Progress towards the Millennium Development Goals,1990-2005
GOAL 6 – Combat HIV/AIDS, malaria and other diseases
Goal 6calls for stopping and reversing the spread of HIV/AIDS, malaria and other major diseases, including tuberculosis. Not surprisingly, all three of these diseases are concentrated in the poorest countries. And they could be largely controlled through education, prevention and, when illness strikes, intervention.
How the indicatorsare calculated
Target 7 - Have halted by 2015 and begun to reverse the spread of HIV/AIDS
Tracking the AIDS epidemic
HIV/AIDS indicatorThe AIDS epidemic is tracked on the basis of estimated prevalence rates in the population aged 15 to 49 years. The prevalence is given by the number of HIV/AIDS cases as a percentage of the population in that age group.
In 2004 alone, an estimated 3.1 million people died of AIDS (500,000 of them among children under 15). At the end of that year, 39.4 million people were living with HIV, the highest number on record.
The worst affected region is sub-Saharan Africa, home to nearly two thirds of all people living with HIV. An estimated 2.3 (2.1-2.6) million AIDS deaths occurred there in 2004. Prevalence rates among adults in that region have reached 7.2 per cent, rising to over 30 per cent in some settings. Prevalence rates appear to have stabilized in most subregions of sub-Saharan Africa, albeit at very high levels. This does not mean that the epidemic has been controlled, only that new infections are roughly equal to the number of deaths each year. AIDS is an increasingly significant cause of death for children under five in the worst affected countries of southern Africa.
Figure 1. HIV prevalence in adults aged 15 to 49 in sub-Saharan Africa and all developing regions (percentage) and number of AIDS deaths in sub-Saharan Africa (millions), 1990–2004
Chart 1. Countries where more than 10 per cent of the adult population are living with HIV or AIDS, 2003Percentage of population 15-49 living with HIV or AIDS
Lesotho / 28.9
Zambia / 16.5
Malawi / 14.2
Central African Republic / 13.5
Mozambique / 12.2
Source: United Nations Statistics Division, Millennium Indicators Database, available from (accessed June 2005); based on data provided by The Joint United Nations Programme on HIV/AIDS (UNAIDS).
The AIDS epidemic is growing fastest in a number of countries in Eastern Europe (see Table 1)..The driving force behind the epidemic in the region is injecting drug use – an activity that has spread explosively in the years of turbulent change since the demise of the Soviet regime. A striking feature is the low age of those infected. More than 80 per cent of HIV-positive people in the region are under 30 years of age. By contrast, in North America and Western Europe, only 30 per cent of infected people are under age 30. The most serious and firmly established epidemic in the region is in Ukraine, which is experiencing a new surge of reported infections, while the Russian Federation is home to the largest epidemic in the entire region (indeed, in all of Europe).
In Asia, where an estimated 5.4–11.8 million people are living with HIV, relatively low national prevalence rates mask localized epidemics that have the potential to escalate dramatically. The large, populous countries of China, India and Indonesia are of particular concern. General prevalence in these countries is low, but this masks serious epidemics already under way in certain provinces, territories and states.
Even in high-income countries in North America, Western Europe and Australia, rising infection rates among some groups suggest that advances in treatment and care have not been matched by consistent progress in prevention.
Virtually every region, including sub-Saharan Africa, has several countries where the epidemic is still at a low level or at an early enough stage to be held in check by effective action. This calls for programmes that can thwart the spread of HIV among the most vulnerable population groups. But in many countries, inadequate resources and a failure of political will and leadership still bar the way – especially where HIV has established footholds among marginalized and stigmatized groups, such as women engaged in commercial sex, injecting drug users and men who have sex with men. Unless reticence is rapidly replaced with pragmatic and forward-looking approaches, HIV will spread more extensively in many countries that, until now, have escaped with only minor epidemics. In countries that have successfully reversed the spread of HIV, including Thailand and Uganda, strong and outspoken political leadership has been a defining feature of the national response.
Table 1. HIV prevalencePercentage of population aged 15 to 49 living with HIV
1990 / 2001 / 2004
Estimated adult
HIV prevalence / Percentage of adults living with HIV who are women / Estimated adult
HIV prevalence / Percentage of adults living with HIV who are women / Estimated adult
HIV prevalence / Percentage of adults living with HIV who are women
Developed regions / 0.2 / <020 / 0.4 / 26 / 0.5 / 29
Commonwealth of Independent States, Europe / <0.1 / <20 / 0.8 / 32 / 1.2 / 35
Commonwealth of Independent States, Asia / <0.1 / <20 / <0.1 / 32 / 0.2 / 33
Northern Africa / <0.1 / <20 / <0.1 / <20 / <0.1 / <20
Sub-Saharan Africa / 2.7 / 54 / 7.3 / 57 / 7.2 / 57
Latin America and the Caribbean / 0.3 / 33 / 0.6 / 38 / 0.7 / 39
Eastern Asia / <0.1 / <20 / 0.1 / 20 / 0.1 / 22
Southern Asia / 0.1 / <20 / 0.5 / 27 / 0.7 / 30
South-Eastern Asia / 0.1 / <20 / 0.5 / 29 / 0.5 / 30
Western Asia / <0.1 / <20 / <0.1 / <20 / <0.1 / <20
Oceania / <0.1 / <20 / 0.4 / 29 / 0.6 / 31
Source: United Nations Statistics Division, “World and regional trends”, Millennium Indicators Database, available at http:/millenniumindicators.un.org (accessed June 2005); based on data provided by UNAIDS.
