Publication: A Comprehensive Review of Empirical and Modeled HIV Incidence Trends (1990-2012)
Loading...
Date
2014-09
ISSN
Published
2014-09
Editor(s)
Abstract
An accurate measurement of HIV incidence is a key for policy makers and HIV program managers directing national HIV response. However, there is no perfect method to measure or estimate the rate at which new HIV infections occur in a population. This review compiles and triangulates longitudinal HIV incidence and prevalence data from published studies and trials, national reports and surveys, and the Joint United Nations Programme on HIV/AIDS estimates from the Spectrum model, focusing on 20 countries in Sub-Saharan Africa with generalized HIV epidemics. Three main points can be taken from this analysis of HIV incidence trends. First, modeled HIV incidence and nationally reported HIV prevalence levels in young females suggest that national HIV incidence has declined since 2000 in all except three countries analyzed (stable estimated HIV trends in Burkina Faso, Burundi, and Uganda), but trial and survey data suggest that in some demographics, HIV incidence remains critically high. Second, all modeled national HIV incidence curves and most empirically observed trends commenced a downward trajectory prior to the introduction of anti-retroviral therapy programs around 2004, suggesting the contribution of other factors, such as HIV prevention programs and natural epidemic dynamics, to this decline. Third, modeled HIV incidence estimates, including the incidence peaks in the past, exhibit much variation between Spectrum model versions and when new data are added, emphasizing the uncertainty of model outputs and the need to use incidence estimates with caution.
Link to Data Set
Citation
“Taaffe, Jessica; Fraser-Hurt, Nicole; Gorgens, Marelize; Harimurti, Pandu. 2014. A Comprehensive Review of Empirical and Modeled HIV Incidence Trends (1990-2012). Policy Research Working Paper;No. 7042. © http://hdl.handle.net/10986/20378 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Publication The Future of Poverty(Washington, DC: World Bank, 2025-07-15)Climate change is increasingly acknowledged as a critical issue with far-reaching socioeconomic implications that extend well beyond environmental concerns. Among the most pressing challenges is its impact on global poverty. This paper projects the potential impacts of unmitigated climate change on global poverty rates between 2023 and 2050. Building on a study that provided a detailed analysis of how temperature changes affect economic productivity, this paper integrates those findings with binned data from 217 countries, sourced from the World Bank’s Poverty and Inequality Platform. By simulating poverty rates and the number of poor under two climate change scenarios, the paper uncovers some alarming trends. One of the primary findings is that the number of people living in extreme poverty worldwide could be nearly doubled due to climate change. In all scenarios, Sub-Saharan Africa is projected to bear the brunt, contributing the largest number of poor people, with estimates ranging between 40.5 million and 73.5 million by 2050. Another significant finding is the disproportionate impact of inequality on poverty. Even small increases in inequality can lead to substantial rises in poverty levels. For instance, if every country’s Gini coefficient increases by just 1 percent between 2022 and 2050, an additional 8.8 million people could be pushed below the international poverty line by 2050. In a more extreme scenario, where every country’s Gini coefficient increases by 10 percent between 2022 and 2050, the number of people falling into poverty could rise by an additional 148.8 million relative to the baseline scenario. These findings underscore the urgent need for comprehensive climate policies that not only mitigate environmental impacts but also address socioeconomic vulnerabilities.Publication Exports, Labor Markets, and the Environment(Washington, DC: World Bank, 2025-07-14)What is the environmental impact of exports? Focusing on 2000–20, this paper combines customs, administrative, and census microdata to estimate employment elasticities with respect to exports. The findings show that municipalities that faced increased exports experienced faster growth in formal employment. The elasticities were 0.25 on impact, peaked at 0.4, and remained positive and significant even 10 years after the shock, pointing to a long and protracted labor market adjustment. In the long run, informal employment responds negatively to export shocks. Using a granular taxonomy for economic activities based on their environmental impact, the paper documents that environmentally risky activities have a larger share of employment than environmentally sustainable ones, and that the relationship between these activities and exports is nuanced. Over the short run, environmentally risky employment responds more strongly to exports relative to environmentally sustainable