Dec 1 2015
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.
Promising new approach to combat HIV