Corrado De Vito. IGIENE PER SCIENZE GEOGRAFICHE Igiene generale ed epidemiologia

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1 IGIENE PER SCIENZE GEOGRAFICHE Igiene generale ed epidemiologia Corrado De Vito Dipar&mento di Sanità Pubblica e Mala6e Infe6ve corrado.devito@uniroma1.it L AIDS nel mondo

2 DEFINIZIONE Sindrome virale ad esordio insidioso e ad evoluzione grave, caraferizzata da una marcata compromissione dei meccanismi di difesa immunologici che espone il soggefo allo sviluppo di ripetute infezioni opportunis&che e/o all insorgenza di tumori EZIOLOGIA L agente eziologico è l HIV (Human Immunodeficincy Virus) un retrovirus a RNA di forma sferica SERBATOIO La sorgente di infezione è l uomo. Il periodo di contagiosità è sconosciuto, si presume che si estenda dall inizio dell infezione per tufa la vita del soggefo

3 MODALITA DI TRASMISSIONE Via parenterale (trasfusioni di sangue ed emoderiva&, scambio di siringhe tra tossicodipenden&, punture e ferite accidentali) Via sessuale Via transplacentare (dalla madre al prodofo del concepimento durante la gravidanza) Via perinatale (al momento del parto) Via congiun&vale (spruzzi di sangue nell occhio) INCUBAZIONE Da 2 se6mane a 6 mesi per la sieroconversione Fino a 1 anni per la comparsa della mala6a conclamata DIFFUSIONE Sindrome riportata per la prima volta in leferatura nel Ubiquitaria, senza differenza di razza e di età con predilezione delle seguen& categorie: Uomini omosessuali Tossicodipenden& Emofiliaci Conta6 sessuali non prote6 con partner infe6 Bambini na& da madri infefe Personale sanitario

4 Durante il "periodo finestra" un soggefo sieronega&vo, cioè una persona che ha già nel suo sangue il virus, ma non ha ancora sviluppato gli an&corpi contro quel virus; può contagiare altre persone che si espongano con lui a comportamen& sessuali rischiosi Un sieroposi&vo informato e trafato adeguatamente, che si sofopone ad un controllo costante, non sarà necessariamente un malato e, con l'adeguata protezione, non è da considerarsi una persona pericolosa per la comunità Le persone a rischio di contagio (escludendo l'africa in cui la mala6a è endemica) non sono solo i maschi omosessuali o i tossicodipenden& di entrambi i sessi che si scambiano siringhe infefe. Oggi, risultano maggiormente esposte le donne (anche se non tossicodipenden&) che adofano pra&che sessuali non protefe e anche gli uomini che, seppure eterosessuali hanno comportamen& sessuali promiscui.

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6 NUMBER OF PEOPLE LIVING WITH HIV, GLOBAL, millions

7 Regional overview ASIA 4.8 MILLION EASTERN EUROPE 1.4 MILLION LATIN AMERICA 1.4 MILLION NORTH AMERICA, WESTERN AND CENTRAL EUROPE 2.3 MILLION OCEANIA 53 CARIBBEAN 23 China 78 Thailand 49 Indonesia 38 Brazil 49 United States of America 1.3 million MIDDLE EAST AND NORTH AFRICA 3 SUB-SAHARAN AFRICA 23.5 MILLION United Republic of Tanzania 1.6 million South Africa 5.6 million Uganda 1.4 million Nigeria 3 million Mozambique 1.4 million Zambia 97 Zimbabwe 1.2 million Kenya 1.6 million Ethiopia 79

8 NUMBER OF PEOPLE NEWLY INFECTED WITH HIV, GLOBAL, millions

9 Number of people newly infected with HIV, , by region SUB-SAHARAN AFRICA EASTERN EUROPE AND CENTRAL ASIA Number of people newly infected with HIV (thousands) Number of people newly infected with HIV (thousands) 25 LATIN AMERICA Number of people newly infected with HIV (thousands) MIDDLE EAST AND NORTH AFRICA Number of people newly infected with HIV (thousands) ASIA Number of people newly infected with HIV (thousands) High estimate Estimate Low estimate Source: UNAIDS estimates. CARIBBEAN Number of people newly infected with HIV (thousands) Number of people newly infected with HIV (thousands) 3 OCEANIA

