HIV/AIDS estimates

In 2003 and during the first quarter of 2004, UNAIDS and WHO worked closely with national governments and research institutions to recalculate current estimates on people living with HIV/AIDS. These calculations are based on the previously published estimates for 1999 and 2001 and recent trends in HIV/AIDS surveillance in various populations. A methodology developed in collaboration with an international group of experts was used to calculate the new estimates on prevalence and incidence of HIV and AIDS deaths, as well as the number of children infected through mother-to-child transmission of HIV.

Different approaches were used to estimate HIV prevalence in countries with low-level, concentrated or generalised epidemics. The current estimates do not claim to be an exact count of infections. Rather, they use a methodology that has thusfar proved accurate in producing estimates that give a good indication of the magnitude of the epidemic in individual countries. However, these estimates are constantly being revised as countries improve their surveillance systems and collect more information.

Adults in this report are defined as women and men aged 15 to 49. This age range covers people in their most sexually active years. While the risk of HIV infection obviously continues beyond the age of 50, the vast majority of those who engage in substantial risk behaviours are likely to be infected by this age. The 15 to 49 range was used as the denominator in calculating adult HIV prevalence.

UNAIDS/WHO Working Group on Global

HIV/AIDS and STI Surveillance

Global Surveillance of HIV/AIDS and sexually transmitted infections (STIs) is a joint effort of WHO and UNAIDS. The UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance, initiated in November 1996, guides respective activities. The primary objective of the Working Group is to strengthen national, regional and global structures and networks for improved monitoring and surveillance of HIV/AIDS and STIs. For this purpose, the Working Group collaborates closely with national AIDS programmes and a number of national and international experts and institutions. The goal of this collaboration is to compile the best information available and to improve the quality of data needed for informed decision-making and planning at national, regional, and global levels. The Epidemiological Fact Sheets are one of the products of this close and fruitful collaboration across the globe.

Within this framework, the Fact Sheets collate the most recent country-specific data on HIV/AIDS prevalence and incidence, together with information on behaviours (e.g. casual sex and condom use) which can spur or stem the transmission of HIV.

Not unexpectedly, information on all of the agreed upon indicators was not available for many countries in 2003. However, these updated Fact Sheets do contain a wealth of information which allows identification of strengths in currently existing programmes and comparisons between countries and regions. The Fact Sheets may also be instrumental in identifying potential partners when planning and implementing improved surveillance systems.

The fact sheets can be only as good as information made available to the UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance. Therefore, the Working Group would like to encourage all programme managers as well as national and international experts to communicate additional information to them whenever such information becomes available. The Working Group also welcomes any suggestions for additional indicators or information proven to be useful in national or international decision-making and planning.

Estimated number of adults and children living with HIV/AIDS, end of 2003 These estimates include all people with HIV infection, whether or not they have developed symptoms of AIDS, alive at the end of 2003:

Adults and children
Women (15-49)
Children (0-15)
Adult rate (%)
Estimated number of deaths due to AIDS
Estimated number of adults and children who died of AIDS during 2003:
Deaths in 2003
Estimated number of orphans
Current living orphans

Assessment of the epidemiological situation 2004

There is limited information on HIV seroprevalence information among antenatal clinic attendees from Somalia since 1985. No evidence of infection was found in Mogadishu in 1998. Testing in two sites outside of Mogadishu found a median of 2 percent HIV prevalence in 1997. In 1999, in three sentinel sites outside of Mogadishu, median HIV prevalence was 1 percent.

In 1999, 1 percent of male STD clinic patients tested in Hargeisa were HIV positive.

DEMOGRAPHIC DATA

Basic indicators                                  YEAR      ESTIMATE

Total population (thousands)                      2004       10,312
Average annual growth rate of urban population    2004       994
Female population aged 15-24 (thousands)          2004       4,513
Population aged 15-49 (thousands)                 1992-2002  2.8
Annual population growth rate (%)                 2003       34.6
% of population in urban areas                    2000-2005  5.7
Crude birth rate (births per 1,000 pop.)          2004       51.7
Crude death rate (deaths per 1,000 pop.)          2004       17.1
Maternal mortality rate (per 100,000 live births) 2000       1100
Life expectancy at birth (years)                  2002       44.3
Total fertility rate                              2002       7.3
Infant mortality rate (per 1,000 live births)     2000       130
Under 5 mortality rate (per 1,000 live births)    2000       219

