Major gains in stemming AIDS
Windhoek – Major strides have been recorded in the global fight against HIV and AIDS, with a remarkable decline in new infections among adults and children as well as reduction in deaths recorded in the past decade. The Joint United Nations Programme on HIV/AIDS (UNAIDS) in its newly-released 2013 report on the pandemic points to a dramatic acceleration towards global targets of eliminating HIV and AIDS.
The UN agency declares in its annual report that the world is within reach of providing antiretroviral therapy (ART) to 15 million people by 2015. Last year, 9.7 million people in low and middle-income countries received ART, representing 61 percent of all who were eligible under the 2010 World Health Organisation (WHO) HIV treatment guidelines.
But under the 2013 WHO guidelines, UNAIDS noted that HIV treatment coverage in low- and middle-income countries represented only 34 percent of the 28.3 million people eligible in 2013. The new HIV treatment guidelines recommend offering ART earlier, with recent evidence indicating that initiation to treatment earlier has resulted in people with HIV having longer, healthier lives, and has substantially reduced the risk of transmitting HIV to others.
Earlier treatment could avert three million deaths and prevent 3.5 million new HIV infections between now and 2025. The UNAIDS report summarises progress towards the targets and elimination commitments established in the 2011 UN Political Declaration, which supports achievement of Millennium Development Goal 6. That goal is to halt and begin reversing spread of the pandemic.
It describes both gains and persistent challenges for 10 specific targets and commitments set by UN member states. Among others, these include to eliminate HIV infections among children and reduce maternal deaths as well as reaching 15 million people living with HIV with life-saving ARVs by the end of 2013.
UNAIDS says ART does not only have potential to significantly reduce the risk of contracting HIV, but has averted 6.3 million AIDS-related deaths worldwide – including 5.2 million deaths in low and middle income countries since 1996. And despite historic gains in expanding treatment services, UNAIDS cautions that efforts to reach universal treatment access face considerable challenges.
In addition to persistent low treatment coverage for children, on a global level men are notably less likely than women to start ART, and key populations often experience major barriers to obtaining treatment and care services.
Only relatively modest gains in treatment access have occurred in Eastern Europe, Central Asia, North Africa and the Middle East. Globally, an estimated 35.3 million people were living with HIV in 2012 ‑ an increase from previous years as more people are receiving life-saving and life-prolonging ART.
There were 2.3 million new HIV infections globally, a 33 percent decline in the number of new infections from 3.4 million in 2001.At the same time the number of AIDS deaths is also declining with 1.6 million recorded in 2012 compared to 2.3 million in 2005. UNAIDS Executive Director. Michel Sidibé. says, “We are now less than two years from the deadline for the MDGs.
“Over the years, the gloom and disappointments chronicled in the early editions of the UNAIDS Global Report on the AIDS epidemic have given way to more promising tidings, including historic declines in AIDS-related deaths and new HIV infections and the mobilisation of unprecedented financing for HIV-related activities in low and middle-income countries.
“Yet AIDS remains an unfinished MDG, underscoring the need for continued and strengthened international solidarity and determination to address this most serious of contemporary health challenges. “When the Millennium Development Goals were established at the dawn of this century, a lack of critical HIV treatment and prevention tools often hindered efforts to respond effectively to the epidemic.
“As this latest Global Report makes clear, today we have the tools we need to lay the groundwork to end the AIDS epidemic “More people than ever are now receiving life-saving antiretroviral therapy, contributing to steady declines in the number of AIDS-related deaths and further buttressing efforts to prevent new infections.
“These achievements reflect the synergistic efforts of diverse stakeholders – the leadership and commitment of national governments, the solidarity of the international community, innovation by programme implementers, the historic advances achieved by the scientific research community and the passionate engagement of civil society, most notably people living with HIV themselves.
“As a result of working together, many countries are now within reach of achieving several of the key targets outlined in the 2011 UN Political Declaration on HIV and AIDS, and they are thus making clear progress towards MDG 6.” Sidibé notes with concern that in some countries where a decline in new HIV infections was reported, disturbing signs had emerged of increases in risky sexual behaviour among young people.
