vladimirov, Sergey Konstantinovitch
AU - Vo, Bay
AU - Vongpradith, Avina
AU - Vu, Giang Thu
AU - Waheed, Yasir
AU - Wamai, Richard G.
AU - Wang, Guan
AU - Wang, Yanzhong
AU - Ward, Paul
AU - Westerman, Ronny
AU - Winkler, Andrea Sylvia
AU - Yadav, Lalit
AU - Jabbari, Seyed Hossein Yahyazadeh
AU - Yazie, Taklo Simeneh
AU - Yi, Siyan
AU - Yiğit, Vahit
AU - Yirdaw, Birhanu Wubale
AU - Yonemoto, Naohiro
AU - Yu, Chuanhua
AU - Yunusa, Ismaeel
AU - Zastrozhin, Mikhail Sergeevich
AU - Zastrozhina, Anasthasia
AU - Zhang, Zhi Jiang
AU - Zumla, Alimuddin
AU - Salomon, Joshua A.
AU - Eaton, Jeffrey W.
AU - Naghavi, Mohsen
AU - Dwyer-Lindgren, Laura
AU - Wang, Haidong
AU - Lim, Stephen S.
AU - Hay, Simon I.
AU - Murray, Christopher J.L.
AU - Kyu, Hmwe H.
N1 - Publisher Copyright: © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2021/10
Y1 - 2021/10
N2 - Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH.
AB - Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH.
UR - http://www.scopus.com/inward/record.url?scp=85117526510&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85117526510&partnerID=8YFLogxK
U2 - 10.1016/S2352-3018(21)00152-1
DO - 10.1016/S2352-3018(21)00152-1
M3 - Article
C2 - 34592142
AN - SCOPUS:85117526510
SN - 2352-3018
VL - 8
SP - e633-e651
JO - The Lancet HIV
JF - The Lancet HIV
IS - 10
ER -