Routine surveillance of HIV (human immunodeficiency virus) infection and AIDS has been established over the past decade in many countries around the world. HIV estimates derived from empirical data are essential to the assessment of the HIV situation in different parts of the world and trends are used in tracking the development of regional epidemics, thereby keeping intervention activities focused on realities. As of the end of 1995, and following an extensive country-by-country review of HIV/AIDS data, a cumulative total of 6 million AIDS cases were estimated to have occurred in adults and children worldwide and currently 20.1 million adults are estimated to be alive and infected with HIV or have AIDS. Of the total prevalent HIV infections, the majority remain concentrated in eastern, central and southern Africa, but the epidemic is evolving with spread of infection from urban to rural areas, as well as to West and South Africa, India and South-east Asia, and to a lesser extent--with proportional shifts to heterosexual infections--in North America, western Europe and Latin America. While the longer-term dimensions of the HIV epidemic at global level cannot be forecast with confidence, WHO currently projects a cumulative total of close to 40 million HIV infections in men, women and children by the year 2000. By that time, the male:female ratio of new infections will be close to 1:1. Recent trends indicate that HIV prevalence levels may be stabilizing or even decreasing among pregnant women in southern Zaire and parts of Uganda, among military recruits aged 21 in Thailand, and in some populations of northern Europe and the USA. While these changes may take place as part of the intrinsic dynamic of the epidemic, there is some evidence that declines in HIV prevalence are related to declines in HIV incidence which are, at least partly, due to prevention efforts. The challenge of surveillance and evaluation methods is now to identify the ingredients of success which may reveal a glimmer of hope.
PIP: By December 15, 1995, 1,291,810 AIDS cases have been reported to the World Health Organization (WHO). WHO estimates that as of the end of 1995, with underdiagnosis, underreporting, and delays in reporting and based on the estimated number of HIV infections worldwide, there have been 6 million AIDS cases since the beginning of the HIV/AIDS epidemic. By the year 2000, WHO expects a cumulative total of about 40 million HIV infections and the male/female ratio to be about 1:1. Most HIV infections are still in eastern, central, and southern Africa. The epidemic is still evolving with the spread of HIV infection from urban to rural areas, to western and southern Africa, to India and southeast Asia, and to a lesser extent with proportional shifts to heterosexual infections in North America, Western Europe, and Latin America. AIDS is becoming a leading cause of death among adults aged 25-44 in many areas of both developed and developing countries. HIV prevalence has started to stabilize. It has already declined in homosexual populations in the US and Europe. In the US, the downward trend of HIV prevalence with time among homosexuals is associated with reductions in other sexually transmitted diseases, behavior change, and public health interventions. HIV prevalence appears to be stable or falling among pregnant women in southern Zaire since 1989, in some areas of Uganda, and among military recruits aged 21 in Thailand. The growth stage of the HIV/AIDS epidemic may be more rapid and time-limited than earlier. Some evidence suggests that reductions in HIV prevalence are associated with reductions in HIV incidence that are at least somewhat due to HIV/AIDS preventions activities. Epidemiologists and evaluation specialists now must identify the components of success and provide a sense of hope.