Beyond the headlines: AIDS is still not over
By Georgia White
August 4, 2017
Over recent weeks, we’ve seen a raft of media coverage on the progress made towards ending AIDS. Thousands of experts just gathered in Paris to discuss the latest science, and UNAIDS launched a major report. Some of the results shown are remarkable, and cause for real optimism. But, what’s missing from the headlines?
Some regions are falling way behind, or getting worse
Most of the headlines following the UNAIDS report have focused on this: more than half of people living with HIV now have access to treatment. No doubt, an incredible achievement – but there are such discrepancies between regions that this news doesn’t show the full picture.
One region that needs an emergency response is West and Central Africa.[1] Compared with Eastern and Southern Africa -- home to most people living with HIV -- the West and Central Africa region has always had lower prevalence of HIV. As a result, the region has not received as much attention from international donors in the HIV/AIDS response, and the outcomes are stark: two-thirds of people living with HIV in West and Central Africa don’t know they are infected, and only 35 per cent of those who have tested positive for HIV are receiving treatment. For children, it’s even worse: Médecins Sans Frontières reports that at the end of 2014, 9 out of 10 of that region’s children living with HIV were not being treated. By comparison, the progress made in Eastern and Southern Africa has been nothing short of remarkable: nearly 80 per cent of those who know their status are now on treatment, and the number of AIDS-related deaths have decreased dramatically in the past six years. Botswana, not long ago on the brink of collapse, has rebounded to become one of the countries on track to end AIDS as a public health threat by 2030. As these comparisons clearly show, results follow investment.
Testing is the key to success, but we are failing populations at risk
Worldwide, a third of people living with HIV do not know their status, and therefore don’t seek treatment that can prolong their lives, and nearly eliminate their risk of infecting others. Ultimately, testing is the key to ending AIDS, but it is also the area where we are failing the most vulnerable people.
We are seeing an emergence of a phenomenon of “missing men” in HIV testing services. We also know from pivotal studies in Malawi, Zambia and Zimbabwe that as recently as 2015 and 2016, less than half of young people (aged 15-24) living with HIV in those countries were aware of their status. The gaps in testing for men and young people are particularly concerning when coupled with the fact that in that region, HIV is spread primarily through heterosexual sex, and young women in Southern Africa are already infected at alarming rates.[2]
Another staggering failure is testing among “key populations”. Once called “high-risk groups,” many of the sub-populations that get pushed to the margins of societies have higher rates of HIV, and are now referred to as “key populations”: gay men and other men who have sex with men, sex workers, prisoners, transgender persons, and people who inject drugs.[3] The UNAIDS report shows that in countries outside Africa, key populations account for 80 per cent of new infections. We have no real way of understanding the full picture, because of a lack of data, but UNAIDS cites surveys that reveal a disturbing story. In Moscow, where homosexuality is criminalized, a survey among men who have sex with men found that only 13 per cent of those with HIV knew their status; a survey of the same population group in parts of India found that 30 per cent knew their status.
Financing gaps threaten to reverse gains made
Ending AIDS remains a complicated tangle of medical puzzles and social injustices. But with dramatic improvements in diagnostics, drugs, and the means of delivering them, we’re now at a point when success depends more and more on money. And yet, we are facing the reality of the lowest level of international donor funding for HIV since 2010.
We will need $7 billion more each year to end AIDS by 2030 (to put that in perspective, Americans spent $28 billion on pet food last year alone). The further cuts to funding for HIV in President Trump’s proposed 2018 budget are causing additional anxiety and uncertainty.
In Paris, the head of PEPFAR,[4] Ambassador Deborah Birx, sought to reassure delegates that the program is there to stay. But there is disquiet about how the projected 18 per cent cut to total HIV funding from the U.S. will impact the countries that rely on PEPFAR support. UNAIDS applauds the increased financial commitments from high-burden countries themselves, but recognizes that it is simply not possible for domestic investments, especially by low-income countries, to compensate for reductions in international donor support.
We must face the hard truth: this is still a steep uphill battle. The announcement that treatment coverage has expanded beyond 50 per cent is undeniably good news. But it’s tempered by the reality that those currently in treatment were relatively easier to reach, test, treat, and support to remain in treatment. The remaining nearly half of people who are living with HIV are those who will be harder to reach, test, and treat. Now is the time for a surge in investment. Without it, gains will be lost. As will countless lives.
Georgia White is a Research and Policy Associate at AIDS-Free World.
[1] Médecins Sans Frontières has been a clear and constant voice on this issue, and UNAIDS has just launched a “catch up” plan for this region.
[2] Adolescent girls account for 74 per cent of new infections among young people in Sub-Saharan Africa, and globally, AIDS-related illnesses are the leading cause of death for women aged 15-49.
[3] Despite the direct connection between gender-based discrimination and very high risks of HIV in some locales, the term “key populations” does not include women and girls.
[4] The U.S. President’s Emergency Plan for AIDS Relief, managed by the U.S. Department of State.
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