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Appropriate Technology. 2007 Jun; 34(2):31.There is now strong evidence from three randomized controlled trials undertaken in Kisumu, Kenya, Rakai District, Uganda (funded by the US National Institutes of Health) and Orange Farm, South Africa (funded by the French National Agency for Research on AIDS) that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60 per cent. This evidence supports the findings of numerous observational studies that have also suggested that the areas with lower HIV prevalence occur where there are high rates of male circumcision in some countries in Africa. Currently, an estimated 665 million men, or 30 per cent of men worldwide, are estimated to be circumcised. (excerpt)
Potential impact of antiretroviral therapy on HIV-1 transmission and AIDS mortality in resource-limited settings.
Journal of Acquired Immune Deficiency Syndromes. 2006 Apr 15; 41(5):632-641.The objective was to estimate the potential impact of antiretroviral therapy on the heterosexual spread of HIV-1 infection and AIDS mortality in resource-limited settings. A mathematic model of HIV-1 disease progression and transmission was used to assess epidemiologic outcomes under different scenarios of antiretroviral therapy, including implementation of World Health Organization guidelines. Implementing antiretroviral therapy at 5% HIV-1 prevalence and administering it to 100% of AIDS cases are predicted to decrease new HIV-1 infections and cumulative deaths from AIDS after 10 years by 11.2% (inter-quartile range [IQR]: 1.8%-21.4%) and 33.4% (IQR: 26%-42.8%), respectively. Later implementation of therapy at endemic equilibrium (40% prevalence) is predicted to be less effective, decreasing new HIV-1 infections and cumulative deaths from AIDS by 10.5% (IQR: 2.6%-19.3%) and 27.6% (IQR: 20.8%-36.8%), respectively. Therapy is predicted to benefit the infected individual and the uninfected community by decreasing transmission and AIDS deaths. The community benefit is greater than the individual benefit after 25 years of treatment and increases with the proportion of AIDS cases treated. Antiretroviral therapy is predicted to have individual and public health benefits that increase with time and the proportion of infected persons treated. The impact of therapy is greater when introduced earlier in an epidemic, but the benefit can be lost by residual infectivity or disease progression on treatment and by sexual disinhibition of the general population. (author's)
Manila, Philippines, WHO, Regional Office for the Western Pacific, 1999.  p.It is estimated that more than 700 000 people were living with HIV infection in the Western Pacific Region in 1998, with more than 18 000 new AIDS cases occurring in the same year. In contrast, the cumulative number of HIV diagnoses reported in all countries of the Region was about 100 000 and reported AIDS incidence in 1998 was 3300. This reflects a very high level of under-diagnosis and under-reporting of HIV and AIDS cases in the Region. The number of people living with HIV infection is projected to reach 1 million in 2000, and the yearly number of new cases of AIDS to doubled. Analysis of the trend of the relative proportion in HIV risk exposure based on reported cases in the Region suggests that there have been three waves. First, sexual contact among men was the driving force in the early epidemic in Australia and New Zealand, with rapid decrease in prevalence by the late 1980's. Second, the widespread sharing of equipment among injecting drug users (IDUs), primarily in Malaysia, China and Viet Nam was most important during the late 1980s and early 1990s, eventually leveling off around 40% of reported cases (it should be noted that this mode of transmission is probably over-represented due to the mandatory HIV testing of injecting drug users in rehabilitation centres or prison). Finally, the more recent trend has been a steady increase in the proportion of reported cases associated with heterosexual contact. Transmission of the virus through this mode has been gradually increasing since the beginning of the epidemic and is expected to continue to increase in the future. (excerpt)
