There is progress, but prevention is in crisis
Despite a series of important successes, the “global AIDS response is at a precarious point.” This is the warning sounded by the new report of the United Nations joint program on HIV/AIDS (UNAIDS), made public last July 18 in Paris, France.
In the document, titled “Miles to Go“, the UN agency warns that “at the halfway point to the 2020 targets, the pace of progress is not matching the global ambition. This report is a wake-up call—action now can still put us back on course to reach the 2020 targets,” writes the UN program’s executive director, Michel Sidibé, in his forward to the document.
Although “time is running out,” there is “some progress to be proud of,” the report explains. In eastern and southern Africa, “a region that is home to more than half (53%) of the world’s 36.9 million [31.1–43.9 million] people living with HIV,” there have been “strong aggregate gains,” the UN agency’s report observes. In the period from 2010 to 2017, deaths from AIDS-related diseases have dropped by 42% in the region; the number of new infections has also dropped, by 30%.
Worldwide, the document explains, antiretroviral therapy continues to gain ground. According to UNAIDS data, it is believed that by the end of 2017 a record number of 21.7 million people had access to the treatment; that is “five and a half times more than just a decade ago.” This represents an increase of 2.3 million people as compared to 2016 (19.4 million). In addition, close to three quarters of the people who live with HIV worldwide, that is about 75%, were aware of their condition at the end of last year, a fundamental step for requesting and getting help.
Thanks to progress making treatment available, the number of deaths from AIDS-related illness dropped by 24% in the period from 2010 to 1070. Last year, less than a million people died from illnesses related to AIDS: 940,000. In 2004, the peak year for deaths, the statistic was 1.9 million.
Access to retroviral drugs to prevent mother-to-child transmission has significantly reduced new HIV infections among children. According to the ONU, thanks to these measures, “globally, 1.4 milllion [880,000–2,100,000] new child infections have been averted since 2010.”
In this context, we should mention that Thailand in 2017 eliminated mother-to-child transmission of the HIV virus, thus becoming the first country in Asia to achieve this objective established by the World Health Organization (WHO).
Some darker areas
Despite this progress and encouraging news, much is yet to be done; efforts need to be redoubled in order to achieve the objectives established in 2015 by the global community to put an end to AIDS as a public health threat before 2030.
Indeed, there are few countries which, since then, have reached the intermediate goals set by the 90-90-90 strategy, which establishes that before teh end of the year 2020 at least 90% of the people in the world who live with HIV should be aware of their condition, 90% of them should be receiving antiviral therapy, and lastly, 90% of these patients should achieve suppression of their viral load.
A first obstacle or problem is an economic one. According to the UN report, funds for fighting AIDS/HIV in medium-to-low income countries reached nearly $20.6 million in 2017, approximately 80% of the goal set by the General Assembly of the United Nations. But during the same year, there were “no new significant commitments from donors,” the document reports. The 20% deficit will be “catastrophic” for the 44 countries which depend the most on international funds in the fight against this pandemic, Sidibé has remarked.
A second shortfall lies in the fact that although the number of new HIV infections continues to drop—from a peak of 3.4 million in 1996 to 2.2 million in 2010 and 1.8 million last year—the decrease is slower than needed to be able to reach the milestone of less than 500,000 new infections by 2020, the UNAIDS report explains. The same is true of the drop in the number of deaths due to AIDS-related diseases: in order to achieve the 2020 goal, an additional decrease of nearly 150,000 per year is needed.
There are also serious consequences due to the “low availability of the virological tests needed for newborns.” Consequently, up to “two thirds of HIV-positive children under two years of age in Africa, Asia, and the Americas start antiretroviral therapy with advanced immunodeficiency.” The total of 940,000 children in therapy is far from the goal of 1.6 million set for this year, and in 2017, approximately 180,000 children were infected with HIV.
A prevention crisis
The report also reveals perhaps the greatest problem at this moment in the fight against HIV/AIDS is what Sidibé calls a “prevention crisis.”
“Health is a human rights imperative and we are deeply concerned about the lack of political commitment and the failure to invest in proven HIV programmes,” explained the executive director of the UN agency during the international conference on AIDS, which took place in Amsterdam, Holland last July 23-27, with the title (which could seem to come from the pen of Pope Francis) Breaking Barriers, Building Bridges.
“If countries think they can treat their way out of their epidemics, they are dangerously mistaken,” continued the diplomat from Mali, who was criticized in Amsterdam for his handling of a sex abuse scandal within the United Nations agency.
In a certain sense, suggests a commission of 40 world experts in the respected scientific journal The Lancet, prevention has fallen victim to the “Getting to zero: End AIDS by 2030” campaign, through which the international community intends to eliminate the pandemic by 2030.
“The prevailing discourse on ending AIDS has bred a dangerous complacency and may have hastened the weakening of global resolve to combat HIV,” said Professor Chris Beyrer, an epidemiologist at Johns Hopkins University Bloomberg School of Public Health in Baltimore, Maryland, and co-president of the commission, quoted by Jon Cohen in Science.
This opinion is shared by the secretary general of the International Catholic Migration Commission, who is also a former special advisor on HIV for Caritas International, Msgr. Robert J. Vitillo, who confirms that a premature declaration of victory has contributed to hampering the fight against AIDS.
“The message was put out a few years ago, even by some U.N. agencies, that we were almost at the end of AIDS. Magazine covers declared, ‘The end of AIDS.’ That message went far and wide and it’s been hard to overcome it. We were not at the end of AIDS then, and we are not there now,” declared Vitillo to Catholic News Service. “There is indeed complacency. There is a sense that we’ve spent so much energy on this one disease while there are other priorities to attend to,” continues the monsignor.
That is precisely the principal message of the new UNAIDS report: we cannot let our guard down in the face of AIDS/HIV, because the battle is not yet won.