Get On The Fast-Track: The Life-Cycle Approach To HIV

Get on the
Fast-Track
The life-cycle
approach to HIV
Finding solutions for everyone
at every stage of life
UNAIDS | 2016
Introduction
Proportion of new HIV infections by sex, global
and eastern and southern Africa, 2015
Percentage (%)
Age (years) Age (years)

Men Women
global eastern and southern Africa
Source: UNAIDS 2016 estimates.

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.
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.
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.
Children (0–14)
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
Number Percentage
of new (%) of
HIV pregnant
infections women
among living with
children HIV
(aged accessing
0–14 PMTCT
years) services
New HIV PMTCT Global targets Global PMTCT

infections coverage of new HIV infections target

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.
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- Number of
related children
deaths living with
among HIV (aged
children 0–14 years)
(aged on
0–14 antiretroviral
years) 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.
Distribution of new HIV infections among children
(aged 0–14 years), global, 2015
Remaining Nigeria
countries
India
Zambia
Malawi Kenya
Zimbabwe Mozambique
Indonesia United Republic of Tanzania

South Africa

Progress toward the elimination of HIV infections
among children (aged 0–14 years), by country, 2015
Decline in new HIV infections Percentage of pregnant women
among children (aged 0-14 years), living with HIV receiving
low- and middle-income countries, antiretroviral medicines (either
2010-2015 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
Legend L
Measures not available Measures not available
For countries not
shown, both ≤ 19% ≤ 32%
measures are not 20–49% 33–65%
available or 50–79% 66–94%
under review. ≥80% ≥95%
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)
Legend L
For countries not
shown, both ≤ 19% ≤ 32%
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
Legend L
For countries not
shown, both ≤ 19% ≤ 32%
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
Legend L
For countries not
shown, both ≤ 19% ≤ 32%
Six-week and final mother-to-child transmission rates,
by country, 2015
Angola
Chad
Ghana
Côte d’Ivoire
Cameroon
Lesotho
Malawi
Kenya
Zimbabwe
Burundi
Mozambique
Zambia
Namibia
Swaziland
Uganda
Botswana
South Africa
Mother-to-child transmission rate (%)
Six-week Final
transmission rate transmission rate

AIDS-related deaths among children by age group,
global, 2000–2015
Number
0–4 5–9 10–14

years years years

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.

Four prongs to eliminate mother-to-child transmission
of HIV and improve maternal health
Prong 1
Women of
Primary prevention of
reproductive age
HIV among women of
childbearing age
Prong 4 Women living with HIV

Provision of appropriate Prong 2
treatment, care and Prevention of
support to women, unintended
children living with HIV pregnancies among
Pregnant women living
and their families women living with HIV
with HIV
Prong 3
Prevention of HIV from a
Children living with HIV woman living with HIV to
her infant
Young people
(15–24)
New HIV infections among young women
Number (aged 15–24 years), global, 2005–2015
New HIV infections Global target

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
Percentage (%)
to the survey, eight countries in sub-Saharan Africa, 2012–2015
Lesotho Namibia Kenya Rwanda South Nigeria Zambia Comoros

Africa*
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.
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.

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.

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) Age (years)

eastern African countries southern African countries
Men Women
Source: Network for Analysis of Longitudinal Population-based HIV/AIDS Data on Africa (ALPHA), 2016.
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 Most HIV transmission is likely

from higher prevalence (men 25-40 from higher prevalence (women
years old) to lower prevalence ) 25-40 years old) to lower
women under 25 years old) prevalence (men 25-40 years old)
As women age, the cycle repeats
Source: Centre for the AIDS Programme of Research in South Africa, 2016.
Number of young people living with HIV (aged 15–19 years)
by mode of HIV acquisition, 25 countries,* 1970–2015
Number
Sexual and unsafe Mother-to-child transmission

injection 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.
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
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.
Past-week adolescent antiretroviral therapy non-adherence,
by access to various social protection measures,
South Africa, 2016
Percentage (%)
No social Support Food Monitoring Support Food security Food

protection group security Food security security,
and support group and and
monitoring monitoring support
group group 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.
Key
populations
throughout
the life cycle
Trends in new HIV infections among key populations,
global, 2011–2015
Number
Gay man and other men

Sex workers People who inject drugs Transgender people*
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.
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)”
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).
1/2
Comprehensive approaches
Detailed strategy mix for HIV prevention among transgender people
Reduce host
susceptibility
Decrease source of
HIV Infection
Increase safer sexual

behaviours, uptake of
services and
adherence
(CONTINUATION ON NEXT SLIDE)

2/2
Detailed strategy mix for HIV prevention among transgender people
Effective anti
discrimination
legislation and
recognition under
the law
1/2
Detailed strategy mix for HIV prevention among people
who inject drugs
Availability of
a services
Risk perception and

adoption of safer
behaviours

2/2
Detailed strategy mix for HIV prevention among people
who inject drugs
Enabling
environment and
empowerment for
service uptake
1/2
Detailed strategy mix for HIV prevention among sex workers
Availability of
a services
Increased agency
and adoption
of safer
behaviours
Violence
systematically
reported by
sex workers and
increased follow-up