SOCIO-ECONOMIC DATA YEAR ESTIMATE SOURCE

Gross national income, ppp, per capita (Int.$)   - 
Gross domestic product, per capita % growth      -
Per capita total expenditure on health (Int.$)   2001  15  World Health Report 2004, 
General government expenditure on health as %
of total expenditure on health                   2001  44.6 World Health Report 2004, 
Total adult illiteracy rate                       -
Adult male illiteracy rate                        -
Adult female illiteracy rate                      - 
Gross primary school enrolment ratio, male       2000/2001  not available UNESCO
Gross primary school enrolment ratio, female     2000/2001  not available UNESCO
Gross secondary school enrolment ratio, male     2000/2001  not available UNESCO
Gross secondary school enrolment ratio, female   2000/2001  not available UNESCO

HIV prevalence in different populations

This section contains information about HIV prevalence in different populations. The data reported in the tables below are mainly based on the HIV database maintained by the United States Bureau of the Census where data from different sources, including national reports, scientific publications and international conferences are compiled. To provide a simple overview of the current situation and trends over time, summary data are given by population group, geographical area (Major Urban Areas versus Outside Major Urban Areas), and year of survey. Studies conducted in the same year are aggregated and the median prevalence rates (in percentages) are given for each of the categories. The maximum and minimum prevalence rates observed, as well as the total number of surveys/sentinel sites, are provided with the median, to give an overview of the diversity of HIV-prevalence results in a given population within the country. Data by sentinel site or specific study from which the medians were calculated are printed at the end of this fact sheet.

The differentiation between the two geographical areas Major Urban Areas and Outside Major Urban Areas is not based on strict criteria, such as the number of inhabitants. For most countries, Major Urban Areas were considered to be the capital city and - where applicable - other metropolitan areas with similar socio-economic patterns. The term Outside Major Urban Areas considers that most sentinel sites are not located in strictly rural areas, even if they are located in somewhat rural districts.

Mapping the geographical distribution of HIV prevalence among different population groups may assist in interpreting both the national coverage of the HIV surveillance system as well in explaining differences in levels of prevalence. The UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance, in collaboration with the WHO Public Health Mapping Team, Communicable Diseases, is producing maps showing the location and HIV prevalence in relation to population density, major urban areas and communication routes. For generalized epidemics, these maps show the location of prevalence of antenatal surveillance sites.

Trends in antenatal sentinel surveillance for higher prevalence countries, or in prevalence among selected populations for countries with concentrated epidemics, are a new addition. These are presented for those countries where sufficient data exist.

The boundaries and names shown and the designations used on the map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

Following WHO and UNAIDS recommendations, AIDS case reporting is carried out in most countries. Data from individual AIDS cases are aggregated at the national level and sent to WHO. However, case reports come from surveillance systems of varying quality. Reporting rates vary substantially from country to country and low reporting rates are common in developing countries due to weaknesses in the health care and epidemiological systems. In addition, countries use different AIDS case definitions. A main disadvantage of AIDS case reporting is that it only provides information on transmission patterns and levels of infection approximately 5-10 years in the past, limiting its usefulness for monitoring recent HIV infections.

Despite these caveats, AIDS case reporting remains an important advocacy tool and is useful in estimating the burden of HIV-related morbidity as well as for short-term planning of health care services. AIDS case reports also provide information on the demographic and geographic characteristics of the affected population and on the relative importance of the various exposure risks. In some situations, AIDS reports can be used to estimate earlier HIV infection patterns using back-calculation. AIDS case reports and AIDS deaths have been dramatically reduced in industrialized countries with the introduction of Anti-Retroviral Therapy (ART).

Curable sexually transmitted infections (STIs)

The predominant mode of transmission of both HIV and other STIs is sexual intercourse. Measures for preventing sexual transmission of HIV and STIs are the same, as are the target audiences for interventions. In addition, strong evidence supports several biological mechanisms through which STIs facilitate HIV transmission by increasing both HIV infectiousness and HIV susceptibility. Thus, detection and treatment of individuals with STIs is an important part of an HIV control strategy. In summary, if the incidence/prevalence of STIs is high in a country, then there is the possibility of high rates of sexual transmission of HIV. Monitoring trends in STIs provides valuable insight into the likelihood of the importance of sexual transmission of HIV within a country, and is part of second generation surveillance. These trends also assist in assessing the impact of behavioural interventions, such as delaying sexual debut, reducing the number of sex partners and promoting condom use.

