Today, fewer people are dying from HIV/AIDS, tuberculosis and malaria, according to a new, first-of-its-kind analysis of trend data from 188 countries. The pace of decline in deaths and infections has accelerated since 2000, when the Millennium Development Goals (MDGs) were established to stop the spread of these diseases by 2015.
Published in The Lancet on July 22, the study ‘Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013’ was conducted by an international consortium of researchers led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.
The study reveals that HIV/AIDS is claiming more lives in Pakistan than ever. Mortality rates from HIV/AIDS increased 11 per cent annually from 2000 to 2013, while declines in death rates from TB and malaria have accelerated since 2000.
“Working closely with our WHO office [WHO-EMRO], Pakistan has prioritized tackling tuberculosis and malaria, and I think we are seeing what happens when you invest in improving the prompt diagnosis and treatment of these deadly diseases. Now we need to make sure HIV/AIDS does not take more lives in Pakistan than it already has,” said Professor Zulfiqar Bhutta, Founding Director of the Centre of Excellence in Women and Child Health at the Aga Khan University and Co-Director at the Center for Global Child Health at The Hospital for Sick Children, and one of the study’s co-authors. AKU was also represented by Dr Muhammad Imran Nisar, Senior Instructor, Department of Paediatrics and Child Health.
Globally, HIV/AIDS and tuberculosis kill fewer people than they have in the past, and declines in new cases and deaths from these diseases have accelerated since 2000. Worldwide, deaths from HIV/AIDS declined at a rate of 1.5 per cent between 2000 and 2013, while tuberculosis deaths declined at a rate of 3.7 per cent.
Pakistan is experiencing the opposite with HIV/AIDS, as increasingly more people have died from the disease since 1990. From 2000 to 2013, the country averaged a 15 per cent annual increase in rates of new HIV/AIDS infections, ultimately rising from less than 1 case per 100,000 to 6.7 per 100,000. Far more Pakistanis die from TB each year (nearly 37,500 were killed by TB in 2013), but the country’s ongoing progress in reducing TB mortality rates starkly contrasts with its burgeoning HIV/AIDS burden.
After adjusting for differences in population size and ages across time, researchers found that there were 277 cases of TB per 100,000 people in Pakistan for 2013. In terms of new cases, Pakistan recorded 151 TB cases per 100,000 that year.
At 1.5 per 100,000, death rates from HIV/AIDS in Pakistan were higher than what was found in Afghanistan and Iran for 2013 (each were less than 1 death per 100,000), but remained lower than India (6.6 deaths per 100,000). TB death rates in Pakistan (32 deaths per 100,000) were lower those in India (58 deaths per 100,000), but were much higher than the TB mortality rates in Iran for 2013 (2.8 deaths per 100,000).
With progress in reducing HIV/AIDS at the global level, success in particular countries and regions varied as their HIV epidemics peaked and declined at different times. The rise in the rates for HIV/AIDS in Pakistan, at a time when most countries are recording progress against the disease, exemplifies this finding and underscores the need for action. But since HIV/AIDS still claims fewer lives in Pakistan than other infectious diseases, namely tuberculosis, the country may have the opportunity to halt its epidemic earlier than other places could in the past.
“The global investment in HIV treatment is saving lives at a rapid clip,” said Dr Christopher Murray, director of IHME and a co-founder of the Global Burden of Disease study. “But the quality of antiretroviral programmes varies widely. In order to reduce HIV-related deaths even further, we need to learn from the best programmes and do away with the worst ones.”
Earlier and more effective treatment has also helped shorten the duration of tuberculosis infections worldwide. However, the authors note that aging of the population will lead to higher numbers of cases and deaths. In both Pakistan and at the global level, the bulk of tuberculosis deaths tend to occur in older age groups.
The study also assessed trends in annual malaria cases and deaths throughout the world. From 2000 to 2013, Pakistan reduced its malaria mortality rates by an average of 4.6 per cent each year, recording 3,160 malaria deaths in 2013. Pakistan also had reductions, although less pronounced, in malaria cases, dropping 2.9 per cent annually between 2000 and 2013.
Since 2004, child deaths from malaria in sub-Saharan Africa have declined 31.5 per cent. Since 2000, the vast majority of countries – including those in sub-Saharan Africa – saw declines in age-standardized malaria death rates. Annual malaria deaths began to decline from a peak of 1.2 million in 2004 to about 855,000 in 2013, having increased from 888,000 in 1990. The highest rates of age-standardized malaria deaths were in Mozambique, Burkina Faso, Guinea-Bissau, Mali, Sierra Leone, The Gambia, and Guinea.
In comparison to many countries in sub-Saharan Africa and Southeast Asia, malaria claims relatively fewer lives in Pakistan.