New HIV Infections Declining, But So Is Funding To Combat The Disease

A new UNAIDS report found that while new HIV infections have declined globally since 2010, the rate of progress has slowed, with some regions showing increases in new infections. Available resources for HIV have also dropped by US$ 1 billion in 2018, marking the first time global HIV funding declined since 2000.

UNAIDS’ Global AIDS Update, Communities at the Centre, launched today in South Africa, shows a “mixed picture” of progress, differing across countries and regions. It also shows a decline in HIV funding – US$ 7.2 billion short of the US$ 26.2 billion UNAIDS estimates is needed by 2020 – resulting in slowed progress towards reaching targets to end the AIDS epidemic.

The overall decline in new cases – 16 percent since 2010 – signifies an impressive improvement, which is driven largely by steady progress across eastern and southern Africa, the regions most affected by HIV. However, there have been increases in new HIV infections in eastern Europe and central Asia (29%), in the Middle East and North Africa (10%) and in Latin America (7%), according to a UNAIDS press release.

“While considerable progress has been made, there is a risk that we will lose momentum. If the world is to be on track to end AIDS by 2030, there must be adequate and predictable financing for development. But, for the first time since 2000, the resources available for the AIDS response globally have declined,” Gunilla Carlsson, UNAIDS acting Executive Director, said in the report forward.

Carlsson called on all partners to “step up action and invest in the response,” which includes “fully funding the Global Fund to Fight AIDS, Tuberculosis and Malaria with at least US$ 14 billion at its replenishment in October and through increasing bilateral and domestic funding for HIV.”

“We urgently need increased political leadership to end AIDS,” Carlsson said, quoted in the release. “This starts with investing adequately and smartly and by looking at what’s making some countries so successful. Ending AIDS is possible if we focus on people not diseases, create road maps for the people and locations being left behind, and take a human rights-based approach to reaching people most affected by HIV.”

In 2018, an estimated:

  • 9 million people globally were living with HIV
  • 3 million were accessing antiretroviral therapy
  • 7 million people became newly infected with HIV
  • 770,000 people died from AIDS-related illnesses

Improved Access to HIV Testing and Treatment, Insufficient Progress on Prevention

The report shows that improvements in providing access to testing and treatment options have helped to reduce AIDS-related deaths, which fell by 33 percent to 770,000 between 2010 and 2018. This improvement was made possible through improved delivery of both HIV and tuberculosis services.

Progress has also continued towards UNAIDS’ 90–90–90 targets: that 90 percent people living with HIV know their status; 90 percent of people living with HIV who know their status are on treatment; and 90 percent of people on treatment have suppressed viral loads.

According to the release, some “79% of people living with HIV knew their HIV status in 2018, 78% who knew their HIV status were accessing treatment and 86% of people living with HIV who were accessing treatment were virally suppressed, keeping them alive and well and preventing transmission of the virus.”

This progress towards the 90–90–90 targets, however, has varied greatly by region and by country. “In eastern Europe and central Asia for example, 72% of people living with HIV knew their HIV status in 2018, but just 53% of the people who knew their HIV status had access to treatment.”

The chart below from the report shows progress on each of these targets compared to the total population of people living with HIV.

Additionally, around 82 percent of pregnant women living with HIV now have access to antiretroviral medicines – an increase of more than 90% since 2010 – which has resulted in a 41 percent reduction in new HIV infections among children, “with remarkable reductions achieved in Botswana (85%), Rwanda (83%), Malawi (76%), Namibia (71%), Zimbabwe (69%) and Uganda (65%) since 2010.”

While access to testing and treatment options has improved, “the full range of options available to prevent new HIV infections are not being used for optimal impact,” the release said.

“For example, pre-exposure prophylaxis (PrEP), medicine to prevent HIV, was only being used by an estimated 300,000 people in 2018, 130,000 of whom were in the United States of America. In Kenya, one of the first countries in sub-Saharan Africa to roll out PrEP as a national programme in the public sector, around 30,000 people accessed the preventative medicines in 2018,” indicating that more progress can be made in expanding access to PrEP.

Addressing Needs of Key Populations

In 2018, the report shows that more than half of all new HIV infections – 54 percent – were among key populations, including sex workers; people who use drugs; gay men and other men who have sex with men; transgender people; and prisoners; as well as their partners.

In 2018, these key populations accounted for around 95 percent of new HIV infections in eastern Europe, central Asia, the Middle East and North Africa.

While gains have been made against HIV-related stigma and discrimination in many countries, “discriminatory attitudes towards people living with HIV remain extremely high,” and there remains “an urgency to tackle the underlying structural drivers of inequalities and barriers to HIV prevention and treatment, especially with regard to harmful social norms and laws, stigma and discrimination and gender-based violence,” according to the release.

The report also highlights that community empowerment and ownership has been key to much of the progress across all sectors of the AIDS response. However, insufficient funding for community-led responses, along with negative policy environments, have impeded these successes from reaching full scale and generating maximum impact.

As part of achieving the 2030 Agenda for Sustainable Development, “governments must protect and uphold the human rights of everyone,” Carlsson of UNAIDS said in the report forward. “As the eyes and ears of the AIDS response, communities play a critical role in holding decision-makers to account and demanding political leadership.”

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