hiv statistics - putting people at a great risk.

millions of people at risk.

Five years ago, the international community working
in HIV and AIDS set a target of "universal access to comprehensive prevention programmes, treatment, care and support".

This week that community is meeting again, at the UN High Level Meeting, to review the world's progress in responding to the HIV epidemic and to agree the way forward.

But how can a response be effective when the global picture of the epidemic is skewed missing out an entire set of people so acutely affected by it?

I am, of course, talking about older people who are left out of HIV statistics and targets.

New infections have led to increasing numbers of people aged 50 and over living with HIV.

However, this has not been recognised.

Neither the 2001 Declaration of Commitment, signed ten years ago at the groundbreaking UN General Assembly Special Session (UNGASS), nor the UN's 2006 Political Declaration on HIV/AIDS makes any reference to older people living with HIV.

In adopting the 2001 Declaration, member states committed that every two years they would report their progress in responding to the epidemic to the UN General Assembly, against 25 core indicators.

But none of these indicators explicitly includes people aged 50 and over, or requests HIV statistics to be broken down by age.

Three indicators - on access to testing, higher risk sex and condom use - are specifically restricted to people aged 15-49.

Requests for prevalence data are also limited to the 15-49 year age group.

Some countries provided HIV statistics

In 2010, member states submitted progress reports.

An analysis of the 119 reports submitted in English shows that some countries are submitting HIV statistics on people aged 50 and over, even though they are not required to do so.

The figures are startling - showing just how at risk older people are of infection. You can read some of the statistics at the bottom of this post.

Because there is no official requirement on how to present HIV statistics on older people, there is no consistency in the way countries do this.

But in total 57 of the 119 reports present HIV statistics on older people (or state that statistics are available) or make other references to older people - reflecting a growing understanding at national level that this age group needs to be given attention.

Despite this, UNAIDS' 2010 Global Report on the AIDS epidemic, which is based on the reports submitted by country governments, does not include any HIV statistics on people aged 50 and over, or make any other reference to older people, either as carers or as people living with HIV.

Why should older people be included in HIV statistics?

The fact is older people are hugely affected by HIV - as carers of family members with HIV and orphaned children, and as people at risk of infection themselves.

Millions of older men and women care for sons and daughters who are living with HIV or for orphaned grandchildren.

In Cambodia, 80% of adult children (who subsequently died of AIDS) were cared for by an older parent.[i]

In east and southern Africa, 40-60% of children orphaned as a result of AIDS are cared for by their grandparents, usually their grandmothers.[ii]

If older people are ignored in the response, how can the children in their care be properly fed, clothed and educated? How can they advise young people about safer sex or protect themselves? How can they receive the treatment, care and support they need?

The absence of older people in HIV statistics at global level implies there is no data at all and no recognition by governments of older people's issues.

It means no attention is paid to older people in the response to HIV, meaning many are unable to access services and support.

There is a clear mismatch between what is reported nationally and what is presented at global level.

It is crucial, therefore, that older people are recognised at this week's UN high-level meeting, and that they are included in any subsequent outcome document and any new commitments and targets, so that every single country has to include older people in its HIV statistics collection and programmes.

[i] Committed to caring: older women and HIV & AIDS in Cambodia, Thailand and Vietnam, Chiang Mai, HelpAge International, 2007, p.14

[ii] The state of the worlds children report: women and children, the double dividend of gender equality, UNICEF, 2007

 

Striking new HIV statistics

Where figures are presented by countries, they provide striking evidence of how older people are at risk from the epidemic:

• In Dominica, 17% of cumulative cases of AIDS (all cases diagnosed since the start of the epidemic) have been in people aged 50 and over.

• In the Netherlands, 28% of people living with HIV are aged 50 and over, and in Sweden and Barbados, 25 per cent.

• In Botswana, men aged 50-54 have the highest prevalence after the 35-39 and 40-44 year age groups, at just under 30 per cent (exact figures not given).

• In Swaziland, 28% of men aged 50-54 have HIV, compared with 20 per cent of men aged 15-49.

• In Sweden, 25% of newly reported cases of HIV and AIDS are in people aged 50 and over.

• In China, 11% of new HIV cases in 2009 were in people aged 50-64 and 4 per cent in people were aged 65 and over.

Some countries have collected HIV statistics on older people against the three indicators focused on the 15-49 year age group. For example:

• In Mozambique, the proportion of people tested for HIV who were 50 or over increased from 5% in 2006 to 7 per cent in 2009.

• In South Africa, the proportion of people aged 50 and over who use a condom has increased since 2005, although people in this age group are far less likely to use a condom than younger people.

Hiv Statistics Worldwide

Hiv Statistics Worldwide

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.