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

Deepa Jahagirdar, Magdalene K. Walters, Amanda Novotney, Edmond D. Brewer, Tahvi D. Frank, Austin Carter, Molly H. Biehl, Hedayat Abbastabar, E. S. Abhilash, Eman Abu-Gharbieh, Laith Jamal Abu-Raddad, Victor Adekanmbi, Daniel Adedayo Adeyinka, Qorinah Estiningtyas Sakilah Adnani, Saira Afzal, Soodabeh Aghababaei, Bright Opoku Ahinkorah, Sajjad Ahmad, Keivan Ahmadi, Sepideh AhmadiEhsan Ahmadpour, Muktar Beshir Ahmed, Tarik Ahmed Rashid, Yusra Ahmed Salih, Addis Aklilu, Tayyaba Akram, Chisom Joyqueenet Akunna, Hanadi Al Hamad, Fares Alahdab, Fahad Mashhour Alanezi, Ekaterina A. Aleksandrova, Kefyalew Addis Alene, Liaqat Ali, Vahid Alipour, Sami Almustanyir, Nelson Alvis-Guzman, Edward Kwabena Ameyaw, Hubert Amu, Catalina Liliana Andrei, Tudorel Andrei, Davood Anvari, Jalal Arabloo, Olatunde Aremu, Judie Arulappan, Desta Debalkie Atnafu, Beatriz Paulina Ayala Quintanilla, Muluken Altaye Ayza, Samad Azari, B. B. Darshan, Maciej Banach, Till Winfried Bärnighausen, Fabio Barra, Amadou Barrow, Sanjay Basu, Shahrzad Bazargan-Hejazi, Habtamu Gebrehana Belay, Tezera Moshago Berheto, Woldesellassie Mequanint Bezabhe, Yihienew Mequanint Bezabih, Akshaya Srikanth Bhagavathula, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Sadia Bibi, Ali Bijani, Catherine Bisignano, Obasanjo Afolabi Bolarinwa, Archith Boloor, Azizbek A. Boltaev, Nikolay Ivanovich Briko, Danilo Buonsenso, Katrin Burkart, Zahid A. Butt, Chao Cao, Jaykaran Charan, Souranshu Chatterjee, Soosanna Kumary Chattu, Vijay Kumar Chattu, Sonali Gajanan Choudhari, Dinh Toi Chu, Rosa A.S. Couto, Richard G. Cowden, Berihun Assefa Dachew, Omid Dadras, Amare Belachew Dagnew, Saad M.A. Dahlawi, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, José das Neves, Louisa Degenhardt, Feleke Mekonnen Demeke, Abebaw Alemayehu Desta, Keshab Deuba, Deepak Dhamnetiya, Govinda Prasad Dhungana, Mostafa Dianatinasab, Daniel Diaz, Shirin Djalalinia, Linh Phuong Doan, Fariba Dorostkar, Hisham Atan Edinur, Andem Effiong, Sahar Eftekharzadeh, Maysaa El Sayed Zaki, Rajesh Elayedath, Muhammed Elhadi, Shaimaa I. El-Jaafary, Ziad El-Khatib, Aisha Elsharkawy, Aklilu Endalamaw, Aman Yesuf Endries, Sharareh Eskandarieh, Ifeanyi Jude Ezeonwumelu, Sayeh Ezzikouri, Mohammad Farahmand, Emerito Jose A. Faraon, Abidemi Omolara Fasanmi, Simone Ferrero, Lorenzo Ferro Desideri, Irina Filip, Florian Fischer, Morenike Oluwatoyin Folayan, Masoud Foroutan, Takeshi Fukumoto, Mohamed M. Gad, Muktar A. Gadanya, Abhay Motiramji Gaidhane, Tushar Garg, Reta Tsegaye Gayesa, Eyob Alemayehu Gebreyohannes, Hailay Abrha Gesesew, Abera Getachew Obsa, Keyghobad Ghadiri, Ahmad Ghashghaee, Syed Amir Gilani, Themba G. Ginindza, Ionela Roxana Glăvan, Ekaterina Vladimirovna