HIV/AIDS: “Unprecedented progress”, despite poor funding
and middle-income countries due to increased access to HIV treatment since 1995 NAIROBI, 21 November 2011 () – 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.
“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
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/.
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.
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
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.
“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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