Global drop in new HIV infections

Global rates of HIV infection and AIDS-related death have both fallen dramatically, the UN has today announced. According to the widely reported figures from the UN’s UNAIDS division, both have fallen by 21% since their peaks at the turn of the millennium. Measures such as improved medical treatment were estimated to have prevented 700,000 AIDS-related deaths in 2010 alone.

The global statistics have been published ahead of World AIDS day on December 1, and to mark a decade since a groundbreaking summit that led to a global strategy for tackling HIV. The report investigated the rates of new HIV infections, people living with HIV worldwide and AIDS-related deaths, to see how far we are currently from the UNAIDS’ ambitious vision: zero new HIV infections, zero discrimination and zero AIDS-related deaths.

The report also outlined strategies of what still needs to be done to prevent new infections and to support the 34 million currently living with HIV.

The news has been widely welcomed, with groups such the charity Medecins Sans Frontieres declaring the fall to be ‘a promising moment to really turn this epidemic around’. However, as the charity and UNAIDS have also highlighted, there is a need to sustain these improvements and continue fighting this worldwide problem with a truly global solution such as the UNAIDS plan.

What is UNAIDS and what does it do?

UNAIDS is the United Nations’ programme for tackling HIV and AIDS as a global problem. Working closely with the World Health Organization its goal is to drive a long-term strategic response to tackle the world AIDS epidemic.

In 2010, the UNAIDS group set out a series of specific goals to achieve by 2015. These include:

• reducing sexual transmission of HIV by half
• eliminating mother-to-baby transmission of HIV and reducing AIDS-related maternal mortality by half
• preventing new HIV infections among people who inject drugs
• ensuring universal access to antiretroviral (anti-HIV) therapy for people living with HIV who are eligible for treatment
• halving the number of deaths due to tuberculosis among people living with HIV
• ensuring that people living with HIV and households affected by HIV have access to essential care and support, and that this goal is addressed in all national HIV plans
• halving the number of countries with punitive laws and practices around HIV transmission, sex work, drug use or homosexuality that might block people from receiving effective responses
• the elimination of HIV-related border controls that might restrict entry, stay and residence in half of the countries that have such restrictions
• ensuring that at least half of all HIV responses address the HIV-specific needs of women and girls
• a zero-tolerance stance on gender-based violence

How have rates of HIV infections and AIDS-related deaths changed?

In the wake of the UNAIDS strategy and improving national plans, new infections and AIDS deaths have both dramatically fallen in number since their peak in the late 1990s.

Although the number of new HIV infections each year remains high (between 2.5 and 3 million people worldwide), this is 21% lower than the number of new infections seen at the peak of the epidemic in 1997. Notably, HIV incidence has fallen in 33 countries, including 22 in the sub-Saharan African region, which has been particularly affected by the AIDS epidemic.

AIDS-related deaths have also fallen by 21% since their peak in the mid-2000’s, from 2.2 million to 1.8 million. Although this may seem like a relatively modest drop, this should also be seen in the light of the rising number of people living with HIV. Since 2001, the number of people living with HIV has risen by 17%, due to both a large number of new HIV infections but also a greater number of people having access to life-prolonging antiretroviral drugs.

UNAIDS placed this pattern into context, estimating that in 2010 alone, some 700,000 AIDS-related deaths were averted by actions such as improving access to medical treatment.

Why are rates of new HIV infections and AIDS-related deaths falling?

UNAIDs said that a decade ago, when the UN brought together world leaders for a global summit on AIDS, only three countries: Senegal, Thailand and Uganda, stood out as having successfully responded to HIV. Since then there has been a tremendous response to HIV as both a global and national problem, and that a number of medical, social, financial and behavioural changes have combined to drive rates down.

For example, UNAIDS said that the decline in new HIV infections is in part due to changes in sexual behaviour, especially among young people. The programme highlighted research that found:

• the percentage of young men with multiple partners in the past years decreased in 11 of 19 countries that recorded such data
• condom use by men increased in 7 out of 17 countries surveyed and by women in 5 of 17 countries
• in 8 of 18 countries surveyed, the percentage of men and women who had sex before they turned 15 dropped
• in many countries with high HIV prevalence, young men are beginning to get circumcised (some clinical trials have shown that voluntary medical circumcision reduces the risk of female-to-male sexual transmission by about 60%)

National programmes ensuring wider access to antiretroviral treatments have also had a major impact on people living with HIV. UNAIDS estimated that approximately 2.5 million deaths have been avoided in low- and middle-income countries since 1995 due to antiretroviral therapy being introduced. Approximately 6.6 million people are now receiving treatment in low- and middle-income countries, which is nearly half of those eligible.

In turn, better access to antiretroviral drugs has also reduced rates of new HIV infection as they reduce they amount of viral particles in a person’s body and therefore the potential for transmission.

What still needs to be addressed?

The report said that in June 2011, the UN member states agreed that by 2015 they would make US$22-24 billion available for the global HIV response each year. UNAIDS said that if all low-and middle-income countries could allocate resources in proportion to their HIV burden, the domestic public-sector allocation of medical services would double by 2017.

However, they added that countries that have the highest rates of HIV and AIDS also tend to have the least resources. Therefore, ‘international donors’ (UN Member States that directly provide development assistance to recipient countries) will also need to continue to support the poorest and worst affected countries.

UNAIDS is particularly focused on implementing a global plan to completely halt new HIV infections among children and to increase the availability of antiretroviral drugs.

The organisation also discussed emerging technologies and strategies such as a vaccine trial in Thailand that found its recipients were 31.2% less likely to become infected with HIV over 42 months than participants that did not receive the vaccine. Although this is not sufficiently effective to grant the vaccine a licence, the report said that continued investment in researching and developing a preventative vaccine is essential.