Glushkova, Mahaveer Golechha, Harish Chander Gugnani, Bhawna Gupta, Sapna Gupta, Veer Bala Gupta, Vivek Kumar Gupta, Samer Hamidi, Senad Handanagic, Shafiul Haque, Harapan Harapan, Arief Hargono, Ahmed I. Hasaballah, Abdiwahab Hashi, Shoaib Hassan, Soheil Hassanipour, Khezar Hayat, Ileana Heredia-Pi, Kamal Hezam, Ramesh Holla, Praveen Hoogar, Mohammad Enamul Hoque, Mostafa Hosseini, Mehdi Hosseinzadeh, Mohamed Hsairi, Rabia Hussain, Segun Emmanuel Ibitoye, Bulat Idrisov, Kevin S. Ikuta, Olayinka Stephen Ilesanmi, Irena M. Ilic, Milena D. Ilic, Seyed Sina Naghibi Irvani, M. Mofizul Islam, Nahlah Elkudssiah Ismail, Ramaiah Itumalla, Ihoghosa Osamuyi Iyamu, Roxana Jabbarinejad, Vardhmaan Jain, Ranil Jayawardena, Ravi Prakash Jha, Nitin Joseph, Ali Kabir, Zubair Kabir, Rohollah Kalhor, Feroze Kaliyadan, Ashwin Kamath, Tanuj Kanchan, Himal Kandel, Getinet Kassahun, Patrick D.M.C. Katoto, Gbenga A. Kayode, Ermiyas Mulu Kebede, Hafte Kahsay Kebede, Himanshu Khajuria, Nauman Khalid, Ejaz Ahmad Khan, Gulfaraz Khan, Khaled Khatab, Min Seo Kim, Yun Jin Kim, Adnan Kisa, Sezer Kisa, Sonali Kochhar, Vladimir Andreevich Korshunov, Parvaiz A. Koul, Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi, Kewal Krishan, Barthelemy Kuate Defo, G. Anil Kumar, Manasi Kumar, Nithin Kumar, Alexander Kwarteng, Dharmesh Kumar Lal, Iván Landires, Savita Lasrado, Zohra S. Lassi, Jeffrey V. Lazarus, Jane Jean Hee Lee, Yeong Yeh Lee, Kate E. LeGrand, Christine Lin, Xuefeng Liu, Emilie R. Maddison, Hassan Magdy Abd El Razek, Phetole Walter Mahasha, Azeem Majeed, Alaa Makki, Ahmad Azam Malik, Wondimu Ayele Manamo, Mohammad Ali Mansournia, Francisco Rogerlândio Martins-Melo, Seyedeh Zahra Masoumi, Ziad A. Memish, Ritesh G. Menezes, Endalkachew Worku Mengesha, Hayimro Edemealem Merie, Amanual Getnet Mersha, Tomislav Mestrovic, Peter Meylakhs, Nour Mheidly, Ted R. Miller, Andreea Mirica, Babak Moazen, Yousef Mohammad, Mokhtar Mohammadi, Arif Mohammed, Salahuddin Mohammed, Shafiu Mohammed, Modhurima Moitra, Ali H. Mokdad, Mariam Molokhia, Mohammad Ali Moni, Ghobad Moradi, Yousef Moradi, Christine Mpundu-Kaambwa, Sumaira Mubarik, Sandra B. Munro, Lillian Mwanri, Jean B. Nachega, Ahamarshan Jayaraman Nagarajan, Aparna Ichalangod Narayana, Muhammad Naveed, Biswa Prakash Nayak, Sabina O. Nduaguba, Sandhya Neupane Kandel, Georges Nguefack-Tsague, Trang Huyen Nguyen, Molly R. Nixon, Chukwudi A. Nnaji, Jean Jacques Noubiap, Virginia Nuñez-Samudio, Thomas Elliot Nyirenda, Onome Bright Oghenetega, Andrew T. Olagunju, Babayemi Oluwaseun Olakunde, Oluwatomi Funbi Owopetu, P. A. Mahesh, Jagadish Rao Padubidri, Smita Pakhale, Tarang Parekh, Fatemeh Pashazadeh Kan, Shrikant Pawar, Veincent Christian Filipino Pepito, Emmanuel K. Peprah, Marina Pinheiro, Khem Narayan