Vadodara, India, Centre for Operations Research and Training [CORT], 2000.  p.Street children live and work in conditions that are not conducive for healthy development. They are exposed to the street subculture such as smoking, drug, alcohol and substance abuse, gambling, engaging in sexual activities or selling sex for survival. The few studies that exist on the sexual behaviour of street children show that these children are more prone to high-risk behaviour and are sexually active at an early age. Often such relationships start as abusive. The circumstances in which they live and work increase their vulnerability also to sexual exploitation and abuse and put them at a higher risk of unintended pregnancies, sexually transmitted infections and even HIV/AIDS. The problem is further compounded by the lack of access to reproductive health information and services. UNICEF, recognising the magnitude of the problem, has undertaken to promote programmes to reduce children's vulnerability to HIV/AIDS, to diminish its impact on children, families and community and to take care of orphans and people living with AIDS. The present study is a situation analysis of children and adolescents carried out CORT to inform programme planning. (excerpt)
Bangkok, Thailand, WHO/UNESCO AIDS Education and Health Promotion Materials Exchange Centre for Asia and the Pacific, 1990. , 10,  p.A resource booklet for use by Asian and Pacific country AIDS education programs, published on World AIDS Day, 1 December 1990 entitled "AIDS and Women" is made up of a background introduction, a set of 1-page country profiles, and annexes chiefly documents issued by international agencies on AIDS and topics related to women. Women are particularly vulnerable in the oncoming AIDS epidemic both because they are getting infected in higher numbers, and because they bear the burdens of family care, income and food production, caring for the sick, and the personal, social and economic problems resulting from death of a spouse. While women increasingly become infected via heterosexual intercourse, and they must decide whether to become pregnant, they often do not have the power to coerce a partner to use condoms, nor do they have the benefit of literacy or education to deal with the issues. Female education, of in-school and out-of-school women, will help a country's total fertility rate and infant mortality rate, but is more important for controlling AIDS. Each country statistical profile includes demographic and health items such as population, age structure, life expectancy, birth, death and total fertility rate, infant, maternal and under-5 mortality rates, adult female illiteracy rate, expenditure on health and education, and number of reported AIDS cases.
Washington, D.C., World Bank, 2001. xvii, 75 p. (World Bank Country Study)This report provides an overview of the challenges and opportunities in addressing the problem of HIV/AIDS in the Caribbean. It presents a snapshot of the HIV/AIDS epidemic in the region, offers examples of ways in which Caribbean countries and regional bodies such as the Caribbean Community have responded to the epidemic, discusses alternative actions for addressing the crisis, highlights a range of strategies for donor coordination and cooperation in the region, and identifies the potential role of the World Bank in addressing the HIV/AIDS epidemic in the Caribbean.
CHRISTIAN SCIENCE MONITOR. 1991 Apr 19; 12-3.This article discusses the efforts of the government to combat the spread of the AIDS epidemic in African countries. According to the WHO, an estimated 6-8 million individuals in the region are affected by the disease. Although a coordinated prevention campaign appears to be making progress, still a large number of deaths are related to AIDS and causes the nation to lose most of its income. Specialists claim progress in awareness of the public on AIDS and changes in sexual behavior. Sexual transmission is most commonly found in heterosexual relationships, often outside marriage. Results from the survey revealed that many urban Zairians are reducing their promiscuity. Condom use reached 9 million from 900,000 in the previous survey. A Zairian official points out the importance of educating the youth on the dangers of the disease. Much of Zaire's television and radio campaigns on AIDS are mostly directed to the youth for the purpose of making them aware of what this disease would bring them.
