UNAIDS Report Shows Progress, More Funding Needed

SUMMARY Approximately 6.6 million people in resource-limited countries are currently receiving antiretroviral therapy and new infections have fallen by 25%, according to a UNAIDS report released this month. But a downturn in funding raises concern about whether these advances can be sustained.

The UNAIDS report, entitled AIDS at 30: Nations at the Crossroads, was released ahead of last week's UN General Assembly High Level Meeting on AIDS. According to the report, nearly 7 million people in low- and middle-income countries are now receiving treatment -- including 1.4 million who started in 2010 -- but that number must double to about 15 million to provide universal access to everyone in need.

The 30th anniversary of AIDS comes on the heels of the welcome news from the HPTN 052 trial that early antiretroviral therapy (ART) can reduce the risk of HIV transmission by 96% among serodiscordant heterosexual couples, adding urgency to the effort to expand treatment access.

But wider access will not come cheap. An analysis by the Investment Framework Study Group published in the June 11, 2011, issue of The Lancet indicates that global funding for HIV/AIDS would need to increase by about 30% immediately -- to US$ 22 million -- and by 20% over the long-term to achieve adequate treatment and prevention coverage.

Below is an edited excerpt from a UNAIDS press announcement summarizing the AIDS at 30 report's findings. The full report is available free online at www.unaids.org/unaids_resources/aidsat30/aids-at-30.pdf.

Global AIDS Response Continues to Show Results as a Record Number ff People Access Treatment and Rates of New HIV Infections Fall by Nearly 25%

As the world marks 30 years of AIDS, UNAIDS estimates 34 million [30.9 million-36.9 million] people are living with HIV and nearly 30 million [25 million-33 million] people have died of AIDS-related causes since the first case of AIDS was reported on 5 June 1981

From left: Michel Sidibé, UNAIDS Executive Director; Christina Rodriguez, Co-Founder, Smart Youth; Asha-Rose Migiro, Deputy Secretary-General at Press conference on AIDS at 30: Progress of nations, held at UN Headquarters, New York City on June 3, 2011. (Photo: UNAIDS/B. Hamilton)

New York/Geneva -- June 3, 2011 -- About 6.6 million people were receiving antiretroviral therapy in low- and middle-income countries at the end of 2010, a nearly 22-fold increase since 2001, according to a new report AIDS at 30: Nations at the Crossroads, released today by the Joint United Nations Programme on HIV/AIDS (UNAIDS).

A record 1.4 million people started lifesaving treatment in 2010 -- more than any year before. According to the report, at least 420,000 children were receiving antiretroviral therapy at the end of 2010, a more than 50% increase since 2008, when 275,000 children were on treatment.

"Access to treatment will transform the AIDS response in the next decade. We must invest in accelerating access and finding new treatment options," said Michel Sidibé, UNAIDS Executive Director. "Antiretroviral therapy is a bigger game-changer than ever before -- it not only stops people from dying, but also prevents transmission of HIV to women, men and children."

His statement follows the recent HPTN052 trial results which found that if a person living with HIV adheres to an effective antiretroviral regimen, the risk of transmitting the virus to his or her uninfected sexual partner can be reduced by 96%.

"Countries must use the best of what science can offer to stop new HIV infections and AIDS-related deaths," said UN Deputy Secretary-General Asha-Rose Migiro. "We are at a turning point in the AIDS response. The goal towards achieving universal access to HIV prevention, treatment, care and support must become a reality by 2015."

HIV prevention efforts showing results

According to the report, the global rate of new HIV infections declined by nearly 25% between 2001 and 2009. In India, the rate of new HIV infections fell by more than 50% and in South Africa by more than 35%; both countries have the largest number of people living with HIV on their continents.

The report found that in the third decade of the epidemic, people were starting to adopt safer sexual behaviors, reflecting the impact of HIV prevention and awareness efforts. However, there are still important gaps. Young men are more likely to be informed about HIV prevention than young women. Recent Demographic Health Surveys found that an estimated 74% of young men know that condoms are effective in preventing HIV infection, compared to just 49% of young women.

In recent years, there has been significant progress in preventing new HIV infections among children as increasing numbers of pregnant women living with HIV have gained access to antiretroviral prophylaxis during pregnancy, delivery and breastfeeding. The number of children newly infected with HIV in 2009 was 26% lower than in 2001.

