HIV/AIDS Progress Report Shows Drop in New HIV Infections and AIDS-Related Deaths

New HIV infections and AIDS-Related Deaths Fall

The Global HIV/AIDS Response—Progress Report 2011, produced by the World Health Organization (WHO), UNICEF and UNAIDS, reveals that the global incidence of HIV infection has stabilised and begun to decline in many countries over the last ten years. According to the report, the number of new HIV infections has fallen by 15%, while AIDS-related deaths have dropped by 22% in the last five years. The number of people receiving anti-retroviral (ARV) therapy increased, with 6.65 million people receiving treatment at the end of 2010, while almost 50% of pregnant women living with HIV received effective ARV regimens related to preventing mother-to-child transmission (PMTCT). Access to ARV therapy in low- and middle-income countries increased from 400,000 in 2003 to 6.65 million in 2010, with 47% coverage of people eligible for treatment, resulting in substantial declines in the number of people dying from AIDS-related causes during the past decade

According to the report, the most affected groups are sex workers, men who have sex with men, transgender people, people who inject drugs, prisoners and migrants in both concentrated and generalised epidemics, who are omitted from national AIDS plans and face legal and structural barriers to accessing HIV services. In addition, the progress report highlighted that more than 50% of the people eligible for treatment globally do not have access to ARV therapy, including many people living with HIV who are unaware of their HIV status.

2010 HIV Epidemics and Responses Around the World

Sub-Saharan Africa

Sub-Saharan Africa continues to bear the largest share of the global HIV burden with 68% of all global cases in a region that accounts for only 12% of the global population. The region reported the highest overall annual increase in the number of people accessing ARV therapy, with a 30% rise over the last decade, while three countries—Botswana, Namibia and Rwanda—achieved universal coverage (defined as 80% or more) for HIV prevention, treatment and care services. The number of new infections in Sub-Saharan Africa dropped by 16% in 2010 from 2001, with 2.2 million new infections, however the number of people living with HIV increased by 12%. Women continue to be the most affected, comprising 59% of the affected population in the region. Regionally, Southern Africa continues to be the most severely affected with 11.1 million HIV sufferers, 31% more than 2001 figures. South Africa's HIV incidence remains the highest globally with an estimated 5.6 million people living with HIV, equal to that of the total number of people living with HIV in the whole of Asia. Countries in Eastern and Southern Africa have achieved much higher coverage rates for ARV therapy (56%) and PMTCT (64%) than countries in Western and Central Africa, at 30% and 18% respectively.

Asia

Asia shows a stabilising epidemic trend overall, but new infections are very high in some communities. Of the 4.8 million people living with HIV in Asia—11% growth from 2001—nearly half (49%) are in India, while women account for 35% of the affected population. In East Asia, the incidence of HIV infection among children rose by 31%, from 1,600 in 2001 to 2,200 in 2010. ARV treatment coverage is increasing, with 39% of adults and children in need of HIV treatment having access. Coverage of PMTCT services is relatively low at 16%. The overall trends in this region hide important variation, both between and within countries. In many Asian countries, national epidemics are concentrated in relatively local areas. In China, for example, five provinces account for 53% of the people living with HIV.

Eastern Europe and Central Asia

In contrast with other regions, Eastern Europe and Central Asia have experienced dramatic growth in HIV, with new infections increasing by 250% in the past decade and an eleven-fold increase in the number of AIDS-related deaths. Over 90% of these infections occur in just two countries: Russia and Ukraine. The region demonstrates high coverage rates for PMTCT and paediatric HIV treatment, with 78% and 65% coverage rates respectively. ARV therapy coverage is very low, however, at 23%, particularly among the most affected people—those who inject drugs.