INTEGRATION. 1992 Jun; (32):22-3.By January 1992, almost 450,000 AIDS cases had been reported to the Global Program on AIDS of the World Health Organization (GPA/WHO), but the estimated number of adult cases was 1.5 million based on about 1000 available HIV serological survey data and HIV data bases. 2 million people in the Americas, 1/2 million in Western Europe, over 6.5 million in Sub=Saharan Africa, and 1 million in South and Southeast Asia have been infected since the pandemic started. In North America and Western Europe, the incidence has been declining since the mid-1980s (50,000 cases/year in the US, several times more in the early 1980s). During 1991 in sub=Saharan Africa, 200,000 adult AIDS cases occurred in accordance with the 10-years latency of the disease. The estimated figures of HIV infection as of early 1992 were 5-7 million men and 3-5 million women with 1.5 million full-blown AIDS cases, 90% of whom have died. In sub-Saharan Africa, 1 out of 3 children born to infected mothers become infected, and almost 1 million infected children have been born in the world since the pandemic started. The peak incidence of AIDS cases is expected in the mid-1990s in developed countries because of high HIV infection rate in the early 1980s. A steady increase of heterosexual transmission is projected depending on the effectiveness of HIV/AIDS prevention programs. In developing countries, AIDS cases and attendant mortality are expected to increase substantially in the 1990s and beyond with AIDS becoming the leading cause of death among adults in productive life. In sub-Saharan African cities, HIV seropositivity may range from under 10% to 30% in the 15-49 age group. The improvement of surveillance and estimation methods of HIV/AIDS prevalence is a prerequisite of AIDS programs of health care systems.
MINERVA GINECOLOGICA. 1991 Dec; 43(12):609-10.AIDS continues to pose a grave global problem because it is spreading in the general population by increasing heterosexual transmission and vertical transmission from seropositive mothers to fetuses. A minor rate of transmission has been observed from blood transfusion and blood products. On October 31, 1990 WHO data indicated that a total of 298,914 AIDS cases had been reported. In Africa there were 75,642 cases: 15,569 were in Uganda, 11,732 in Zaire, 9139 in Kenya, 7160 in Malawi, 3647 in the Ivory Coast, 3494 in Zambia, and 3134 in Zimbabwe, with the rest averaging less than 4% of the total African caseload. There were 180,663 cases in the Americas: 149,498 in the US, 11,070 in Brazil, 4941 in Mexico, 4427 in Canada, 2456 in Haiti, 1368 in the Dominican Republic, 870 in Venezuela, 743 in Honduras, 710 in Argentina, 648 in Trinidad an Tobago, 643 in Colombia, 507 in the Bahamas, and 203 in Panama, the rest being less than 200. Asia had only 790 cases: 290 in Japan, 116 in Israel, 48 in India, 45 in Thailand, 37 each in Turkey and the Philippines, 31 in Lebanon, and 27 in Hong Kong. Europe had 39,526 cases: 9718 in France and 6701 in Italy as of June 30, 1990, however, by December 31, 1990 there were 8227 cases reported of whom 4074 had died. There were 6210 in Spain, 5266 in the German Federal Republic, 3798 in England, 1462 in Switzerland, 1443 in the Netherlands, 999 in Romania, 764 in Belgium, 663 in Denmark, 481 in Portugal, 450 in Austria, 443 in Sweden, and 347 in Greece. Little attention has paid to notification in eastern Europe: 40 cases in the USSR, 43 in Poland, 23 in Czechoslovakia, 22 in the German Democratic Republic, 42 in Hungary which is contrasted to 999 cases in Romania. Oceania had 2293 cases: 2040 in Australia, 207 in New Zealand, 16 in French Polynesia, 14 in New Caledonia, 13 in New Guinea, 2 in Tonga, 1 in Fiji, and 1 in the Federated States of Micronesia.
