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The life-cycle approach to HIV

This publication by UNAIDS in 2016 explores the life-cycle approach to HIV, offering solutions for every individual at each stage of life. It delves into global statistics, funding sources, investments, and targets to avert new infections and deaths. The focus is on finding comprehensive strategies for children (aged 0-14) and pregnant women living with HIV. The report highlights progress in various regions and emphasizes the importance of fast-tracking interventions to achieve the goal of ending the AIDS epidemic by 2030.

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The life-cycle approach to HIV

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  1. Get on the Fast-Track The life-cycle approach to HIV Finding solutions for everyone at every stage of life UNAIDS | 2016

  2. Introduction

  3. Proportion of new HIV infections by sex, global and eastern and southern Africa, 2015 Percentage (%) Age (years) global Age (years) eastern and southern Africa Men Women Source: UNAIDS 2016 estimates.

  4. Investments in the AIDS responses of low- and middle-income countries, by source of funding, 2000–2015 US$ (billion) Domestic (public and private) Other bilateral governments Other multilaterals and foundations United States (bilateral) Global Fund to Fight AIDS, Tuberculosis and Malaria Source: UNAIDS estimates, June 2016 - UNAIDS-Kaiser Family Foundation. Financing the response to AIDS in low- and middle-income countries till 2015 - OECD CRS last accessed June 2016.

  5. Additional HIV infections averted through a Fast-Track response, compared to 2015 levels of coverage, 2016–2030 Number (millions) Eastern and southern Africa Asia and the Pacific Latin America and the Caribbean Western and central Africa Eastern Europe and central Asia North Africa and the Middle East) Source: Lamontagne E, Over M, Stover J et al. The economic returns of ending the AIDS epidemic by 2030. 2016, in press.

  6. Additional AIDS-related deaths averted through a Fast-Track response, compared to 2015 levels of coverage, 2016–2030 Number (millions) Eastern and southern Africa Asia and the Pacific Latin America and the Caribbean Western and central Africa Eastern Europe and central Asia North Africa and the Middle East) Source: Lamontagne E, Over M, Stover J et al. The economic returns of ending the AIDS epidemic by 2030. 2016, in press.

  7. Finding solutions for everyone at every stage of life Children (0–14)

  8. New HIV infections among children (aged 0–14 years) and percentage of pregnant women living with HIV receiving antiretroviral medicines (either prophylaxis or lifelong therapy) to prevent mother-to-child transmission, global, 2005–2015 Percentage (%) of pregnant women living with HIV accessing PMTCT services Number of new HIV infections among children (aged 0–14 years) New HIV infections PMTCT coverage Global targets of new HIV infections Global PMTCT target Source: UNAIDS 2016 estimates. Note: In 2010, single-dose nevirapine was no longer included in ARV coverage as an effective regimen for the prevention of mother-to-child transmission.

  9. Children (aged 0–14 years) living with HIV on antiretroviral therapy and number of AIDS-related deaths among children, global, 2005–July 2016 Number of AIDS-related deaths among children (aged 0–14 years) Number of children living with HIV (aged 0–14 years) on antiretroviral therapy Children living with HIV on antiretroviral treatment AIDS-related deaths among children Global child antiretroviral treatment target Source: 2016 Global AIDS Response Progress Reporting; UNAIDS 2016 estimates.

  10. Distribution of new HIV infections among children (aged 0–14 years), global, 2015 Remaining countries Nigeria India Zambia Malawi Kenya Zimbabwe Mozambique Indonesia United Republic of Tanzania South Africa Source: UNAIDS 2016 estimates.

