We have impactful new data and technologies to help us better
prevent new infections in the years to come. Now, for the first time in
history, the world can look ahead to the beginning of the end of the AIDS
pandemic.
The Challenge
In the 30 years since HIV/AIDS was first discovered, the disease has become
a devastating pandemic, taking the lives of 30 million people around the world.
In 2010 alone, HIV/AIDS killed 1.8 million people, 1.2 million of whom were
living in sub-Saharan Africa. Though
life-saving antiretroviral treatment is available, access is not yet
widespread; of the estimated 14.2 million HIV-positive individuals in need of
treatment, nearly 8 million are not currently able to access it.
Even more troublesome, new HIV infections continue to outpace those added
onto antiretroviral treatment. More than 390,000 infants and children were
newly infected with HIV in 2010, and 2.7 million total new HIV infections
occurred in the same year—a rate that has held relatively constant since 2006.
Because individuals in their most productive years (15-49 years old) are
most commonly infected with HIV/AIDS, the disease has a wide socioeconomic
impact that threatens development progress in many poor countries, especially
those in sub-Saharan Africa. 14.8 million
children in the region have already lost one or more parents to the disease. In
South Africa
alone, 1.9 million children have been orphaned due to AIDS, exacerbating a
social dynamic that is already deeply challenged by crime, violence and
unemployment. HIV/AIDS targets people during their most productive years,
making economic progress in many sub-Saharan African countries even more of a
challenge. Some estimates suggest that annual GDP growth in highly affected
countries can be 2-4% lower than in countries with the absence of AIDS.
In 2005, world leaders at the G8 summit in Gleneagles and at the U.N. World
Summit in New York
pledged to reach universal access to prevention, care and treatment by 2010.
Though this target was not achieved, leaders recommitted to the fight against
AIDS in 2011 by agreeing to work toward achieving universal access to HIV
prevention, treatment, care and support by 2015. Delivering these essential
services will require a strengthening of health systems, especially in Africa, which is home to two-thirds of those requiring
antiretroviral (ARV) treatment, but only 3% of the global health care workers
to provide it.
The Opportunity
We are at a critical moment in the fight against HIV/AIDS. The world has made
incredible progress in its efforts to understand, prevent and treat this
disease, and progress has been particularly rapid during the last ten years.
But by the end of 2010 more than 6.6 million people were on life-saving
antiretroviral treatment, up from just 300,000 in 2002; of that 6.6 million
more than 5 million were living in sub-Saharan Africa.
Botswana, Rwanda, and Namibia
have already achieved universal access to ARVs, while Benin, Guinea,
Kenya, Lesotho, Senegal,
South Africa, Swaziland, Togo,
Zambia, and Zimbabwe
have coverage rates between 50 to 80% and are making progress towards universal
access.
Though we have not made enough progress on the prevention of HIV, we now
have impactful new data and technologies to help us better prevent new infections
in the years to come. More sophisticated treatment regimens now make it
possible to prevent the transmission of HIV from mother-to-child in as many as
98% of cases. Nearly half of all pregnant women with HIV can now receive ARV
prophylaxis for PMTCT and a global effort co-led by UNAIDS and the US Office of
the Global AIDS Coordinator (OGAC) has called for leadership from the 22
highest-burden MTCT countries to help virtually eliminate transmission from
mother-to-child by 2015.
New research over the last two years has also provided groundbreaking data
on two fronts: the impact of treatment as prevention, and the role of male
circumcision in prevention strategies. The HPTN 052 clinical trial showed that
treatment acts as prevention, reducing the likelihood of an HIV-positive
individual on treatment passing HIV on to others by up to 96%. Voluntary
medical male circumcision, another powerful tool, was shown to reduce the
likelihood of HIV infection by up to 60%. Combination prevention, including
treatment-as-prevention and other strategies such as PMTCT, the ABC strategy to
prevent sexual transmission (Abstain, Be faithful, & correct and consistent
use of Condoms), male circumcision, and reduction of unsafe blood and medical
injections, will play a central role in moving us towards ending the pandemic.
Now, for the first time in history, the world can look ahead to the
beginning of the end of the AIDS pandemic. We have the tools necessary to
achieve an AIDS-free generation if we focus our efforts on three interim goals:
virtual elimination of mother-to-child transmission by 2015, expansion of
antiretroviral treatment to 15 million people by 2015, and implementation of
innovative prevention techniques to stop new infections. To bend the curve of
the AIDS pandemic, these goals cannot be achieved in isolation from one
another, nor can their achievement be the sole responsibility of a small number
of donor countries. Only when working in parallel--through the broad support of
donors, African governments, international organizations, and the private
sector--will the beginning of the end of AIDS become a reality.
During a time of financial austerity and economic crisis in many parts of
the world, it is essential for both donor and recipient countries to reaffirm
their commitments to combating HIV/AIDS while making strategic investments.
From 2002 to 2009, global funding for HIV/AIDS increased dramatically from $800
million to $6.8 billion annually, and these international investments are
paying off: the Global Fund to Fight AIDS, Tuberculosis, and Malaria has helped
3.3 million people receive ARV treatment and conducted 190 million HIV
counseling and testing sessions, while the U.S. President's Emergency Plan for
AIDS Relief (PEPFAR) has directly supported 3.9 million people on ARV treatment
and reached more than 13 million people with care services, including more than
4.1 million orphans as of 2011.
Sustaining our current progress, with an aim towards beginning to end AIDS,
will require increased focus on prevention, expanded ARV treatment, and
continued scientific research. At this critical juncture, it is imperative for
all of us to make strategic investments and to keep an eye on the finish line.

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