THE EXPLODING GLOBAL HIV/AIDS PANDEMIC

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• THE EXPLODING GLOBAL HIV/AIDS PANDEMIC

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• THE POTENTIAL ENORMITY OF THE HIV/AIDS PANDEMIC
  IS PROFOUND

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Three-year-old Emmanuel stands outside his house
in Kampala, Uganda. Emmanuel has been infected
with HIV since his birth, and lives now with some
relatives as his parents, both are HIV positive,
are unable to take care of him.
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AIDS awareness billboard in Lundazi, Zambia
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• A DEADLY SITUATION
• UNLESS METHODS OF PREVENTION, WITH OR WITHOUT A
  VACCINE, ARE SUCCESSFUL, THE WORST OF THE GLOBAL
  PANDEMIC WILL OCCUR IN THE 21ST CENTURY
• New England Journal of Medicine

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• HIV HAS INFECTED MORE THAN 60 MILLION PEOPLE
  AROUND THE WORLD.

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• AIDS HAS ALREADY KILLED MORE THAN 25 MILLION
  PEOPLE, SURPASSING TUBERCULOSIS AND MALARIA AS
  THE LEADING INFECTIOUS CAUSE OF DEATH WORLDSIDE.
• World Health Organization

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• IN 2007 ALONE, A RECORD 2.61 MILLION PEOPLE HAVE
  DIED INCLUDING 330,000 CHILDREN.
• IN 2007 33.2 MILLION PEOPLE LIVED WITH THE
  DISEASE.

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• IN AFRICA, FOR THE FIRST TIME, HIV-INFECTED WOMEN
  AGED 15-49 OUTNUMBER INFECTED MEN.

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• THE IMPACT ON DEVELOPING NATIONS IS STAGGERING,
  WITH EVEN GREATER POTENTIAL DISASTER TO COME.

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• Over 19 million women are living with HIV/AIDS.
• By the year 2010, five countries (Ethiopia,
  Nigeria, China, India, and Russia) with 40
  percent of the world's population will add 50 to
  75 million infected people to the worldwide pool
  of HIV disease.

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• There are 14,000 new infections every day (95
  percent in developing countries). HIV/AIDS is a
  "disease of young people" with half of the 5
  million new infections each year occurring among
  people ages 15 to 24.

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• The UN estimates that, currently, there are 14
  million AIDS orphans and that by 2010 there will
  be 25 million.

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• AFRICA HAS BEEN THE EPICENTR OF HIV/AIDS GLOBALLY
  AND CONTINUES TO CARRY THE LARGEST DISEASE
  BURDEN, WITH 70 OF PEOPLE LIVING WITH AIDS
  WORLDWIDE, 83 OF GLOBAL AIDS DEATHS, AND 95 OF
  THE WORLDS AIDS ORPHANS.

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• AIDS HAS REVERSED DECADES OF PROGRESS FROM
  IMPORTANT PUBLIC HEALTH EFFORTS TO IMMUNIZE
  CHILDREN, CONTROL DISEASES, AND IMPROVE NUTRITION.

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• AIDS IS LOWERING LIFE EXPECTANCY AND
  SIGNIFICANTLY AFFECTING INTERNATIONAL BUSINESS.

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• IF THE GLOBAL SPREAD OF HIB/AIDS CONTINUES
  UNCHECKED, SOUTH AND SOUTHEAST ASIA, AND PERHAPS
  CHINA WILL FOLLOW THE DISASTEROUS COURSE OF
  SUB-SARAHAN AFRICA.

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• CURRENTLY, THERE ARE AN ESTIMATED 6.7 MILLION
  HIV-INFECTED PEOPLE IN SOUTH AND SOUTHEAST ASIA.

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• IN INDIA ALONE, UNAIDS ESTIMATES THAT BETWEEN 3
  AND 5 MILLION OF ITS NEARLY 1 BILLION POPULATION
  ARE INFECTED, AND THE NUMBER OF NEW INFECTIONS IS
  CONTINUING TO DOUBLE EVERY MONTH.

