In-depth: TB - the year that was

HIV/AIDS: "Unprecedented progress", despite poor funding

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About 2.5 million deaths are estimated to have been averted in low- and middle-income countries due to increased access to HIV treatment since 1995

NAIROBI, 21 November 2011 (PlusNews) - New HIV infections and AIDS-related deaths have continued to fall, and the number of people on treatment has risen to nearly 50 percent of those eligible, despite an overall fall in global funding, states a UNAIDS report.

The 2011 UNAIDS World AIDS Day report shows that 2.7 million people were newly infected with HIV in 2010 - a reduction of 21 percent since 1997 - while some 6.6 million people now have access to life-prolonging antiretroviral drugs, an increase of 1.35 million since 2009.

"Even in a very difficult financial crisis, countries are delivering results in the AIDS response," said Michel Sidibé, executive director of UNAIDS, in a statement. "We have seen a massive scale-up in access to HIV treatment which has had a dramatic effect on the lives of people everywhere."

Fewer infections, fewer deaths

Declines in new HIV infections are largely attributed to increases in the numbers of people on treatment; studies show that treatment reduces the risk of transmitting the virus to an uninfected partner. According to the report, the number of new HIV infections in Botswana - which scaled up access to treatment from less than 5 percent in 2000 to over 80 percent today - is between 30 and 50 percent lower now than it would have been without ARVs.

About 2.5 million deaths are estimated to have been averted in low- and middle-income countries due to increased access to HIV treatment since 1995.

Fewer HIV infections are also the result of changes in sexual behaviour, including fewer sexual partners and increased condom use. The rate of new HIV infections in urban Zimbabwe fell from almost 6 percent in 1991 to less than 1 percent in 2010; studies estimate that without behaviour change, there could have been an additional 35,000 new infections annually.

"The advances we are seeing are also as a result of more women accessing prevention of mother-to-child transmission - nearly half of all HIV-positive women around the world now have access to ARVs to prevent transmission to their unborn children," Peter Ghys, chief of information for the UNAIDS Improved Country Response Division, told IRIN/PlusNews.

An estimated 400,000 new HIV infections in children have been averted since 1995 due to increased access to effective ARV regimens in low- and middle-income countries by 2010.

New biomedical interventions are also showing results; studies show that 2,000 new HIV infections were averted among men in western Kenya's Nyanza province following the scale-up of voluntary male circumcision.

Smarter investments

But according to UNAIDS, smarter investments could yield even better results; the organization's new "Investment Framework" has four goals: maximizing the benefits of the HIV response; using country-specific epidemiology to ensure rational resource allocation; encouraging countries to implement the most effective programmes based on local context and increasing efficiency in HIV prevention, treatment, care and support.

"The new investment framework is focused on achieving specific goals within a given country, as each country has its own drivers and dynamics," Ghys said. "There is a need to focus on programmes shown to be high-impact."

For example, estimates in the report highlight that circumcising 20 million men across eastern and southern Africa would avert about 3.4 million new HIV infections by 2015.

Sub-Saharan Africa
	2010	2001
Adults and children living with HIV	22.9 million	20.5 million
Adults and children newly infected with HIV	1.9 million	2.2 million
Adult prevalence (%)	5.0	5.9
Adult and child deaths due to AIDS	1.2 million	1.4 million
Source: UNAIDS

According to UNAIDS, this new strategic approach to spending would avert some 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 report notes, for example, that in Cambodia, investments have matched the scale of the epidemic and were aligned to epidemiological trends, resulting in a dramatic reduction in HIV incidence. In Vietnam, on the other hand, the epidemic is primarily driven by injecting drug use and sex between men but coverage and investment in effective harm reduction programmes for these populations remain insufficient; UNAIDS estimates that policies and investments based on the principles of the investment framework could halve new HIV infections there by 2015.

"We are also urging countries to ensure that high-impact HIV interventions can be put into action by assessing and removing blockages - such as criminalization of the activities of men who have sex with men - to programme success," said Ghys.

Finding the money

The biggest hindrance to rapidly reducing new infections and saving lives, however, is likely to be money. For the new framework to achieve universal access to HIV prevention, treatment, care and support by 2015, funding will need to be scaled up to US$22-$24 billion annually.

At the end of 2010 about $15 billion in total funding was available in low- and middle-income countries; donor funding was cut by 10 percent from $7.6 billion in 2009 to $6.9 billion in 2010.

According to Médecins Sans Frontières (MSF), without increased funding, opportunities to prevent new infections are being missed and there is a real risk that the fight against HIV could regress.

"Right now, we're in an absurd situation where the signposts all point in one direction to get a handle on HIV/AIDS, yet the funding crunch is pulling us the opposite way," Shelagh Woods, head of MSF's project in rural Malawi, said in a statement. "We have to act fast and reach as many people as possible to save lives and avoid slipping back, but countries can't do this alone."

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