  11. Progress toward the elimination of HIV infections among children (aged 0–14 years), by country, 2015 Decline in new HIV infections among children (aged 0-14 years), low- and middle-income countries, 2010-2015 Percentage of pregnant women living with HIV receiving antiretroviral medicines (either prophylaxis or lifelong therapy) to prevent mother-to-child transmission, low- and middle-income countries, 2015 Asia and the Pacific Afghanistan Australia Bangladesh India Indonesia Malaysia Mongolia Myanmar Nepal Pakistan Papua New Guinea Philippines Sri Lanka Thailand Viet Nam Eastern Europe and Central Asia Azerbaijan Belarus Georgia Kazakhstan Kyrgyzstan Republic of Moldova Tajikistan Ukraine Uzbekistan L Measures not available ≤ 32% 33–65% 66–94% ≥95% Legend Measures not available ≤ 19% 20–49% 50–79% ≥80% For countries not shown, both measures are not available or under review.

  12. Progress toward the elimination of HIV infections among children (aged 0–14 years), by country, 2015 Decline in new HIV infections among children (aged 0-14 years), low- and middle-income countries, 2010-2015 Percentage of pregnant women living with HIV receiving antiretroviral medicines (either prophylaxis or lifelong therapy) to prevent mother-to-child transmission, low- and middle-income countries, 2015 Latin America and the Caribbean Argentina Bahamas Belize Bolivia (Plurinational State of) Brazil Colombia Costa Rica Cuba Dominican Republic Ecuador El Salvador Guatemala Guyana Haiti Honduras Jamaica Mexico Nicaragua Panama Paraguay Peru Suriname Trinidad and Tobago Uruguay Venezuela (Bolivarian Republic of) L Measures not available ≤ 32% 33–65% 66–94% ≥95% Legend Measures not available ≤ 19% 20–49% 50–79% ≥80% For countries not shown, both measures are not available or under review.

  13. Progress toward the elimination of HIV infections among children (aged 0–14 years), by country, 2015 Decline in new HIV infections among children (aged 0-14 years), low- and middle-income countries, 2010-2015 Percentage of pregnant women living with HIV receiving antiretroviral medicines (either prophylaxis or lifelong therapy) to prevent mother-to-child transmission, low- and middle-income countries, 2015 Eastern and southern Africa Angola Botswana Eritrea Kenya Lesotho Madagascar Malawi Mozambique Namibia Rwanda South Africa South Sudan Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe Middle East and North Africa Algeria Djibouti Egypt Iran (Islamic Republic of) Morocco Somalia Sudan Yemen L Measures not available ≤ 32% 33–65% 66–94% ≥95% Legend Measures not available ≤ 19% 20–49% 50–79% ≥80% For countries not shown, both measures are not available or under review.

  14. Progress toward the elimination of HIV infections among children (aged 0–14 years), by country, 2015 Decline in new HIV infections among children (aged 0-14 years), low- and middle-income countries, 2010-2015 Percentage of pregnant women living with HIV receiving antiretroviral medicines (either prophylaxis or lifelong therapy) to prevent mother-to-child transmission, low- and middle-income countries, 2015 Western and central Africa Benin Burkina Faso Burundi Cameroon Cabo Verde Central African Republic Chad Côte d’Ivoire Democratic Republic of the Congo Equatorial Guinea Gabon Gambia Ghana Guinea Liberia Mali Mauritania Niger Senegal Sierra Leone Togo Western &Central Europe &North America Greece Italy Latvia Spain L Measures not available ≤ 32% 33–65% 66–94% ≥95% Legend Measures not available ≤ 19% 20–49% 50–79% ≥80% For countries not shown, both measures are not available or under review.

  15. Six-week and final mother-to-child transmission rates, by country, 2015 Angola Chad Ghana Côte d’Ivoire Democratic Republic of the Congo Cameroon Lesotho Malawi Kenya United Republic of Tanzania Zimbabwe Burundi Mozambique Zambia Namibia Swaziland Uganda Botswana South Africa Mother-to-child transmission rate (%) Six-week transmission rate Final transmission rate Source: UNAIDS 2016 estimates.

  16. AIDS-related deaths among children by age group, global, 2000–2015 Number 0–4 years 5–9 years 10–14 years Source: UNAIDS 2016 estimates.

  17. Percentage of infants born to women living with HIV receiving a virological test within the first two months of life, by country, 2015 Percentage (%) Source: 2016 Global AIDS Response Progress Reporting.

