Although Strides Have Been Made In The Hiv Response Children Are Still Affected By The Epidemic
Of the estimated 38.0 million people living with HIV worldwide in 2020, 2.78 million were children aged 0-19. Each day in 2020, approximately 850 children became infected with HIV and approximately 330 children died from AIDS related causes, mostly because of inadequate access to HIV prevention, care and treatment services.
As of 2020, roughly 15.4 million children under the age of 18 had lost one or both parents to AIDS-related causes. Millions more have been affected by the epidemic, through a heightened risk of poverty, homelessness, school dropout, discrimination and loss of opportunities, as well as COVID-19. These hardships include prolonged illness and death. Of the estimated 680,000 people who died of AIDS-related illnesses in 2020, 120,000 of them were children under 20 years of age.
In 2020, around 150,000 children aged 0-9 were newly infected with HIV, bringing the total number of children aged 0-9 living with HIV to 1.03 million . Nearly 90 per cent of these children live in sub-Saharan Africa. One bright spot on the global horizon is the rapid decline of approximately 52 per cent in new HIV infections among children aged 0-9 since 2010 due to stepped-up efforts to prevent mother-to-child transmission of HIV. However, the number of new HIV infections among adolescents has declined at a slower rate of about 38 per cent.
Only 53% Of Children Infected With Hiv Have Access To Treatment
Compared to 67% of adults who had access to treatment. In other words, HIV statistics suggest that about 850,000 infected children are not getting the treatment that could potentially save their lives. In addition to that, over half of the children are from the Democratic Republic of the Congo, Kenya, Mozambique, Nigeria, and South Africa.
Goal : Improving Access To Care And Health Outcomes
The second goal of the NHAS is to improve access to medical care and health outcomes. Currently, 45% of patients develop AIDS within three years of receiving their HIV diagnosis, suggesting that people with HIV have difficulty accessing the health care system and obtaining life-saving antiretroviral medications. The Patient Protection and Affordable Care Act expands Medicaid coverage to include all people younger than 65 years with incomes up to 133% of the federal poverty level. More importantly for people with HIV, the ACA also eliminates the disability criteria for Medicaid enrollment. The ACA does increase the availability of health insurance, but the challenge of linking patients to care and maintaining them in care remains. The NHAS appropriately calls for improving connections between testing and care sites and enhancing linkages to substance abuse treatment and mental health services. Lead agencies tasked with accomplishing these goals should explore the use of new health delivery models, such as the patient-centered medical home, community health workers, and integrated medical information systems, because these programs have the potential to increase care coordination and retention.
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Since 2017 Public Health England Has Published Data On Trans People Accessing Hiv Care And Those Newly Diagnosed With Hiv
- The majority of trans people accessing HIV care are trans women. In 2019, 111 trans women, 31 trans men and 7 gender diverse people were accessing HIV care in England.
- Trans people aged 35-49 are the largest group in terms of age.
- The majority of trans people accessing HIV care are white , with 47 trans people of other or mixed ethnicity making up the second largest group.
- Nearly all of the trans people accessing HIV care in 2019 acquired HIV through sex between men.
Impact Across The Country
- Although HIV has been reported in all 50 states, the District of Columbia, and U.S. dependencies, the impact of the epidemic is not uniformly distributed.
- Ten states accounted for about two-thirds of HIV diagnoses among adults and adolescents in 2019 .31 Regionally, the South accounted for more than half of HIV diagnoses in 2019.32
- Rates of HIV diagnoses per 100,000 provide a different measure of the epidemicâs impact, since they reflect the concentration of diagnoses after accounting for differences in population size across states. The District of Columbia has the highest rate in the nation, compared to states, nearly 3 times the national rate and Georgia was the state with highest rate , twice that of the national rate.33,34 Nine of the top 10 states by rate are in the South.35
- New HIV diagnoses are concentrated primarily in large U.S. metropolitan areas , with Miami, Orlando, and Atlanta topping the list of the areas most heavily burdened.36
|Table 1: Top Ten States/Areas by Number and Rate of New HIV Diagnoses , 2019|
|CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2019 vol. 32. May 2021.|
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How Are We Monitoring Progress In Canada
In February 2018, PHAC convened an expert working group meeting to discuss the measures within the HIV continuum of care for Canada. Based on a review of measures used internationally, the PHAC expert group recommended monitoring a four-stage continuum: Stage 1 the estimated number of all people living with HIV Stage 2 the number of all PLHIV who have been diagnosed Stage 3 the number on PLHIV who have been diagnosed and who are on ART and Stage 4 the number of PLHIV on ART who are virally suppressed .
