UNAIDS reports slow progress on the 2020 HIV targets
UNAIDS’ new report ‘Miles to go—closing gaps, breaking barriers, righting injustices’ has warned that countries are lagging behind the 2020 target for HIV reduction.
The report highlights how countries are at a half-way point to achieving the 2020 goals and warns that the pace of progress is not matching global ambitions.
Michel Sidibe, Executive Director of UNAIDS, commented:
“We are sounding the alarm. Entire regions are falling behind, the huge gains we made for children are not being sustained, women are still most affected, resources are still not matching political commitments and key populations continue to be ignored. All these elements are halting progress and urgently need to be addressed head-on.”
Over the last seven years the number of HIV infections have decreased by 18%, from 2.2 million in 2010 to 1.8 million in 2017. Although this figure is 50% lower than 1996, when infections peaked at 3.4 million, the pace of the decline is too slow to meet global targets of 500,000 cases by 2020.
The regions most affected by HIV, such as eastern and southern Africa, have experienced the strongest reduction in new HIV infections; with
a 30% decrease since 2010.
However, the number of new HIV infections are rising in around 50 countries. The annual number has doubled in Eastern Europe and Central Asia and new HIV infections have increased by a quarter in the Middle East and North Africa over the past 20 years.
How is treatment driving progress?
The number (940,000) of deaths related to AIDS is the lowest this century due to antiretroviral therapy roll-out. It dropped to below 1 million for the first time in 2016.
Access to treatment is also increasing with 21.7 million people now receiving treatment, 2.3 million of these accessed treatment in the same year.
Around the world 36.9 million people live with HIV, of these almost 60% received treatment in 2017. However, to reach the 30 million target an annual increase of 2.8 million people is required.
Which regions are lagging behind?
Western and Central Africa are lagging behind other regions with 30% of children and 41% of adults living with HIV accessing treatment. This is significantly lower than figures for South and East Africa where 59% of children and 66% of adults receive treatment.
Similarly, deaths related to AIDS have dropped by 24% in Western and Central Africa since 2010 whereas a 42% decrease was recorded in Eastern and Southern Africa.
Nigeria has over 50% of HIV infections in the region but little process has been made to reduce new infections in recent years. Since 2010, new HIV infections have only decreased by 5%.
What progress has been made to protect children?
The report also criticised the progress made on HIV programmes for children, highlighting that progress is not being sustained. Over the past two years the number of children infected by HIV has declined by 8% and only 50% of children living with HIV are receiving treatment. In 2017 alone HIV killed 111,000 children.
There has been significant progress in preventing transmission during birth with 80% of infected pregnant women receiving antiretroviral medicine. However, the number of children found to be infected during birth or breastfeeding (180,000) still lags significantly behind the 2018 target of 40,000.
Mr Sidibé added:
“One child becoming infected with HIV or one child dying of AIDS is one too many. Ending the AIDS epidemic is not a foregone conclusion and the world needs to heed this wake-up call and kick-start an acceleration plan to reach the targets.”
Who is most at risk from new infection?
The report indicates that key populations are not considered thoroughly in HIV programming. Key populations and their sexual partners account for 47% of all new HIV infections, 97% of new HIV infections were found in Eastern Europe and Central Asia, and one in three new HIV infections happened among people who inject drugs.
Mr Sidibé said:
“The right to health for all is non-negotiable. Sex workers, gay men and other men who have sex with men, prisoners, migrants, refugees and transgender people are more affected by HIV but are still being left out from HIV programmes. More investments are needed in reaching these key populations.”
Half of all sex workers in Eswatini, Lesotho, Malawi, South Africa, and Zimbabwe are infected with HIV, the report found. Female sex workers face a 13-times-higher risk than others.
Vincent Pelletier, Positive Leader and Executive Director of Coalition PLUS commented:
“Communities are echoing UNAIDS’ call. We need universal access to adapted prevention services, and protection from discrimination. We call upon world leaders to match commitments with funding, in both donor and implementing countries.”
HIV sufferers still experience discrimination and stigma
The report found that discrimination from health-care workers, law enforcement, teachers, employers, parents, religious leaders and community members is preventing people from accessing prevention, treatment and sexual health services.
Across 19 countries, one fifth of people who responded to UNAIDS’ survey were denied health care and avoided visiting a health facility because of fear of stigma or discrimination. In 5 of 13 countries with available data, over 40% of people thought children with HIV infections should drop out of school and not study with students who are HIV-negative.
What progress has been made towards the 90–90–90 target?
Significant process has been made towards the 90-90-90 targets with 75% of people living with HIV now understanding their HIV status. Among this group of people, 79% were on treatment and of those on treatment, 81% had suppressed viral loads.
Six countries, including Botswana, Cambodia, Denmark, Namibia, the Netherlands and Swaziland have successfully reach the 90-90-90 targets and seven more countries are track to meeting the targets.
What is needed to achieve the 2020 goal?
In 2017 $20.6 billion was available for the AIDS response, a rise of 8% since 2016 and 80% of the total 2020 target set by the UN. However, there were no significant new commitments and UNAIDS have urged donors and domestic sources to increase their investment to achieve the 2020 target.
The report also emphasised the importance of collaboration between health systems and communities to reduce stigma and discrimination to enable greater access to treatments and preventative advice.
Mr Sidibé concluded:
“For every challenge there is a solution. It is the responsibility of political leaders, national governments and the international community to make sufficient financial investments and establish the legal and policy environments needed to bring the work of innovators to the global scale. Doing so will create the momentum needed to reach the targets by 2020.”
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Image credit: UNODC