Clinical services offering STI care are an important access point for people at high risk for both STIs and HIV. Identifying people with STIs allows for not only the benefit of treating the STI, but for prevention education, HIV testing, identifying HIV-infected persons in need of care, and partner notification for STIs or HIV infection. Consequently, monitoring different components of STI prevention and control can also provide information on HIV prevention and control activities within a country.

Health service and care indicators

HIV prevention strategies depend on the twin efforts of care and support for those living with HIV or AIDS, and targeted prevention for all people at risk or vulnerable to the infection. It is difficult to capture such a large range of activities with one or just a few indicators. However, a set of well-established health care indicators may help to identify general strengths and weaknesses of health systems. Specific indicators, such as access to testing and blood screening for HIV, help to measure the capacity of health services to respond to HIV/AIDS - related issues.

Access to health care

% of population with access to health services - total
% of 1-yr-old children fully immunized - DPT 2002 40 WHO/UNICEF
% of births attended by skilled health personnel 2000 34.2 WHO
% of ANC clinics where HIV testing is available
% of 1-yr-old children fully immunized - Measles 2001 36 WHO/UNICEF
Percentage of contraceptive users using condoms
% of population with access to health services - urban
% of population with access to health services - rural
Contraceptive prevalence rate (%) 1990-1999 1 UNICEF/UNPOP

In most countries the HIV epidemic is driven by behaviours (e.g.: multiple sexual partners, injecting drug use) that expose individuals to the risk of infection. Information on knowledge and on the level and intensity of risk behaviour related to HIV/AIDS is essential in identifying populations most at risk for HIV infection and in better understanding the dynamics of the epidemic. It is also critical information in asssessing changes over time as a result of prevention efforts. One of the main goals of the 2nd generation HIV serveillance systems is the promotion of a standard set of indicators defined in the National Guide (Source: National AIDS Programmes, A Guide to Monitoring and Evaluation, UNAIDS/00.17) and regular behavioural surveys in order to monitor trends in behaviours and to target interventions.

The indicators on knowledge and misconceptions are an important prerequisite for prevention programmes to focus on increasing people's knowledge about sexual transmission, and, to overcome the misconceptions that act as a disincentive to behaviour change. Indicators on sexual behaviour and the promotion of safer sexual behaviour are at the core of AIDS programmes, particulary with youg people who are not yet sexually active or are embarking on their sexual lives, and who are more amenable to behavioural change than adults. Finally, higher risk male-male sex reports on unprotected anal intercourse, the highest risk behaviour for HIV among men who have sex with men.

Knowledge of HIV prevention methods

Prevention indicator: Percentage of young people 15-24 who both correctly identify two ways of preventing the sexual transmission of HIV and who reject three misconceptions about HIV transmission.

Prevention indicators

Male and female condoms are the only technology available that can prevent sexual transmission of HIV and other STIs. Persons exposing themselves to the risk of sexual transmission of HIV should have consistent access to high quality condoms. AIDS Programs implement activities to increase both availability of and access to condoms. Thes activities should be monitored and have resources directed to problem aresas. The indicator below highlights the availability of condoms. However, even if condoms are widely available, this does not mean that individuals can or do acess them.

Condom availability nationwide

Total number of condoms available for distribution nationwide during the preceding 12 months, divided by the total population aged 15-49.

Sources

Data presented in this Epidemiological Fact Sheet come from several sources, including global, regional and country reports, published documents and articles, posters and presentations at international conferences, and estimates produced by UNAIDS, WHO and other United Nations agencies. This section contains a list of the more relevant sources used for the preparation of the Fact Sheet. Where available, it also lists selected national Web sites where additional information on HIV/AIDS and STI are presented and regularly updated. However, UNAIDS and WHO do not warrant that the information in these sites is complete and correct and shall not be liable whatsoever for any damages incurred as a result of their use.

