Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990–2019, for 204 countries and territories: The Global Burden of Diseases Study 2019

GBD 2019 HIV Collaborators

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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.

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).

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.

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.

Original languageEnglish
Pages (from-to)e633-e651
Number of pages19
JournalThe Lancet HIV
Issue number10
Publication statusPublished - Oct 2021
Externally publishedYes

Bibliographical note

L Abu-Raddad acknowledges the support of Qatar National Research Fund (NPRP 9-040-3-008) who provided the main funding for generating the data provided to the GBD-IHME effort. T Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. S Bazargan-Hejazi was partly supported by the National Institute of Health (NIH) National Center for Advancing Translational Science UCLA CTSI (grant number UL1TR001881). L Degenhardt is supported by an NHMRC Senior Principal Research Fellowship (1135991) and a US NIH National Institute on Drug Abuse (NIDA) grant (R01DA1104470). NDARC, UNSW Sydney, is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Programme. J Eaton was supported by the Bill & Melinda Gates Foundation (OPP1190661), UNAIDS, the National Institute of Allergy and Infectious Disease of the NIH under award numbers R01AI136664, and the MRC Centre for Global Infectious Disease Analysis (reference MR/R015600/1), jointly funded by the UK Medical Research Council (MRC) and the UK Foreign, Commonwealth, and Development Office (FCDO), under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 programme supported by the European Union. V B Gupta acknowledges funding support from National Health and Medical Research Council (NHMRC), Australia. V K Gupta acknowledges support from NHMRC, Australia. S Haque is grateful to the DSR, Jazan University, Saudi Arabia for providing the access of the Saudi Digital Library for this study. P Hoogar would like to acknowledge the Centre for Bio Cultural Studies Directorate of Research, Manipal Academy of Higher Education, Manipal-Karnataka, India. Y J Kim's portion of this work was supported by the Research Management Centre, Xiamen University Malaysia (Np:XMUMRF-C6/ITCM/0004). S L Koulmane Laxminarayana acknolwedges institutional support by Manipal Academy of Higher Education. K Krishan is supported by the UGC Centre of Advanced Study (phase 2), awarded to the Department of Anthropology, Panjab University, Chandigarh, India. M Kumar acknowledges grant FIC/NIH K43 TW010716-04. I Landires is member of the Sistema Nacional de Investigación, supported by the Secretaría Nacional de Ciencia, Tecnología e Innovación, Panama. J Lazarus acknowledges support to ISGlobal from the Spanish Ministry of Science, Innovation, and Universities through the Centro de Excelencia Severo Ochoa 2019–23 programme (CEX2018-000806-S), and from the Government of Catalonia, Spain, through the CERCA programme. P Mahasha acknowledges grants, innovation, and product development from the South African Medical Research Council. P Meylahk's portion of this research was supported by the Russian Science Foundation (under grant project number 20-18-00307; the health of nation: the multidimensional analysis of health, health inequality, and health-related quality of life). M Molokhia is supported by the National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas’ National Health Service Foundation Trust and King's College London. J Nachega is an infectious disease internist and epidemiologist and Principal Investigator of NIH/Fogarty International Center (grant numbers 1R25TW011217-01, 1R21TW011706-01, and 1D43TW010937-01A1). A Samy acknowledges support from a fellowship of the Egyptian Fulbright Mission programme. A Shetty acknowledges the support given by Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal. N Taveira's work is partially funded by Fundação para a Ciência e Tecnologia, Portugal, and Aga Khan Development Network, Portugal Collaborative Research Network in Portuguese speaking countries in Africa (project 332821690), and by the LIFE project (RIA2016MC-1615), and European and Developing Countries Clinical Trials Partnership. G Tessema was funded by the Australian National Health and Medical Research Council Investigator (grant number 1195716). B Unnikrishnan acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. A Zumla acknowledges support from the European and Developing Countries Clinical Trials Partnership programme, Horizon 2020, and the European Union's Framework Programme for Research and Innovation (grants PANDORA-ID-NET, TESA-2, and CANTAM-2).

Funding Information:
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.

Publisher Copyright:
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license


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