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Visualizing progress against HIV, TB and malaria

A newly-diagnosed HIV positive woman, who arrived at the hospital with symptoms of tuberculosis (TB), lies in the treatment ward of the Mildmay Uganda clinic, which receives funding from the US government through the Centers for Disease Control and Prevention (CDC), in Kampala, Uganda. --AP

First, the good news: Death rates for people with HIV/AIDS, tuberculosis, and malaria all have decreased globally since the Millennium Development Goals (MDG) were established in 2000, according to a report published Monday as part of the Global Burden of Disease (GBD).

Also, in regions such as Latin America and Eastern Europe, researchers found that the HIV epidemic was smaller than previously thought. The study found that interventions such as antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV saved 19.1 million years of life. That represents all the years that all the people who might have contracted and died from HIV/AIDS were able to live instead. The vast majority of these years of life were in developing countries.

The bad news? HIV infections in 101 countries continue to rise — more than half of the countries in the study — and not all ART programs are saving as many lives as they could. Researchers found that the quality of treatment varied widely across programs.

The following screen grab, taken from the Institute for Health Metrics and Evaluation’s new MDG data visualization tool, illustrates the global progress made in fighting HIV/AIDS, TB, and malaria.

Rates of death from HIV/AIDS, malaria, and tuberculosis worldwide, 1990-2013

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Be sure to check out the online version of the tool designed by IHME data scientist Michael Freeman. With measurements for child causes of death, maternal causes of death, HIV, TB, and malaria for 188 countries over two decades, there are a lot of numbers. But a tutorial embedded in the tool walks you through the different dimensions of the data visualization step by step.

The study’s authors made revisions to the scale of the HIV/AIDS epidemic in Latin America and Eastern and Central Europe. For the year 2010, the new study estimates that deaths in Colombia, Peru, and Venezuela were two-thirds lower than reported in the last GBD study. The image below shows the updated estimates of deaths from HIV/AIDS in these countries according to the newest analysis.

HIV/AIDS deaths in Venezuela, Peru, and Colombia, 1990-2013

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In Eastern and Central Europe, researchers estimated that the number of people living with HIV was more than 60% smaller than previously thought.

Why are the numbers from the new study so different from the older study?

The old study relied more heavily on estimates from UNAIDS (read the paper for a detailed explanation). In many countries, such as Latin America and Eastern and Central Europe, UNAIDS relies upon surveys of prevalence of HIV/AIDS in high-risk groups as well as local opinion about the percentage of people in these groups.

There is a wealth of reliable data sources on prevalence of the disease within high-risk groups, but the precise percentage of people in these groups is extremely difficult to assess. As a result, the GBD researchers opted instead to rely more on vital registration (death certificate) data in these countries, which researchers believe provide a more accurate picture of the scale of the HIV/AIDS epidemic in the population as a whole.

It’s important to point out that vital registration data have their own limitations. For example, social stigma surrounding HIV/AIDS contributes to underreporting of deaths from the disease.

In red, the image below shows the number of HIV/AIDS deaths recorded in Russia by age group. Green and blue indicate the number of HIV/AIDS deaths that researchers deemed to be incorrectly reported as other causes. Those other causes include tuberculosis, meningitis, and encephalitis, or causes that are not true causes of death. So researchers have to correct for misclassified deaths by reclassifying them as HIV/AIDS.

HIV deaths in Russia by age group, both sexes, 2005

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Source: The Lancet

Regardless of the methods being used to track the HIV/AIDS epidemic, the trend lines in study after study are the same: deaths are falling markedly.

In all, nearly 20 million years of life were saved by programs to prevent and treat HIV/. From 1990 through 2013, South Africa and Brazil were the developing countries with the largest number of life years saved through these interventions. This screen grab shows the pace of decline in death rates from HIV/AIDS in South Africa, which have begun to decline after rising dramatically over the past decade.

Rates of death from HIV/AIDS in South Africa, 1990-2013

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The study reveals just how much work remains in the fight against HIV/AIDS. Even though so many life years have been saved through AIDS interventions, researchers found this number would be even greater if all ART programs were as successful as the top-performing programs. Instead of a world where more than 1 million people still die of HIV/AIDS annually, — an unacceptably high number in an era when effective treatments are available – we could live in a world where HIV/AIDS deaths are much lower and new infections increasingly rare.

Katie Leach-Kemon, a weekly contributor of global health visual information posts for Humanosphere, is a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.


About Author

Katie Leach-Kemon

Katherine (Katie) Leach-Kemon is a policy translation specialist at the Institute for Health Metrics and Evaluation (IHME). Katie specializes in two of IHME's research areas, the Global Burden of Disease and health financing. Katie has helped produce IHME's Financing Global Health report since it was first published in 2009. She received an MPH from the University of Washington and served as a Peace Corps volunteer in Niger. Her work has been published in The Lancet, Health Affairs, and the Journal of the American Medical Association. You can follow her on Twitter @kleachkemon.