Figure 1. Four-stage HIV continuum of care framework for Canada
This diagram shows the four-stage continuum Canada uses to measure the HIV continuum of care:
Stage 1 the estimated number of all people living with HIV Stage 2 the number of all PLHIV who have been diagnosed Stage 3 the number on PLHIV who have been diagnosed and who are on ART and Stage 4 the number of PLHIV on ART who are virally suppressed.
HIV estimates related to incidence, prevalence and the first 90-90-90 target were developed using HIV surveillance data reported by provinces and territories, estimated deaths among persons living with HIV, and back-calculation statistical modelling methods. Additional detail on these methods is provided in Appendix 1.
The development of estimates for the second and third 90-90-90 targets required additional information from the provinces and territories, including the following where available:
Data limitations and caveats
Us Response To The Global Epidemic
The U.S. President’s Emergency Plan for AIDS Relief is the U.S. Governments response to the global HIV/AIDS epidemic and represents the largest commitment by any nation to address a single disease in history. Through PEPFAR, the U.S. has supported a world safer and more secure from infectious disease threats. It has demonstrably strengthened the global capacity to prevent, detect, and respond to new and existing riskswhich ultimately enhances global health security and protects Americas borders. Among other global results, PEPFAR provided HIV testing services for nearly 50 million people in Fiscal Year 2020 and, as of September 30, 2020, supported lifesaving ART for nearly 18.2 million men, women, and children.
In addition, the National Institutes of Health represents the largest public investment in HIV/AIDS research in the world. NIH is engaged in research around the globe to understand, diagnose, treat, and prevent HIV infection and its many associated conditions, and to find a cure.
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Lessons From Past National Strategies
Since the late 1980s, two US presidents have each released a national plan for responding to the AIDS crisis. These efforts, although well intentioned, have largely been unsuccessful, and they highlight plan-construction errors that should be avoided in the future. The first plan was released under President Reagan, who in 1987 created the Presidential Commission on the HIV Epidemic. The commission issued 597 recommendations, calling for increased HIV testing, stronger legal protection for people with HIV, prevention and treatment of substance abuse, and expansion of the workforce providing HIV care and treatment., Unfortunately, because of President Reagan’s lukewarm commitment to ensuring implementation of the commission’s recommendations, their report was largely ignored.
In December 1996, President Clinton released the first National AIDS Strategy. The strategy outlined six goals: strengthen HIV-related research reduce the number of new HIV infections give persons with HIV access to high-quality services, both medical and supportive eliminate HIV-related discrimination support international efforts to address the HIV epidemic and ensure that research advances are translated into care and prevention programs. Although the plan had specific objectives, it lacked a timeline for meeting targets and did not clearly identify federal offices responsible for each goal, making the strategy’s impact difficult to assess.
The Global Hiv/aids Epidemic
HIV, the virus that causes AIDS, is one of the worlds most serious public health challenges. But there is a global commitment to stopping new HIV infections and ensuring that everyone with HIV has access to HIV treatment.
According to UNAIDS:
Number of People with HIVThere were approximately 37.7 million people across the globe with HIV in 2020. Of these, 36 million were adults and 1.7 million were children aged 0-14 years. More than half were women and girls.
New HIV InfectionsAn estimated 1.5 million individuals worldwide acquired HIV in 2020, marking a 31% decline in new HIV infections since 2010. Of these new HIV infections:
- 1.3 million were individuals ages 15+
- 160,000 were among children aged 0-14 years
HIV TestingApproximately 84% of people with HIV globally knew their HIV status in 2020. The remaining 16% still need access to HIV testing services. HIV testing is an essential gateway to HIV prevention, treatment, care and support services.
