The Tipping Point: Understanding a Crucial Milestone in the AIDS Response

One way to measure progress in fighting AIDS is to compare the number of new HIV infections with the increase in HIV-positive people on antiretroviral therapy (ART) over a given time period. An AIDS epidemic reaches its "tipping point" when the number of annual new HIV infections falls below the annual increase in patients starting ART. Coverage matters. A first milestone is treating approximately two thirds of the people in need in a given country. Once that level is reached, countries and advocates can track progress to the tipping point.

However, a country can reach the tipping point and then cross back -- returning to a situation where incidence outstrips rate of ART initiation. That's why it is essential to achieve optimal coverage rates of high-impact prevention including voluntary medical male circumcision, male and female condoms and harm reduction. Newer strategies such as PrEP and, eventually, a microbicide or vaccine should also be used for maximum impact.

The pace at which treatment and prevention are scaled up is key. To reach the tipping point the rate at which people are started on treatment should accelerate immediately. To stay on course countries and donors need to increase financial and human resource commitments to strategic combination prevention.