This is the first blog in a two-part series. You can read the second part here.
In advance of World AIDS Day, which takes place on December 1 each year, UNAIDS has released its annual report on the epidemic. We are making significant progress against HIV/AIDS, as a number of scientific discoveries in recent years, further global and local engagement, and an unprecedented rise in access to treatment have meant fewer new infections and deaths. In this post, I’d like to focus on the good news: how far we’ve come since the epidemic began more than thirty years ago. To avoid confusion from the get-go, the UNAIDS Global Report focuses on results in 2011. For a more digestible snapshot, check out the UNAIDS World AIDS Day report, which is full of gorgeous infographics.
The UNAIDS report is more positive than it has ever been, insisting that the end of AIDS is “entirely feasible.” In 24 months–between 2009 and 2011–60 percent more people were accessing antiretroviral therapy (ART), which has saved lives and prevented infections, now that we know that treatment can drop viral loads to almost zero, vastly decreasing the risk of passing the virus on to others. In 25 low- and middle-income countries, new infection rates have dropped 50 percent in ten years. Thirteen of those countries are in sub-Saharan Africa. That’s an unbelievable achievement. Overall, new infections have dropped 20 percent globally since 2001. Apart from wider availability of ART and great international investment in HIV programs, this meteoric rise in access was achieved by lowering costs through more affordable drug prices and task-shifting responsibilities from overworked doctors to nurses and other healthcare workers.
Half of the reductions of new HIV infections were among children, which means that efforts to scale up prevention of mother-to-child transmission (PMTCT) interventions are working. Michel Sidibé, the executive director of UNAIDS, writes in his opening letter that these results have “emboldened our conviction that achieving an AIDS-free generation is not only possible, but imminent.” There was a 43 percent reduction in MTCT since 2003, with more than half of that reduction occurring between 2009 and 2011. According to UNAIDS this was the result of scaling prophylactic ART and infant feeding-based prevention efforts.
Behavior change, miraculously, is happening. The report finds that among many countries with generalized epidemics, young people are not engaging in as much risky sexual behavior, such as having sex early, not using condoms, and having multiple partners. Behavior change is a complex, tricky issue–as the report points out. It requires individual and social shifts and remains a key barrier to a number of health, environmental, and other issues, of which HIV prevention is only one. This illustrates that some aspects of behavior change programs are working–and that funding should continue for condom promotion, safe sex, and other initiatives.
National governments have stepped up their roles in combating the epidemic. A record number of countries–186, or 96 percent of U.N. member states–reported national HIV/AIDS data to UNAIDS. This means a more expanded view of AIDS globally and illustrates that increasing numbers of countries are tracking and trying to understand how their epidemics look. Some countries are also successfully integrating HIV into their general health systems. This eliminates the need for siloed, vertical responses, which is strengthening health systems, decreasing costs, and better addressing issues such as HIV and tuberculosis (TB) coinfection. TB-related deaths among people living with HIV have dropped by a quarter since 2004.
Although marginalized and high-risk populations are often left out of AIDS plans, some countries are improving their efforts to reach female sex workers. Three-quarters of the countries who reported to UNAIDS said that they had implemented risk reduction programs for sex workers, and the available data on this population is growing. There is much, much more to be done for marginalized populations, as I will discuss in my next post, and especially so when those populations are also criminalized. But the fact that a larger number of countries are recognizing the centrality of harm reduction strategies to combat HIV/AIDS among sex workers, instead of punitive measures, is a heartening trend.
Furthermore, in a new trend, domestic spending on HIV programs increased 15 percent from 2010 in low- and middle-income countries. This is the first time in the history of the epidemic that the majority of funding is coming from domestic sources (public and private) rather than international aid agencies, NGOs, and foundations. Many emerging economies–such as South Africa, which increased its domestic funding fivefold between 2006 and 2009–are now in the position to shoulder more of the cost of HIV/AIDS. This means that locally tailored solutions are more possible and that the ever-present funding gap is decreasing.
And still, there is so much to be done, and there are only a thousand days to go before we reach 2015–the deadline for current global AIDS targets. In my next post, I’ll discuss the gaps and some possible ways forward to put AIDS fully behind us. As UNAIDS points out, we’re so close to getting there.
Header photo, showing a decrease in HIV prevalence in the Kabuga Health Center in Rwanda, is courtesy of the Gates Foundation, via Flickr, CC BY 2.0.