Caribbean

The epidemic in the Caribbean has slowed significantly, with new infections dropping by one-third from 2001 levels, with the Dominican Republic and Jamaica experiencing the highest declines at 25%. The number of AIDS-related deaths in the region dropped by 50% from 2001's level to 9,000. Women account for the majority of the population living with HIV at 53%. Haiti and the Dominican Republic continue to account for 70% of the HIV cases in the region with 182,000 cases.

Latin America

Latin America currently has a stable HIV epidemic with new infections levelling off. HIV is most prevalent among men who have sex with men in Latin America, with women accounting for 36% of adults living with HIV. Brazil accounts for one-third of the people living with HIV in Central and South America.

North America, Western and Central Europe

The HIV epidemic in North America and Western and Central Europe remains stable overall, with the incidence of HIV infection having changed little since 2004. The total number of people living with HIV in the region grew by 34% from 2001 figures of 1.6 million, with the United States accounting for the majority of the infections at 1.2 million. Despite a stable epidemic, the rates of diagnosed HIV cases doubled between 2000 and 2009 in Bulgaria, Czech Republic, Hungary, Lithuania, Slovakia and Slovenia and increased by more than 50% in the United Kingdom. In contrast, the number of people newly diagnosed with HIV decreased by more than 20% in Latvia, Portugal and Romania.

Middle East and North Africa

The Middle East and North Africa (MENA) recorded the highest number of HIV infections ever in the region in 2010, at 59,000—a 36% increase over 2001 figures of 43,000 cases. In addition, both the number of people living with HIV and AIDS-related deaths increased by 47% and 59% respectively from 2001 levels. The number of children living with HIV has more than doubled, from 24,000 in 2001 to 40,000 in 2010. Major factors in this growth are injecting drug use and unprotected sex. The national HIV prevalence among adults in the MENA region is low—except for Djibouti and South Sudan, where HIV is spreading in the general population, and where at least 1% of pregnant women using antenatal services have tested HIV-positive. Coverage of HIV services is very low in the region: 10% for ARV therapy, 5% for paediatric treatment and 4% for PMTCT.

The full report can be accessed here.

Outlook and Implications

The figures provide evidence of the progress made in terms of increasing capacity at all levels to combat HIV/AIDS. The decrease and stabilisation of the spread of HIV/AIDS in most regions—other than MENA—show the effectiveness and efficacy of programmes that have been implemented. Given the international funding and monetary allocations towards combating HIV/AIDS, especially in sub-Saharan Africa, progress towards reducing the number of new HIV infections by 15% and AIDS-related deaths by 22% has been slow. Nevertheless, the figures will offer encouragement to international health organisations and governments towards trying to attain the 2015 UN Millennium Development Goals of achieving universal access to ARV therapies. This will be spurred on by various programmes, including: the WHO Global Health Sector Strategy on HIV/AIDS 2011–15; the UNAIDS 2011–15 Strategy: Getting to Zero; and UNICEF's strategic and programmatic focus on equity, which will help guide national and global efforts to respond to the epidemic and move on from an emergency response towards a long-term, sustainable model of delivering HIV services. With governments and international health organisations looking to maintain and build on the progress made, there will be greater need for national HIV responses to the local epidemics to better serve the most-affected populations, as in Sub-Saharan Africa and MENA these currently do not serve marginalised populations such as men who have sex with men, drug users and sex workers. With most emergency programmes organised centralised in nature, there will be a greater need to decentralise programmes to bring them closer to people in need and to integrate with other health and community services to achieve the greatest impact, a move that is already coming into force in the most affected countries, such as South Africa and Swaziland.

Going forward the progress made in combating HIV/AIDS will face financial pressures, as international funding drops due to the economic woes being experienced by the major contributors in Europe and North America (see World: 3 October 2011: UNITAID Starts Withdrawal from CHAI Projects and World: 16 August 2011: AIDS Funding Disbursements Drops—UNAIDS/Kaiser Study). Advances in HIV science such as prophylaxis and vaccines, as well as programme innovations, will play a major role in cutting the costs associated with combating HIV/AIDS.