Ismail, S. O., H. J. Ahmed, L. Grillner, et al. 1990 Sexually Transmitted Diseases in Men in Mogadishu, Somalia International Journal of STD and AIDS, vol. 1, pp. 102-106.
Duffy, G. 1999 Report on STD/HIV Prevalence Study in Somaliland: Part 2 Ministry of Health and Labor, Somaliland, in Collaboration with ICD, UNICEF, & WHO, November, unpublished report.
Jama, H., L. Grillner, G. Biberfeld, et al. 1987 Sexually Transmitted Viral Infection in Various Population Groups in Mogadisbu, Somalia Genitourinary Medicine, vol. 63, no. 5, pp. 329-332.
Scott, D. A., A. L. Corwin, N. T. Constantine, et al. 1991 Low Prevalence of Human Immunodeficiency Virus-1 (HIV-1), HIV-2, and Human T Cell Lymphotropic Virus-1 Infection in Somalia American Journal of Tropical Medicine and Hygiene, vol. 45, no. 6, pp. 653-659.
Kulane, A., A. A. Hilowle, A. A. Hassan, et al. 2000 Prevalence of HIV, HTLV I/II and HBV Infections during Long Lasting Civil Conflicts in Somalia XIII International AIDS Conference, Durban, South Africa, 7/9-14, Poster MoPeC2433.
Ahmed, H. J. 1997 STD/HIV Prevalence and Chemotherapy Studies in Somaila Department of Medical Microbiology, University of Goteborg, Goteborg, Sweden, document.
Ahmed, H. J., K. Omar, S. Y. Adan, et al. 1991 Syphilis and Human Immunodeficiency Virus Seroconversion during a 6-Month Follow-up of Female Prostitutes in Mogadishu, Somalia International Journal of STD and AIDS, vol. 2, pp. 119-123.
Burans, J. P., E. Fox, M. A. Omar, et al. 1990 HIV Infection Surveillance in Mogadishu, Somalia East African Medical Journal, vol. 67, no. 7, pp. 466-472.
Corwin, A. L., J. G. Olson, M. A. Omar, et al. 1991 HIV-1 in Somalia: Prevalence and Knowledge among Prostitutes AIDS, vol. 5, no. 7, pp. 902-904.
Corwin, A., J. Olson, M. Omar, et al. 1991 Human Immunodeficiency Viral Type 1 Infection among Prostitutes in Somalia VII International Conference on AIDS, Florence, Italy, 6/16-21, Poster M.C.3032.

Somalia:Epidemiological Fact Sheet on HIV/AIDS and sexually transmitted infections

UNAIDS/WHO Epidemiological Fact Sheet 2000 Update
http://pdf.usaid.gov/pdf_docs/PNACL607.pdf

2000 Update
World Health Organization
UNAIDS/WHO Epidemiological Fact Sheet 2000 Update

Country Information

Population pyramid, 1999 UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance 0-4 15-19 30-34 45-49 60-64 75-79 Age Gender

MALE FEMALE

Indicators Year Estimate Source
Total Population (thousands) 1999 9,672 UNPOP
Population Aged 15-49 (thousands) 4,255
Annual Population Growth 1990-1998 2.2 UNPOP
% of Population Urbanized 1998 26 UNPOP
Average Annual Growth Rate of Urban Population 1990-1998 3.0 UNPOP
GNP Per Capita (US$)
GNP Per Capita Average Annual Growth Rate
Human Development Index Rank (HDI) 1998 175/175 UNDP
% Population Economic Active
Unemployment Rate
Total Adult Literacy Rate
Adult Male Literacy Rate 1990 36 UNICEF
Adult Female Literacy Rate 1990 14 UNICEF
Male Secondary School Enrollment Ratio 1996 6.6 UNESCO
Female Secondary School Enrollment Ratio 1996 3.5 UNESCO
Crude Birth Rate (births per 1,000 pop.) 1998 52 UNPOP
Crude Death Rate (deaths per 1,000 pop.) 1999 17 UNPOP
Maternal Mortality Rate (per 100,000 live births) 1990 1,600 WHO
Life Expectancy at Birth 1998 47 UNPOP
Total Fertility Rate 1998 7.2 UNPOP
Infant Mortality Rate (per 1,000 live births) 1999 114 UNICEF/UNPOP

The UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance, initiated in November 1996, guides respective activities. The primary objective of the working group is to strengthen national, regional and global structures and networks for improved monitoring and surveillance of HIV/AIDS and STIs. For this purpose, the working group collaborates closely with national AIDS programmes and a number of national and international experts and institutions. The goal of this collaboration is to compile the best information available and to improve the quality of data needed for informed decisionmaking and planning at national, regional and global levels. The Epidemiological Fact Sheets are one of the products of this close and fruitful collaboration across the globe.

