During 2003, some 5 million people became infected with the human immunodeficiency virus (HIV), which causes AIDS.

The year also saw 3 million deaths from HIV/AIDS - a high global total, Despite antiretroviral therapy, which reduced AIDS and AIDS, related deaths in the richer countries. Deaths among those already infected will continue to increase for some years even if prevention programmes manage to cut the number of new infections to zero. However, with the HIV-positive population still expanding the annual number of AIDS deaths can be expected to increase for many years.

Young people and children with HIV/AIDS and the AIDS orphans

In 2003, an estimated 700,000 children aged 14 or younger became infected with HIV. Over 90% were babies born to HIV-positive women, who acquired the virus at birth or through their mother's breast milk. Of these, almost nine-tenths were in sub-Saharan Africa. Africa's lead in mother-to-child transmission of HIV was firmer than ever despite the evidence that HIV ultimately impairs women's fertility; once infected, a woman can be expected to bear 20 % fewer children than she otherwise would.

HIV/AIDS around the world

High-income Countries

The total number of people living with HIV continues to rise in high-income countries, largely due to widespread access to antiretroviral treatment. It is estimated that 1.6 million people are living with HIV in these countries- a figure that includes 80,000 who were newly infected in 2003. AIDS claimed approximately 18,000 lives in the past year. There is mounting evidence that prevention activities in several high-income countries are not keeping pace with the changes occurring in the spread of HIV. Such, shortcomings are most evident where HIV is lodged also among marginalized groups of populations, including immigrants and refugees.

For further information, see our web page HIV and AIDS epidemic in high income countries

Sub-Saharan Africa

In Africa south of the Sahara desert, an estimated 3.2 million adults and children became infected with HIV during the year 2003. This brought the total number of people living with HIV/AIDS in the region to 26.6 million by the end of the year.

For the moment, overall HIV prevalence, the regional total of people living with HIV or AIDS continues to rise because there are still more newly infected individuals joining it every year than there are people leaving it through death. However, as people infected years ago succumb to HIV related illnesses (average survival in absence of antiretroviral therapy is estimated at around 8-10 years), mortality from AIDS is increasing. HIV prevalence varies considerably across the continent- ranging from less than 1% in Mauritania to almost 40% in Botswana and Swaziland.

AIDS killed approximately 2.3 million people in 2003. In the coming years, unless there is far broader access to life prolonging therapy, and providing that new infections do not start rising again, the number of surviving HIV positive Africans can be expected to stabilize and finally shrink, as AIDS increasingly claims the lives of those infected long time ago.

Unlike women in other regions in the world, African women are considerably more likely - at least 1.2 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.

See our web pages AIDS in Africa , AIDS orphans in Africa and HIV and AIDS drugs in Africa .

Eastern Europe and Central Asia

The AIDS epidemic in Eastern Europe and Central Asia shows no signs of declining. Some 230,000 people were infected with HIV in 2003, bringing the total number of people living with the virus to 1.5 million. AIDS claimed 30,000 lives in the past year.

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 1 million people aged 15-49 are living with HIV in the Russian Federation (although various estimates from that country put the figure at between 600,000and 1.5 million).

See our web page AIDS in the Russian Federation Ukraine, and Belarus.

Asia and the Pacific

Over 1 million people in Asia and the Pacific acquired HIV in 2003, bringing the number of people living with HIV to an estimated 7.4 million. A further 500,000 people are estimated to have died of AIDS in 2003.

National adult prevalence is still under 1% in the majority of this region's countries. That figure, though, can be misleading. Several countries in the region are so large and populous that the attention is only drawn to major urban areas, which may obscure serious epidemics in some smaller provinces and states. Although national adult HIV prevalence in India, for example, is below 1%, five states have an estimated prevalence of over 1% among adults.

North Africa and the Middle East

The notion that this region has sidestepped the global epidemic is not supported by the latest estimates, which indicate that 55,000 people acquired HIV infection in the past year, bringing the total number of people living with HIV/AIDS in the Middle East and North Africa to 600, 000. AIDS killed a further 45,000 people in 2003.

For further information, see our web pages HIV and AIDS in the Middle East and North Africa .

Latin America and the Caribbean

More than 2 million people are now living with HIV in Latin America and the Caribbean including the estimated 200,000 that contracted HIV in the past year. At least 100,000 people died of AIDS in the same period- the highest regional death toll after sub-Saharan Africa and Asia.

All the main modes of transmission coexist 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.

For further information, see our web pages HIV and AIDS in Latin America and the Caribbean .

The Future

What is needed on a massive national and international level is to:

• end the stifling silence that continues to surround HIV in many countries,
• explode myths and misconceptions that translate into dangerous sexual practices,
• expand prevention initiatives such as condom promotion that can reduce sexual transmission,
• create conditions in which young children have the knowledge and the emotional and financial support to grow up free of HIV,
• devote real money to providing care for those infected with HIV and support to their families.
• A trail of successful responses has already been blazed by a small number of dedicated communities and governments. The challenge for everyone is to adapt and massively expand successful approaches that make it harder for the virus to spread, and that make it easier for those affected to live full and rewarding lives.

For further information, see our web page Stigma, discrimination and attitudes to HIV & AIDS.

Notes

The latest UNAIDS and WHO estimates published in 2003 are lower than those published in 2002. But the number of people living with HIV/AIDS is not actually lower, nor is there a decline in the epidemic. Better data and understanding has enabled the UNAIDS Secretariat and WHO to arrive at more accurate estimates.

* The proportion of adults (15 to 49 years of age) living with HIV/AIDS in 2003, using 2003 population numbers.

Adults in this report are defined as men and women aged 15-49. This age range captures those in their most sexually active years. While the risk of HIV infection continues beyond the age of 50, the fast majority of people with substantial risk behaviour are likely to have become infected by this age. Since population structures differ greatly from one country to another, especially for children and the upper adult ages, the restriction of 'adults' to 15-49 has the advantage of making different populations more comparable.

Source:
UNAIDS (2003) AIDS epidemic update, December UNAIDS (2002) AIDS epidemic update', December
UNAIDS (2002) 'Report on the global HIV/AIDS epidemic', July
UNAIDS Fact Sheet (2001) 'Gender and HIV', August

Global Estimates of the HIV/AIDS epidemic, as of end 2003.

The number of adults* and children infected with HIV during 2003

Regional HIV/AIDS statistics, end of 2003.

Notes

# The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information. These ranges are more precise than those of previous years, and work is under way to increase even further the precision of the estimate that will be published mid-2004.

$ Defined as children 0-14, as of end 2001, who have lost one or both parents to AIDS.

Adults in this report are defined as men and women aged 15-49. This age range captures those in their most sexually active years. While the risk of HIV infection continues beyond the age of 50, the fast majority of people with substantial risk behaviour are likely to have become infected by this age. Since population structures differ greatly from one country to another, especially for children and the upper adult ages, the restriction of 'adults' to 15-49 has the advantage of making different populations more comparable.

The latest UNAIDS and WHO estimates published in 2003 are lower than those published in 2002. But the number of people living with HIV/AIDS is not actually lower, nor is there a decline in the epidemic. Better data and understanding has enabled the UNAIDS Secretariat and WHO to arrive at more accurate estimates.

Sources:

· UNAIDS (2003) AIDS epidemic update, December

· UNAIDS (2002) AIDS epidemic update', December

· UNAIDS (2002) 'Report on the global HIV/AIDS epidemic', July

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