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close this bookEpidemiological Fact Sheet on HIV/AIDS and Sexually Transmitted Infections: Nicaragua (UNAIDS, 2000, 12 p.)
View the document(introduction...)
View the documentCountry Information
View the documentEstimated number of people living with HIV/AIDS
View the documentHIV sentinel surveillance
View the documentReported AIDS cases
View the documentCurable Sexually Transmitted Infections (STIs)
View the documentHealth service indicators
View the documentKnowledge and behaviour
View the documentSources:
View the documentAnnex: HIV Surveillance data by site

(introduction...)

2000 Update

Country Information


Population pyramid, 1999

Indicators

Year

Estimate

Source

Total Population (thousands)

1999

4,938

UNPOP

Population Aged 15-49 (thousands)

1999

2,366

UNPOP

Annual Population Growth

1990-1998

2.8

UNPOP

% of Population Urbanized

1998

62

UNPOP

Average Annual Growth Rate of Urban Population

1990-1998

3.4

UNPOP

GNP Per Capita (US$)

1997

410

World Bank

GNP Per Capita Average Annual Growth Rate

1996-1997

10.4

World Bank

Human Development Index Rank (HDI)

1999

121

UNDP

% Population Economic Active


33.6

ILO

Unemployment Rate

1997

13.3

ILO

Total Adult Literacy Rate

1995

66

UNESCO

Adult Male Literacy Rate

1995

65

UNESCO

Adult Female Literacy Rate

1995

67

UNESCO

Male Secondary School Enrollment Ratio

1997

43.4

UNESCO

Female Secondary School Enrollment Ratio

1997

51.1

UNESCO

Crude Birth Rate (births per 1,000 pop.)

1999

35

UNPOP

Crude Death Rate (deaths per 1,000 pop.)

1999

16

UNPOP

Maternal Mortality Rate (per 100,000 live births)

1990

370

WHO

Life Expectancy at Birth

1998

51

UNPOP

Total Fertility Rate

1998

4.9

UNPOP

Infant Mortality Rate (per 1,000 live births)

1999

68

UNICEF/UNPOP

Contact address:

UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance
20, Avenue Appia
CH-1211 Geneva 27
Switzerland
Fax: +41 22 791 4878
email: surveillance@UNAIDS.org
http://www.who.ch/emc/diseases/hiv
http://www.unaids.org

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.

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 agreed-upon 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-to-child 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

4900



Adults (15-49)

4800

Adult rate (%)

0.20

Women (15-49)

1200



Children (0-15)

<100



Estimated number of deaths due to AIDS

Estimated number of adults and children who died of AIDS during 1999:

Deaths in 1999

360

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

520

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

427

Assessment of epidemiological situation – Nicaragua

There is no information on HIV prevalence among antenatal women from Nicaragua.

A study conducted in Managua in 1990-91 reported that over one percent of sex workers tested were HIV positive.

There is no information available on HIV prevalence among male STD clinic patients or IVDU.

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 HIV-prevalence 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.

HIV prevalence in selected populations in percent (for blood donors: 1/100 000)

Group

Area


1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

Pregnant women

Major Urban Areas

N-sites



















Minimum



















Median



















Maximum

















Pregnant women

Outside Major Urban Areas

N-sites



















Minimum



















Median



















Maximum

















Group

Area


1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

Sex workers

Major Urban Areas

N-sites








1











Minimum








1.6











Median








1.6











Maximum








1.6









Sex workers

Outside Major Urban Areas

N-sites



















Minimum



















Median



















Maximum

















Group

Area


1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

Injecting drug users

Major Urban Areas

N-sites



















Minimum



















Median



















Maximum

















Injecting drug users

Outside Major Urban Areas

N-sites



















Minimum



















Median



















Maximum

















Group

Area


1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

STI patients

Major Urban Areas

N-sites



















Minimum



















Median



















Maximum

















STI patients

Outside Major Urban Areas

N-sites



















Minimum



















Median



















Maximum

















Group

Area


1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

Blood Donors

National

N-sites



















Minimum



















Median



















Maximum

















Blood Donors

Major Urban Areas

N-sites



















Minimum



















Median



















Maximum

















Group

Area


1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

Men having sex with men

Major Urban Areas

N-sites



















Minimum



















Median



















Maximum

















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.


