AEGiS-15IAC: Undiagnosed HIV infections: The rate-limiting step for the 3 by 5 initiative?

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Undiagnosed HIV infections: The rate-limiting step for the 3 by 5 initiative?

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WeOrB1282)

Archibald CP, Alexander P, Gatali M, Geduld J
Centre for Infectious Disease Prevention and Control, Health Canada, Ottawa, Canada

BACKGROUND: To determine the proportion of HIV+ persons unaware of their infection. Access to voluntary HIV counseling and testing (VCT) is a critical component of WHO's new 3 by 5 initiative (providing antiretroviral therapy (ART) to 3 million HIV+ people in the developing world by 2005) since diagnosis is the first step in obtaining HIV care.

METHODS: Estimates for Canada were produced by combining recent estimates of national prevalence with HIV/AIDS surveillance data. Estimates for other countries were obtained by reviewing articles from various international/national organizations and from Medline/PubMed.

RESULTS: Two methods are used for measuring proportion of HIV+ unaware of infection: a direct method in which persons are tested for HIV and also asked to self-report HIV status, and an indirect method that compares known HIV diagnoses to estimated number of infected persons. In Canada, we estimated that 30% of the 56,000 persons living with HIV in 2002 were unaware of their infection. Estimates for the general HIV+ population in other developed countries are similar (25% in USA, 30% in UK), but estimates are generally lower for risk groups more likely to be aware of risk (20% in UK and 25% in Canada for MSM) and higher for groups less aware of risk (37% in Europe for heterosexuals, 77% in USA for young MSM). The estimated proportion unaware is much greater in developing countries: >50% in Argentina and El Salvador, 66% in Brazil, >80% in Iran, and >90% in several sub-Saharan African countries. Factors related to undiagnosed HIV infection will also be presented.

CONCLUSIONS: A significant proportion of the world's 40 million HIV+ persons remain undiagnosed and so cannot benefit from available treatments or counseling to prevent further spread of HIV. This is especially true in developing countries. More VCT and laboratory facilities, trained staff and an emphasis on work designed to reduce social stigma and discrimination is crucial to decrease the proportion undiagnosed and ultimately achieve the goal of 3 by 5 - providing ART to all those in need.

Keywords: AEGIS, HIV Infections, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Prevalence, Heterosexuality, Developing Countries, Organizations, Counseling, Demography, Research Design, Europe, Canada, Argentina, Brazil, Iran, El Salvador

040711
WeOrB1282