[Unpublished] 1992. , 15 p. (WHO/GPA/RES/SFI/92.1)A summary of current state and future trends to HIV infections and AIDS cases in world regions prepared from the most recent information on file at the WHO Global Programme on AIDS as of January 1992. HIV infection and AIDS began in the 1980s or earlier in homosexual or bisexual men and intravenous drug users in urban Americas, Australia, and Western Europe, and in heterosexuals in East and Central Africa. There is another virus called HIV-2 with a lower virulence, but similar mode of transmission and clinical syndrome prevalent in West Africa. By 1992 450,000 AIDS cases were reported to WHO, but about 1.5 million AIDS cases are thought to have occurred, including 500,000 in children. About 9-11 million HIV infections, including 1 million in children, are estimated to exist. In Australia, North America, and Western Europe, spread of HIV to homosexuals has decreased, but growth in the intravenous drug-using population and heterosexuals may still occur. In Latin America prevalence is high in homosexual or bisexual men, injecting drug users, and prostitutes, and is increasing dramatically in women. In Africa heterosexual transmission is still the rule; infections from blood products account for about 10% of cases. In East and Central Africa 2/3 of the HIV cases are in 9 countries, where urban HIV prevalence reaches 25-33% in adults. In Africa there is also a growing problem of 750,000 pediatric AIDS so far, and possible 10 million orphans in the 1990s. Spread of HIV in high risk populations in South East Asia is rapid, notably in Bangkok, Thailand, in Yangon, Myanmar, and in Bombay and in northeastern India. The potential for spread in this region is a great concern. Areas of East Asia contiguous with South East Asia are also at risk. In Eastern Europe there are clusters of outbreaks related to improper use of blood products. WHO predicts that 4 million people have HIV and TB. WHO projects that global HIV infection will amount to 15-20 million by 2000. A major research topic and concern is estimation of when and at what level HIV prevalence will peak in world regions.
WORLD HEALTH FORUM. 1991; 12(4):496-7.WHO estimates that the number of AIDS cases worldwide will grow from about 1.5 million to 12-18 million by 2000--a 10 fold increase. Further it expects the cumulative number of HIV infected individuals to increase from 9-11 million to 30-40 million by 2000--a 3-4 fold increase. Dr. Hiroshi Nakajima, the Director-General of WHO, points out that despite the rise in AIDS, there is something for which to be thankful--neither air, nor water, nor insects disseminate HIV and causal social contact does not transmit it. Further since AIDS is basically a sexually transmitted disease, health education can inform people of the need to make life style changes which in turn prevents its spread. In addition, Dr. Nakajima illustrates how frank health education and information campaigns in the homosexual community in developed countries have resulted in reduced infection rates. In fact, many of the people disseminating the safer sex message in the homosexual community were people living with HIV and AIDS. HIV has infected >7 million adults and children in Sub-Saharan Africa since the AIDS pandemic began. It is now spreading quickly in south and southeast Asia where at least 1 million people carry HIV. In fact, WHO believes that by the mid to late 1990s HIV will infect more Asians than Africans. Further Latin America is not HIV free and it can be easily spread there too. Heterosexual intercourse has replaced homosexual intercourse and needle sharing by intravenous drug users as the leading route of HIV transmission.
FAR EASTERN ECONOMIC REVIEW. 1992 Feb 20; 28-9.As the AIDS epidemic and HIV transmission in India increasingly resembles that observed in sub-Saharan Africa, Indian society's arrogant perception of invulnerability to the pandemic is proving to be considerably ill-conceived. The dimensions of the epidemic have multiplied greatly since AIDS was 1st identified among prostitutes in Madras, with the trends observed in Maharashtra and Tamil Nadu being especially ominous. AIDS has forced Indian society and research professionals to acknowledge the existence of domestic prostitution, homosexuals, and drug users. While only 103 AIDS cases and 6,400 HIV infections have been officially identified, it is clear that these cases represent only a tiny fraction of the true extent of the epidemic in India. The government will therefore spend up to US$7.75 million on an anti-AIDS program aimed at ensuring secure blood supplies, and checking heterosexual transmission through education and the promotion of condoms. The program also targets IV-drug users and truck drivers for education and behavioral change. India is the 2nd country after Zaire to accept foreign loans for such a purpose. It will receive US$85 million over 5 years from the World Bank in addition to supplemental funds from the WHO and the U.S. Weak attempts, however, have been made to test blood supplies, with only 15% being tested in Tamil Nadu. A large gap also remains between health educators and needy target groups. Finally, while some top officials realize the need for immediate action against AIDS, broad public awareness and coping will come only after AIDS mortality begins to mount in the population.