SENTINEL SURVEILLANCE IN PREGNANT WOMEN


SENTINEL SURVEILLANCE IN HIGH RISK POPULATIONS *

* (Sex workers, STI patients, Injecting drug users)

The boundaries and names shown and the designations used on these maps 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.

Reported AIDS cases

AIDS cases by year of reporting

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

Total

Unkn

0

0

0

0

0

0

0

0

1

3

3

9

13

10

24

38

21

25

18

10

2

182

5

Date of last report: 30-04-1999

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).

AIDS cases by mode of transmission

Hetero: Heterosexual contacts.

Homo/Bi: Homosexual contacts between men.

IDU: Injecting drug use. This transmission category also includes cases in which other high-risk behaviours were reported, in addition to injection of drugs.

Blood: Blood and blood products.

Perinatal: Vertical transmission during pregnancy, birth or breastfeeding.

NS: Not specified/unknown.

Sex

Trans. Group

<96

1996

1997

1998

1999 Unkn

Total

%

All

Total

122

20

18

10

2

172

100.0


Hetero

57

8

8

9

0

82

47.7


Homo/Bi

52

9

10

1

0

72

41.9


IDU

10

2

0

0

0

12

7.0


Blood

2

0

0

0

0

2

1.2


Perinatal

1

1

0

0

0

2

1.2


Other Known

0

0

0

0

0

0

0.0


Unknown

0

0

0

0

0

0

0.0

Male

Total









Hetero









Homo/Bi









IDU









Blood









Perinatal









Other Known









Unknown








Female

Total









Hetero









IDU









Blood









Perinatal









Other Known









Unknown








NS

Total









Hetero









IDU









Blood









Perinatal









Other Known









Unknown








Aids cases by age and sex

Sex

Age

<96

1996

1997

1998

1999

Unkn.

Total

%


All









All











0-4










5-9










10-14










15-19










20-24










25-29










30-34










35-39










40-44










45-49










50-54










55-59










60+










NS









Male

All










0-4










5-9










10-14










15-19










20-24










25-29










30-34










35-39










40-44










45-49










50-54










55-59










60+










NS









Female

All










0-4










5-9










10-14










15-19










20-24










25-29










30-34










35-39










40-44










45-49










50-54










55-59










60+










NS









NS

All










0-4










5-9










10-14










15-19










20-24










25-29










30-34










35-39










40-44










45-49










50-54










55-59










60+










NS









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.

Estimated incidence and prevalence of curable STIs


Incidence

Prevalence

STI's

Year

Male

Female

All

Year

Male

Female

All

Chlamydia trach.









Gonorrhoea









Syphilis









Trichomonas









Comments:
Source:

STI Incidence, men

Prevention Indicator 9: Proportion of men aged 15-49 years who reported episodes of urethritis in the last 12 months.

Year

Area

Age

Rate

N=






Comments:
Sources:

STI Prevalence, women

Prevention Indicator 8: Proportion of pregnant women aged 15-24 years attending antenatal clinics whose blood has been screened with positive serology for syphilis.

Year

Area

Age

Rate

N=






Comments:
Sources:

STI Case management (counselled)

Prevention Indicator 7: Proportion of people presenting with STI or for STI care in health facilities who received basic advice on condoms and on partner notification.

Year

Area

Age

Rate

N=






Comments:
Sources:

STI Case management (treatments)

Prevention Indicator 6: Proportion of people presenting with STI in health facilities assessed and treated in an appropriate way (according to national standards).