employment. However, over the long run, this pattern reverses, as the impact of exports on environmentally sustainable employment is more persistent.Publication The Macroeconomic Implications of Climate Change Impacts and Adaptation Options(Washington, DC: World Bank, 2025-05-29)Estimating the macroeconomic implications of climate change impacts and adaptation options is a topic of intense research. This paper presents a framework in the World Bank's macrostructural model to assess climate-related damages. This approach has been used in many Country Climate and Development Reports, a World Bank diagnostic that identifies priorities to ensure continued development in spite of climate change and climate policy objectives. The methodology captures a set of impact channels through which climate change affects the economy by (1) connecting a set of biophysical models to the macroeconomic model and (2) exploring a set of development and climate scenarios. The paper summarizes the results for five countries, highlighting the sources and magnitudes of their vulnerability --- with estimated gross domestic product losses in 2050 exceeding 10 percent of gross domestic product in some countries and scenarios, although only a small set of impact channels is included. The paper also presents estimates of the macroeconomic gains from sector-level adaptation interventions, considering their upfront costs and avoided climate impacts and finding significant net gross domestic product gains from adaptation opportunities identified in the Country Climate and Development Reports. Finally, the paper discusses the limits of current modeling approaches, and their complementarity with empirical approaches based on historical data series. The integrated modeling approach proposed in this paper can inform policymakers as they make proactive decisions on climate change adaptation and resilience.Publication The Asymmetric Bank Distress Amplifier of Recessions(Washington, DC: World Bank, 2025-07-11)One defining feature of financial crises, evident in U.S. and international data, is asymmetric bank distress—concentrated losses on a subset of banks. This paper proposes a model in which shocks to borrowers’ productivity dispersion lead to asymmetric bank losses. The framework exhibits a “bank distress amplifier,” exacerbating economic downturns by causing costly bank failures and raising uncertainty about the solvency of banks, thereby pushing banks to deleverage. Quantitative analysis shows that the bank distress amplifier doubles investment decline and increases the spread by 2.5 times during the Great Recession compared to a standard financial accelerator model. The mechanism helps explain how a seemingly small shock can sometimes trigger a large crisis.Publication Impact of Heat Waves on Learning Outcomes and the Role of Conditional Cash Transfers(Washington, DC: World Bank, 2025-07-14)This paper evaluates the impact of higher temperatures on learning outcomes in Peru. The results suggest that 1 degree above 20°C is equivalent to 7 and 6 percent of a standard deviation of what a student learns in a year for math and reading tests, respectively. These results hold true when the main specification is changed, splitting the sample, collapsing the data at school level, and using other climate specifications. The paper aims to improve understanding of how to deal with the impacts of climate change on learning outcomes in developing countries. The evidence suggests that conditional cash transfer programs can mitigate the negative effects of higher temperatures on students’ learning outcomes in math and reading.
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication West Africa HIV/AIDS Epidemiology and Response Synthesis : Implications for Prevention(Washington, DC, 2008-11)This synthesis paper describes the HIV epidemics in 15 West African countries - Benin, Burkina Faso, Cote d'Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, Togo, Cape Verde, The Gambia, Guinea Bissau, Liberia, and Sierra Leone. It focuses particularly on the degree to which the epidemics in each country are concentrated or generalized, and the implications for effective prevention. The urgent need for rigorous analytic work to equip countries with a sound, situation-specific analytical base for action motivated this study. The analysis team critically reviewed and interpreted all available surveillance, survey and research data (the amount and quality of which varied considerably by country). For the first ten countries listed, short country visits enabled interviews and more thorough search for data and other information, and the programmatic response to the HIV/AIDS epidemic was also assessed to develop recommendations for improving resource allocation and program effectiveness.Publication Swaziland - HIV Prevention Response and Modes of Transmission Analysis(World Bank, 2009-03-01)The purpose of this modes of transmission (MoT) study is 'to contribute to the ongoing efforts to understand the