Global, regional, and national burdens of HIV/AIDS acquired through sexual transmission 1990–2019: an observational study
Xinsheng Wu A # , Xinyi Zhou B C # , Yuanyi Chen B C # , Yi-Fan Lin D # , Yuwei Li B C , Leiwen Fu B C , Qi Liu B C and Huachun Zou A E F *A
B
C
D
E
F
Handling Editor: Somesh Gupta
Abstract
Sexual transmission accounts for a substantial proportion of HIV infections. Although some countries are experiencing an upward trend in HIV infections, there has been a lack of studies assessing the global burden of HIV/AIDS acquired through sexual transmission. We assessed the global, regional, and national burdens of HIV/AIDS acquired through sexual transmission from 1990 to 2019.
Data on deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALY) of HIV/AIDS acquired through sexual transmission in 204 countries and territories from 1990 to 2019 were retrieved from the Global Burden of Disease Study (GBD) 2019. The burdens and trends were evaluated using the age-standardised rates (ASR) and estimated annual percentage change (EAPC).
Globally, HIV/AIDS acquired through sexual transmission accounted for ~695.8 thousand (95% uncertainty interval 628.0–811.3) deaths, 33.0 million (28.7–39.9) YLLs, 3.4 million (2.4–4.6) YLDs, and 36.4 million (32.2–43.1) DALYs in 2019. In 2019, Southern sub-Saharan Africa (11350.94), Eastern sub-Saharan Africa (3530.91), and Western sub-Saharan Africa (2037.74) had the highest ASR of DALYs of HIV/AIDS acquired through sexual transmission per 100,000. In most regions of the world, the burden of HIV/AIDS acquired through sexual transmission has been increasing from 1990 to 2019, mainly in Oceania (EAPC 17.20, 95% confidence interval 12.82–21.75), South Asia (9.00, 3.94–14.30), and Eastern Europe (7.09, 6.35–7.84).
HIV/AIDS acquired through sexual transmission results in a major burden globally, regionally, and nationally.
Keywords: disability-adjusted life years (DALY), Eastern Europe, global burden of disease, HIV/AIDS, Oceania, sexual transmission, South Asia, sub-Saharan Africa.
References
1 UNAIDS. Global HIV & AIDS statistics — Fact sheet. 2024. Available at https://www.unaids.org/en/resources/fact-sheet
2 GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396(10258): 1204-22.
| Crossref | Google Scholar |
3 UN Statistics Division. UN Department of Economic and Social Affairs Millennium development goals indicators. 2008. Available at https://unstats.un.org/UNSDWebsite/
4 GBD 2019 HIV Collaborators. Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990–2019, for 204 countries and territories: the Global Burden of Diseases Study 2019. Lancet HIV 2021; 8(10): e633-51.
| Crossref | Google Scholar |
5 National AIDS Trust. HIV in the UK statistics. 2022. Available at https://www.nat.org.uk/about-hiv/hiv-statistics
6 Zuma K, Simbayi L, Zungu N, Moyo S, Marinda E, Jooste S, et al. The HIV epidemic in South Africa: key findings from 2017 National Population-Based Survey. Int J Environ Res Public Health 2022; 19(13): 8125.
| Crossref | Google Scholar |
7 Centers for Disease Control and Prevention. New HIV diagnoses and people with diagnosed HIV in the US and dependent areas by area of residence, 2021. Available at https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics
8 He N. Research progress in the epidemiology of HIV/AIDS in China. China CDC Wkly 2021; 3(48): 1022-30.
| Crossref | Google Scholar |
9 Adedini SA, Mobolaji JW, Alabi M, Fatusi AO. Changes in contraceptive and sexual behaviours among unmarried young people in Nigeria: Evidence from nationally representative surveys. PLoS ONE 2021; 16(2): e0246309.
| Crossref | Google Scholar |
11 GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet 2020; 396(10258): 1223-49.
| Crossref | Google Scholar |
12 Collaboration ATC. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV 2017; 4(8): e349-56.
| Crossref | Google Scholar |
13 Samji H, Cescon A, Hogg RS, Modur SP, Althoff KN, Buchacz K, et al. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS ONE 2013; 8(12): e81355.
| Crossref | Google Scholar |
14 Collins SE, Grant PM, Shafer RW. Modifying antiretroviral therapy in virologically suppressed HIV-1-infected patients. Drugs 2016; 76(1): 75-98.
| Crossref | Google Scholar |
15 Sebaaly JC, Kelley D. HIV clinical updates: new single-tablet regimens. Ann Pharmacother 2019; 53(1): 82-94.
| Crossref | Google Scholar |
16 Fauci AS, Lane HC. Four decades of HIV/AIDS – much accomplished, much to do. N Engl J Med 2020; 383(1): 1-4.
| Crossref | Google Scholar |
17 Wu X, Wu G, Ma P, Wang R, Li L, Sun Y, et al. Immediate and long-term outcomes after treat-all among people living with HIV in China: an interrupted time series analysis. Infect Dis Poverty 2023; 12(1): 73.
| Crossref | Google Scholar |
18 Zaniewski E, Brazier E, Ostinelli CHD, Wood R, Osler M, Technau K-G, et al. Regression discontinuity analysis demonstrated varied effect of Treat-All on CD4 testing among Southern African countries. J Clin Epidemiol 2021; 140: 101-10.
