Health-e (Cape Town)

Africa: Unaids Upbeat About Aids Retreat

UNAIDS World AIDS Day Report 2011

The AIDS epidemic is in decline and if countries "invest smartly" in a few key interventions, they can achieve "substantial and sustainable progress" against HIV.

This is the upbeat message from UNAIDS, at the launch today (21 Nov) of its annual world report on the state of the epidemic.

The report paints a picture of the world finally coming to grips with the virus that 34 million people live with globally. One-fifth fewer people were infected with HIV in 2010 than in 1997, while the lives of some 2.5 million people have been saved since 1995, thanks to antiretroviral treatment.

"Just a few years ago, talking about ending the AIDS epidemic in the near term seemed impossible, but science, political support and community responses are starting to deliver clear and tangible results," says UNAIDS Executive Director Michel Sidibe.

"Yet, to be effective, the AIDS response must be transformed. We need to move from a short-term, piecemeal approach to a long-term strategic response with matching investment," urges Sidibe.

UNAIDS has devised a recipe for achieving success called the New Investment Framework, which urges countries to focus on six key programmes:

  • Focused interventions for key populations at higher risk, particularly sex workers and their clients, men who have sex with men, and people who inject drugs;
  • Elimination of new HIV infections among children;
  • Behaviour change programmes;
  • Condom promotion and distribution;
  •  Treatment, care and support for people living with HIV;
  •  Voluntary medical male circumcision in countries with high HIV prevalence and low rates of circumcision.

"The Investment Framework starts with the premise that, while there have been tremendous gains in the global response to HIV, a systematic effort to match investment to needs has so far been largely lacking. The resulting mismatch has stretched scarce resources too thinly over too many objectives," according to UNAIDS.

Access to antiretroviral therapy is the cornerstone of the framework as it enables people with HIV to be healthy and productive and it makes them far less infectious.

A recent study found ARVs to be almost as effective as condoms at reducing HIV infection. The study of "discordant couples" - where one partner is HIV positive and the other HIV negative found that if the positive partner was on ARVs, the risk of them transmitting HIV to their partner was reduced by 96 percent.

At least 6.6 million people in low and middle-income countries are now on ARV treatment, an increase of more than 1.35 million (and 8%) over the previous year. This is almost half of those who need it.

In sub-Saharan Africa, there has been a 20% increase in people getting ARVs between 2009 and 2010 alone.

In Botswana, Namibia and Rwanda, over 80% of those who need treatment are getting it while Swaziland and Zambia have achieved coverage levels of between 70% and 80%. South Africa is reaching around 60% of those who need it.

The current economic crisis has cut about $1-billion in international aid money for AIDS since 2009. Thus, there is an urgent need to invest smartly to maximize return, and prevent endless spending on AIDS.

"In June 2011, UN Member States agreed on a new set of global targets, including making at least US$ 22-24 billion available for the global HIV response annually by 2015. This level of resourcing is critical if the new global goals are to be achieved," according to UNAIDS.

"A more strategic approach to spending would achieve extraordinary results, averting at least 12.2 million new HIV infections, including 1.9 million among children, and 7.4 million AIDS-related deaths between 2011 and 2020 compared with a continuation of current approaches."

The UNAIDS report compares Brazil, which has invested strategically, to Russia, which has not.

Brazil's HIV response has focusing on ensuring access to HIV prevention and treatment services for the most vulnerable and marginalized. By 2008, the country invested more than US$ 600 million, close to the estimate of what is needed for a full-scale response.

In contrast, Russia spent about the same amount, which is "roughly equal to the total amount required in

2015", according to UNAIDS. Yet new HIV infections are increasing, as little of the invested total goes towards programmes for people who inject drugs, men who have sex with men or sex workers - the most at-risk groups in that country

As a consequence of investing in less effective interventions, there has been a 250% increase in the number of people living with HIV in Eastern Europe and Central Asia, 90% of whom live in Russia and Ukraine.

"The world faces a clear choice: maintain current efforts and make incremental progress, or invest smartly and achieve rapid success in the AIDS response," urges UNAIDS.

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