epidemic and response in Swaziland and thus help the country improve the scope (doing the right kind of activities), relevance (with the right populations), and comprehensiveness (reaching all members of target populations) of Human Immunodeficiency Virus (HIV) prevention efforts'. The process for the Know Your Epidemic (KYE) was an in-depth review of available epidemiological data from Swaziland and the sub-region, and application of the UNAIDS incidence estimation model. The aim was to determine the epidemiology of new (incident) infections. For the Know Your Response (KYR) part, data were collected on the policy context for prevention, prevention and prevention activities by implementers, and data from the National AIDS Spending Assessment (NASA) of 2008 were reviewed. In a final step, the KYE and KYR evidence was linked to produce an epidemic, response and policy synthesis with recommendations to improve the HIV prevention response through aligning prevention activities with the evidence on the sources of new infections. The study examined the hypothesis that multiple, concurrent long-term heterosexual relationships, happening in a context of implicitly permissive social norms, gender inequality and economic need, are a key contributor to HIV transmission in Swaziland.Publication The New HIV/AIDS Program in Peru : The Role of Prioritizing and Budgeting for Results(World Bank Group, Washington, DC, 2015-01)This study aims to evaluate and develop recommendations on how the HIV/AIDS program in Peru can achieve better Value for Money. In Peru, the HIV epidemic concentrates mostly among men who have sex with men (MSM), with AIDS being the first cause of death for men ages 30-49 in 2010 and the second cause of death for women aged 25-34 (BOD, 2013). UNAIDS (2013) estimates there were 76,000 people living with HIV/AIDS (PLWA) in 2012, and this study estimates 67,000 PLWA in 2013. The Ministry of Health reports that 27,502 PLWA currently receive ART, a 43-48 percent coverage of eligible people, and 66 percent coverage of all diagnosed eligible individuals (WHO, 2013 guidelines). In 2011, there was a transition from international to domestic public funding, which increased from US$17.7 million in 2005-10 to US$57.8 million in 2011-13. The main achievements of the Peru HIV/AIDS program to date include: (i) collaboration with NGOs to provide ART; (ii) free provision of ART; (iii) educating poor women on mother to child HIV transmission; and (iv) access to reduced ARV prices through the PAHO Drug Fund. Major challenges include: (i) limited testing and laboratory capacity in the provinces; (ii) less than half of the budget is allocated to high-risk groups; (iii) wage bill issued by other programs and; (iv) limited number of community health workers (CHWs) for IEC.Publication Kenya - HIV Prevention Response and Modes of Transmission Analysis(World Bank, 2009-03-01)In 2007, an estimated 33.2 million people in the world were living with HIV, and despite twenty years of prevention programmes, an estimated 2.5 million new infections occurred in that year. Underpinning the shortcoming in the prevention response is the inadequate use of evidence to inform the response. The result has been largely ineffective prevention interventions, with non-optimal use of available resources and the loss of early opportunities to address the unique factors driving infection in the populations most at risk within the country. The overall objective of this study is: 'to contribute to the ongoing efforts to understand the epidemic and response in Kenya and thus help the country improve the scope (doing the right kind of activities), relevance (with the right populations) and comprehensiveness (reaching all members of target populations) with HIV prevention efforts', with an ultimate goal of helping Kenya make more effective HIV/AIDS-related decisions. The report then assesses the relevance, comprehensiveness and cost of major HIV responses in relation to the epidemiological analysis and policy environment, and draws some conclusions about the state of the epidemic and about whether the prevention responses (and the resources allocated to them) are congruent with the evidence on where resources should best be directed. This study describes the epidemiology of HIV in Kenya over time: trends in HIV prevalence and incidence, magnitude and current phase of the epidemic, the main transmission pathways for new infections; and the heterogeneity of the HIV epidemic (by sex, geography, age group, and risk behaviors).Publication World Bank-Financed HIV Projects in the Caribbean(World Bank, Washington, DC, 2010-10)This paper summarizes the key findings of an 'After Action Review' (AAR) that reflects a decade of experience in designing and implementing ten HIV/AIDS projects in the Caribbean, financed by the World Bank. The objective is to identify what worked (and what didn't) in the project approach, design and implementation, distilling useful lessons for other projects in small states.
