Care and support for people living with HIV/AIDS

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Annex 1.How reliable are estimates of HIV infection and AIDS deaths?ies in urban and rural communities have made it possible to validate the results ofsentinel surveillance in pregnant women. These studies offer important insights intothe differentials of HIV infection by age and sex. They also confirm that sentinel surveillancein pregnant women yields remarkably robust estimates for HIV prevalencein the general population of reproductive age, as shown in Figure 28.Figure 28. HIV prevalence rates among pregnant women and amongall adults aged 15-49%3530pregnant womenall adults2520151050Lusaka,Zambia1994-1996MposhiZambia1994-1996Mwanza,Tanzania1990-1991Rakai,Uganda1990Rakai,Uganda1991Rakai,Uganda1992Kisumu,Kenya1998Source: Sentinel surveillance data from antenatal clinics and population-based studies, selected Africancountries, 1990-1998In countries where the HIV epidemic is concentrated in a few groups with high-riskbehaviour – mostly drug injectors and men who have sex with men, as well as sexworkers and their clients – the methods for estimating HIV prevalence are different.This is the case in most countries in Asia, the Americas and Europe. Here, becausethere are very few HIV infections in the general population, and because many of theinfections are in groups largely or entirely made up of men, data from pregnantwomen are of very limited use. Rather, HIV estimates in such cases are based oninformation on HIV prevalence in each group of people with high-risk behaviour,together with estimates of the size of each of these populations. Since these behavioursare often socially unacceptable and sometimes illegal, information on both HIVprevalence levels and the size of the population affected can be much harder tocome by. Consequently, uncertainties around these estimates may well be greaterfor countries where the epidemic is concentrated in specific groups.117
Report on the global HIV/AIDS epidemic – June 2000In the industrialized world, where the availability of antiretroviral therapy provides apowerful incentive to get tested for HIV for anyone who thinks he or she may havebeen exposed to the virus, surveillance systems increasingly include data from HIVtesting and – where available – HIV reporting. In addition, robust AIDS case registrationsystems with reporting rates of up to 80% and higher allow for the use of statisticalback-calculation methods. However, such methods have become less usefulsince the introduction of antiretroviral therapies, because it is no longer easy todefine the relationship between initial HIV infection and the onset of AIDS in patientsin treatment.In regions where life-prolonging therapy is not widely available, simple back-calculationprocedures are used to generate estimates of new HIV infections and of HIVrelateddeaths. These procedures are based on the well-known natural course of HIVinfection which determines the relationship between HIV incidence, prevalence andmortality. Similarly, estimates for HIV infections through mother-to-child transmission(including breastfeeding) and HIV mortality in children can be calculated. Theseestimates are based on age-specific fertility rates in countries and on region-specificrates of mother-to-child transmission which are documented in numerous studies.The estimates published in this report (apart from those specifically referenced otherwise)are based on the information available in March 2000. They are provisional.WHO and UNAIDS, together with staff at national AIDS programmes and researchinstitutions, keep HIV/AIDS estimates under constant review with a view to updatingthem as improved knowledge about the epidemic becomes available and asadvances are made in the methods for deriving estimates.The purpose of publishing these estimates is to help governments, nongovernmentalorganizations and others who have a stake in bringing HIV/AIDS under control togauge the status of the epidemic in their country and to monitor the effectiveness ofefforts at prevention and care being made by all partners.118
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Care and support for people living with HIV/AIDS

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