May 6, 2016
Credit: United Nations
New York -- A new report released by the United Nations Secretary-General, Ban Ki-moon, warns that the AIDS epidemic could be prolonged indefinitely if urgent action is not implemented within the next five years. The report, On the Fast-Track to end the AIDS epidemic, reveals that the extraordinary acceleration of progress made over the past 15 years could be lost and urges all partners to concentrate their efforts to increase and front-load investments to ensure that the global AIDS epidemic is ended as a public health threat by 2030.
"The AIDS response has delivered more than results. It has delivered the aspiration and the practical foundation to end the epidemic by 2030," said Mr Ban in the report. "But if we accept the status quo unchanged, the epidemic will rebound in several low- and middle-income countries. Our tremendous investment, and the world's most inspiring movement for the right to health, will have been in vain."
The review of progress looks at the gains made, particularly since the 2011 United Nations Political Declaration on HIV and AIDS, which accelerated action by uniting the world around a set of ambitious targets for 2015. "The progress made has been inspiring," said Mr Ban in the report. "Reaching 15 million people with antiretroviral therapy nine months before the December 2015 deadline is a major global victory." The report outlines that the rapid treatment scale-up has been a major contributing factor to the 42% decline in AIDS-related deaths since the peak in 2004 and notes that this has caused life expectancy in the countries most affected by HIV to rise sharply in recent years.
The report underlines the critical role civil society has played in securing many of the gains made and the leadership provided by people living with HIV. Community efforts have been key to removing many of the obstacles faced in scaling up the AIDS response, including reaching people at risk of HIV infection with HIV services, helping people to adhere to treatment and reinforcing other essential health services.
A major area of success has been in reducing new HIV infections among children. In 2011 UNAIDS and partners launched the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive at the UN General Assembly High-level meeting on AIDS and in just five years, from 2009 to 2014, new HIV infections have been halved in the countries that account for 90% of all pregnant women living with HIV. Some around 85 countries are now poised to virtually eliminate new HIV infections among children.
In the report, however, Mr Ban also calls the shortfalls in the implementation of the 2011 Political Declaration on HIV and AIDS distressing, revealing that even as new HIV prevention tools and approaches have emerged, HIV prevention programmes have weakened in recent years owing to inadequate leadership, weak accountability and declining funding. He notes that new HIV infections declined by just 8% between 2010 and 2014.
The report draws attention to regions where new HIV infections are continuing to rise -- eastern Europe and central Asia, where new HIV infections rose by 30% between 2000 and 2014, mostly among people who inject drugs, the Middle East and North Africa and the Asia-Pacific region.
It notes that gender norms that perpetuate inequality continue to prevail across many societies and that girls and young women remain particularly affected by HIV. Of the 2.8 million young people aged 15-24 years living with HIV in sub-Saharan Africa, 63% were female.
The report highlights that despite the progress made on expanding access to antiretroviral therapy, around 22 million people still do not have access to treatment. The report attributes the most substantial barrier to scaling up HIV treatment as late diagnosis, highlighting that around half of all people living with HIV are unaware of their HIV status -- this underscores the urgency of increasing access to HIV testing, particularly for people at higher risk of infection.
Despite the challenges outlined in the report, it does offer substantial hope for the future, stating that if the world can alter the status quo, the AIDS epidemic can be ended as a public health threat by as soon as 2030. To do this, the report outlines that the response needs to be inclusive, accessible and grounded in human rights and that it must focus on scaling up services for the people and places most in need. The report also emphasizes the necessity of repealing punitive laws and repressive policies that criminalize same-sex sexual relations, people who use drugs and sex workers, since they impede access to services.
"We must reinforce rights-based approaches, including those that foster gender equality and empower women," said Mr Ban in the report. "Access to services must be ensured for the people most affected, marginalized and discriminated against including people living with HIV, young women and their sexual partners in sub-Saharan Africa, children and adolescents everywhere, and gay men and other men who have sex with men, sex workers and their clients, people who inject drugs, transgender people, people in prison, people with disabilities, migrants and refugees."
The report gives strong emphasis to the links between the response to HIV and the success of the Sustainable Development Goals (SDGs), underlining the strong links to SDG 3 (ensure healthy lives and promote well-being for all), SDG 5 (achieve gender equality and empower women and girls), SDG 10 (reduce inequality in access to services and commodities), SDG 16 (promote just, peaceful and inclusive societies) and SDG 17 (revitalize the partnership for sustainable development).
The report notes that the scale-up of resources in recent years has been a strong driving force behind the progress made in responding to HIV. It estimates that in 2014 US$ 19.2 billion was available in low- and middle-income countries for the response to HIV and that by 2020 resources need to increase to an estimated US$ 26.2 billion to achieve the 2030 target of ending the AIDS epidemic.
The report urges countries to embrace the UNAIDS Fast-Track approach to ending the AIDS epidemic, which will require reaching an ambitious set of goals by 2020, including reducing the numbers of people newly infected with HIV and people dying from AIDS-related causes to fewer than 500 000 per annum and eliminating HIV-related discrimination. Targets to reach these goals include reaching the 90-90-90 treatment target for 2020, which calls for 90% of people living with HIV to know their status, 90% of people who know their HIV-positive status to access treatment and 90% of people on treatment to have suppressed viral loads.
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