Pokhrel, Roman V. Polibin, Richard Charles G. Pollok, Maarten J. Postma, Zahiruddin Quazi Syed, Amir Radfar, Raghu Anekal Radhakrishnan, Fakher Rahim, Vafa Rahimi-Movaghar, Shadi Rahimzadeh, Mosiur Rahman, Amir Masoud Rahmani, Pradhum Ram, Chhabi Lal Ranabhat, Priyanga Ranasinghe, Chythra R. Rao, Sowmya J. Rao, Priya Rathi, David Laith Rawaf, Salman Rawaf, Lemma Demissie Regassa, Inayat ur Rehman, Andre M.N. Renzaho, Nima Rezaei, Omid Rezahosseini, Mohammad Sadegh Rezai, Aziz Rezapour, Rezaul Karim Ripon, Voilet Rodrigues, Denis O. Roshchin, Godfrey M. Rwegerera, Umar Saeed, Sahar Saeedi Moghaddam, Rajesh Sagar, K. M. Saif-Ur-Rahman, Marwa Rashad Salem, Mehrnoosh Samaei, Abdallah M. Samy, Milena M. Santric-Milicevic, Satish Saroshe, Brijesh Sathian, Maheswar Satpathy, Monika Sawhney, Aletta Elisabeth Schutte, Allen Seylani, Masood Ali Shaikh, Mohammed Feyisso Shaka, Hina Shamshad, Morteza Shamsizadeh, Mohammed Shannawaz, Adithi Shetty, Jae Il Shin, K. M. Shivakumar, Jasvinder A. Singh, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Ranjani Somayaji, Sergey Soshnikov, Emma Elizabeth Spurlock, Dan J. Stein, Mu'awiyyah Babale Sufiyan, Hooman Tadbiri, Birkneh Tilahun Tadesse, Eyayou Girma Tadesse, Animut Tagele Tamiru, Elvis Enowbeyang Tarkang, Nuno Taveira, Yohannes Tekalegn, Fisaha Haile Tesfay, Gizachew Assefa Tessema, Rekha Thapar, Marcos Roberto Tovani-Palone, Eugenio Traini, Bach Xuan Tran, Alexander C. Tsai, Biruk Shalmeno Tusa, Saif Ullah, Chukwuma David Umeokonkwo, Bhaskaran Unnikrishnan, Sahel Valadan Tahbaz, Jorge Hugo Villafañe, Sergey Konstantinovitch Vladimirov, Bay Vo, Avina Vongpradith, Giang Thu Vu, Yasir Waheed, Richard G. Wamai, Guan Wang, Yanzhong Wang, Paul Ward, Ronny Westerman, Andrea Sylvia Winkler, Lalit Yadav, Seyed Hossein Yahyazadeh Jabbari, Taklo Simeneh Yazie, Siyan Yi, Vahit Yiğit, Birhanu Wubale Yirdaw, Naohiro Yonemoto, Chuanhua Yu, Ismaeel Yunusa, Mikhail Sergeevich Zastrozhin, Anasthasia Zastrozhina, Zhi Jiang Zhang, Alimuddin Zumla, Joshua A. Salomon, Jeffrey W. Eaton, Mohsen Naghavi, Laura Dwyer-Lindgren, Haidong Wang, Stephen S. Lim, Simon I. Hay, Christopher J.L. Murray, Hmwe H. Kyu

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Abstract

Background: 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. Methods: 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). Findings: 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. Interpretation: 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. Funding: 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.

Original languageEnglish
Pages (from-to)e633-e651
JournalThe Lancet HIV
Volume8
Issue number10
DOIs
Publication statusPublished - Oct 2021
Externally publishedYes

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