UNAIDS report applauds progress against HIV, but warns of unsafe behaviour in some countries, faltering prevention efforts and a funding gap
Are we winning against HIV? The latest update from UNAIDS wants to say yes, we are. There is a lot of progress – a lot of ground has been won in the last decade and more. New infections are down and so are deaths, thanks to antiretroviral drugs which have now reached nearly 10 million people. But our grip on the pandemic sometimes seems fragile. Risky behaviour appears to be increasing in some countries – and the money to fund prevention efforts is never enough.
The good news is that the number of people newly infected has dropped to 1.9 million in low and middle-income countries in 2012, which is 30% lower than in 2001. There are 26 countries where the rate of new infections is dropping. So far so good. As the report points out, “opportunities to dramatically lower HIV incidence have never been more promising”. We have the tools: drugs to keep people well also prevent 96% of the risk of infecting other people, male circumcision also lowers transmission rates by 60% and giving antiretroviral drugs to people at risk lowers their chances of infection.
There has been an impressive 34% drop in new infections in sub-Saharan Africa since 2001, although the biggest drop is in the Caribbean, where it has been 49%. New infections are still on the rise in eastern Europe, however, and in Central Asia, north Africa and the Middle East.
But worryingly, unsafe behaviour is putting the gains that have been made at risk in some countries in sub-Saharan Africa where the epidemic has been most concentrated and the efforts greatest. The report says:
Recent evidence indicates a significant increase in the number of sexual partners in some countries (Burkina Faso, Congo, Côte d’Ivoire, Ethiopia, Gabon, Guyana, Rwanda, South Africa, Uganda, the United Republic of Tanzania and Zimbabwe), as well as a decline in condom use (in Côte d’Ivoire, Niger, Senegal and Uganda).
Many countries do not have a comprehensive strategy for rolling out the sort of behavioural change programmes which have been shown to help prevent new infections, says the report. Such programmes may also be wrongly seen as less urgent than they were.
There are worrisome signs that social and behavioural programming might now have a lower priority. Mid-term reviews identified declining support for social-behavioural HIV prevention programmes in several countries, including in Namibia, where the highly successful ‘Take control’ campaign was discontinued in 2011.
There is little change in the HIV burden among people who use drugs – the report categorically says we are not on track to reduce HIV transmission by 50% in that group by 2015.
HIV prevalence among people who inject drugs remains high – up to 28% in Asia. HIV prevention coverage for people who inject drugs remains low, with only two of 32 reporting countries providing the recommended minimum of at least 200 sterile syringes per year for each person who injects drugs. Among 35 countries providing data in 2013, all but four reached less than 10% of opiate users with substitution therapy. In addition to exceptionally low coverage, an effective AIDS response among people who inject drugs is undermined by punitive policy frameworks and law enforcement practices, which discourage individuals from seeking the health and social services they need.
There is better news on women and children, with 62% of pregnant women with HIV in 2012 being put on antiretroviral drugs which will save their lives and that of their baby. The number of newly infected children dropped by a third from 2009 to 2012. But getting the numbers down further will be harder – they need access to better prevention services as well as contraception and family planning.
The funding is short of what is needed, says the report, but there was $19.9 billion available in 2012, which is a 10% increase over the previous year because low and middle income countries stepped up their contribution while rich countries flatlined.
HIV continues to lead the way in people-based and rights-based services, says the report, and is increasingly linked in with other health and development programmes. But the report argues that we need to maintain the special focus on Aids that has got us this far.
For the sake of continued progress against the AIDS epidemic, the high priority accorded to HIV needs to be maintained and the effective aspects developed further and embedded into future health and development goals.
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