10 Incidence meter: Towards zero new HIV infections The rate of new HIV infections has been reduced by more than 5% among adults (15-49 years) in 25 countries between 21 and 211 Source: AIDSinfo % Mexico %.31 Belize.2 54 %.22.1 Haiti 33 % Jamaica 52 %.37 Bahamas.3 73 %.9 Dominican Republic % Suriname.3 4 %.15 Trinidad and Tobago % Barbados % Ghana % Sierra Leone %.18 Mali % Burkina Faso 57 %.55 Togo % Niger 54 %.74 Gabon Central African Rep public %.63 Cameroon % %.31.8 Rwanda 58 % Zambia % Djibouti 9 % Ethiopia % Malawi %.9 Burundi % Kenya % Nepal 57 %.4 India % Myanmar %.5 Thailand 88 % Cambodia.7 34 % Malaysia.4.5 Pa ercentage change in HIV incidence (21-211) HIV incidence 21 HIV incidence % Country % Namibia Bot swana 1 % 5 % Zimbabwe 31 % Mozambique % 2.42 South Africa % Swaziland UNAIDS World AIDS Day Report 212

11 The treatment gap in lowand middle-income countries Antiretroviral therapy reached 8 million people by the end of 211, a twenty-fold increase since 23. In 211, for the first time, a majority (54%) of people eligible for antiretroviral therapy in low- and middle-income countries were receiving it. This chart shows the gap in 211 between the number of people receiving antiretroviral therapy and the number of people eligible for treatment. Source: UNAIDS 212 Global Report People receiving HIV treatment People eligible for HIV treatment MIDDLE EAST AND NORTH AFRICA TREATMENT GAP 85 % EASTERN EUROPE AND CENTRAL ASIA % ASIA AND PACIFIC % SUB-SAHARAN AFRICA % LATIN AMERICA AND CARIBBEAN % GLOBALLY % 38 UNAIDS World AIDS Day Report 212

12 Sexual risks: changes in the percentages of men and women years old having sex before age 15 years; men and women years old having multiple partners; and those with multiple partners who used a condom at last sex, in selected countries with adult HIV prevalence greater than 1%, for selected years a Sex before age 15 years among 15- to 24-year-olds Multiple partners in the past 12 months among 15- to 49-year-olds Condom use at last high-risk sex among 15- to 49-year-olds Women Men Women Men Women Men Years of comparison Benin Burkina Faso Cameroun Congo Côte d'ivoire Ethiopia a Ghana Guyana Haiti 2 25 Kenya Lesotho Malawi 2 21 Mali Mozambique Namibia 2 26 Nigeria Rwanda 2 21 South Africa Uganda United Republic of Tanzania Zambia Zimbabwe 25 21

13 Prevalence of HIV infection among sex workers versus the general population in countries with available data, 212 Afghanistan Czech Republic Philippines Tunisia Bulgaria Lebanon Romania Armenia Georgia Mexico Bolivia Indonesia Madagascar Tajikistan Belarus Malaysia Chile Viet Nam Honduras Dominican Republic Papua New Guinea Senegal Panama Cape Verde Suriname Guyana Burundi Estonia Guinea Sierra Leone Jamaica Guinea-Bissau Chad Nigeria Uganda Swaziland 1% 2% 3% 4% 5% 6% 7% 8% Prevalence among sex workers (%) reported by the country (212) Prevalence among people years old (211)

14 Prevalence of HIV infection among people who inject drugs versus the general population in countries with available data, most recent year Japan Bangladesh Tunisia Afghanistan Philippines Hungary New Zealand Finland Romania Serbia Germany China Bulgaria Azerbaijan Pakistan Australia Oman Kazakhstan Georgia Sweden Mexico Netherlands Armenia Morocco Iran (Islamic Republic of) Luxembourg Canada Brazil Nepal Madagascar Tajikistan Indonesia Switzerland Malaysia Kyrgyzstan Spain Belarus Uzbekistan Viet Nam Myanmar Cambodia Senegal Latvia Ukraine Mauritius Thailand Estonia Nigeria Kenya 1% 2% 3% 4% 5% 6% Prevalence among people who inject drugs reported by the country in 212 Total prevalence among people years old in the general population in 211 Sources: 212 country progress reports ( and UNAIDS estimates.

15 Trends in mother-to-child transmission rates by subregion in sub-saharan Africa, Percentage of HIV-exposed children infected Western Africa Central Africa Eastern Africa Southern Africa Source: UNAIDS estimates.