It was 1981 when the world first witnessed the emergence of a strange disease, which was later christened as AIDS in a report published by the Centers for Disease Control in the US. Since then sustained efforts have been undertaken to combat the epidemic. Now, in a bid to assess the achievements and set future goals to tackle the global epidemic, the United Nations has released a report, titled ‘Uniting for universal access: Towards zero new HIV infections, zero discrimination and zero AIDS-related deaths’. Based on data submitted by 182 countries and on national reviews of universal access to HIV prevention, treatment care and support, the report assesses progress and gaps in the global response.
The report provides five key recommendations to bolster the global fight against HIV: Harness the energy of young people for an HIV prevention revolution, revitalise the push towards achieving universal access to HIV prevention, treatment, care and support by 2015; work with countries to make HIV programmes more cost effective, efficient and sustainable; promote health, human rights and dignity of women and girls and ensure mutual accountability in the AIDS response so as to translate commitments into action.
Hope lies in the fact that the world has moved from a state of “denial to action to achievement”. The epidemic may have claimed more than 25 million lives and left more than 60 million people infected in the last 30 years, but we must take comfort in the fact that worldwide efforts and investments to fight AIDS are finally yielding result — already, the report has confirmed a 25 per cent drop in the number of new HIV infections globally. However against this historic progress in the global decline in AIDS incidence, the number of people acquiring infections continue to be on the rise in Eastern Europe, Central Asia, North Africa, Middle East and parts of Asia; additionally, Sub-Saharan Africa is still the most severely affected region, accounting for 68 per cent of all people living with HIV, 69 per cent of new infections and 72 per cent of all AIDS-related death.
It is also heartening to note that the global coverage for antiretroviral prophylaxis — medicines that prohibit HIV or other types of retroviruses from multiplying in the body — is now accessible to at least 50 per cent of those infected by the virus. In fact, by the end of 2010 more than six million people were on antiretroviral treatment. However it must be mentioned that more than 10 years after intervention processes were undertaken to prevent vertical transmission of the disease in areas which had little or no access to adequate resources, the world remains far from protecting newborns from becoming infected. Thus increased efforts are required to integrate HIV testing into antenatal services that monitor the physiological state of pregnant women. It is a matter of concern that only 26 per cent of pregnant women in low- and middle-income countries were tested for HIV in 2009. India too has shown little progress in preventing mother-child transmission of HIV infection.
There is need for continued vigilance, given the evolving nature of easily transmitted epidemic. Prevention strategies must be reinforced and adapted to impact young people, an increasing number of whom are becoming sexually active, to outpace the spread of the infection. Let us not forget that in spite of a 25 per cent of decline in the number of young people infected with AIDS in the top 10 countries where it is most prevalent, the epidemic continued to outpace our response. This underscores the need to revolutionise our efforts to prevent new infections. Given that young people are leading the global revolution against AIDS, the extra emphasis on injecting youth power is a step in the right direction.
At this point, it may be mentioned that too often AIDS prevention strategies at the national level consist of fragmented and disconnected programmes. For instance, in Asia an overwhelming 90 per cent of prevention resources for young people support programmes focussed on low-risk youth, who account for only five per cent of the people acquiring HIV infection. Likewise in Eastern Europe and Central Asia, where the disease is widespread among those people who use drugs, 89 per cent of prevention investment fails to focus on these people who are at high-risk.
While the constantly evolving nature of the epidemic has made the case for additional funds for the global health financial architecture that supports the fights against AIDS, several other social issues — stigma, discrimination and gender inequality, human rights — continue to undermine the efforts. Therefore, even after 30 years into the epidemic human rights violations and social taboos continue to prevent open discussion of the HIV challenge, deter individuals from seeking needed services and support, thus increasing individual vulnerability. Also, globally fewer than 60 per cent of countries report having a mechanism that records, documents and addresses cases of HIV-related discrimination.
Ultimately, it is important to realise that in spite of the recent gains in making treatment more accessible to patients and the relative success of global prevention strategies, the international response to the AIDS epidemic has failed to keep pace with the need for treatment worldwide. Of the 21 countries that have provided data on drug users who are also on antiretrovirals, only 7 countries have reported being able to reach more than five per cent of their target users. Therefore, UN Secretary-General Ban Ki-moon has urged Governments across the world to pledge more money to fight AIDS, noting that funding has remained stagnant at around $16 billion since 2007 despite rising costs of drugs and treatment.