HIV Treatment AccessAs of June 2020, 28.2 million people with HIV were accessing antiretroviral therapy globally. That means 9.5 million people are still waiting. HIV treatment access is key to the global effort to end AIDS as a public health threat. People with HIV who are aware of their status, take ART as prescribed, and get and keep an undetectable viral load can live long, healthy lives and have effectively no risk of sexually transmitting HIV to their HIV-negative partners.
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Hiv And Sex Education
The status of sexual health education varies substantially throughout the USA and is insufficient in many areas. In most states, fewer than half of high schools teach all 16 topics CDC recommends for effective sex education. Many also argue that sex education is not starting early enough.71
The percentage of schools in which students are required to receive instruction on HIV prevention is decreasing, from 64% in 2000 to 41% in 2014.72
Conservative support for abstinence-only sex education has also been a major barrier to progress, and has been shown to be associated with increased HIV rates among adolescents.73
President Obama eliminated three-quarters of the budget for abstinence-only sex education in 2009, which had previously received the majority of funding.7475 However, funding for abstinence-only sex education began to rise again in the following years and stood at US $85 million in 2016.76
In February 2018, this was renewed for two more years at US $75 million annually under the new name of sexual risk avoidance education.77 As of 2019, 37 states require that information on abstinence be provided, 27 of which require for abstinence to be emphasised, with the 10 remaining states requiring that abstinence is covered. In contrast, only 12 states require discussion of sexual orientation. Of these, nine states require that discussion be inclusive.78
How Have Deaths From Hiv/aids Changed Over Time
Global deaths from HIV/AIDS halved within a decade
The world has made significant progress against HIV/AIDS. Global deaths from AIDS have halved over the past decade.
In the visualization we see the global number of deaths from HIV/AIDS in recent decades this is shown by age group. In the early 2000s 2004 to 2005 global deaths reached their peak at almost 2 million per year.
Driven mostly by the development and availability of antiretroviral therapy , global deaths have halved since then. In 2017, just under one million died from the disease.
You can explore this change for any country or region using the change country toggle on the interactive chart.
HIV/AIDS once accounted for more than 1-in-3 deaths in some countries, but rates are now falling
Global progress on HIV/AIDS has been driven by large improvements in countries which were most affected by the HIV epidemic.
Today the share of deaths remains high: more than 1-in-4 deaths in some countries are caused by HIV/AIDS. But in the past this share was even higher.In the visualization we see the change in the share of deaths from HIV/AIDS over time. From the 1990s through to the early 2000s, it was the cause of greater than 1-in-3 deaths in several countries. In Zimbabwe, it accounted for more than half of annual deaths in the late 1990s.
We see that over the past decade this share has fallen as antiretoviral treatment has become more widely available.
Children living with HIV
New HIV infections of children
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Intimate Partner Violence And Hiv
- Women living with HIV are disproportionately affected by intimate partner violence , including physical, sexual, and emotional abuse compared to the general population. 44,45 Intimate partner violence , sometimes referred to as domestic violence, has been shown to be associated with increased risk for HIV among women, as well as poorer treatment outcomes for those who are already infected.46,47
- Among all U.S. women, 36% report having experienced IPV, including rape, physical violence, and/or stalking in their lifetime among HIV positive women in the U.S., IPV is even more prevalent, with 55% reporting having experienced IPV.48,49,50
- In many cases, the factors that put women at risk for contracting HIV are similar to those that make them vulnerable to experiencing trauma or IPV women in violent relationships are at a 4 times greater risk for contracting STIs, including HIV, than women in non-violent relationships, and women who experience IPV are more likely to report risk factors for HIV.51 These experiences are interrelated and can become a cycle of violence, HIV risk, and HIV infection.