ANTIBIOTICS AND CHEMOTHERAPY. 1991; 43:1-13.Delphi techniques used by the World Health Organization predict more than 6 million cases of AIDS and millions more to be infected with HIV by the year 2000. In the absence of quick solutions to the epidemic, one must prepare to work against and survive it. The modes of HIV transmission are constant and seen widely throughout the world. Transmission may occur through sexual intercourse and the receipt of donated semen; transfusion or surgically-related exposure to blood, blood products, or donated organs; and perinatally from an infected mother to child. There are, however, 3 patterns of transmission. Pattern I transmission is characterized by most cases occurring among homosexual or bisexual males and urban IV-drug users. Pattern II transmission is predominantly through heterosexual intercourse, while pattern III of only few reported cases is observed where HIV was introduced in the early to mid-1980s. Both homosexual and heterosexual transmission have been documented in the latter populations. Significant case underreporting exists in some countries. Investigators are therefore working to find incidence rates of both infection and AIDS cases to better estimate actual present and future needs in the fight against the epidemic. Surveillance data does reveal a rapidly rising and marked number of reported AIDS cases. The cumulative number reported to the World Health Organization increased over 15-fold over the past 4 years to reach 141,894 cases by March 1, 1989. Large, increasing numbers of cases are reported from North and Latin America, Oceania, Western Europe, and areas of central, eastern and southern Africa. 70% of all reported cases were from 42 countries in the Americas. 85% of these are within the United States. Increases in the proportion of IV-drug users who are infected with HIV are noteworthy especially in Western Europe and the U.S. The epidemic in Italy is also specifically discussed.
POPULATION. 1991 Nov; 17(11):1.According to its latest predictions, the World Health Organization (WHO) anticipates that by the end of the century the number of people worldwide infected with HIV will be somewhere between 30-40 million -- sharply up from the previous projection of 25-30 million. As of April 1991, some 8-10 million adults and 1 million children worldwide were already infected with HIV. While the infection rate appears to be slowing in some industrialized countries, the number of new infections is increasing rapidly in the developing world -- particularly in sub-Saharan Africa. Asia, Latin America, and the Caribbean have also seen marked increases in the number of infections. WHO estimates that by the end of the century, 25-30 million children will have been born with the disease. Already, some 1.5 million people have developed AIDS since the beginning of the pandemic. Although heterosexual intercourse accounts for about 70% of all HIV transmissions, only 6% of contraceptive users choose condoms, the only effective barrier against the virus. Since no cure yet exists for AIDS, experts say that education is the first line of defense, but these prevention campaigns can only work if they receive full commitment from government leaders. UNFPA has already begun addressing the AIDS pandemic through public information activities and education. UNFPA has incorporated AIDS features to population education and teacher training curricula in many countries, and regularly provides large supplies of condoms.
INTEGRATION. 1990 Oct; (25):42-4.Indicating a worsening of the AIDS epidemic, the World Health Organization (WHO) has revised its previous estimate of HIV-infected people from 6-8 million to 8-10 million worldwide. Developing countries, especially countries in sub-Saharan Africa and Asia, account for most of the increase in the rate of infection. According to WHO estimates, the number of HIV-infected people in sub-Saharan Africa has increased from 2.5 million in 1987 to around 5 million today. WHO believes that approximately 1 in 40 adult men and women in this region is infected with HIV, up from 1 in 50 in 1987. Additionally, while in 1987 most of the cases were found in urban areas, rural areas are now reporting a significant number of infections. In Asia, a region that had reported virtually no HIV infections as recently as 2 years ago, there now appears to be 1/2 million people infected with the virus. Injecting drug users and prostitutes account for most of the new cases. In the developed world, the rate of new HIV infections appears to be slowing, but WHO warns against complacency, since many groups in this region may yet see an increase in the rate of infection. Furthermore, WHO officials point out that the current estimates may need to be revised further upward, fearing that Asia and Latin America will see marked increases in the rate of infection and that the epidemic will continue to expand in sub-Saharan Africa. The new revised figures reflect an increase in heterosexual transmissions worldwide, and WHO expects that this will lead to an increase in AIDS cases among women and children in the 1990s.
