Global effort to reduce new HIV infections is stalling, UN warns
BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4744 (Published 19 July 2019) Cite this as: BMJ 2019;366:l4744
The global pace of progress in reducing new HIV infections and increasing access to treatment is slowing down, says a report from the Joint United Nations Programme on HIV/AIDS (UNAIDS).1
Communities at the Centre shows that, while some countries are making very good progress towards UN targets, others are seeing rises in new infections and AIDS related deaths.
Launching the report, Gunilla Carlsson, UNAIDS executive director, said, “We urgently need increased political leadership to end AIDS. This starts with investing adequately and smartly and by looking at what’s making some countries so successful.”
Around 1.7 million people became newly infected with HIV in 2018, down 16% since 2010. This decline has been driven mostly by steady progress in eastern and southern Africa. South Africa, for example, has reduced new HIV infections by over 40% and AIDS related deaths by around 40% since 2010. But new HIV infections increased by 29% in eastern Europe and central Asia, by 10% in the Middle East and north Africa, and by 7% in Latin America.
Deaths from AIDS related illness have declined from a peak of 1.7 million in 2004 to 770 000 in 2018. Again, the greatest progress has been in eastern and southern Africa. In eastern Europe and central Asia AIDS related deaths have risen by 5% and in the Middle East and north Africa by 9% since 2010.
Key populations
Globally, over half (54%) of all new HIV infections were among key populations: sex workers, people who use drugs, men who have sex with men, transgender people, and prisoners, as well as their partners. But the report shows that, in many countries, these key populations are still being marginalised and left behind in the response to HIV.
In 2013 UNAIDS set an ambitious “90-90-90” target stating that, by 2020, 90% of all people with HIV will know their serostatus, 90% will receive sustained antiretroviral therapy, and 90% of those will have viral suppression.2 But the report shows that there is still some way to go in achieving these targets: in 2018 only 79% of people with HIV worldwide knew their HIV status, 63% were receiving antiretroviral therapy, and 53% of those had suppressed viral loads.
The report emphasises the central role of communities in eradicating AIDS. It cites a community based project in KwaZulu-Natal province in South Africa, managed by Médecins Sans Frontières, that links people to treatment and helps them to remain in care. By 2018 the 90-90-90 targets were achieved in Eshowe town, rural Eshowe, and Mbongolwane, well ahead of the 2020 deadline.
Young women
New HIV infections in young women (aged 15-24) fell by 25% from 2010 to 2018. But the report says that an unacceptable 6000 adolescent girls and young women still become infected with HIV every week, and it calls for expansion of sexual and reproductive health and rights programmes for young women.
Greater provision of antiretroviral therapy to pregnant women with HIV has driven progress towards eliminating transmission of HIV from mother to child. About 160 000 children worldwide acquired HIV in 2018, down by 41% from 280 000 in 2010. The report also shows that condom use has increased in sub-Saharan Africa over the past decade and that countries are gradually adopting pre-exposure prophylaxis (PrEP) as an additional HIV prevention option.
It warns that that the gap between required funding and available resources is widening. For the first time, money available for the AIDS response fell worldwide by almost $1bn (£804m; €891m), as donors have given less and domestic investments have not grown enough to offset inflation. UNAIDS is urging donors to fully fund the Global Fund to Fight AIDS, Tuberculosis and Malaria and to boost bilateral and domestic resources for HIV and AIDS.