“Stigma and discrimination remain rife in many parts of the world, and punitive laws continue to deter those most at risk from seeking essential HIV services. “Although total financial resources for HIV programmes in low- and middle-income countries rose modestly in 2012, our ability to lay the foundation for an end to the AIDS epidemic continues to be undermined by a major resource gap.
“These challenges are real, and they must be taken seriously if countries are to achieve their AIDS targets. “However, the enormous progress that this report describes highlights the undeniable fact that the AIDS response has encountered – and overcome – such challenges in the past.”
Due to sustained progress in scaling up services to prevent mother-to-child transmission – there has been a 52 percent reduction in new HIV infections among children and an aggregate 33 percent reduction among adults and children since 2001. And if scale-up is continued, UNAIDS says it is possible to provide services to 90 percent of pregnant women living with HIV by 2015 to prevent mother-to-child transmission of the virus.
Furthermore, if other services to end vertical transmission and safeguard maternal health are accelerated it will be possible to reduce the number of new HIV infections among children by 90 percent. Eliminating HIV infections among children and reducing maternal deaths is one of specific targets of MDG 6, which UN member states committed to achieving by 2015
The UNAIDS report finds that antiretroviral (ARV) drug coverage among pregnant women living with HIV reached 62 percent in 2012, and the number of children newly infected with HIV in 2012 was 35 percent lower than in 2009. To keep mothers alive and healthy, UNAIDS says that continued progress is needed in scaling up ART.
The UN agency stresses that achieving the global goal of reducing the number of children infected by 2015 will require similar scale-up of other prevention strategies, including primary HIV prevention for women and access to contraception and other family planning services.
Africa Lags Behind
As of December 2012, over 900 000 pregnant women living with HIV globally received ARV prophylaxis or treatment. Globally, eight low- and middle-income countries – including four priority countries (Botswana, Ghana, Namibia and Zambia) – have already met the goal of providing ARVs to 90 percent of pregnant women living with HIV.
In Ghana, for example, the risk that a woman living with HIV will transmit the virus to her child declined from 31 percent in 2009 to nine percent in 2012. The coverage of services for women living with HIV, to prevent mother-to-child transmission in Ghana, increased dramatically from 32 percent in 2009 to more than 90 percent in 2012.
While many countries have made historic strides in expanding access to ARVs for pregnant women living with HIV, progress has been much slower in other Africa countries. At the end of last year, 13 countries with generalised epidemics – including five priority countries (Angola, Chad, the DRC, Ethiopia and Nigeria) – reached less than 50 percent of pregnant women living with HIV with ARVs.
Notable declines in ARV coverage were recorded in Lesotho (75 percent in 2011 to 57 percent in 2012), and Kenya (66 percent to 53 percent), while it stalled in Angola at 17 percent. The annual number of new infections among children in 2012 was 260 000 in low and middle-income countries, 35 percent lower than in 2009. From 2001 to 2012, there was a 52 percent decline in new HIV infections among children.
Coverage of ARV programmes targeting prevention of mother-to-child transmission increased from 57 percent in 2011 to 63 percent in 2012, while expanded access to services to prevent mother-to-child transmission saved more than 670 000 children from contracting HIV between 2009 and 2012.
Countries that have achieved over 80 percent of ARV provision to pregnant women living with HIV – apart from Botswana, Namibia, Ghana, and Zambia – are Swaziland, Zimbabwe, South Africa, Rwanda, Togo, Sierra Leone and Mozambique. Although significant progress was recorded, the 2013 Global Plan progress report suggests that only about half of priority countries are on track to achieve the 2015 target of eliminating mother to child HIV transmissions.
It concludes that improving the situation requires a number of steps including: reducing the number of women getting infected with HIV, reducing the unmet need for family planning, increasing access to safe and non-coercive HIV testing, improving availability of ARVs for pregnant women living with HIV, and improving the diagnosis and treatment of HIV among children.