The life-cycle approach to HIV Finding solutions for everyone at every stage of life

1. The life-cycle
approach to HIV
Get on the
Fast-Track
Finding solutions for everyone
at every stage of life
UNAIDS | 2016

2. Introduction

3. Source: UNAIDS 2016 estimates.
Proportion of new HIV infections by sex, global
and eastern and southern Africa, 2015
Men
Age (years)
global
Percentage(%)
Women
Age (years)
eastern and southern Africa

4. Investments in the AIDS responses of low- and middle-
income countries, by source of funding, 2000–2015
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.
Global Fund to Fight AIDS, Tuberculosis and Malaria
US$(billion)
United States (bilateral)
Other bilateral governmentsDomestic (public and private) Other multilaterals and foundations

5. Source: Lamontagne E, Over M, Stover J et al. The economic returns of ending the AIDS epidemic by 2030. 2016, in press.
Additional HIV infections averted through a Fast-Track
response, compared to 2015 levels of coverage, 2016–2030
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)
Number(millions)

6. Additional AIDS-related deaths averted through a Fast-Track
response, compared to 2015 levels of coverage, 2016–2030
Source: Lamontagne E, Over M, Stover J et al. The economic returns of ending the AIDS epidemic by 2030. 2016, in press.
Number(millions)
Eastern and southern Africa
Western and central Africa
Asia and the Pacific Latin America and the Caribbean
Eastern Europe and central Asia North Africa and the Middle East)

7. Finding solutions for everyone
at every stage of life
Children (0–14)

8. 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
Source: UNAIDS 2016 estimates.
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.
New HIV
infections
PMTCT
coverage
Global targets
of new HIV infections
Global PMTCT
target
Number
of new
HIV
infections
among
children
(aged
0–14
years)
Percentage
(%) of
pregnant
women
living with
HIV
accessing
PMTCT
services

9. Source: 2016 Global AIDS Response Progress Reporting; UNAIDS 2016 estimates.
Children (aged 0–14 years) living with HIV on antiretroviral
therapy and number of AIDS-related deaths among children,
global, 2005–July 2016
Children living with HIV on antiretroviral treatment
Global child antiretroviral treatment target
AIDS-related deaths among children
Number of
AIDS-
related
deaths
among
children
(aged
0–14
years)
Number of
children
living with
HIV (aged
0–14 years)
on
antiretroviral
therapy

10. Source: UNAIDS 2016 estimates.
Distribution of new HIV infections among children
(aged 0–14 years), global, 2015
Nigeria
India
Kenya
Indonesia
Zimbabwe
South Africa
United Republic of Tanzania
Mozambique
Remaining
countries
Malawi
Zambia

11. Progress toward the elimination of HIV infections
among children (aged 0–14 years), by country, 2015
For countries
not shown, both
measures are
not available or
under review.
L
Measures not available
≤ 32%
33–65%
66–94%
≥95%
Decline in new HIV infections
among children (aged 0-14
years), low- and middle-income
countries, 2010-2015
Percentage of pregnant women
living with HIV receiving
antiretroviral medicines (either
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
Measures not available
≤ 19%
20–49%
50–79%
≥80%

12. Progress toward the elimination of HIV infections
among children (aged 0–14 years), by country, 2015
For countries
not shown, both
measures are
not available or
under review.
Decline in new HIV infections
among children (aged 0-14
years), low- and middle-income
countries, 2010-2015
Percentage of pregnant women
living with HIV receiving
antiretroviral medicines (either
prophylaxis or lifelong therapy)
to prevent mother-to-child
transmission, low- and middle-
income countries, 2015
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)
L
Measures not available
≤ 32%
33–65%
66–94%
≥95%
Legend
Measures not available
≤ 19%
20–49%
50–79%
≥80%

