Global HIV incidence has fallen by a fifth in the last ten years, UNAIDS annual update shows.
A generally up-beat assessment of the worldwide HIV epidemic from UNAIDS ahead of World AIDS Day demonstrates that the number of new infections has either stabilised or fallen in 25% of countries – including many of those hit hardest by the epidemic in sub-Saharan Africa.
Thanks to increasing access to antiretroviral therapy, AIDS-related mortality has also fallen significantly.
“We are breaking the trajectory of the AIDS epidemic with bold actions and smart choices,” said Michel Sidibé, Executive Director of UNAIDS.
However, the report also described the massive scale of the global epidemic and how funding for prevention and care fell in 2009.
“Many countries are under-investing and need to increase their domestic commitments to sustain and scale-up the AIDS response,” said UNAIDS.
Data included in UNAIDS’ Report on the Global HIV Epidemic show that there are now an estimated 33.3 million people living with HIV around the world.
Using information from 182 countries, UNAIDS believes that there were 2.6 million new HIV infections in 2009. The report includes “scorecards” assessing individual country’s responses to the epidemic.
“The report gives new evidence that investments in HIV prevention programmes are producing significant results,” said UNAIDS.
Prevention gains were greatest in the countries with the worst epidemics.
Between 2001 and 2009, the rate of new infections stabilised or declined by at least 25% in 56 countries, including 34 in sub-Saharan Africa. HIV incidence fell by at least a quarter in four countries with especially severe epidemics: Ethiopia, South Africa, Zambia and Zimbabwe.
Prevention appears to have been especially successful with younger people. According to UNAIDS: “In South Africa the rate of new HIV infections among 18-year-olds declined sharply from 1.8% in 2005 to 0.8% in 2008 and among women 15-24 year-olds it dropped from 5.5% to 2.2% between 2003 and 2008.
Significant progress was made in the prevention of mother-to-child transmission. An estimated 370,000 children were newly infected with HIV in 2009 – a drop of almost a quarter compared to 2004. New infant HIV infections have fallen by 32% in southern Africa.
Traditional mainstays of HIV prevention – condom use and partner reduction – are being credited with the dramatic falls in HIV incidence.
UNAIDS explained: “In 59 countries including 18 of the 25…with the highest HIV prevalence, less than 25% of men reported having sex with more than one partner in the last 12 months.”
Data also showed that condom availability and use increased sharply: “Eleven countries – from Burkino Faso, to India, and Peru – report more than 75% condom use at last higher-risk sex.”
Condom use by men who have sex with men was also high, and more than 60% of sex workers report using a condom with their last client.
Nevertheless, prevention services for injecting drug users still remains inadequate, with harm reduction programmes reaching less than a third of those who need them. UNAIDS emphasises that this “is far short of what is needed to protect drug users worldwide”.
Prevention efforts are also been hampered by continued persecution of men who have sex with men in many countries – “79 countries worldwide criminalize same sex relations and six apply the death penalty”, stressed UNAIDS.
In addition, the number of new HIV diagnoses among gay men in north America and western Europe remains high, and UNAIDS highlighted high levels of risky sex in this population.
Although circumcision programmes have been rolled out in a number of high prevalence countries, there is no evidence that this had an impact on HIV incidence.
However, the fall in new infections coincided with an increase in the number of people taking antiretroviral drugs.
UNAIDS estimates that 5.2 million individuals are now receiving therapy with anti-HIV drugs.
“Over the course of the last year alone, an additional 1.2 million people received treatment – a 30% increase compared to 2008,” said a spokesperson.
Expanding access to life-saving therapy has led to a fall in AIDS-related mortality. The total number of deaths last year was 1.8 million – a 20% reduction on the level of mortality recorded in 2004.
But the report emphasises the need to maintain a high level of commitment.
There were two new infections last year for every person starting therapy, and 10 million people are still waiting for HIV treatment.
The $15.9 billion spent on the global epidemic in 2009 is estimated to be $10 billion short of what was needed in 2010.
Moreover, there was worrying evidence that funding is falling. “Donor governments’ disbursements for the AIDS response in 2009 stood at $7.6 billion, lower than the $7.7 billion in 2008,” said UNAIDS, who emphasised “declines in international investments will affect low-income countries the most – nearly 90% rely on international funding for their AIDS programmes.”