Global, regional, and national sex-specific burden and control of the HIV epidemic, 19902019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Abstract

Abstract Background: The sustainable development goals (SDGs) aim to end HIVAIDS 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 003), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold 10).

Findings: In 2019, there were 368 million (95 uncertainty interval [UI] 351-389) people living with HIV worldwide. There were 084 males (95 UI 078-091) per female living with HIV in 2019, 099 male infections (091-110) for every female infection, and 102 male deaths (095-110) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 2852 decrease in incident cases, 95 UI 1958-3543, and a 3966 decrease in deaths, 3649-4236). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 005 (95 UI 005-006) and the global incidence-to-mortality ratio was 194 (176-212). 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.