The working group and its partners have established a framework standardizing the collection of data deemed important for a thorough understanding of the current status and trends of the epidemic, as well as patterns of risk and vulnerability in the population. Within this framework, the Fact Sheets collate the most recent country-specific data on HIV/AIDS prevalence and incidence, together with information on behaviours (e.g casual sex and condom use) which can spur or stem the transmission of HIV.

Not unexpectedly, information on all of the agreedupon indicators was not available for many countries in 1999. However, these updated Fact Sheets do contain a wealth of information which allows identification of strengths in currently existing programmes and comparisons between countries and regions. The Fact Sheets may also be instrumental in identifying potential partners when planning and implementing improved surveillance systems.

The fact sheets can be only as good as information made available to the UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance. Therefore, the working group would like to encourage all programme managers as well as national and international experts to communicate additional information to the working group whenever such information becomes available. The working group also welcomes any suggestions for additional indicators or information proven to be useful in national or international decision-making and planning.

Estimated number of people living with HIV/AIDS

In 1999 and during the first quarter of 2000, UNAIDS and WHO worked closely with national governments and research institutions to recalculate current estimates on people living with HIV/AIDS. These calculations are based on the previously published estimates for 1997 and recent trends in HIV/AIDS surveillance in various populations. A methodology developed in collaboration with an international group of experts was used to calculate the new estimates on prevalence and incidence of HIV and AIDS deaths, as well as the number of children infected through mother-tochild transmission of HIV. Different approaches were used to estimate HIV prevalence in countries with low-level, concentrated or generalized epidemics. The current estimates do not claim to be an exact count of infections. Rather, they use a methodology that has thus far proved accurate in producing estimates that give a good indication of the magnitude of the epidemic in individual countries. However, these estimates are constantly being revised as countries improve their surveillance systems and collect more information.

Adults in this report are defined as women and men aged 15 to 49. This age range covers people in their most sexually active years. While the risk of HIV infection obviously continues beyond the age of 50, the vast majority of those who engage in substantial risk behaviours are likely to be infected by this age. The 15 to 49 age range was used as the denominator in calculating adult HIV prevalence.

Estimated number of adults and children living with HIV/AIDS, end of 1999

These estimates include all people with HIV infection, whether or not they have developed symptoms of AIDS, alive at the end of 1999:

Adults and children
Adults (15-49) Adult rate (%)
Women (15-49)
Children (0-15)
- Estimated number of deaths due to AIDS
Estimated number of adults and children who died of AIDS during 1999:
Deaths in 1999
- Estimated number of orphans
Estimated number of children who have lost their mother or both parents to AIDS (while they were under the age of 15) since the beginning of the epidemic:
Cumulative orphans
Estimated number of children who have lost their mother or both parents to AIDS and who were alive and under age 15 at the end of 1999:
Current living orphans

Assessment of epidemiological situation - Somalia

The only information on HIV seroprevalence information among antenatal clinic attendees from Somalia since 1985 are two studies conducted in Hargeysa and Bosaso in 1997 and in Somaliland in 1999. HIV prevalence in pregnant women ranged from 0.4% to 2%. Information on HIV seroprevalence among sex workers is available from the mid-1980s until 1990. In Mogadishu, the major urban area, no evidence of HIV infection was found among sex workers tested in 1985-86 or in 1987. In 1988-89, 0.5 percent of sex workers tested were HIV positive. The rate increased to 2 percent in 1990. HIV seroprevalence increased among sex workers in Chismayu and Merca from no evidence of HIV infection in 1989 to 4 percent in 1990. No recent information is available on this group. Among STD clinic patients tested in Mogadishu between 1986 and 1990, there was no evidence of HIV infection.