BULLETIN OF THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE. 1990 Dec; 65(4):75.WHO estimates of pediatric AIDS cases are 400,000 by September 1990, not including 300,000 who have already died. WHO projects that 10 million or more infants and children will have HIV infections by 2000, in addition to 25-30 million adults. The primary mode of transmission in most countries is heterosexual contact, resulting in a rapidly increasing prevalence in women of childbearing age. WHO predicts that pediatric AIDS will be a major, and in some countries the predominant, cause of death in children in the 1990s. Even though child survival programs have made progress recently, by immunization and diarrhea control, the fruits of these efforts are expected to be reversed. The world's cumulative total of HIV infected women is about 3 million. In the U.S., 20,000 infants have been born to infected mothers. In contrast, in Eastern Europe, about 1000 children are infected, mostly from unscreened blood transfusions and unsterilized needles and syringes. The impact of childhood AIDS is expected to be an increase in child mortality by 50% in many developing countries. Serious social repercussions for children also stem from projected 10 million uninfected children orphaned by AIDS, mostly in sub-Saharan Africa. The only way to lessen this tragedy is for people to protect themselves by practicing safe sex and having sexually transmitted diseases treated.
IN POINT OF FACT 1990 Jun; (68):1-3.The global AIDS and HIV situation, in terms of prevalence, by region and sex, means of transmission, progress in treatment, and the tasks undertaken by the WHO Global Programme on AIDS are summarized as of June 1990. Over 250,000 cases of AIDS had been reported to WHO from over 150 countries by mid-1990. Because of under-reporting WHO estimates that actually 700,000 cases of AIDS exist. WHO predicts 1 million cases by 2000. 6-8 million persons with HIV are estimated, and 15-20 million are predicted for 2000, depending on the rate of increase in Asia and Latin America. Heterosexual transmission accounts for about 60% cases, increasing rapidly, especially in urban areas. 75-80% of cases in 2000 will have been heterosexually transmitted. Developing countries have 2/3 of current HIV infections, expected to be 75-80% in 2000. It is thought that 1 out of 20 adults in sub-Saharan Africa is HIV+. Among men, the ratio is 1 out of 75 in North America, 1 in 125 in South America, 1 in 200 in Western Europe. Among women, the ratio is 1 in 700 in North America, 1 in 500 in South America, 1 in 700 in Western Europe and 1 in 20,000 women in Eastern Europe. Progress has been made in treating HIV with antiviral drugs such as Zidovudine, and in managing complications of HIV such as Pneumocystis carinii pneumonia, Kaposi's sarcoma, and cytomegalovirus retinitis. A potential lead for a vaccine has been reported from animal research. The objectives, activities, collaborative functions and priorities of the WHO Global Programme on AIDS are summarized.
Report of the Meeting on HIV Infection and Drug Injecting Intervention Strategies, Geneva, 18-20 January 1988.
[Unpublished] 1989. 12 p. (WHO/GPA/SBR/89.1)To reduce the transmission of human immunodeficiency virus (HIV) infection, new and innovative strategies must be developed for reaching intravenous drug abusers. Drug injection is the risk factor in at least 21% of cases of acquired immunodeficiency syndrome (AIDS) in Europe and 25% of US AIDS cases. Moreover, a major proportion of heterosexual AIDS cases in developed countries are a result of sexual contact with an HIV- infected intravenous drug abuser. At a meeting organized by the World Health Organization's Global Program on AIDS in January 1988, the following approaches were identified as effective for HIV risk reduction among this population: 1) outreach programs that provide education and social support to drug injectors who are attempting to change their behavior; 2) access to sterile needles and syringes in return for used injection equipment; 3) information on the decontamination of drug injection equipment, e.g., through bleaching; and 4) wider use of methadone and other detoxification methods to decrease the prevalence of the drug addiction problem. Given the numerous problems inherent in contacting drug abusers for testing and treatment programs, community outreach programs independent of the formal health care system are needed. The greatest success has been achieved in outreach efforts that involve former drug addicts who are familiar with the life-style and needs of drug injectors. The staff of drug treatment programs within the health care system needs education on the promotion of safe sex practices, condom and virucide use, and family planning techniques. Voluntary testing of drug injectors for antibodies to HIV can provide essential data on the prevalence and incidence of HIV infection in this population and provides an opportunity for counseling; mandatory testing is not warranted, however.