2/2
Detailed strategy mix for HIV prevention among sex workers
Improved risk
environment
1/2
Detailed strategy mix for HIV prevention among gay men
and other men who have sex with men
Reduce
transmissibility
Increase access
Increase safer sexual

behaviours, uptake of
services and adherence

2/2
Detailed strategy mix for HIV prevention among gay men
and other men who have sex with men
Decriminalization of
same sex behaviours
and empowerment
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.
Geospatial data visualization
in the UNAIDS Key Populations Atlas
Adulthood
(25–49)
New HIV infections among men and women
(aged 25–49 years), global, 2005–2015
Women aged 25-49 years

Men aged 25-49 years

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

Algeria
Djibouti
Egypt
Iran (Islamic Republic of)
Lebanon
Morocco
Somalia
Sudan
Tunisia
Yemen
Legend L L
45–89% 41–80% 37–72%
44% or lower 40% or lower 36% or lower For countries not
Measures not available shown, both
measures are not
under review.
Country status
with HIV (%)
Western and central Africa
Benin
Burkina Faso
Burundi
Cabo Verde
Cameroon
Central African Republic
Chad
Côte d’Ivoire
Equatorial Guinea
Gabon
Gambia
Ghana
Guinea
Liberia
Mali
Mauritania
Niger
Senegal
Sierra Leone
Togo
Western & Central Europe & North America

Greece
Latvia
Spain
Legend L L
45–89% 41–80% 37–72%
shown, both
measures are not
under review.
Percentage of people living with HIV (aged 15–49 years)
who have ever been tested for HIV and received the results,
men and women, 21 countries, 2011–2015
Men living with HIV Women living with HIV

(aged 15–49 years) (aged 15–49 years)
Source: Demographic and Health Surveys, 2011–2015.

*Includes Dominican Republic and Haiti.
Comparison of men and women 10 years after HIV infection,
before and after the availability of antiretroviral therapy,
three locations in southern Africa
Percentage (%)
Alive, started antiretroviral Alive, never had antiretroviral Died

therapy therapy
Source: Network for Analysis of Longitudinal Population-based HIV/AIDS data on Africa (ALPHA), 2016.
A comprehensive approach
Detailed strategy mix for HIV prevention among adolescent boys
and adult men in high-prevalence settings—a menu of options
Sexual behaviors
Demand and uptake

of health services
Susceptibility and
transmissibility
Health-seeking and
gender-based
violence
Ageing
(50+)
Number of people living with HIV (aged 50 years and over),
high-income countries and low- and middle-income countries,
2000–2015 and projected to 2020
Number (million)
People living with HIV People living with HIV (aged

(aged 50 years and over) 50 years and over) in low-
in high-income countries and middle-income countries

Note: Projections 2016–2020 are based on an assumption that scale up of antiretroviral treatment will reach 81% coverage of all people living with HIV by 2020. Country income classifications are from 2015.
Critical risks, services and strategic information
for people living with HIV aged 50 and over
UNAIDS
Joint United Nations
Programme on HIV/AIDS
20 Avenue Appia
CH-1211 Geneva 27
Switzerland
+41 22 791 3666
unaids.org

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Age (years) Age (years)

Source: UNAIDS 2016 estimates.

New HIV PMTCT Global targets Global PMTCT

Source: UNAIDS 2016 estimates.

Indonesia United Republic of Tanzania

Source: UNAIDS 2016 estimates.

Eastern Europe and Central Asia

Middle East and North Africa

Western & Central Europe & North America

Mother-to-child transmission rate (%)

Source: UNAIDS 2016 estimates.

0–4 5–9 10–14

Source: UNAIDS 2016 estimates.

Source: 2016 Global AIDS Response Progress Reporting.

Prong 4 Women living with HIV

New HIV infections Global target

Source: UNAIDS 2016 estimates.

Lesotho Namibia Kenya Rwanda South Nigeria Zambia Comoros

Source: Population-based surveys, 2012–2015.

Source: Demographic and Health Surveys, 2010-2015.

15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59

Source: Demographic and Health Surveys, 2011–2015.

Age (years) Age (years)

Among men linked to young women (<25),

Most HIV transmission is likely Most HIV transmission is likely

As women age, the cycle repeats

Sexual and unsafe Mother-to-child transmission

Source: Swaziland Central Statistics Office 2016; PEPFAR Swaziland 2016.

No social Support Food Monitoring Support Food security Food

Gay man and other men

Selling and buying sexual services criminalized

Selling sexual services criminalized

Buying sexual services criminalized

Other punitive regulation

Data not available

Imprisonment 15 years to life

Increase safer sexual

(CONTINUATION ON NEXT SLIDE)

Risk perception and

(CONTINUATION ON NEXT SLIDE)

(CONTINUATION ON NEXT SLIDE)

Increase safer sexual

(CONTINUATION ON NEXT SLIDE)

Women aged 25-49 years

Source: UNAIDS 2016 estimates.

People living with HIV on antiretroviral therapy (all ages)

Eastern Europe and Central Asia

Middle East and North Africa

Western & Central Europe & North America

Men living with HIV Women living with HIV

Source: Demographic and Health Surveys, 2011–2015.

Alive, started antiretroviral Alive, never had antiretroviral Died

Demand and uptake

People living with HIV People living with HIV (aged

Source: UNAIDS 2016 estimates.

Joint United Nations

+41 22 791 3666

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