Users also downloaded
Showing related downloaded files
Publication Argentina Country Climate and Development Report(World Bank, Washington, DC, 2022-11)The Argentina Country Climate and Development Report (CCDR) explores opportunities and identifies trade-offs for aligning Argentina’s growth and poverty reduction policies with its commitments on, and its ability to withstand, climate change. It assesses how the country can: reduce its vulnerability to climate shocks through targeted public and private investments and adequation of social protection. The report also shows how Argentina can seize the benefits of a global decarbonization path to sustain a more robust economic growth through further development of Argentina’s potential for renewable energy, energy efficiency actions, the lithium value chain, as well as climate-smart agriculture (and land use) options. Given Argentina’s context, this CCDR focuses on win-win policies and investments, which have large co-benefits or can contribute to raising the country’s growth while helping to adapt the economy, also considering how human capital actions can accompany a just transition.Publication The Journey Ahead(Washington, DC: World Bank, 2024-10-31)The Journey Ahead: Supporting Successful Migration in Europe and Central Asia provides an in-depth analysis of international migration in Europe and Central Asia (ECA) and the implications for policy making. By identifying challenges and opportunities associated with migration in the region, it aims to inform a more nuanced, evidencebased debate on the costs and benefits of cross-border mobility. Using data-driven insights and new analysis, the report shows that migration has been an engine of prosperity and has helped address some of ECA’s demographic and socioeconomic disparities. Yet, migration’s full economic potential remains untapped. The report identifies multiple barriers keeping migration from achieving its full potential. Crucially, it argues that policies in both origin and destination countries can help maximize the development impacts of migration and effectively manage the economic, social, and political costs. Drawing from a wide range of literature, country experiences, and novel analysis, The Journey Ahead presents actionable policy options to enhance the benefits of migration for destination and origin countries and migrants themselves. Some measures can be taken unilaterally by countries, whereas others require close bilateral or regional coordination. The recommendations are tailored to different types of migration— forced displacement as well as high-skilled and low-skilled economic migration—and from the perspectives of both sending and receiving countries. This report serves as a comprehensive resource for governments, development partners, and other stakeholders throughout Europe and Central Asia, where the richness and diversity of migration experiences provide valuable insights for policy makers in other regions of the world.Publication Lebanon Economic Monitor, Fall 2022(Washington, DC, 2022-11)The economy continues to contract, albeit at a somewhat slower pace. Public finances improved in 2021, but only because spending collapsed faster than revenue generation. Testament to the continued atrophy of Lebanon’s economy, the Lebanese Pound continues to depreciate sharply. The sharp deterioration in the currency continues to drive surging inflation, in triple digits since July 2020, impacting the poor and vulnerable the most. An unprecedented institutional vacuum will likely further delay any agreement on crisis resolution and much needed reforms; this includes prior actions as part of the April 2022 International Monetary Fund (IMF) staff-level agreement (SLA). Divergent views among key stakeholders on how to distribute the financial losses remains the main bottleneck for reaching an agreement on a comprehensive reform agenda. Lebanon needs to urgently adopt a domestic, equitable, and comprehensive solution that is predicated on: (i) addressing upfront the balance sheet impairments, (ii) restoring liquidity, and (iii) adhering to sound global practices of bail-in solutions based on a hierarchy of creditors (starting with banks’ shareholders) that protects small depositors.Publication Classroom Assessment to Support Foundational Literacy(Washington, DC: World Bank, 2025-03-21)This document focuses primarily on how classroom assessment activities can measure students’ literacy skills as they progress along a learning trajectory towards reading fluently and with comprehension by the end of primary school grades. The document addresses considerations regarding the design and implementation of early grade reading classroom assessment, provides examples of assessment activities from a variety of countries and contexts, and discusses the importance of incorporating classroom assessment practices into teacher training and professional development opportunities for teachers. The structure of the document is as follows. The first section presents definitions and addresses basic questions on classroom assessment. Section 2 covers the intersection between assessment and early grade reading by discussing how learning assessment can measure early grade reading skills following the reading learning trajectory. Section 3 compares some of the most common early grade literacy assessment tools with respect to the early grade reading skills and developmental phases. Section 4 of the document addresses teacher training considerations in developing, scoring, and using early grade reading assessment. Additional issues in assessing reading skills in the classroom and using assessment results to improve teaching and learning are reviewed in section 5. Throughout the document, country cases are presented to demonstrate how assessment activities can be implemented in the classroom in different contexts.Publication World Development Report 2006(Washington, DC, 2005)This year’s Word Development Report (WDR), the twenty-eighth, looks at the role of equity in the development process. It defines equity in terms of two basic principles. The first is equal opportunities: that a person’s chances in life should be determined by his or her talents and efforts, rather than by pre-determined circumstances such as race, gender, social or family background. The second principle is the avoidance of extreme deprivation in outcomes, particularly in health, education and consumption levels. This principle thus includes the objective of poverty reduction. The report’s main message is that, in the long run, the pursuit of equity and the pursuit of economic prosperity are complementary. In addition to detailed chapters exploring these and related issues, the Report contains selected data from the World Development Indicators 2005‹an appendix of economic and social data for over 200 countries. This Report offers practical insights for policymakers, executives, scholars, and all those with an interest in economic development.