- It has also been suggested that women are at risk of experiencing violence upon disclosure of their HIV status to partners.52
You Cant Avoid Other Hiv
Myth. People with HIV can get infections like pneumonia, tuberculosis, candidiasis, cytomegalovirus, and toxoplasmosis. The best way to cut the risk is to take HIV medications. People with advanced HIV infection can prevent some of these infections with specific drugs in addition to antiretroviral therapy. You can lessen exposure to some germs by avoiding undercooked meat, litter boxes, and contaminated water.
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How Homelessness Among Lgbtq People Ties In To Hiv
Homelessness is a major risk factor for acquiring HIV. People who experience homelessness are not only at a much higher risk for acquiring HIV, they are also much less likely to receive HIV medical treatment, and they have worse health outcomes than people with HIV who have housing.
Unfortunately, LGBTQ peopleespecially LGBTQ youthare much more likely to experience homelessness than the general population. LGBTQ youth are 120% more likely to experience homelessness than their cisgender, straight counterparts. And though LGBTQ people do not comprise 40% of the population, LGBTQ youth comprise 40% of all homeless youth.
LGBTQ homeless youth experience many other hardships that are considered risk factors for acquiring HIV, including poor mental health, minority stress, substance use, unprotected sex, and survival sex.
Within the LGBTQ youth population, a persons identity can affect how they experience homelessness and the factors that lead to homelessness. For instance:
Homelessness among young gay and bisexual men has been connected with a greater lifetime risk for HIVmeaning the risk extends much longer than their period of homelessness. Young gay and bisexual men who run away from home engage in oral and anal sex on average one year younger than non-runaway young gay and bisexual men. They are also more likely to experience forced sexual contact, get diagnosed with an STI, and use drugs, including injection drugs.
Hiv Deaths In The United States
In the United States, no less than 675,000 Americans have died since the first cases were diagnosed back in 1981. In 2018, approximately 1.2 million Americans were estimated to be living with the virus. From 2014 to 2018, HIV diagnoses decreased by about 7%, but that number varied depending on the region.
According to the Centers for Disease Control and Prevention , there were 15,820 deaths in people diagnosed with HIV in the United States in 2018. That’s a significant decrease from the over 50,000 deaths reported at the height of the epidemic in 1995.
Despite the advances, there remains a clear disparity in the populations affected by the disease in the United State. Among some of the key risk factors affecting mortality rates are geography, sexuality, and race.
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Hiv Statistics From 2020 Recognize Baton Rouge As The Leading City In The Us Regarding The Highest Hiv Rates
In accordance with the most recent figures, Baton Rouge is the city with the highest HIV rates in America. Shared needles are the main source of infection as the city struggles with opioid abuse. Miami, Florida, is in second place, while the third-place belongs to New Orleans, Louisiana. Other cities in the top ten list in descending order are Jackson , Orlando , Memphis , Atlanta , Columbia , Jacksonville , and Baltimore .
The Global Distribution Of Deaths From Hiv/aids
In some countries HIV/AIDS is the cause of more than a quarter of all deaths
Globally, 1.7% of deaths were caused by HIV/AIDS in 2017.
This share is high, but masks the wide variations in the toll of HIV/AIDS across the world. In some countries, this share was much higher.In the interactive map we see the share of deaths which resulted from HIV/AIDS across the world. Across most regions the share was low: across Europe, for example, it accounted for less than 0.1% of deaths.
But across some countries focused primarily in Southern Sub-Saharan Africa the share is very high. More than 1-in-4 of deaths in South Africa and Botswana were caused by HIV/AIDS in 2017. The share was also very high across Mozambique Namibia Zambia Kenya and Congo .
Death rates are high across Sub-Saharan Africa
The large health burden of HIV/AIDS across Sub-Saharan Africa is also reflected in death rates. Death rates measure the number of deaths from HIV/AIDS per 100,000 individuals in a country or region.
In the interactive map we see the distribution of death rates across the world. Most countries have a rate of less than 10 deaths per 100,000 often much lower, below 5 per 100,000. Across Europe the death rate is less than one per 100,000.
Across Sub-Saharan Africa the rates are much higher. Most countries in the South of the region had rates greater than 100 per 100,000. In South Africa and Mozambique, it was over 200 per 100,000.
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