While showing a downward trend in AIDS-related deaths, a new United Nations report out today warns that19 million of the 35 million people living with the virus globally do not know their HIV-positive status and therefore, ending the AIDS epidemic by 2030 will require smart scale-up to close the gap.
“Whether you live or die should not depend on access to an HIV test,” said Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS) in a press release on the launch of the new report.
The first-ever UNAIDS Gap Report, shows that as people find out their HIV-positive status, they seek life-saving treatment. For example, in sub-Saharan Africa, almost 90 percent of people who tested positive for HIV went on to access antiretroviral therapy (ART).
“Smarter scale-up is needed to close the gap between people who know their HIV status and people who don’t, people who can get services and people who can’t and people who are protected and people who are punished,” Mr. Sidibé said.
There is progress, the report highlights, noting that efforts to increase access to antiretroviral therapy are working. Research shows that in sub-Saharan Africa, 76 percent of people on ART have achieved viral suppression, where they are unlikely to transmit the virus to their sexual partners. In 2013, an additional 2.3 million people gained access to life-saving medicines, bringing the global number of people accessing ART to nearly 13 million by the end of 2013.
“If we accelerate all HIV scale-up by 2020, we will be on track to end the epidemic by 2030,” said Mr. Sidibé. “If not, we risk significantly increasing the time it would take- adding a decade, if not more.”
By ending the epidemic by 2030, the world would avert 18 million new HIV infections and 11.2 million AIDS-related deaths between 2013 and 2030, according to UNADS.
However, major regional challenges persist. Just 15 countries account for more than 75 percent of the 2.1 million new HIV infections reported in 2013. In fact, in sub-Saharan Africa, just three countries- Nigeria, South Africa and Uganda- account for 48 percent of all new HIV infections.
“There will be no ending AIDS without putting people first, without ensuring that people living with and affected by the epidemic are part of a new movement,” Mr. Sidibe said.
Entire countries are being left behind- for example, six nations- Central African Republic, Democratic Republic of the Congo, Indonesia, Nigeria, Russian Federation and South Sudan- are facing the triple threat of high HIV burden, low treatment and no or little decline in new HIV infections.
To address that, the report advocates setting up country targets and sound policies that will create the space necessary to address complex micro-epidemics with tailored solutions that will help reach people faster with better HIV services. However, a lack of data, widespread stigma and discrimination, punitive legal environments, barriers to civil society engagement and low investment in essential programmes are all holding back results.
Countries that ignore discrimination and continue inequalities face serious public health and financial consequences of inaction, the report says, stressing that ensuring access to quality HIV services is both a human right and a public health imperative.
For this reason some regions are doing better than others. The highest number of people living with HIV is in sub-Saharan Africa (24.7 million) and Asia and the Pacific (4.8 million). And AIDS related deaths were seen to be rising steeply in the Middle East and North Africa, by 66 percent and in Eastern Europe and Central Asia, by six percent since 2005.
Treatment was most available in Western Europe and North America, while coverage was lowest in the Middle East and North Africa, at just 11 percent of those who were affected. In addition, new HIV infections declined most in the Caribbean – by 40 percent.
The world is seeing the lowest levels of new HIV infections this century, at 2.1 million. In the last three years alone, new HIV infections have fallen by 13 percent. AIDS-related deaths are at their lowest since the peak in 2005, having declined by 35 percent. New HIV infections among children have fallen by 58 percent since 2001 and dropped below 200,000 for the first time in the 21 most affected countries in Africa.
But the focus must remain on people who are often marginalized in society, says UNAIDS. HIV prevalence is estimated to be 28 times higher among people who inject drugs, 12 times higher among sex workers and up to 49 times higher among transgender women than the rest of the adult population. And in sub-Saharan Africa, adolescent girls and young women account for one in four new HIV infections. Closing the gap between people who are reached with HIV services and people who are not requires research, protective laws that promote freedom and equality for all people.
“Without a people-centred approach, we will not go far in the post-2015 era,” Mr. Sidibé warned.