HIV sentinel surveillance

This section contains information about HIV prevalence in different populations. The data reported in the tables below are mainly based on the HIV data base maintained by the United States Bureau of the Census where data from different sources, including national reports, scientific publications and international conferences is compiled. To provide for a simple overview of the current situation and trends over time, summary data are given by population group, geographical area (Major Urban Areas versus Outside Major Urban Areas), and year of survey. Studies conducted in the same year are aggregated and the median prevalence rates (in percentages) are given for each of the categories. The maximum and minimum prevalence rates observed, as well as the total number of surveys/sentinel sites, are provided with the median, to give an overview of the diversity of HIVprevalence results in a given population within the country. Data by sentinel site or specific study on which the medians were calculated are printed at the end of this fact sheet.

The differentiation between the two geographical areas Major Urban Areas and Outside Major Urban Areas is not based on strict criteria, such as the number of inhabitants. For most countries, Major Urban Areas were considered to be the capital city and - where applicable - other metropolitan areas with similar socio-economic patterns. The term Outside Major Urban Areas considers that most sentinel sites are not located in strictly rural areas, even if they are located in somewhat rural districts.

Maps of HIV sentinel sites

Mapping the geographical distribution of HIV sentinel sites for different population groups may assist interpreting both the national coverage of the HIV surveillance system and explaining differences in levels and trends of prevalence. The UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance, in collaboration with the UNICEF/WHO HealthMap Programme, has produced maps showing the location and HIV prevalence of HIV sentinel sites in relation to population density, major urban areas and communication routes. Maps illustrate separately the most recent results from HIV sentinel surveillance in pregnant women and in sub-populations at higher risk of HIV infection.

Following WHO and UNAIDS recommendations, AIDS case reporting is carried out in most countries. Data from individual AIDS cases is aggregated at the national level and sent to WHO. However, case reports come from surveillance systems of varying quality. Reporting rates vary substantially from country to country and low reporting rates are common in developing countries due to weaknesses in the health care and epidemiological systems. In addition, countries use different AIDS case definitions. A main disadvantage of AIDS case reporting is that it only provides information on transmission patterns and levels of infection approximately 5-10 years in the past, limiting its usefulness for monitoring recent HIV infections.

Despite these caveats, AIDS case reporting remains an important advocacy tool and is useful in estimating the burden of HIV-related morbidity as well as for short-term planning of health care services. AIDS case reports also provide information on the demographic and geographic characteristics of the affected population and on the relative importance of the various exposure risks. In some situations, AIDS reports can be used to estimate earlier HIV infection patterns using back-calculation. AIDS case reports and AIDS deaths have been dramatically reduced in industrialized countries with the introduction of HAART (Highly Active Anti-Retroviral Therapy).

Curable Sexually Transmitted Infections (STIs)

The predominant mode of transmission of both HIV and other STIs is sexual intercourse. Measures for preventing sexual transmission of HIV and STI are the same, as are the target audiences for interventions. In addition, strong evidence supports several biological mechanisms through which STI facilitate HIV transmission by increasing both HIV infectiousness and HIV susceptibility. Significant also is the observation of a sharp decline in the concentration of HIV in the genital secretions when the infection is treated. Monitoring trends in STI can provide valuable information on the sexual transmission of HIV as well as the impact of behavioural interventions, such as promotion of condom use.

Clinical services offering STI care are an important access point for people at high risk for both AIDS and STI, not only for diagnosis and treatment but also for information and education. Therefore, control and prevention of STI have been recognized as a major strategy in the prevention of HIV infection and ultimately AIDS. One of the cornerstones of STI control is adequate management of patients with symptomatic STIs. This includes diagnosis, treatment and individual health education and counselling on disease prevention and partner notification. Consequently, monitoring different components of STI control can also provide information on HIV prevention within a country.