The gender dimension
The AIDS epidemic is affecting a growing number of women and girls (see Table 1). Globally, just under half of all people living with HIV are female. But as the epidemic worsens, the share of infected women and girls is increasing. Women and girls make up almost 57 per cent of all people infected with HIV in sub-Saharan Africa. Among Africans aged 15 to 24, the difference between the sexes is even more pronounced. In the worst affected countries, recent national surveys show as many as three young women living with HIV for every young man. In most other regions too, the proportion of women and girls living with HIV has grown in the last five years. These trends point to serious shortcomings in the response to AIDS. Services that can protect women against HIV should be expanded, and education and prevention are needed to counteract the factors that contribute to women’s vulnerability and risk.
Why are women, especially younger women, more vulnerable than men in regions such as sub-Saharan Africa, where heterosexual sex is the primary means of transmission? There is a combination of factors at play, both biological (the female reproductive tract is more susceptible to infection) and social (men tend to have more sexual partners than women, and women may not be able to insist that men use condoms or abstain from sex, which are the only two widely available means to prevent HIV transmission). Paradoxically, marriage and long-term relationships do not protect women from HIV. A recent study in Cambodia found that 13 per cent of men in urban areas and 10 per cent of men in rural areas reported having sex with both their wives and female sex workers. In Thailand, a 1999 study found that 75 per cent of HIV-positive women were likely to have been infected by their husbands. Violence also increases the risk of infection among women, and especially among adolescent girls, since forced sex and consequent abrasions facilitate entry of the virus.[1] The underlying realities of sex and gender must be taken into account in strategies to achieve this MDG target.
The AIDS epidemic has other important gender dimensions. One is that women and girls bear the brunt of caring for sick relatives, which furthers their descent into poverty. UN Secretary-General Kofi Annan described the vicious cycle in his statement for International Women’s Day in 2004: “As AIDS forces girls to drop out of school, whether they are forced to take care of a sick relative, run the household, or help support the family, they fall deeper into poverty. Their own children, in turn, are less likely to attend school and more likely to become infected. Thus, society pays many times over the deadly price of the impact on women of AIDS.” Furthermore, pregnant women may lack the money or the independence within the household to pay for and take the drugs needed to prevent transmission of HIV to their infants.
The impact of AIDS on social and economic development
One way in which AIDS affects social and economic development is its impact on the labour force. Not only does it reduce the supply of skilled and experienced workers, lower productivity and raise labour costs, it also undermines human capital development and growth by depriving new generations of parental guidance, skills transfer, and education both in and out of school. The fact that the primary impact of the epidemic is on the working-age population means that women and men with important economic and social roles are prevented from making their full contribution to development. Together these factors have a negative impact on economic growth by weakening the tax base, lowering demand, and discouraging foreign and domestic investment. As a result of AIDS, the rate of growth of the gross domestic product in several highly affected countries is already measurably lower.
At the level of the family, the epidemic has eroded the savings capacity of households and the profits of informal, household-based enterprises. Households impoverished by the loss of adult labour due to AIDS also face the burden of care for the sick and dying. This task often falls on the young – especially girls – which can disrupt or cut short their schooling. The lack of time and skills leads to lowered food production, which can threaten food security. The epidemic also erodes savings and profits of formal productive enterprises, lowering government revenues to finance public services, including health services, which are in increased demand as a result of AIDS. Education is also under pressure, as the sector loses the staff to plan, train and deliver services. In sub-Saharan Africa, several government ministries are already unable to fill vacancies due to AIDS-related illness and mortality; in the most affected areas, the very process of governance, the quality and range of public services, and the likelihood of sustainable economic and social development are all under threat.
Focusing on young people and groups at high risk
In countries with generalized epidemics, where HIV transmission is established among the general population and occurs mainly through heterosexual contact, HIV prevalence is tracked among those aged 15 to 24. Data is acquired through antenatal clinics in the capital city treating pregnant women in this age group and through national population-based surveys.
