The world is poised to end the AIDS epidemic by 2030 – provided it can
accelerate the pace of progress achieved globally over the past 15
years, according to a new World Health Organization (WHO) report.
Already, much has been achieved. This year, the Millennium
Development Goal that called for halting and reversing the spread of HIV
on a global basis was met.
By 2014, the number of HIV deaths was reduced by 42% – from a peak of more than 2 million in 2004 to an estimated 1.2 million.
Since 2000, an estimated 7.8 million lives have been saved, fewer
people are acquiring HIV, and projections of an end to the epidemic by
2030 – a goal once considered unattainable by many experts – are now
realistic, according to the WHO report,
Global Health Sector Response to HIV 2000-2015.
The rapid scale-up of access to antiretroviral therapy (ART), one of
the greatest public health achievements in recent times, has made
treatment available to more than 16 million people living with HIV
across the globe. Today, more than 11 million people in the WHO African
Region alone are receiving HIV treatment, versus about 11 000 who were
taking the medications 15 years ago. That is a thousand-fold increase.
Yet more must be done. Globally 60% of all people living with HIV have not yet enrolled in antiretroviral treatment.
“In the last 15 years, new HIV infections have reduced by 41% in the
African Region, more than in any region in the world,” said Dr
Matshidiso Moeti, WHO Regional Director for Africa. “But the number of
people acquiring HIV infection is still too high and young women and
adolescent girls continue to be disproportionately at risk.”
Treatment for all people living with HIV
Recent findings from clinical trials have confirmed that the early
and expanded use of antiretroviral treatment saves lives by keeping
people living with HIV healthier and by reducing the risk that they will
transmit the virus to partners.
In September, that confirmation led WHO to recommend that all people
living with HIV start ART as soon as possible after diagnosis.
At ICASA, WHO is presenting a set of recommendations to enable
countries to expand treatment to all — rapidly and efficiently. These
recommendations include using innovative testing strategies to help more
people learn they are HIV positive; moving testing and treatment
services closer to where people live; starting treatment faster among
people who are at advanced stages of HIV infection when they are
diagnosed; and reducing the frequency of clinic visits recommended for
people who are stable on ART.
“WHO’s new implementation guidelines showing how to treat all people
living with HIV and decrease new infections are transformative,” said Dr
Deborah Birx, US Global AIDS Coordinator. “Short of an HIV vaccine or
cure, this gives us the critical tools we need to create an AIDS-free
generation with the Fast Track Strategy. We must seize this moment and
chart a bold course together to end the AIDS epidemic as a public health
threat.”
Improving HIV prevention
The same drugs that help people living with HIV to remain healthy
also prevent people at substantial risk of contracting HIV from becoming
infected. Pre-exposure prophylaxis, or PrEP, is the use of an
antiretroviral medication to prevent the acquisition of HIV infection by
uninfected persons. In a quest to step up prevention, WHO now
recommends PrEP be offered to all people at substantial risk of HIV
infection.
Other established prevention tools continue to reduce the number of
new HIV infections. They include male condoms and female condoms,
participation in behavior-change programmes and other prevention
services for key populations. For example, more than 10 million men in
Africa have volunteered to undergo medical circumcision, which reduces
their risk of contracting HIV by 60%.
Ending AIDS as part of the SDG agenda
At the UN General Assembly in September, world leaders endorsed the
Sustainable Development agenda. This agenda includes the target of
ending the AIDS epidemic by 2030 – by reducing new infections by an
additional 75% by 2020 and by ensuring that, in the coming 5years, 90%
of people living with HIV are aware their infection, 90% of those are on
ART, and 90% of people on ART have no detectable virus in their blood
(UNAIDS’ “90-90-90” target).
Increasing emphasis on and targeting of effective prevention
alongside increased treatment is also essential to reducing new
infections from the current 2 million per year to the UN target of less
than 500 000 by 2020 and 200 000 by 2030.
Achieving these targets will require bold action, with the health sectors of nations around the world playing a central role.
“Despite the significant progress, half the people living with HIV
globally do not know they have acquired the virus and do not receive
treatment that can save their lives and avoid infecting others,” said Dr
Winnie Mpanju-Shumbusho, WHO Assistant Director General for HIV/AIDS,
Tuberculosis, Malaria and Neglected Tropical Diseases. “We must now step
up our efforts to reach the missing half with testing and treatment and
the prevention of new infections, or we will miss the unique
opportunity to end the AIDS epidemic within a generation,” she added.
The effort is at a critical juncture, with success within reach, and
failure likely to result in a resurgence of the disease and its costs.