  18. Four prongs to eliminate mother-to-child transmission of HIV and improve maternal health Women of reproductive age Prong 1 Primary prevention of HIV among women of childbearing age Women living with HIV Prong 4 Provision of appropriate treatment, care and support to women, children living with HIV and their families Prong 2 Prevention of unintended pregnancies among women living with HIV Pregnant women living with HIV Prong 3 Prevention of HIV from a woman living with HIV to her infant Children living with HIV

  19. Finding solutions for everyone at every stage of life Young people (15–24)

  20. New HIV infections among young women (aged 15–24 years), global, 2005–2015 Number New HIV infections Global target Source: UNAIDS 2016 estimates.

  21. Percentage of young women (aged 15–24 years) reporting use of a condom at last sexual intercourse with a non-regular partner in the 12 months prior to the survey, eight countries in sub-Saharan Africa, 2012–2015 Percentage (%) Lesotho Namibia Kenya Rwanda South Africa* Nigeria Zambia Comoros Source: Population-based surveys, 2012–2015. * Data for South Africa refers to condom use at last sex among young women aged 15-24 who reported being sexually active.

  22. Demand for family planning satisfied by modern methods among young women (aged 15–24 years), by country, 2010–2015 Percentage (%) Source: Demographic and Health Surveys, 2010-2015.

  23. Percentage of people living with HIV (aged 15–59 years) who have ever been tested for HIV and received the results, by age group, 19 low- and middle-income countries, 2011–2015 Percentage (%) 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 Age (years) Source: Demographic and Health Surveys, 2011–2015.

  24. Distribution of new HIV infections among men and women by five-year age groups, nine locations in eastern and southern Africa, 2010–2014 Percentage (%) Age (years) eastern African countries Age (years) southern African countries Men Women Source: Network for Analysis of Longitudinal Population-based HIV/AIDS Data on Africa (ALPHA), 2016.

  25. Cycle of HIV transmission, results from a phylogenetic study, KwaZulu-Natal, South Africa, 2016 Among men linked to young women (<25), 39% were simultaneously linked to a 25-40-year-old woman Most HIV transmission is likely from higher prevalence (men 25-40 years old) to lower prevalence )women under 25 years old) Most HIV transmission is likely from higher prevalence (women 25-40 years old) to lower prevalence (men 25-40 years old) As women age, the cycle repeats Source: Centre for the AIDS Programme of Research in South Africa, 2016.

  26. Number of young people living with HIV (aged 15–19 years) by mode of HIV acquisition, 25 countries,* 1970–2015 Number Sexual and unsafe injection transmission Mother-to-child transmission ** The 25 countries included in the analysis are Botswana, Brazil, Cameroon, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Haiti, India, Indonesia, Iran (Islamic Republic of), Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Swaziland, Thailand, Uganda, Ukraine, United Republic of Tanzania, Zambia and Zimbabwe. Source: UNAIDS special analysis, 2016; for more details, see annex on methodology.

  27. Detailed strategy mix for HIV prevention among young women–a menu of options Support choices of women who have agency Reduce susceptibility and transmissibility Enhance agency among adolescent girls and young women

  28. Programmes for adolescent girls and young women (aged 15–24 years) in Swaziland, 2016 DREAMS* The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) DREAMS and the Global Fund PEPFAR Country Operational Plan PEPFAR Country Operational Plan and the Global Fund *DREAMS is supported by the United States President’s Emergency Plan for AIDS Relief (PEPFAR), the Bill & Melinda Gates Foundation, Girl Effect, Johnson & Johnson, Gilead Sciences, and ViiV Healthcare. Source: Swaziland Central Statistics Office 2016; PEPFAR Swaziland 2016. 1 Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe Women. The partnership is supported by the United States President’s Emergency Plan for AIDS Relief (PEPFAR), the Bill & Melinda Gates Foundation, Girl Effect, Johnson & Johnson, Gilead Sciences and ViiV Healthcare. 2 Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Uganda, United Republic of Tanzania, Zambia and Zimbabwe. Together, these countries accounted for an estimated 55% of new HIV infections among adolescent girls and young women in 2015.

