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UN report says end of AIDS is 'feasible'
by Chuck Colbert
2012-11-28

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Schwartlander. Photo courtesy of UNAIDS


The global response to the worldwide AIDS epidemic continues making remarkable progress in HIV prevention, improved treatment, and reduced AIDS-related deaths, a new report says, holding out hope and possibility for the end of AIDS.

"The global community has embarked on an historic quest to lay the foundation for the eventual end of the AIDS epidemic," the United Nations (UN) report states. "This effort is more than merely visionary. It is entirely feasible."

The report was released Nov. 20, in advance of World AIDS Day on Saturday, Dec. 1.

However, unsafe sexual behavior, intravenous drug use, stigma, discrimination and misinformation remain formidable challenges in stemming a disease that, entering its fourth decade, has claimed nearly 30 million HIV-related deaths.

Since the beginning of the epidemic, more than 60 million people have contracted HIV.

"Results," the title of a 48-page report issued by the Joint United Nations Programme on HIV/AIDS (UNAIDS), shows a dramatic 50 percent decrease in new HIV infections across 25 low- and middle-income countries, mostly in Africa, the continent most affected by HIV.

Better yet, in some countries with the highest prevalence of HIV in the world, rates of infection have been reduced dramatically since 2001. For example, in Malawi the infection rate dropped by 73 percent. In Botswana, the rate is down 71 percent, with similar decreases reported in Namibia (down 68 percent), Zambia (down 58 percent), Zimbabwe (down 50 percent), and South Africa and Swaziland (down 41 percent).

Declining numbers of HIV infections in children is a particularly encouraging finding of the report. Half the global reductions in new HIV infections in the last two years have been among newborns.

Last year, for instance, 330,000 children worldwide were infected with HIV, down from 370,000 in 2010 and 43 percent fewer than in 2003, according to UNAIDS.

Altogether, new infections globally fell to 2.5 million last year, down from 2.6 million, which represents a 20-percent decrease from 2001.

Overall, in 2011, an estimated 34 million worldwide are living with HIV, according to UNAIDS, at the same time 2.6 million people became newly infected, with 1.7 million deaths. The death rate, moreover, is down 24 percent from 2005 and is nearly six percent below the rate in 2010.

For more good news in HIV prevention, "Results" shows that Sub-Sahara Africa has cut AIDS-related deaths by one third in the last six years and increased the number of people on antiretroviral treatment by 59 percent in the last two years alone.

The report shows in fact that antiretroviral therapy has emerged as a powerful force for saving lives—an estimated 14 million life-years, including 9 million in sub-Sahara Africa, according to the report.

In the last two years the numbers of people accessing treatment has increased by 63 percent globally.

However, the report notes, some 7 million people worldwide do not have access to this life-saving HIV treatment, including 72 percent of children living with the virus.

Still, "The pace of progress is quickening," said Michel Sidibe, executive director of UNAIDS, in a statement. "What used to take a decade is now being achieved in 24 months."

"We are scaling up faster and smarter than ever before," he added. "It is the proof that with political will and follow through we can reach our shared goals by 2015."

A native of Mali, who has served as Under-Secretary-General of the United Nations since Jan. 1, 2009, Sidibe was referring to 10 specific targets pledged in a 2011 United Nations Political Declaration on HIV and AIDS: Intensifying Our Efforts to Eliminate HIV and AIDS."

The targets are outlined and discussed in "Global Report," a 108-page UNAIDS document, released on the same day as "Results."

Among those goals are to reduce HIV sexual transmission and reduce transmission among people who inject drugs—both by 50 percent.

Two other targets include eliminating new infections among children and substantially reducing the number of mothers dying from AIDS-related causes.

Additional goals are to provide anti-retroviral therapy to 1.5 million people, reduce the number of people living with HIV who die from tuberculosis by 50 percent, close the global AIDS resource gap, and reach annual global investments of $22 billion to $24 billion (measured in U.S. currency) in low- and middle income countries.

Still other targets aim to eliminate gender inequalities and gender-bases abuse and violence and to increase the capacity for women and girls to protect themselves from HIV.

The elimination of stigma and discrimination against people living affected by HIV is another goal, along with eliminating travel and residence restrictions for people living with HIV.

Bernhard Schwartlander, director for Evidence, Innovation, and Policy at UNAIDS, sounded an upbeat tone about reaching the goals.

"I am optimistic that with the progress we're seeing we can actually achieve the targets we set last year," he told reporters during a telephone conference call last Tuesday, Nov. 20.

Schwartlander is a medical doctor and holds a doctorate in medical epidemiology. Prior to joining the United Nations, Dr. Schwartlander was the director of Infections Disease Epidemiology at the Robert Koch-Institut in Berlin.

Nonetheless, prevention programs for groups of people who are most at risk—sex workers, drug users, and men who have sex with men—are too limited, the UNAIDS report says.

And yet, education efforts aimed at teaching about safer sex practices, including the use of condoms, and the prudence of having fewer sexual partners has shown success in some countries, such as Kenya, Malawi, Niger, Mozambique, Namibia and Zambia.

However, in other countries risky sexual behavior has increased—namely the Ivory Coast, Guyana and Rwanda.

Guyana, Haiti, Lesotho and Rwanda, for instance, report statistically significant increases in men having sex under the age of 15. Haiti and Lesotho report a similar statistically significant finding for women having sex under the age of 15.

At the same time, condom use by men has decreased by a statistically significant measure in the Ivory Coast, Uganda, Benin and Burkina Faso. The same results hold for condom use by women in Ethiopia and Uganda.

The report notes another challenge stemming the spread of HIV—a stepped-up effort to offer men circumcision, which in trials has shown to be effective in the preventing some new infections.

Altogether, UNAIDS sounds the alarm bell concerning the populations most at risk for HIV. One group is men who have sex with men. "Go to any capital city in the world, men who have sex with men are significantly more likely to have HIV—on average 13 times more than the general population," the "Results" report states, adding, "As global HIV prevalence trends appear to have stabilized, there is disturbing evidence suggesting that global HIV prevalence among men who have sex with men may have increased between 2010 and 2012."

And the report states, "People who inject drugs are the worst off: Evidence from 49 countries shows that their risk of being infected with HIV is 22 times higher than the general population."

UNAIDS acknowledges the challenge in getting people to change their behavior. "It involves knowledge, motivation, and choices, which are influenced by sociocultural norms, as well as risk assessment in relation to immediate benefits and future consequences. It involves both rational decision-making and impulsive and automatic behavior," according to the report.

More money would also help. The report says that only 5 percent of HIV funding in the worst-hit nations was spent on programs aimed at changing behavior, including the promotion of condom use.

©Copyright. Chuck Colbert. All rights reserved.

PHOTO CAPTION Dr. Bernhard Schwartlander, director for Evidence, Innovation, and Policy at UNAIDS. Photo courtesy of UNAIDS


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