Table 2. HIV prevalence among 15 to 24 years olds from national population-based surveys, 2001/2004Percentage living with HIV
Women / Men
Burkina Faso / 1.17 / 0.51
Burundi / 3.3 / 1.6
Cameroon / 4.8 / 1.4
Dominican Republic / 0.7 / 0.4
Ghana / 1.2 / 0.1
Kenya / 5.9 / 1.3
Mali / 1.3 / 0.3
Niger / 0.8 / 0.3
South Africa / 12.0 / 6.1
United Republic of Tanzania / 4.0 / 3.0
Zambia / 11.2 / 3.0
Zimbabwe / 18.0 / 5.0
Source: United Nations Statistics Division, “World and regional trends”, Millennium Indicators Database, available from (accessed June 2005); based on data provided by UNAIDS.
Data on HIV prevalence among pregnant women in capital cities are currently available for 26 countries in sub-Saharan Africa for the period 2000-2003. Data show HIV prevalence reaching 39 per cent in sites in Swaziland, almost 33 per cent in Botswana, 32 per cent in South Africa, 28 per cent in Lesotho, and 22 per cent in Zambia. Sustained prevention programmes in some countries have demonstrated that the spread of HIV can be controlled. The most notable case is Uganda. Although no other country has so dramatically reversed the epidemic, they have succeeded in reducing rates of infection. Ambitious and sustained prevention efforts are urgently needed in other countries.
The small amount of data available from population-based surveys in countries shows a wide gender gap. In all 12 countries with data, young women are more likely than young men to be infected, and in six countries, young women are more than three times as likely to be infected as men.
In other parts of the world, HIV infections are concentrated among sub-populations that are at particularly high risk. These include injecting drug users, men who have sex with men, commercial sex workers, migrants and other groups. In many countries, HIV prevalence rates among injecting drug users are high and, in several countries of Asia and Eastern Europe, they are on the rise. Although several countries have seen declines in HIV prevalence among commercial sex workers as a result of successful prevention programmes – like the public campaigns on condom use in Thailand – other countries in different regions see rising prevalence rates among sex workers. Most developing countries have insufficient data to be able to assess trends among men who have sex with men.
Indicators of knowledge and HIV preventionProgress made in educating people about the risk of HIV/AIDS is assessed by tracking the percentage of young people who know the basic facts about HIV/AIDS— that is, the percentage of women and men aged 15 to 24 who correctly identify the two major ways of preventing the sexual transmission of HIV (using condoms and limiting sex to one faithful, uninfected partner); who reject two common local misconceptions; and who know that a healthy looking person can transmit the AIDS virus. Progress in preventing the spread of HIV is tracked on the basis of the percentage of women and men who use condoms during sex to protect themselves from becoming infected.
Preventing HIV infection
Because there is no cure for AIDS, prevention is paramount. A fundamental aspect of the prevention strategy is educating people about the risks of HIV infection. Still, most young people are unaware of their HIV status. Millions more know too little about how HIV is transmitted to protect themselves against it.
These young people do not know, for example, that healthy looking individuals can have HIV or that consistent condom use can protect them from infection with the virus. Surveys in sub-Saharan Africa found that only 21 percent of young women and only 30 percent of young men aged 15 to 24 had the critical information needed to protect themselves. Only 13 per cent of young women in South-Eastern Asia had this basic level of knowledge, and 7 per cent of young women and men in the Commonwealth of Independent States (CIS).
Table 3. Young people with a comprehensive and correct knowledge of HIV/AIDS, 1999/2003Women aged 15-24 / Men aged 15-24
Number of countries
covered by the surveys / Per cent who have comprehensive knowledge1/ / Number of countries covered by the surveys / Per cent who have comprehensive knowledge1/
Developed regions (Albania only) / 1 / 0 / - / -
CIS / 6 / 7 / 2 / 7
Sub-Saharan Africa / 32 / 21 / 14 / 30
Latin America and the Caribbean / 6 / 28 / 1 / 24
Eastern Asia (Mongolia only) / 1 / 32 / - / -
Southern Asia (India only) / 1 / 21 / 1 / 17
South-Eastern Asia / 3 / 13 / - / -
Source: United Nations Statistics Division, “World and regional trends”, Millennium Indicators Database, available from (accessed June 2005); based on data provided by United Nations Children’s Fund, UNAIDS and the World Health Organization.
1/Percentage of young women and men aged 15 to 24 who correctly identified the two major ways of preventing the sexual transmission of HIV (using condoms and limiting sex to one faithful, uninfected partner), who reject two common local misconceptions, and who know that a healthy looking person can transmit the AIDS virus.
Consistent use of condoms is an effective method to prevent HIV infection, and the percentage of women who know that they can protect themselves in this way is an indication of the extent to which national information and education programmes about HIV have succeeded. Only a limited number of countries have collected data on condom use at the last occurrence of higher-risk sex, and not many countries have had successive surveys to indicate trends. Nevertheless, the data on behaviour that do exist suggest that about 25 percent of women in sub-Saharan Africa used a condom the last time they had sex with a high-risk partner (not their usual partner), and 43 percent of young men used a condom with a high-risk partner (see Table 4). Women within marriage are also at risk of contracting HIV and often lack the power to negotiate condom use with their husbands. Only 5 per cent of married women worldwide report using condoms as acontraceptive method.