  29. Past-week adolescent antiretroviral therapy non-adherence, by access to various social protection measures, South Africa, 2016 Percentage (%) Food security, support group and monitoring No social protection Support group Food security Monitoring Food security and support group Support group and monitoring Food security and monitoring Source: L. D. Cluver, E. Toska, F. M. Orkin, F. Meinck, R. Hodes, A. R. Yakubovich & L. Sherr (2016) Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa?, AIDS Care, 28:sup2, 73-82, DOI: 10.1080/09540121.2016.1179008.

  30. Finding solutions for everyone at every stage of life Key populations throughout the life cycle

  31. Trends in new HIV infections among key populations, global, 2011–2015 Number Sex workers People who inject drugs Transgender people* Gay man and other men who have sex with men * Data on transgender people are from the Asia-Pacific and Latin America and Caribbean regions only. Source: UNAIDS special analysis, 2016.

  32. Country status Criminalization of any aspect of sex work, by country, 2016 Selling and buying sexual services criminalized Selling sexual services criminalized Buying sexual services criminalized Partial criminalization Other punitive regulation Not subject to punitive regulation /not criminalized Issue determined /differs at subnational level Data not available Source: Sexual Rights Initiative. 2016. National sexual rights law and policy database. (http://sexualrightsdatabase.org/page/welcome, accessed 13 November, 2016)”

  33. Country status Criminalization of same-sex sexual relations, by country Death penalty Imprisonment 15 years to life Imprisonment up to 14 years Relationship between males is illegal, no penalty specified Promotion ("propaganda") laws limiting freedom of expression Laws penalizing same-sex sexual acts decriminalized, or never existed Data not available Source: International Lesbian, Gay, Bisexual, Trans and Intersex Association, State Sponsored Homophobia 2016: A world survey of sexual orientation laws: criminalisation, protection and recognition (Geneva; May 2016).

  34. Comprehensive approaches Detailed strategy mix for HIV prevention among transgender people 1/2 Reduce host susceptibility Decrease source of HIV Infection Increase safer sexual behaviours, uptake of services and adherence (CONTINUATION ON NEXT SLIDE)

  35. Comprehensive approaches Detailed strategy mix for HIV prevention among transgender people 2/2 Effective anti discrimination legislation and recognition under the law

  36. Comprehensive approaches Detailed strategy mix for HIV prevention among people who inject drugs 1/2 Availability of a services Risk perception and adoption of safer behaviours (CONTINUATION ON NEXT SLIDE)

  37. Comprehensive approaches Detailed strategy mix for HIV prevention among people who inject drugs 2/2 Enabling environment and empowerment for service uptake

  38. Comprehensive approaches Detailed strategy mix for HIV prevention among sex workers 1/2 Availability of a services Increased agency and adoption of safer behaviours Violence systematically reported by sex workers and increased follow-up (CONTINUATION ON NEXT SLIDE)

  39. Comprehensive approaches Detailed strategy mix for HIV prevention among sex workers 2/2 Improved risk environment

  40. Comprehensive approaches Detailed strategy mix for HIV prevention among gay men and other men who have sex with men 1/2 Reduce transmissibility Increase access Increase safer sexual behaviours, uptake of services and adherence (CONTINUATION ON NEXT SLIDE)

  41. Comprehensive approaches Detailed strategy mix for HIV prevention among gay men and other men who have sex with men 2/2 Decriminalization of same sex behaviours and empowerment

  42. Rapid scale-up of HIV testing and counselling services for sex workers: the experience of the Red Umbrella Programme in South Africa, 2013–2016 Percentage (%) Actual Target Source: Networking HIV & AIDS Community of Southern Africa (NACOSA), 2016.

  43. Geospatial data visualization in the UNAIDS Key Populations Atlas

  44. Finding solutions for everyone at every stage of life Adulthood (25–49)

  45. New HIV infections among men and women (aged 25–49 years), global, 2005–2015 Women aged 25-49 years Men aged 25-49 years Source: UNAIDS 2016 estimates.