Health service indicators

HIV prevention strategies depend on the twin efforts of care and support for those living with HIV or AIDS, and targeted prevention for all people at risk or vulnerable to the infection. These efforts may range from reaching out to vulnerable communities through large-scale educational campaigns or interpersonal communication; provision of treatment for STIs; distribution of condoms and needles; creating and enabling environment to reduce risky behaviour; providing access to voluntary testing and counselling; home or institutional care for persons with symptomatic HIV infection; and preventing perinatal transmission and transmission through infected needles or blood in health care settings. It is difficult to capture such a large range of activities with one or just a few indicators. However, a set of well-established health care indicators - such as the percentage of a population with access to health care services; the percentage of women covered by antenatal care; or the percentage of immunized children - may help to identify general strengths and weaknesses of health systems. Specific indicators, such as access to testing and blood screening for HIV, help to measure the capacity of health services to respond to HIV/AIDS - related issues.

Access to health care

Indicators Year Estimate Source 

% of population with access to health services - total:
% of population with access to health services - urban:
% of population with access to health services - rural:
Contraceptive prevalence rate (%): 1990-1999 1 UNICEF/UNPOP
 of births attended by trained health personnel: 1990-1999 2 UNICEF
% of 1-yr-old children fully immunized - DPT: 1995-1998 24 UNICEF
% of 1-yr-old children fully immunized - Polio: 1995-1998 24 UNICEF
% of 1-yr-old children fully immunized - Measles: 1995-1998 47 UNICEF
Proportion of blood donations tested:

% of ANC clinics where HIV testing is available: HIV/AIDS Hospital Occupancy Rate (Days):

Knowledge and behaviour

In most countries the HIV epidemic is driven by behaviours (e.g.: multiple sexual partners, intravenous drug use) that expose individuals to the risk of infection. Information on knowledge and on the level and intensity of risk behaviour related to HIV/AIDS is essential in identifying populations most at risk for HIV infection and in better understanding the dynamics of the epidemic. It is also critical information in assessing changes over time as a result of prevention efforts. One of the main goals of the 2nd generation HIV surveillance systems is the promotion of regular behavioural surveys in order to monitor trends in behaviours and target interventions.

Sources

Data presented in this Epidemiological Fact Sheet come from several different sources, including global, regional and country reports, published documents and articles, posters and presentations at international conferences, and estimates produced by UNAIDS, WHO and other United Nations Agencies. This section contains a list of the more relevant sources used for the preparation of the Fact Sheet. Where available, it also lists selected national Web sites where additional information on HIV/AIDS and STI are presented and regularly updated. However, UNAIDS and WHO do not warrant that the information in these sites is complete and correct and shall not be liable whatsoever for any damages incurred as a result of their use.

Ahmed, H. J., K. Omar, S. Y. Adan, et al., 1991, Syphilis and Human Immunodeficiency Virus Seroconversion during a 6-Month Follow-up of Female Prostitutes in Mogadishu, Somalia, International Journal of STD and AIDS, vol. 2, pp. 119-123.
Burans, J. P., E. Fox, M. A. Omar, et al., 1990, HIV Infection Surveillance in Mogadishu, Somalia, East African Medical Journal, vol. 67, no. 7, pp. 466-472.
Corwin, A., J. Olson, M. Omar, et al., 1991, Human Immunodeficiency Viral Type 1 Infection among Prostitutes in Somalia, VII International Conference on AIDS, Florence, Italy, 6/16-21, Poster M.C.3032.
Corwin, A. L., J. G. Olson, M. A. Omar, et al., 1991, HIV-1 in Somalia: Prevalence and Knowledge among Prostitutes, AIDS, vol. 5, no. 7, pp. 902-904.
Duffy, G., Report on STD/HIV Prevalence Study in Somaliland, Ministry of Health and Labor, Somaliland, November 1999.
Ismail, S. O., H. J. Ahmed, L. Grillner, et al., 1990, Sexually Transmitted Diseases in Men in Mogadishu, Somalia, International Journal of STD and AIDS, vol. 1, pp. 102-106.
Jama, H., L. Grillner, G. Biberfeld, et al., 1987, Sexually Transmitted Viral Infection in Various Population Groups in Mogadisbu, Somalia, Genitourinary Medicine, vol. 63, no. 5, pp. 329-332.
Scott, D. A., A. L. Corwin, N. T. Constantine, et al., 1991, Low Prevalence of Human Immunodeficiency Virus-1 (HIV-1), HIV-2, and Human T Cell Lymphotropic Virus-1 Infection in Somalia, American Journal of Tropical Medicine and Hygiene, vol. 45, no. 6, pp. 653-659.