AIDS epidemic changing course

A new UNAIDS report claims the world has finally "turned the corner" on the Aids epidemic, citing a downward trend in new HIV infections and Aids-related deaths over the past decade and stabilisation of the number of people living with HIV globally.

"We are breaking the trajectory of the Aids epidemic," said Michel Sidibe, UNAIDS executive director, in a statement.

Global HIV prevalence was 33.3 million by the end of 2009, a slight increase from 2008, in large part because many more people are accessing antiretroviral (ARV) treatment and living longer with the virus.

More than five million people are receiving ARVs and in 2009 alone, 1.2 million people were initiated onto treatment. As a result, Aids-related deaths are down nearly 20% compared with five years ago and in Botswana, one of only two countries in sub-Saharan Africa to have achieved universal access to treatment, Aids-related deaths have halved since 2002.

Effective prevention
The bi-annual UNAIDS report, which provides a detailed snapshot of the epidemic and progress in achieving the Millennium Development Goal of halting and reversing the spread of HIV by 2015, attributes the more than 25% declines in HIV incidence seen in 33 countries since 2001 to effective HIV prevention. The most dramatic declines were seen in sub-Saharan Africa, the region worst hit by the epidemic. Only in seven countries, most of them in Eastern Europe and Central Asia, has HIV incidence increased in recent years.

"We are getting there," said Sheila Tlou, UNAIDS director for eastern and southern Africa, at the launch of the report in Johannesburg. "Our vision of zero new infections, zero discrimination and zero Aids-related deaths is possible."

Adequate funding required

While the UNAIDS report suggests that prevention is working, Tlou warned that the response was fragile and needed to be kept alive with adequate funding. "Domestic funding is still too low," she said. "Aids programmes need to be made more sustainable and affordable and we need to become less reliant on international donors."

At a time when donors are flat-lining or cutting back their contributions to the Aids response, UNAIDS estimates that nearly US$16 billion was available for combating HIV in 2009, $10 billion short of what was needed in 2010. Although domestic expenditure is the largest source of HIV financing globally, UNAIDS estimates that nearly half the countries in sub-Saharan Africa are spending less than they can afford and could substantially increase the portion of their Aids budgets from domestic sources.

Stigma and discrimination

Apart from financing, Tlou said the greatest barrier to scaling up the Aids response was stigma and discrimination, particularly in relation to marginalised and high-risk groups, such as men who have sex with men, sex workers and injecting drug users, who have been driven underground by punitive laws that often prevent them from accessing HIV services.

The report revealed that progress on treatment access has also been uneven. Only 29% of children needing ARVs were getting them by the end of 2009 compared with 37% of adults.

Brian Pazvakavambwa of the World Health Organisation pointed out that access to treatment for tuberculosis patients co-infected with HIV and for pregnant women was also comparatively low and blamed weak health systems and fragmented implementation for the failure to link programmes such as prevention of mother-to-child transmission (PMTCT) with treatment.

While access to PMTCT has increased significantly, resulting in fewer children being born with HIV, only 15% of HIV-positive pregnant women received ARVs in 2009.

"A lot of work still needs to be done," said Pazvakavambwa at the launch. "We need to continue expanding and linking all parts of the response; if we can link our programmes better we can do better in terms of all health outcomes." - (IRIN/Plus News, November 2010)

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