Year

Area

Age

Rate

N=






Comments:
Sources:

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

60

UNICEF/UNPOP

% of births attended by trained health personnel:

1990-1999

65

UNICEF

% of 1-yr-old children fully immunized – DPT:

1995-1998

69

UNICEF

% of 1-yr-old children fully immunized – Polio:

1995-1998

73

UNICEF

% of 1-yr-old children fully immunized – Measles:

1995-1998

71

UNICEF

Proportion of blood donations tested:




% of ANC clinics where HIV testing is available:




HIV/AIDS Hospital Occupancy Rate (Days):




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 Programmes implement activities to increase both availability of and access to condoms. The two condom availability indicators below are intended to highlight areas of strength and weakness at the beginning and end of the distribution system so that programmatic resources can be directed appropriately to problem areas.

Condom availability (central level)

Prevention Indicator 2: Availability of condoms in the country over the last 12 months (central level).

Year

Area

N

Rate





Comments:
Sources:

Condom availability (peripheral level)

Prevention Indicator 3: Proportion of people who can acquire a condom (peripheral level).

Year

Area

N

Rate





Comments:
Sources:

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.

Knowledge of HIV- related preventive practices

Prevention Indicator 1: Proportion of people citing at least two acceptable ways of protection from HIV infection.

Year

Area

Age Group

Male

Female

All







Comments:
Sources:

Reported non-regular sexual partnerships

Prevention Indicator 4: Proportion of sexually active people having at least one sex partner other than a regular partner in the last 12 months.

Year

Area

Age Group

Male

Female

All







Comments:
Sources:

Reported condom use in risk sex (gen pop)

Prevention Indicator 5: Proportion of people reporting the use of a condom during the most recent intercourse of risk.

Year

Area

Age Group

Male

Female

All







Comments:
Sources:

Ever use of condom

Percentage of people who ever used a condom.

Year

Area

Age Group

Male

Female

All







Comments:
Sources:

Median age at first sexual experience

Median age of people at which they first had sexual intercourse.

Year

Area

Age Group

Male

Female

All







Comments:
Sources:

Year

Area

Age Group

Male

Female

All

1997

All

20-24


18.2


1997

All

45-49


17.8


Comments:


Sources:

DHS/1993

Adolescent pregnancy

Percentage of teenagers 15-19 who are mothers or pregnant with their first child.

Year

Area

Age Group

Rate

N






Comments:
Sources:

Proportion of people ever having had sex with same sex

Year

Area

Age Group

Rate

N






Comments:
Sources:

Reported non-regular sexual partnerships (MSM)

Year

Area

Age Group

Rate

N






Comments:
Sources:

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.

Low, N., G. D. Smith, A. Gorter, et al., 1990, AIDS and Migrant Populations in Nicaragua, Lancet, vol. 336, no. 8782/8783, pp. 1593 1594. Nicaragua, 1991, PAHO/WHO HIV Surveillance, Pan American Health Organization/World Health Organization.

Websites:

Annex: HIV Surveillance data by site

Group

Area


1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

Pregnant women

Major Urban Areas

N-sites



















Minimum



















Median



















Maximum

















Pregnant women

Outside Major Urban Areas

N-sites



















Minimum



















Median



















Maximum

















Group

Area


1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

Sex workers

Major Urban Areas

N-sites



















Minimum



















Median



















Maximum

















Sex workers

Outside Major Urban Areas

N-sites



















Minimum



















Median



















Maximum

















Group

Area


1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

Injecting drug users

Major Urban Areas

N-sites



















Minimum



















Median



















Maximum

















Injecting drug users

Outside Major Urban Areas

N-sites



















Minimum



















Median



















Maximum

















Group

Area


1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

STI patients

Major Urban Areas

N-sites



















Minimum



















Median



















Maximum

















STI patients

Outside Major Urban Areas

N-sites



















Minimum



















Median



















Maximum

















Group

Area


1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

Blood Donors

National

N-sites



















Minimum



















Median



















Maximum

















Blood Donors

Major Urban Areas

N-sites



















Minimum



















Median



















Maximum

















Group

Area


1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

Men having sex with men

Major Urban Areas

N-sites



















Minimum



















Median



















Maximum