  46. People living with HIV on antiretroviral therapy, all ages, global, 2010–July 2016 Number (millions) People living with HIV on antiretroviral therapy (all ages) Global target Source: Global AIDS Response Progress Reporting, 2016; UNAIDS 2016 estimates.

  47. Country status Progress toward the 90–90–90 targets, all ages, by country, 2015 Viral suppression among people living with HIV (%) Knowledge of status among people living with HIV (%) Coverage of antiretroviral therapy among people living with HIV (%) Asia and the Pacific Afghanistan Australia Bangladesh Cambodia India Indonesia Malaysia Mongolia Myanmar Nepal Pakistan Papua New Guinea Philippines Sri Lanka Thailand Viet Nam Eastern Europe and Central Asia Armenia Azerbaijan Belarus Georgia Kazakhstan Kyrgyzstan Republic of Moldova Tajikistan Ukraine Uzbekistan L 81% or higher 41–80% 40% or lower Measures not available L 73% and higher 37–72% 36% or lower Measures not available Legend 90% and higher 45–89% 44% or lower Measures not available For countries not shown, both measures are not available or under review. Source: 2016 Global AIDS Response Progress Reporting; UNAIDS 2016 estimates.

  48. Country status Progress toward the 90–90–90 targets, all ages, by country, 2015 Viral suppression among people living with HIV (%) Knowledge of status among people living with HIV (%) Coverage of antiretroviral therapy among people living with HIV (%) Latin America and the Caribbean Argentina Bahamas Barbados Belize Bolivia (Plurinational State of) Brazil Chile Colombia Costa Rica Cuba Dominican Republic Ecuador El Salvador Guatemala Guyana Haiti Honduras Jamaica Mexico Nicaragua Panama Paraguay Peru Suriname Trinidad and Tobago Uruguay Venezuela (Bolivarian Republic of) L 81% or higher 41–80% 40% or lower Measures not available L 73% and higher 37–72% 36% or lower Measures not available Legend 90% and higher 45–89% 44% or lower Measures not available For countries not shown, both measures are not available or under review. Source: 2016 Global AIDS Response Progress Reporting; UNAIDS 2016 estimates.

  49. Country status Progress toward the 90–90–90 targets, all ages, by country, 2015 Viral suppression among people living with HIV (%) Knowledge of status among people living with HIV (%) Coverage of antiretroviral therapy among people living with HIV (%) Eastern and southern Africa Angola Botswana Eritrea Kenya Lesotho Madagascar Malawi Mauritius Mozambique Namibia Rwanda South Africa South Sudan Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe Middle East and North Africa Algeria Djibouti Egypt Iran (Islamic Republic of) Lebanon Morocco Somalia Sudan Tunisia Yemen L 81% or higher 41–80% 40% or lower Measures not available L 73% and higher 37–72% 36% or lower Measures not available Legend 90% and higher 45–89% 44% or lower Measures not available For countries not shown, both measures are not available or under review. Source: 2016 Global AIDS Response Progress Reporting; UNAIDS 2016 estimates.

  50. Country status Progress toward the 90–90–90 targets, all ages, by country, 2015 Viral suppression among people living with HIV (%) Knowledge of status among people living with HIV (%) Coverage of antiretroviral therapy among people living with HIV (%) Western and central Africa Benin Burkina Faso Burundi Cabo Verde Cameroon Central African Republic Chad Côte d’Ivoire Democratic Republic of the Congo Equatorial Guinea Gabon Gambia Ghana Guinea Liberia Mali Mauritania Niger Senegal Sierra Leone Togo Western &Central Europe &North America Greece Latvia Spain L 81% or higher 41–80% 40% or lower Measures not available L 73% and higher 37–72% 36% or lower Measures not available Legend 90% and higher 45–89% 44% or lower Measures not available For countries not shown, both measures are not available or under review. Source: 2016 Global AIDS Response Progress Reporting; UNAIDS 2016 estimates.

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