About 115 low- and middle-income countries are providing optimal treatment regimens for pregnant women living with HIV as recommended by the World Health Organization (WHO). There are 31 countries that still use sub-optimal regimens in many of their HIV prevention programs. UNAIDS urges all countries using sub-optimal regimens to revise their treatment guidelines and make the transition to optimal WHO recommended regimens.

AIDS is not over -- significant challenges remain

According to the latest estimates from UNAIDS, 34 million [30.9 million-36.9 million] people were living with HIV at the end of 2010 and nearly 30 million [25 million-33 million] have died from AIDS-related causes since AIDS was first reported 30 years ago.

Despite expanded access to antiretroviral therapy, a major treatment gap remains. At the end of 2010, 9 million people who were eligible for treatment did not have access. Treatment access for children is lower than for adults -- only 28% of eligible children were receiving antiretroviral therapy in 2009, compared to 36% coverage for people of all ages.

While the rate of new HIV infections has declined globally, the total number of HIV infections remains high, at about 7000 per day. The global reduction in the rate of new HIV infections hides regional variations. According to the report, above-average declines in new HIV infections were recorded in sub-Saharan Africa and in South-East Asia, while Latin America and the Caribbean experienced more modest reductions of less than 25%. There has been an increase in the rate of new HIV infections in Eastern Europe and in the Middle East and North Africa.

In virtually all countries, HIV prevalence among populations at increased risk of HIV infection -- men who have sex with men, people who inject drugs, sex workers and their clients, and transgender people -- is higher than among other populations. Access to HIV prevention and treatment for populations at higher risk of infection is generally lower due to punitive and discriminatory laws, and stigma and discrimination. As of April 2011, 79 countries, territories and areas criminalize consensual same-sex relations; 116 countries, territories and areas criminalize some aspect of sex work; and 32 countries have laws that allow for the death penalty for drug-related offences.

According to the report, gender inequalities remain a major barrier to effective HIV responses. HIV is the leading cause of death among women of reproductive age, and more than a quarter (26%) of all new global HIV infections are among young women aged 15-24.

AIDS resources declining

According to the report, investments in the HIV response in low- and middle-income countries rose nearly 10-fold between 2001 and 2009, from US$ 1.6 billion to US$ 15.9 billion. However, in 2010, international resources for HIV declined. Many low-income countries remain heavily dependant on external financing. In 56 countries, international donors account for at least 70% of HIV resources.

"I am worried that international investments are falling at a time when the AIDS response is delivering results for people," said Mr Sidibé. "If we do not invest now, we will have to pay several times more in the future."

A 2011 investment framework proposed by UNAIDS and partners found that an investment of at least US$ 22 billion is needed by the year 2015, US$ 6 billion more than is available today. When these investments are directed towards a set of priority programs that are based on a country's epidemic type, the impact is greatest. It is estimated that the return on such an investment would be 12 million new HIV infections averted and 7.4 million AIDS-related deaths averted by the year 2020. The number of new infections would decline from about 2.5 million in 2009 to about 1 million in 2015.

Perspectives on AIDS from leaders around the world

The report features commentaries from 15 leaders in the global AIDS response, including South Africa's President Jacob Zuma, former United States President Bill Clinton, former President of Brasil Luiz Inácio Lula da Silva, the President of Mali, Amadou Toumani Touré, and Jean Ping, Chairperson of the African Union Commission. The commentaries cover a range of areas, such as AIDS funding, South-South cooperation, youth leadership, the empowerment of women, key affected populations, injecting drug use, human rights, stigma and discrimination and systems integration.

Young people leading the HIV prevention revolution

AIDS at 30: Nations at the crossroads also includes an article on a recent event held on Robben Island, South Africa, where Archbishop Desmond Tutu, Co-chair of the UNAIDS High Level Commission on HIV Prevention, passed the baton of leadership in the AIDS response to a new generation of young leaders.

According to the report, some of the most important HIV prevention successes have been led by young people. Data indicate that young people in many heavily affected countries are increasingly adopting safer sexual behaviors.

6/17/11

References

B Schwartlander, J Stover, T Hallett, et al. (Investment Framework Study Group). Towards an improved investment approach for an effective response to HIV/AIDS. The Lancet 377(9782):2031-2041 (free full text with registration). June 11, 2011.

UNAIDS. AIDS at 30: Nations at the Crossroads. June 2011. http://www.unaids.org/unaids_
resources/aidsat30/aids-at-30.pdf.

Other Source

UNAIDS. Global AIDS Response Continues to Show Results as a Record Number ff People Access Treatment and Rates of New HIV Infections Fall by Nearly 25%. Press release. June 3, 2011.