AIDS in Africa: a review of medical, public health, social science, and popular literature. Summary report.
Aachen, Germany, Federal Republic of, MISEREOR, 1988 Feb 24. , 31 p.Heterosexual intercourse is the major means of transmission of HIV in Africa. It is mainly considered a sexually transmitted disease (STD) here. Africa has the added burden of having the highest rates of STDs, such as gonorrhea, and highest levels of STD complications, such as infertility, than do other regions of the world. Little literature exists on the way HIV patients are treated in Africa. Since medical treatment of AIDS will consume a large segment of health care budgets, practitioners need to write about humane and cost saving approaches to manage these patients in the hospital and in the community. In the beginning of the AIDS epidemic in Africa, widely quoted studies of HIV seroprevalence were misleading. Since then, ELISA assays using genetic engineering techniques that produce pure preparations have improved the reliability of HIV testing. African health care budgets cannot always support an expensive spectrophotometer used to measure results, however. This report lists seroprevalence rates of HIV-1 and HIV-2 infection in various population subgroups in some African countries, yet one must be cautious in drawing conclusions based on them. Researchers can conclude that a bimodal age distribution of HIV-1 seropositivity exists with a peak of prevalence in infants (< 1 years old) and a larger peak in the 16-29 year old group. In addition, differences in the female:male ratio of positives of different ages are noteworthy:< 15 years F:M=1:1; 15-30 years F:M=6:1; > 30 year F:M=.6:1. Africa has been more adversely affected by stigmatization of AIDS than any other region. 1 event that accelerated this was the publication by American researchers that AIDS originated in Africa. Their results were based on very high HIV antibody rates in remote African tribes and later proved to be unreliable.
AIDS. 1988; 2 Suppl 1:S247-52.This update on world prevalence of HIV infections and patterns of transmission begins with definitions of AIDS, and an evaluation of efficiency of reporting, and ends with tentative projections and global impact of the pandemic. In developed countries the CDC/WHO clinical and serological definition of AIDS as formulated in 1985 and modified in 1987 is used, but in rural Africa the WHO clinical definition of AIDS is appropriate. AIDS reporting has improved, and is considered 80% complete from the U.S. Reporting is variable among some European and Latin American countries, and is only preliminary in Eastern Europe, Middle East, Asia and the Pacific. Estimates of 10-20% reporting in Africa is given. About 250,000 cases are probably ongoing. ELISA tests are now considered very accurate. Global transmission patterns fall into 3 classes: I. homosexual and bisexual men, iv drug users, their partners, with a male to female ratio of 10-15:1, in industrialized countries. Here overall prevalence is 1%, but may be as high as 50% susceptible groups. Pattern II. heterosexuals, sex ratio 1:1, common perinatal transmission, significant transmission by syringes and blood products, in Central and Eastern Africa and parts of the Caribbean and Latin America. Pattern III. both homosexuals and heterosexuals, infected after mid-1980s, most cases transmitted by foreign travellers, some by imported blood products, in Eastern Europe, North Africa, the Middle East, Asia and the Pacific Islands excluding Australia and New Zealand. WHO estimates that up to 10 million people are already infected with HIV, and that by 1991 1 million will develop AIDS. The average incubation time is 8-9 years. The majority of cases will appear within 4-5 years. Since most cases are adults aged 20-49 years, and many are urban, more educated adults, economic and political destabilization may be possible in some areas.