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HIV Infections Down, but Treatment Access Still Uneven

Elizabeth Whitman

UNITED NATIONS, Jun 3 2011 (IPS) - Officials underscored the importance of stepped-up action Friday to combat HIV/AIDS, the worst epidemic the world has seen since it began 30 years ago, ahead of a high-level meeting on the disease at the United Nations next week.

Although greater numbers of people have gained access to treatment and rates of new infections have dropped, declining by 25 percent globally from 2001 to 2009, “We still have a long way to go,” said Asha-Rose Migiro, deputy U.N. secretary-general, in a press briefing to launch the report “AIDS at 30: Nations at the Crossroads“.

At the end of 2010, for instance, about 6.6 million people in low and middle-income countries were receiving antiretroviral therapy. Yet 9.0 million eligible people in those same countries were not receiving treatment.

The goal of the Joint United Nations Programme on HIV/AIDS, or UNAIDS, for the future is zero new infections, zero discrimination against HIV/AIDS, and zero deaths from AIDS. A deadline has not yet been specified, but Migiro hoped that next week, leaders would “chart a bold new path” to achieve such these goals.

Taking advantage of key opportunities

Today, the global community is at a crossroads in combating HIV/AIDS. Even as its response to AIDS has dramatically improved simply over the past decade, the recent global economic crisis has hindered this progress, with international AIDS funding decreasing in 2010 for the first time since 2000.

Meanwhile, UNAIDS models have shown that right now is a crucial time to intensify efforts to prevent and treat AIDS, particularly with new research showing that if an HIV-positive person has effective antiretroviral therapy, he or she can reduce the risk of transmitting the virus to an uninfected partner by 96 percent.

According to a UNAIDS investment framework, investing at least 22 billion dollars by 2015 in programmes tailored to a country’s specific needs could result in 12 million fewer HIV infections and 7.4 million fewer AIDS-related deaths by 2020.

Furthermore, if governments and civil society promote and invest wisely in methods that are proven to help reduce the risk of HIV infection, such as condoms or male circumcision, “We have a real opportunity here to break the back of the epidemic,” Matthew Kavanagh, director of U.S. advocacy for Health Global Access Project (Health GAP), told IPS.

He emphasised that if at least 15 million people are put on antiretroviral therapy by 2015, the universal access level of 80 percent coverage will have been achieved.

At that point, “the prevention methods start to kick in,” Kavanagh added. But in order to achieve such a goal, leaders and civil society need to make concrete decisions and set deadlines, taking into account new research and information, as well as overcome numerous social, political, and economic challenges.

A multi-faceted epidemic

Finding ways to prevent and treat HIV on a global scale has and will continue to demand coordination and cooperation. Unfortunately, discrimination against persons living with HIV, debates over drugs for treatment, a lack of focus on high-risk populations – namely, men who have sex with men, people who inject drugs, and sex workers – and gender inequality threaten efforts to combat AIDS.

Addressing these issues and more at next week’s High Level Meeting and during current negotiations for that meeting’s outcome text will prove key to developing effective steps in the fight against the epidemic, experts say.

The debate over brand name or generic drugs is just one example, on a political level, of the many challenges to achieving consensus in the global AIDS response. Generic drugs are more affordable to people in low and middle-income countries, but bilateral free trade treaties currently pending threaten to undermine their availability, said Kavanagh.

“The U.S. and the EU are making one of their top priorities getting rid of any language that would challenge bilateral trade agreements,” Kavanagh told IPS. “These bilateral trade agreements are… trying to get countries… to give up the flexibilities and rights” they have that allows them access to generic drugs that are much more affordable.

On the ground, “many national prevention strategies ignore or inadequately focus on three populations that are at higher risk of HIV infection,” according to a draft of the outcome document. “Many people from these populations find it difficult or impossible to access HIV services.”

The document also noted that “stigma and discrimination remain among the most significant barriers to an effective response.” Furthermore, over 56 countries have actually criminalised HIV transmission or exposure, essentially institutionalising discrimination.

Still, Michel Sidibe, executive director of UNAIDS, said in a press briefing that we are living in a “completely different world” today compared to 30 years ago, at the start of the AIDS epidemic, in terms of perceptions of the disease and people living with it.

Sidibe was similarly positive about the cooperative ties that have been forged between wealthier nations and poorer ones. “Ninety-four percent of the people who are on treatment in the developing world today are in treatment based on resources from the developed world,” he told IPS.

Continuing that cooperation will be extremely challenging, but just as important, and it extends beyond material resources.

“How we tap our knowledge which is existing in the emerging nation and also in the developed world” is imperative “to be able to come out with a new way to treat people,” he concluded.