| Crossref | Google Scholar |
19 UN Population Division. SDG Indicator 3.7.1 on contraceptive use; 2020. Available at https://www.un.org/development/desa/pd/data/sdg-indicator-371-contraceptive-use
20 Haakenstad A, Angelino O, Irvine CMS, Bhutta ZA, Bienhoff K, Bintz C, et al. Measuring contraceptive method mix, prevalence, and demand satisfied by age and marital status in 204 countries and territories, 1970–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2022; 400(10348): 295-327.
| Crossref | Google Scholar |
21 Wu X, Wu G, Ma P, Wang R, Li L, Chen Y, et al. Associations of modern initial antiretroviral therapy regimens with all-cause mortality in people living with HIV in resource-limited settings: a retrospective multicenter cohort study in China. Nat Commun 2023; 14(1): 5334.
| Crossref | Google Scholar |
22 Trickey A, Zhang L, Gill MJ, Bonnet F, Burkholder G, Castagna A, et al. Associations of modern initial antiretroviral drug regimens with all-cause mortality in adults with HIV in Europe and North America: a cohort study. Lancet HIV 2022; 9(6): e404-13.
| Crossref | Google Scholar | PubMed |
23 Mundt S, Briggs S. HIV-related stigma and discrimination in the New Zealand healthcare setting: a mixed-methods study. Sex Health 2016; 13(6): 582-8.
| Crossref | Google Scholar |
24 Park H, Kim K. Trends and factors associated with oral contraceptive use among Korean women. Healthcare 2021; 9(10): 1386.
| Crossref | Google Scholar |
25 Steiner RJ, Pampati S, Kortsmit KM, Liddon N, Swartzendruber A, Pazol K. Long-acting reversible contraception, condom use, and sexually transmitted infections: a systematic review and meta-analysis. Am J Prev Med 2021; 61(5): 750-60.
| Crossref | Google Scholar |
26 Taye BT, Mihret MS, Muche HA. Risk factors of precancerous cervical lesions: the role of women’s socio-demographic, sexual behavior and body mass index in Amhara region referral hospitals; case-control study. PLoS ONE 2021; 16(3): e0249218.
| Crossref | Google Scholar |
27 Atlani L, Caraël M, Brunet JB, Frasca T, Chaika N. Social change and HIV in the former USSR: the making of a new epidemic. Soc Sci Med 2000; 50(11): 1547-56.
| Crossref | Google Scholar |
28 Ginsburg O, Bray F, Coleman MP, Vanderpuye V, Eniu A, Kotha SR, et al. The global burden of women’s cancers: a grand challenge in global health. Lancet 2017; 389(10071): 847-60.
| Crossref | Google Scholar |
29 Stover J, Brown T, Puckett R, Peerapatanapokin W. Updates to the spectrum/estimations and projections package model for estimating trends and current values for key HIV indicators. AIDS 2017; 31(Suppl 1): S5-S11.
| Crossref | Google Scholar |
30 GBD 2017 HIV Collaborators. Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. Lancet HIV 2019; 6(12): e831-59.
| Crossref | Google Scholar |
31 UNAIDS. 2020 Global AIDS Update – Seizing the moment – Tackling entrenched inequalities to end epidemics. 2020. Available at https://www.unaids.org/en/resources/documents/2020/global-aids-report
32 Teshale AB, Yeshaw Y, Alem AZ, Ayalew HG, Liyew AM, Tessema ZT, et al. Comprehensive knowledge about HIV/AIDS and associated factors among women of reproductive age in sub-Saharan Africa: a multilevel analysis using the most recent demographic and health survey of each country. BMC Infect Dis 2022; 22(1): 130.
| Crossref | Google Scholar |
33 Teshale AB, Tessema ZT, Alem AZ, Yeshaw Y, Liyew AM, Alamneh TS, et al. Knowledge about mother to child transmission of HIV/AIDS, its prevention and associated factors among reproductive-age women in sub-Saharan Africa: Evidence from 33 countries recent Demographic and Health Surveys. PLoS ONE 2021; 16(6): e0253164.
| Crossref | Google Scholar |
34 Fasil N, Worku A, Oljira L, Tadesse AW, Berhane Y. Association between sexual and reproductive health education in peer group and comprehensive knowledge of HIV among adolescent girls in rural eastern Ethiopia: a community-based cross-sectional study. BMJ Open 2022; 12(10): e063292.
| Crossref | Google Scholar |
35 Global Burden of Disease Health Financing Collaborator Network. Spending on health and HIV/AIDS: domestic health spending and development assistance in 188 countries, 1995–2015. Lancet 2018; 391(10132): 1799-829.
| Crossref | Google Scholar |
36 MacPhail C, Pettifor AE, Pascoe S, Rees HV. Contraception use and pregnancy among 15–24 year old South African women: a nationally representative cross-sectional survey. BMC Med 2007; 5: 31.
| Crossref | Google Scholar |
39 Lloyd CB, Mensch BS. Marriage and childbirth as factors in dropping out from school: an analysis of DHS data from sub-Saharan Africa. Popul Stud 2008; 62(1): 1-13.
| Crossref | Google Scholar |
40 Munakampe MN, Zulu JM, Michelo C. Contraception and abortion knowledge, attitudes and practices among adolescents from low and middle-income countries: a systematic review. BMC Health Serv Res 2018; 18(1): 909.
| Crossref | Google Scholar |
41 de Looze M, Madkour AS, Huijts T, Moreau N, Currie C. Country-level gender equality and adolescents’ contraceptive use in Europe, Canada and Israel: findings from 33 countries. Perspect Sex Reprod Health 2019; 51(1): 43-53.
| Crossref | Google Scholar |