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Ending AIDS? These three places show the epidemic is far from over

At first glance, Nigeria, Russia, and Florida have little in common. But each has had difficulty mounting an effective response to HIV/AIDS at a time when neighboring countries or states, buoyed by recent research advances, have made progress toward bringing their epidemics to an end.

Five of the main metrics that public health experts track to gauge progress against HIV are: How many people are living with the virus? What is the rate of new infection? What percentage of infected people are receiving antiretroviral drugs, which both stave off disease and prevent transmission? How many infected people have progressed to AIDS and how many have died from it? And how many children are infected by their mothers?

Much of the world has seen encouraging declines on many of those fronts. But Nigeria, Russia, and Florida stand out from their neighbors and, in some cases, the entire world. None of these three locales has high numbers on every one of these measures. But each ranks first—an unenviable distinction—in at least one of the five metrics assessed by total cases, rates, or proportions.

The aim of this package is not to shame Russia, Nigeria, or Florida, or, given their profound differences in population, politics, and economies, to compare them head-to-head. Rather, these stories describe the distinct challenges that have hampered each locale's response to HIV/AIDS. And they highlight people who are confronting those shortcomings and coming up with tailor-made, local solutions.

Science produced these stories in collaboration with the PBS NewsHourwhich is airing a companion five-part series. Reporting for this project was supported by the Pulitzer Center.

Comparing epidemics

It’s difficult to compare HIV/AIDS epidemics from one place to another because of differences in population size. These radar graphics capture this complexity by charting five different measures for each country or state. The graphic below compares Nigeria, Russia, and the United States with the rest of the world in raw numbers. Although Russia has roughly the same number of people living with HIV as the United States, the paucity of treatment means many more deaths from AIDS and many more new infections. South Africa has more HIV-infected people than any other country, and more people receiving treatment, which explains why it has fewer deaths and fewer newly infected children than Nigeria does. A relatively small country like Mozambique (one-sixth the size of Nigeria) stands out because it has a large number of infected people per population.

HIV/AIDS by country (2016)

Choose a country to see how Nigeria, Russia, and the United States compare to:

Countries where data are not available for at least one measure are not shown. Dropdown menu shows the top 30 countries ranked in new infections.

* ARV stands for antiretroviral treatment.

Nigeria: children at risk

Since 2008, Nigeria has had more cases of mother-to-child transmission (MTCT) than any other country. Nigeria does not have the most severe epidemic in its region, but it has 3.2 million HIV-infected people—a huge challenge. Equatorial Guinea, in contrast, has the highest new infection rate and the highest prevalence of HIV, but it has a total population of only 1.2 million.

HIV in Western and Central Africa

Choose a country to see how Nigeria compares to:

Countries where data are not available for at least one measure are not shown.

Children newly infected with HIV, all countries

South Africa 60,000 40,000 20,000 80,000 0 Nigeria 1990 2000 2010 2016

Russia: a growing problem

Russia’s rate of new infection outstrips every other country in Eastern Europe and Central Asia—even Ukraine, which has more infected people per capita. Limited access to ARV drugs contributes to the country’s high rate of new infections, because untreated people are more likely to transmit the virus. But Russia has succeeded in sharply reducing MTCT.

HIV in Eastern Europe and Central Asia

Choose a country to see how Russia compares to:

Countries where data are not available for at least one measure are not shown.

New infection rate, Eastern Europe and Central Asia

0.6 0.4 0.2 0.8 0 2006 2010 2014 2008 2012 2016 Russia Ukraine Annual (per 1000)

Florida: high across the board

Compared with other U.S. states, Florida has a big problem. Georgia has the highest rates of new infection, but half the population of Florida. New York has a larger infected population, but has a lower death rate and fewer new infections. The United States only had 122 newly diagnosed children in 2016—some detected late and possibly born elsewhere—but Florida again stands out.

HIV in U.S. states

Choose a state to see how Florida compares to:

States where data are not available for at least one measure are not shown.

** “Newly infected” is used interchangeably with “newly diagnosed” even though diagnosis often happens long after infection.

Transmission routes in Florida

Homosexual Heterosexual Needle sharing Homosexual andneedle sharing Other