13. Progress toward the elimination of HIV infections
among children (aged 0–14 years), by country, 2015
For countries
not shown, both
measures are
not available or
under review.
Decline in new HIV infections
among children (aged 0-14
years), low- and middle-income
countries, 2010-2015
Percentage of pregnant women
living with HIV receiving
antiretroviral medicines (either
prophylaxis or lifelong therapy)
to prevent mother-to-child
transmission, low- and middle-
income countries, 2015
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
L
Measures not available
≤ 32%
33–65%
66–94%
≥95%
Legend
Measures not available
≤ 19%
20–49%
50–79%
≥80%

14. Progress toward the elimination of HIV infections
among children (aged 0–14 years), by country, 2015
For countries
not shown, both
measures are
not available or
under review.
Decline in new HIV infections
among children (aged 0-14
years), low- and middle-income
countries, 2010-2015
Percentage of pregnant women
living with HIV receiving
antiretroviral medicines (either
prophylaxis or lifelong therapy)
to prevent mother-to-child
transmission, low- and middle-
income countries, 2015
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
Legend
Measures not available
≤ 19%
20–49%
50–79%
≥80%
L
Measures not available
≤ 32%
33–65%
66–94%
≥95%
Spain

15. Six-week and final mother-to-child transmission rates,
by country, 2015
Source: UNAIDS 2016 estimates.
Six-week
transmission rate
Final
transmission rate
Mother-to-child transmission rate (%)
Angola
Chad
Ghana
Côte d’Ivoire
Cameroon
Lesotho
Malawi
United Republic of Tanzania
Zimbabwe
Burundi
Mozambique
Zambia
Namibia
Swaziland
Uganda
Botswana
South Africa
Democratic Republic of the Congo
Kenya

16. AIDS-related deaths among children by age group,
global, 2000–2015
Source: UNAIDS 2016 estimates.
Number
0–4
years
5–9
years
10–14
years

17. Percentage of infants born to women living with HIV receiving
a virological test within the first two months of life, by country, 2015
Source: 2016 Global AIDS Response Progress Reporting.
Percentage(%)

18. Four prongs to eliminate mother-to-child transmission
of HIV and improve maternal health
Prong 4
Provision of appropriate
treatment, care and
support to women,
children living with HIV
and their families
Women of
reproductive age
Women living with HIV
Pregnant women living
with HIV
Children living with HIV
Prong 1
Primary prevention of
HIV among women of
childbearing age
Prong 2
Prevention of
unintended
pregnancies among
women living with HIV
Prong 3
Prevention of HIV from a
woman living with HIV to
her infant

19. Finding solutions for everyone
at every stage of life
Young people
(15–24)

20. New HIV infections among young women
(aged 15–24 years), global, 2005–2015
Source: UNAIDS 2016 estimates.
New HIV infections Global target
Number

21. 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.
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
to the survey, eight countries in sub-Saharan Africa, 2012–2015Percentage(%)
Lesotho Namibia Kenya Rwanda South
Africa*
Nigeria Zambia Comoros

22. Demand for family planning satisfied by modern methods
among young women (aged 15–24 years), by country, 2010–2015
Source: Demographic and Health Surveys, 2010-2015.
Percentage(%)

23. 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
Source: Demographic and Health Surveys, 2011–2015.
Percentage(%)
15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59
Age (years)

24. Distribution of new HIV infections among men and women
by five-year age groups, nine locations in eastern
and southern Africa, 2010–2014
Source: Network for Analysis of Longitudinal Population-based HIV/AIDS Data on Africa (ALPHA), 2016.
Percentage(%)
Age (years)
eastern African countries
Age (years)
southern African countries
Men Women

25. Cycle of HIV transmission, results from a phylogenetic study,
KwaZulu-Natal, South Africa, 2016
Source: Centre for the AIDS Programme of Research in 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
from higher prevalence (men
25-40 years old) to lower
prevalence )women under 25
years old)
Most HIV transmission is
likely from higher prevalence
(women 25-40 years old) to
lower prevalence (men 25-40
years old)
As women age, the cycle repeats

26. ** 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.
Number of young people living with HIV (aged 15–19 years)
by mode of HIV acquisition, 25 countries,* 1970–2015
Mother-to-child transmissionSexual and unsafe
injection transmission
Number

