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PEPFAR Implementation: Progress and Promise
HIV/AIDS has evolved into one of the world’s greatest public health crises. More than 39 million people are estimated to be living with HIV/AIDS worldwide, over 60 percent of them in sub-Saharan Africa (UNAIDS,2006). HIV prevalence among adults aged 15–49 now exceeds 15 percent in many countries and has approached nearly 25 percent in Botswana, Lesotho, Swaziland, and Zimbabwe. In 2006 alone, more than 4 million people are estimated to have become infected with HIV, including nearly 2 million women and over half a million children under the age of 14. The Joint United Nations Programme on HIV/AIDS (UNAIDS) has estimated that nearly 3 million people died of AIDS worldwide in 2006, and that AIDS has reversed the gains in life expectancy that had been achieved by Africa over the past 50 years (UNAIDS, 2004a, 2006).
By 2006, an estimated 12 million children had been orphaned in sub-Saharan Africa as a result of HIV/AIDS (UNICEF, 2006). The status of girls and women makes them especially vulnerable to HIV, and they now account for nearly half of people living with HIV worldwide and 59 percent of those in sub-Saharan Africa (UNAIDS, 2006). In addition, HIV/AIDS has severely strained national economies and contributed to political instability in many of the countries experiencing an epidemic (UN, 2003b; CSIS, 2005; Rice, 2006). Chapter 2 provides more background about the HIV/AIDS pandemic.