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• RAPID INCREASES ARE OCCURRING IN EASTERN EUROPE
  AND CENTRAL ASIA, AND AIDS REMAIN A SERIOUS
  THREAT IN LATIN AMERICA AND THE CARIBBEAN.

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• HIV INFECTIONS IN THE FORMER SOVIET UNION HAVE
  DOUBLED IN JUST TWO YEARS.

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• THE SECRETARY-GENERAL OF THE UNITED NATIONS HAS
  STATED THAT AIDS IS HAVING AN IMPACT ON GROSS
  DOMESTIC PRODUCT IN SOME COUNTRIES.

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• THE MICRO-ECONOMIC EFFECTS OF ABSENTEEISM,
  DECLINE IN A SKILLED WORKFORCE, AND PAYMENTS FOR
  SICKNESS AND DEATH BENEFITS IN THE DEVELOPING
  WORLD WILL LEAD TO MACRO-ECONOMIC EFFECTS
  WORLDWIDE.

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• THERE IS A PARALLEL EPIDEMIC OF TUBERCULOSIS IN
  THE DEVELOPING WORLD.

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• THE HIV/AIDS EPIDEMIC IN THE UNITED STATES

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• An estimated one million people are currently
  living with HIV in the United States, with
  approximately 40,000 new infections occurring
  each year.

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• 70 percent of these new infections occur in men
  and 30 percent occur in women.

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• By race, 54 percent of the new infections in the
  United States occur among African Americans, and
  64 percent of the new infections in women occur
  in African American women.

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• 75 percent of the new infections in women are
  heterosexually transmitted.
• Half of all new infections in the United States
  occur in people 25 years of age or younger.

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• IN THE UNITED STATES THE EPIDEMIC CONTINUES TO
  EVOLVE.

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• ALTHOUGH THE INCIDENCE OF NEW AIDS CASES HAS
  DECLINED, THE DECLINE IN DEATH RATES HAS LEVELED
  OFF.
• NEW DRUG THERAPIES THAT PREVENT PROGRESSION FROM
  HIV INFECTION TO AIDS.

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• ACCORDING TO THE CDC, THE RATE OF NEW HIV
  INFECTIONS HAS BEEN CONSTANT SINCE 1990 WITH NO
  DECLINE, MEANING THAT THE OVERALL EPIDEMIC IS
  CONTINUING TO EXPAND.

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• HIV INFECTION RATES ARE CONTINUING TO CLIMB IN A
  NUMBER OF SUBPOPULATION GROUPS, SUCH AS WOMEN,
  RACIAL AND ETHNIC MINORITIES, YOUNG HOMOSEXUAL
  MEN, PEOPLE OVER 50 YEARS OF AGE, AND INDIVIDUALS
  WITH ADDICTIVE DISORDERS.

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• THE RECENT APPEARANCE OF MULTI-DRUG RESISTANT
  STRAINS OF HIV PRESENT A SERIOUS PUBLIC HEALTH
  CONCERN.

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• THESE DATA FOREBODE AN EPIDEMIC OF EVEN GREATER
  MAGNITUDE AHEAD.

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• CDC ESTIMATES THAT ABOUT ONE MILLION AMERICANS
  ARE CURRENTLY INFECTED WITH HIV.

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• PREVALENCE OF AIDS IS HIGHER AMONG AFRICAN
  AMERICANS AND HISPANICS, WHO ACCOUNT FOR 45 AND
  20 RESPECTIVELY.

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• OF WOMEN WITH AIDS, MINORITIES ACCOUNT FOR 80 OF
  CASES AMONG MEN, MINORITIES ACCOUNT FOR 61 OF
  CASES.

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• AIDS RESEARCH
• NIH HAS DEVELOPED A COMPREHENSIVE BIOMEDICAL AND
  BEHAVIORAL RESEARCH PROGRAM TO BETTER UNDERSTAND
  THE BASIC BIOLOGY OF HIV, DEVELOP EFFECTIVE
  THERAPIES TO TREAT IT, AND DESIGN INTERVENTIONS
  TO PREVENT NEW INFECTIONS FROM OCCURING.