27. 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

28. Programmes for adolescent girls and young women
(aged 15–24 years) in Swaziland, 2016
*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.
DREAMS*
DREAMS and
the Global Fund
PEPFAR Country
Operational Plan
PEPFAR Country Operational
Plan and the Global Fund
The Global Fund to Fight
AIDS, Tuberculosis and
Malaria (Global Fund)

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

30. Finding solutions for everyone
at every stage of life
Key
populations
throughout
the life cycle

31. Trends in new HIV infections among key populations,
global, 2011–2015
* Data on transgender people are from the Asia-Pacific and Latin America and Caribbean regions only.
Source: UNAIDS special analysis, 2016.
Number
Sex
workers
People who inject
drugs
Gay man and other men
who have sex with men
Transgender
people*

32. Country status
Criminalization of any aspect of sex work, by country, 2016
Source: Sexual Rights Initiative. 2016. National sexual rights law and policy database. (http://sexualrightsdatabase.org/page/welcome, accessed 13 November, 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

33. Country status
Criminalization of same-sex sexual relations, by country
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).
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

34. Comprehensive approaches
Detailed strategy mix for HIV prevention among transgender people
1/2
Reduce host
susceptibility
Decrease source of
HIV Infection
Increase safer
sexual behaviours,
uptake of services
and adherence
(CONTINUATION ON NEXT SLIDE)

35. Comprehensive approaches
Detailed strategy mix for HIV prevention among transgender people
2/2
Effective anti
discrimination
legislation and
recognition under
the law

36. Comprehensive approaches
Detailed strategy mix for HIV prevention among people
who inject drugs
(CONTINUATION ON NEXT SLIDE)
1/2
Availability of
a services
Risk perception
and adoption of
safer behaviours

37. Comprehensive approaches
Detailed strategy mix for HIV prevention among people
who inject drugs
2/2
Enabling
environment and
empowerment for
service uptake

38. Comprehensive approaches
Detailed strategy mix for HIV prevention among sex workers
1/2
(CONTINUATION ON NEXT SLIDE)
Availability of
a services
Increased agency
and adoption
of safer
behaviours
Violence
systematically
reported by
sex workers and
increased follow-up

39. Comprehensive approaches
Detailed strategy mix for HIV prevention among sex workers
2/2
Improved risk
environment

40. Comprehensive approaches
Detailed strategy mix for HIV prevention among gay men
and other men who have sex with men
1/2
(CONTINUATION ON NEXT SLIDE)
Reduce
transmissibility
Increase access
Increase safer
sexual behaviours,
uptake of services
and adherence

41. Comprehensive approaches
Detailed strategy mix for HIV prevention among gay men
and other men who have sex with men
2/2
Decriminalization
of same sex
behaviours and
empowerment

42. Rapid scale-up of HIV testing and counselling services
for sex workers: the experience of the Red Umbrella Programme
in South Africa, 2013–2016
Source: Networking HIV & AIDS Community of Southern Africa (NACOSA), 2016.
Percentage(%)
Actual
Target

43. Geospatial data visualization
in the UNAIDS Key Populations Atlas

44. Finding solutions for everyone
at every stage of life
Adulthood
(25–49)

45. New HIV infections among men and women
(aged 25–49 years), global, 2005–2015
Source: UNAIDS 2016 estimates.
Women aged 25-49 years
Men aged 25-49 years

46. People living with HIV on antiretroviral therapy,
all ages, global, 2010–July 2016
Source: Global AIDS Response Progress Reporting, 2016; UNAIDS 2016 estimates.
Number(millions)
People living with HIV on antiretroviral therapy (all ages)
Global target

