Guest post by Katrina F Ortblad, a global burden of disease specialist from the University of Washington’s Institute for Health Metrics and Evaluation.
The massive scale-up of antiretroviral drugs (ARTs) and prevention programs over the past decade has resulted in incredible progress in disease reduction around the world, yet HIV/AIDS still kills around 1.5 million people every year. These findings were recently reported in a new study by the Institute for Health Metrics and Evaluation (IHME).
The rate of HIV/AIDS remains high in many countries, especially in sub-Saharan Africa. The screen grab below shows rates of premature death and disability, also known as healthy years lost, due to HIV/AIDS across the world in 2010.
These rates adjust for differences in population growth and ages across countries and can offer insight into how well each country is performing in the fight against this disease. Globally, Swaziland, Lesotho, South Africa, Zimbabwe, and Mozambique had some of the highest rates of healthy years lost from HIV/AIDS.
Why do Rwanda and Botswana have lower rates of HIV/AIDS than South Africa and Zimbabwe, and are there ways that lower-performing countries could learn from higher performing countries?
While comparisons of rates are useful for highlighting strengths and challenges across countries, they only tell one part of the story. The screen grab below shows number of years of healthy life lost due to HIV/AIDS by country, stripping away all adjustments for population size and aging shown in the previous map. It’s helpful for understanding which countries account for the largest share of overall disease burden from HIV/AIDS. From this perspective, countries in Eastern and Southern sub-Saharan African countries were still large contributors to the overall burden of disease from HIV/AIDS.
Countries in these regions alone accounted for nearly half of all healthy years lost from HIV/AIDS. From this perspective, it is clear that HIV/AIDS in India and Nigeria has also played a major role in driving up the global toll of healthy years lost from this disease, in part due to these countries’ large populations.
While disease burden from HIV/AIDs in countries such as South Africa, Nigeria, India, Tanzania, and Mozambique account for a substantial percentage of the healthy years lost at the global level, the ranking of HIV/AIDS relative to other causes of disease burden in India differs greatly from these other countries. The figure below, taken from IHME’s online visualization tool, shows how HIV/AIDS is likely a major health policy priority in many sub-Saharan African countries as it is the first- and second-ranking cause of disease burden in those countries, but is only the 15th-leading cause of burden in India behind causes such as preterm birth complications, diarrheal diseases, lower respiratory infections, and chronic obstructive pulmonary disease (COPD).
Largely as a result of scale ups in treatment, many countries with high levels of HIV/AIDS have reduced mortality rates from the disease over time. For example, Rwanda decreased its HIV/AIDS death rate by 83% since its peak in 1996, and Zambia lowered its death rate by 61% since 2000 as shown in the screen grab below. The figure accounts for changes in population size and aging over time. Other sub-Saharan African countries with large HIV/AIDS epidemics including Botswana, Namibia, Kenya, and Uganda decreased their mortality rates by over 50% since the peak of their epidemics. In other sub-Saharan African countries like Democratic Republic of the Congo, Angola and the Central African Republic, however, progress has been nearly nonexistent. India succeeded in reducing rates of HIV/AIDs by a modest 9% since 2007.
While declining rates of HIV/AIDS in countries with historically high levels are encouraging, many challenges remain. Expanded access and adherence to treatment in these countries is necessary to further reduce mortality from the disease. Also, ninety eight countries have experienced increases in their HIV/AIDS mortality rates, such as China, Afghanistan, Bangladesh, and Egypt. While these countries do not account for large shares of the global HIV/AIDS burden compared to sub-Saharan African countries, it is disturbing that mortality is increasing in these countries despite advances in medical treatment for the condition.
The combined burden of disease from all of these countries where mortality rates are increasing is starting to add up. Countries with low levels of HIV/AIDS are accounting for an increasing share of total healthy years lost from HIV/AIDS. In 2005, 80.3% of the global burden of HIV/AIDS occurred in countries where the disease was among the top five leading causes of healthy years lost, but just 15.5% of the total HIV/AIDS burden was in countries where the disease was not among the top 10 causes of disease burden. By 2010, these fractions changed to 75.2% and 20.0%, respectively.