Moreover, there is a crying need for all partners to work together, incorporate more civil society actors and plan out effective programmes and strategies that build on the latest scientific developments. This will serve as an extraordinary step towards a world of zero infection, zero discrimination and zero HIV-related deaths.
The report provides five key recommendations to bolster the global fight against HIV: Harness the energy of young people for an HIV prevention revolution, revitalise the push towards achieving universal access to HIV prevention, treatment, care and support by 2015; work with countries to make HIV programmes more cost effective, efficient and sustainable; promote health, human rights and dignity of women and girls and ensure mutual accountability in the AIDS response so as to translate commitments into action.
Hope lies in the fact that the world has moved from a state of “denial to action to achievement”. The epidemic may have claimed more than 25 million lives and left more than 60 million people infected in the last 30 years, but we must take comfort in the fact that worldwide efforts and investments to fight AIDS are finally yielding result — already, the report has confirmed a 25 per cent drop in the number of new HIV infections globally. However against this historic progress in the global decline in AIDS incidence, the number of people acquiring infections continue to be on the rise in Eastern Europe, Central Asia, North Africa, Middle East and parts of Asia; additionally, Sub-Saharan Africa is still the most severely affected region, accounting for 68 per cent of all people living with HIV, 69 per cent of new infections and 72 per cent of all AIDS-related death.
It is also heartening to note that the global coverage for antiretroviral prophylaxis — medicines that prohibit HIV or other types of retroviruses from multiplying in the body — is now accessible to at least 50 per cent of those infected by the virus. In fact, by the end of 2010 more than six million people were on antiretroviral treatment. However it must be mentioned that more than 10 years after intervention processes were undertaken to prevent vertical transmission of the disease in areas which had little or no access to adequate resources, the world remains far from protecting newborns from becoming infected. Thus increased efforts are required to integrate HIV testing into antenatal services that monitor the physiological state of pregnant women. It is a matter of concern that only 26 per cent of pregnant women in low- and middle-income countries were tested for HIV in 2009. India too has shown little progress in preventing mother-child transmission of HIV infection.
There is need for continued vigilance, given the evolving nature of easily transmitted epidemic. Prevention strategies must be reinforced and adapted to impact young people, an increasing number of whom are becoming sexually active, to outpace the spread of the infection. Let us not forget that in spite of a 25 per cent of decline in the number of young people infected with AIDS in the top 10 countries where it is most prevalent, the epidemic continued to outpace our response. This underscores the need to revolutionise our efforts to prevent new infections. Given that young people are leading the global revolution against AIDS, the extra emphasis on injecting youth power is a step in the right direction.
At this point, it may be mentioned that too often AIDS prevention strategies at the national level consist of fragmented and disconnected programmes. For instance, in Asia an overwhelming 90 per cent of prevention resources for young people support programmes focussed on low-risk youth, who account for only five per cent of the people acquiring HIV infection. Likewise in Eastern Europe and Central Asia, where the disease is widespread among those people who use drugs, 89 per cent of prevention investment fails to focus on these people who are at high-risk.
While the constantly evolving nature of the epidemic has made the case for additional funds for the global health financial architecture that supports the fights against AIDS, several other social issues — stigma, discrimination and gender inequality, human rights — continue to undermine the efforts. Therefore, even after 30 years into the epidemic human rights violations and social taboos continue to prevent open discussion of the HIV challenge, deter individuals from seeking needed services and support, thus increasing individual vulnerability. Also, globally fewer than 60 per cent of countries report having a mechanism that records, documents and addresses cases of HIV-related discrimination.
Ultimately, it is important to realise that in spite of the recent gains in making treatment more accessible to patients and the relative success of global prevention strategies, the international response to the AIDS epidemic has failed to keep pace with the need for treatment worldwide. Of the 21 countries that have provided data on drug users who are also on antiretrovirals, only 7 countries have reported being able to reach more than five per cent of their target users. Therefore, UN Secretary-General Ban Ki-moon has urged Governments across the world to pledge more money to fight AIDS, noting that funding has remained stagnant at around $16 billion since 2007 despite rising costs of drugs and treatment.
Moreover, there is a crying need for all partners to work together, incorporate more civil society actors and plan out effective programmes and strategies that build on the latest scientific developments. This will serve as an extraordinary step towards a world of zero infection, zero discrimination and zero HIV-related deaths.