47. Source: 2016 Global AIDS Response Progress Reporting; UNAIDS 2016 estimates.
Country status
Progress toward the 90–90–90 targets, all ages, by country, 2015
For countries
not shown, both
measures are
not available or
under review.
Knowledge of status
among people living
with HIV (%)
Coverage of
antiretroviral therapy
among people living
with HIV (%)
Viral suppression
among people living
with HIV (%)
Asia and the Pacific
Afghanistan
Australia
Bangladesh
Cambodia
India
Indonesia
Malaysia
Mongolia
Myanmar
Nepal
Pakistan
Papua New Guinea
Philippines
Sri Lanka
Thailand
Eastern Europe and Central Asia
Azerbaijan
Belarus
Georgia
Kazakhstan
Kyrgyzstan
Republic of Moldova
Tajikistan
Ukraine
Uzbekistan
Legend
90% and higher
45–89%
44% or lower
Measures not available
L
81% or higher
41–80%
40% or lower
Measures not available
L
73% and higher
37–72%
36% or lower
Measures not available
Viet Nam
Armenia

48. Source: 2016 Global AIDS Response Progress Reporting; UNAIDS 2016 estimates.
Country status
Progress toward the 90–90–90 targets, all ages, by country, 2015
For countries
not shown, both
measures are
not available or
under review.
Knowledge of status
among people living
with HIV (%)
Coverage of
antiretroviral therapy
among people living
with HIV (%)
Viral suppression
among people living
with HIV (%)
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
90% and higher
45–89%
44% or lower
Measures not available
L
81% or higher
41–80%
40% or lower
Measures not available
L
73% and higher
37–72%
36% or lower
Measures not available
Barbados
Chile

49. Source: 2016 Global AIDS Response Progress Reporting; UNAIDS 2016 estimates.
Country status
Progress toward the 90–90–90 targets, all ages, by country, 2015
For countries
not shown, both
measures are
not available or
under review.
Knowledge of status
among people living
with HIV (%)
Coverage of
antiretroviral therapy
among people living
with HIV (%)
Viral suppression
among people living
with HIV (%)
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)
Lebanon
Morocco
Somalia
Legend
90% and higher
45–89%
44% or lower
Measures not available
L
81% or higher
41–80%
40% or lower
Measures not available
L
73% and higher
37–72%
36% or lower
Measures not available
Mauritius
Tunisia
Yemen
Sudan

50. Source: 2016 Global AIDS Response Progress Reporting; UNAIDS 2016 estimates.
Country status
Progress toward the 90–90–90 targets, all ages, by country, 2015
For countries
not shown, both
measures are
not available or
under review.
Knowledge of status
among people living
with HIV (%)
Coverage of
antiretroviral therapy
among people living
with HIV (%)
Viral suppression
among people living
with HIV (%)
Western and central Africa
Benin
Burkina Faso
Burundi
Cabo Verde
Cameroon
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
Latvia
Spain
Legend
90% and higher
45–89%
44% or lower
Measures not available
L
81% or higher
41–80%
40% or lower
Measures not available
L
73% and higher
37–72%
36% or lower
Measures not available

51. 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
Source: Demographic and Health Surveys, 2011–2015.
*Includes Dominican Republic and Haiti.
Women living with HIV
(aged 15–49 years)
Men living with HIV
(aged 15–49 years)

52. Comparison of men and women 10 years after HIV infection,
before and after the availability of antiretroviral therapy,
three locations in southern Africa
Source: Network for Analysis of Longitudinal Population-based HIV/AIDS data on Africa (ALPHA), 2016.
Percentage(%)
Alive, started antiretroviral
therapy
Alive, never had antiretroviral
therapy
Died

53. 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

54. Finding solutions for everyone
at every stage of life
Ageing
(50+)

55. 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
Source: UNAIDS 2016 estimates.
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.
People living with HIV
(aged 50 years and over)
in high-income countries
People living with HIV (aged
50 years and over) in low-
and middle-income countries
People living with HIV
(aged 50 years and over)
in high-income countries
People living with HIV (aged
50 years and over) in low-
and middle-income countries
Number(million)

56. Critical risks, services and strategic information
for people living with HIV aged 50 and over

57. UNAIDS
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Programme on HIV/AIDS
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