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

Background Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980–2017 and forecast these estimates to 2030 for 195 countries and territories. Methods We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package—a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce age-sex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections. Findings Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87–2·04) and has since decreased to 0·95 million deaths (0·91–1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79–3·67) and since then have gradually decreased to 1·94 million (1·63–2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8–39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets. Interpretation Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact

Challenges to Effective Teaching of the Behavioural and Social Sciences to Medical Students in Nigeria.

Background: In line with the international trends, most  Nigerian medical schools  include the Behavioural and  Social Sciences(BSS) in their  curricula. The accrediting body  for university education in  Nigeria, The National University Commission (NUC) listed a number of special topics of relevance to the behavioural  and social science contents of medical school curricula. Aim: To sensitize medical educators to the challenges in  the translation of this NUC  directives to action. Methods: A review of published works on the integration of the  BSS into medical education  curricula. Information on teaching of BSS was obtained through targetted informal discussions with at least two students and one lecturer each various medical schools in universities across the country. Results: The review showed differences in who teaches, the design and methods of teaching the BSS. Barriers to effective didactic teaching of BSS in Nigerian medical schools were highlighted.Conclusion: There is a need to design empirical studies and nation-wide surveys that will further explore the issue raised concerning the effective teaching and integration of the BSS into medical educatio

The Nigerian Male: Changing Gender Roles and Relationships

No Abstract Available African Journal for the Psychological Study of Social Issues Vol.6(1) 2001: 15-2

Health Beliefs and Locus of Control as Predictors of Cancer Screening Behaviour among Women in Obafemi Awolowo University Community

Among Nigerian women breast and cervical cancers are leading causes of death. Screening programmes that are being introduced are recording slow uptake. The study examined the role of the Health Belief Model and Health Locus of Control in predicting cancer screening behaviour. Using a cross-sectional design, 460 women were recruited by means of convenient sampling between ages 18-60 years in the Obafemi Awolowo University Ile-Ife community. The adapted versions of the Multidimensional Health Locus of Control Scale, Health Behaviour Scale and Cancer Health Belief Scale were administered. Multivariate analysis revealed that none of the health belief factors were significant predictors of breast cancer screening behaviour. However, occupation (OR = 298.26, p < 0.05), perceivedbenefits of screening (OR= 0.35, p < 0.05), internal locus of control (OR = 1.43, p < 0.05) and health risks behaviour (OR= 0.42, p < 0.05) all significantly predicted cervical cancer screening behaviour of women.Keywords: Health beliefs, Health locus of control, cancer screening, Breast and cervical cance

HIV vaccine acceptability in seronaive patients in a resource limited setting - a pilot study

Background: Current lifetime antiretroviral regimes are associated with clinically important toxicities, and have several limitations (eg. cost, development of resistance, complications). There is need for an alternative regime that must be acceptable, easy to administer and permanent for the eradication of HIV/AIDS. This creates a necessity for vaccine trials in human subjects. Objectives: To evaluate the response and acceptability profile of a possible coming HIV vaccine trial and usage among a study population that are not aware of their serostatus. Methods: Five hundred males and females who were seronaive regarding their HIV status were recruited into the study. An open ended questionnaire was administered before and after counselling to assess the acceptability of the proposed vaccine with and without counselling.Results: Male:female ratio was one to one. Ninety percent (450 out of 500) said they would not take part in a new HIV vaccine trial but only sixty five percent (325 out 500) reacted negatively after counselling. Sixty eight percent (340 out of 500) said they would partake in the vaccination after a successful trial has been carried out on other human subjects and after counselling, this increased to eighty five percent (425 out of 500). The general attitude to HIV vaccine was that of fear and distrust. Discussion: Coming HIV vaccine trials and usage is likely to be met with suspicion and distrust in resource limited settings. Certain barriers to acceptability of the vaccines need to be addressed to increase acceptability both to the trials and usage of the vaccine. Successful trial will lead to increased acceptability of usage.Sudanese Journal of Dermatology Vol. 3(3) 2005: 113-11