UNITED NATIONS — There has been “significant progress” in expanding access to HIV treatment over the last decade, but testing and treatment gaps still place the goal of getting 30 million people on treatment by 2020 out of reach, according to new findings from UNAIDS.
An estimated 24.5 million people of the 37.9 million living with HIV were accessing treatment as of mid-2019, more than double the number of HIV-positive people on treatment in 2010, according to the UNAIDS report, “Power to the People.” But since 2010, new HIV infections have only slightly declined, and some regions have seen a rise in new cases.
“Social injustices, inequality, denial of citizenship rights, and stigma and discrimination are holding back progress against HIV and the Sustainable Development Goals.”— Winnie Byanyima, executive director, UNAIDS
“Gains continue to be made against the epidemic, but those gains are getting smaller year after year,” said Ninan Varughese, director of the UNAIDS New York office, during a Tuesday media briefing at the U.N.
Recent progress in reducing new HIV infections is most pronounced in eastern and southern Africa, the regions most affected by HIV. The number of new HIV infections in the two regions declined by 28% from 2010 to 2018, and incidence rates among adolescent girls and young women dropped by 42% over the same time period.
Outside of eastern and southern Africa, though, the number of new HIV infections has declined by only 4% since 2010. And the number of new infections rose by 29% in Eastern Europe and Central Asia. The figure also rose, though with smaller increases, in the Middle East, North Africa, and Latin America.
And while the number of HIV-positive people on antiretroviral treatment continues to rise, nearly half of the people living with HIV in 2018 had unsuppressed viral loads, meaning they have an increased risk of transmitting the virus, according to the UNAIDS findings.
“In many parts of the world, significant progress has been made in reducing new HIV infections, reducing AIDS-related deaths, and reducing discrimination, especially in eastern and southern Africa, but gender inequality and denial of human rights are leaving many people behind,” UNAIDS Executive Director Winnie Byanyima said in a statement.
“Social injustices, inequality, denial of citizenship rights, and stigma and discrimination are holding back progress against HIV and the Sustainable Development Goals,” Byanyima said.
UNAIDS estimates that $26.2 billion is needed for the AIDS response in 2020, according to Varughese. About $19 billion was available for HIV and AIDS prevention and treatment in 2018, marking a $1 billion drop from funding available in 2017, according to Varughese.
UNAIDS’ 2020 targets include ensuring that 90% of all people receiving antiretroviral therapy have viral suppression and that 90% of all people living with HIV know their status.
So far, Botswana, Cambodia, Rwanda, Spain, Thailand, Kenya, Nepal, and Italy are among the 19 countries on track to reach the 2030 target of eliminating AIDS as a public health threat, Varughese said.
There is also a need to focus on prevention and treatment among members of “key populations” who are more likely to become infected with HIV, according to Varughese. These include men who have sex with men, sex workers, and people who inject drugs.
Other challenges include reducing the gap in time from when someone learns they are HIV positive to then accessing treatment.
“It can be four years until treatment begins. This really puts pressure on the number of new infections,” Varughese said.
Byanyima, who officially began her new position as executive director of UNAIDS at the beginning of November, presented the latest report’s findings in Nairobi on Tuesday, ahead of World AIDS Day on Dec. 1. The report highlights the need for people living with HIV to engage in decision-making and service delivery. Better engagement is linked to a decline in new HIV infections and a rise in treatment access, the report shows.
Ensuring that communities and people living with HIV have the power to influence prevention and treatment work is “key” to ending HIV and AIDS, Varughese said.
“Communities have played an integral role and a huge part in the response to AIDS. Communities have helped ensure that more than 24 million people are on treatment. Communities have acted to change laws that discriminate,” Varughese said during Tuesday’s press conference. “We see that, globally, civic space is shrinking and we need to protect that civic space.”