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• THE TRANSMISSIBLE NATURE OF HIV MAKES IT
  RADICALLY DIFFERENT FROM NON-TRANSMISSIBLE
  DISEASES SUCH AS HEART DISEASE AND CANCER.

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• THE TRANSMISSIBILITY OF HIV - BETWEEN INDIVIDUALS
  AND ACROSS BORDERS AND POPULATIONS - IS WHAT
  DEFINES THE GLOBAL PANDEMIC AND MAKES IT
  IMPERATIVE THAT THE U.S. HELP ADDRESS PREVENTION
  AND TREATMENT WORLDWIDE.

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• THE TRANSMISSIBILITY OF THE INFECTION MEANS THAT
  THERE IS THE POTENTIAL FOR UNLIMITED GLOBAL
  SPREAD.

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• IT ALSO MEANS THAT, WITH THE DEVELOPMENT OF
  APPROPRIATE BIOMEDICAL AND BEHAVIORAL
  INTERVENTIONS, THERE IS THE POSSIBILITY FOR
  DRAMATIC REDUCTIONS IN NEW INFECTIONS - AND
  ULTIMATE CONTROL OF THE PANDEMIC - IN A WAY THAT
  WILL NEVER BE POSSIBLE FOR NONINFECTIOUS DISEASES.

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• NIH CONTINUES TO PLACE A HIGH PRIORITY ON PRIMARY
  PREVENTION OF NEW HIV INFECTIONS AS THE MOST
  EFFECTIVE MEANS OF CONTROLLING THE SPREAD OF THE
  EPIDEMIC IN THE UNITED STATES AND GLOBALLY.

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• NATIONAL INSTITUTES OF HEALTH RESEARCH PRIORITIES

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• PRIORITY HEALTH DISPARITIES IN THE UNITED
  STATES
• AIDS REMAINS THE NUMBER ONE CAUSE OF DEATH FOR
  YOUNG AFRICAN AMERICAN MEN.

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• PRIORITY BETTER THERAPIES

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• PRIORITY BETTER THERAPIES
• PRIORITY HIV PREVENTION

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• PRIORITY BETTER THERAPIES
• PRIORITY HIV PREVENTION
• PRIORITY VACCINES

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• PREVENTION
• NIH CONTINUES TO PLACE A HIGH PRIORITY ON PRIMARY
  PREVENTION OF NEW HIV INFECTIONS AS THE MOST
  EFFECTIVE MEANS OF CONTROLLING THE SPREAD OF THE
  EPIDEMIC IN THE UNITED STATES AND GLOBALLY.

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• VACCINES
• A SAFE AND EFFECTIVE HIV PREVENTION VACCINE IS
  ESSENTIAL FOR THE GLOBAL CONTROL OF THE AIDS
  PANDEMIC.

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• TREATMENTS THERE ARE TREATMENTS THAT HAVE
  EXTENDED LIFE AND IMPROVED THE QUALITY OF LIFE
  FOR MANY HIV-INFECTED PEOPLE IN THE UNITED STATES
  AND WESTERN EUROPE.

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• TREATMENT FAILURE NOW AFFECTS A GROWING
  PROPORTION OF THOSE RECEIVING TREATMENT.
• TREATMENT IS TOO ARDUOUS, TOXICITIES DEVELOP, AND
  IT COSTS TOO MUCH.
• 15,00O PER YEAR FOR DRUGS.

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• THE NEED FOR SIMPLER, LESS TOXIC, AND CHEAPER
  DRUGS AND DRUG REGIMENS TO TREAT HIV INFECTION
  CONTINUE TO BE ITEMS OF HIGH PRIORITY FOR
  RESEARCHERS.
• IMPROVED REGIMENS ARE NOW IN CLINICAL TRIALS, AND
  SOME WILL BE AVAILABLE IN THE NEXT FEW YEARS.

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• AS ALWAYS, IT IS VERY EXPENSIVE...

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• END OF LECTURE FOR NOVEMBER 3rd, 2010
• QUESTIONS?