Federal government websites often end in. The site is secure. Preview improvements coming to the PMC website in October Learn More or Try it out now. 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 countries and territories and measures progress in the control of the epidemic. To estimate age-specific and sex-specific trends in 48 of 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 of 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. Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. No regions met suggested thresholds for progress. The number of incident cases and deaths in males and females approached parity in , although there remained more females with HIV than males with HIV. Establishing this baseline before the indirect effects of the COVID pandemic have been fully realised is also crucial, because these effects might bear on the recalibration of future targets.
Measurable targets relating to incidence and deaths have been proposed to assess progress in HIV, but they have not been synthesised to provide a comprehensive assessment of HIV burden. However, improvements in these metrics might not necessarily reflect progress and data might be misreported; 7 underreporting presents a problem for any modelling effort that relies on treatment coverage to inform disease-burden estimates.
Together, these metrics can be used to provide a current epidemiological picture of HIV, but to our knowledge they have not been measured for all countries and territories. Although there are well documented declines in the generalised sub-Saharan African epidemic, case studies highlight acceleration of HIV incidence in key populations, including men who have sex with men, sex workers, and people who inject drugs.
