The new UNAIDS Outlook 2010 report, released ahead of the recent 18th International AIDS Conference
in Vienna, shows that young people are leading the prevention revolution, with 15 of the most severely
affected countries reporting a 25% drop in HIV prevalence among this key population.

The new UNAIDS Outlook report
outlines a radically simplified HIV treatment
platform called Treatment 2.0 that
could decrease the number of AIDSrelated
deaths drastically and could also
greatly reduce the number of new HIV
infections. Evidence shows that new HIV
infections among young people, in the 15
countries most affected by HIV, are dropping
significantly as young people
embrace safer sexual behaviours.
Also in the report, a sweeping new
UNAIDS and Zogby International public
opinion poll shows that nearly 30 years
into the AIDS epidemic, region by region,
countries continue to rank AIDS high on
the list of the most important issues facing
the world.
And an economic analysis makes the case for making health a necessity, not a
luxury, outlining the critical need for
donor countries to sustain AIDS investments
and calling on richer developing
countries to invest more in HIV and
health.
The report was launched in Geneva
ahead of the XVIII International AIDS
Conference in Vienna. The UNAIDS
Executive Director, Michel Sidibé,
stressed that innovation in the AIDS
response can save more lives. “For countries
to reach their universal access targets
and commitments, we must reshape the
AIDS response. Through innovation we
can bring down costs so investments can
reach more people.”
According to UNAIDS’ estimates there
were 33.4 million people living with HIV worldwide at the end of 2008. In the same
year there were nearly 2.7 million new
HIV infections and 2 million AIDSrelated
deaths.
Treatment 2.0 saves lives
Treatment 2.0 is a new approach to
simplify the way HIV treatment is
currently provided and to scale up access
to life saving medicines. Using a combination
of efforts it could bring down treatment
costs, make treatment regimens
simpler and smarter, reduce the burden on
health systems and improve the quality of
life for people living with HIV and their
families. Modelling suggests that compared
with current treatment approaches,
Treatment 2.0 could avert an additional 10
million deaths by 2025. In addition, the new approach could
also reduce new HIV infections by up to 1
million annually if countries provide antiretroviral
therapy to all people in need,
following revised WHO treatment guidelines.
Today, 5 million of the 15 million
people in need are accessing these lifesaving
medicines.
To achieve the full benefits of Treatment
2.0 progress has to be made across five areas:
● Create a better pill and diagnostics:
UNAIDS calls for the innovation of a
smarter, better pill that is less toxic and for
diagnostics that are easier to use.
Monitoring treatment requires complex
equipment and specialised laboratory
technicians. A simple diagnostic tool
could help to reduce the burden on health
systems. Such a simplified treatment platform
could defray costs and increase
people’s access to treatment.
● Treatment as prevention: antiretroviral
therapy reduces the level of the virus in
the body. Evidence shows that when
people living with HIV have lowered their
viral load they are less likely to transmit
HIV. It is estimated that ensuring
everyone in need has access to treatment,
according to the current treatment guidelines,
could result in up to a one third
reduction in new HIV infections annually.
Optimising HIV treatment coverage
will also result in other health prevention
benefits, including much lower rates of
tuberculosis and malaria among people
living with HIV.
● Stop cost being an obstacle: despite
drastic reductions in drug pricing over the
past ten years, the costs of antiretroviral
therapy programmes continue to rise. Drugs
can be even more affordable—however,
potential gains are highest in the area of
reducing the non-drug-related costs of
providing treatment, such as hospitalisation,
monitoring treatment, and out-of-pocket
expenses. Currently these costs are twice the
cost of the drugs themselves. Treatment 2.0
is expected to reduce the cost per AIDSrelated
death averted by half.
● Improve uptake of voluntary HIV
testing and counselling and linkages to
care: when people know their HIV status
they can start treatment when their CD4
count is around 350, rather than waiting
until they are feeling sick. Starting treatment
at the right time increases the effiacacy of current treatment regimens and
increases life expectancy.
● Strengthen community mobilisation: by
involving the community in managing
treatment programmes, treatment access
and adherence can be improved. Demand
creation will also help bring down costs for
extensive outreach and help reduce the
burden on health care systems.
“Not only could Treatment 2.0 save lives,
it has the potential to give us a significant
prevention dividend,” said Sidibé, speaking
at the launch of the report.
Young people leading the revolution
A new UNAIDS study shows that young
people are leading the HIV prevention revolution.
HIV prevalence among young people
has declined by more than 25% in 15 of the
25 countries most affected by AIDS. These
declines are largely due to falling new HIV
infections among young people.
In eight countries – Côte d’Ivoire,
Ethiopia, Kenya, Malawi, Namibia, the
United Republic of Tanzania, Zambia and
Zimbabwe – significant HIV prevalence
declines have been accompanied by positive
changes in sexual behaviour among
young people.
For example, in Kenya there was a 60%
decline in HIV prevalence between 2000
and 2005. HIV prevalence dropped from
14.2% to 5.4% in urban areas and from
9.2% to 3.6% in rural areas in the same
period. Similarly in Ethiopia there was a
47% reduction in HIV prevalence among
pregnant young women in urban areas and effia
29% change in rural areas.
Young people in 13 countries, including
Cameroon, Ethiopia, and Malawi, are
waiting longer before they become sexually
active. Young people were also having
fewer multiple partners in 13 countries.
And condom use by young people during
last sex act increased in 13 countries.
There are 5 million young people living
with HIV worldwide, making up about
40% of new infections.
The Benchmark survey
An international public poll on HIV
commissioned for the first time by
UNAIDS shows that nearly 30 years into
the AIDS epidemic, region by region,
countries continue to rank AIDS high on
the list of the most important issues facing
the world. For example, in India about two
thirds report that the AIDS epidemic is
more important than other issues the
world is currently facing.
Overall, respondents put AIDS as the
top healthcare issue in the world.
Furthermore, about half of the respondents
are optimistic that the spread of HIV can
be stopped by 2015.
There is recognition of efforts to raise
public awareness about HIV over the
course of the AIDS response, with one in
three respondents considering it the
greatest achievement of the response so
far. This was followed by implementation
of HIV prevention programmes and the
development of new antiretroviral drugs.
When asked about how their country was doing against the epidemic, about
41% of respondents said that their
country was dealing effectively with the
problem. Only one in three people
believe the world is responding effectively
to AIDS.
For 62% of people surveyed in Sweden,
the availability of funding/resources or the
availability of affordable health care is
keeping the world from effectively
responding to HIV. Some 60% of people in
the United Kingdom also felt that the lack
of funding was the main obstacle. Other
challenges cited by the people surveyed
mirror on the ground experience, with
more than half of respondents saying the
availability of prevention services was the
most important obstacle – stigma and
discrimination were cited as another
barrier.
When it came to HIV treatment, nearly
six in ten believe it is the duty of the state
to provide for free or subsidised treatment
for people living with HIV.
The poll surveyed adults in 25 countries representing all regions with nearly 12,000
respondents.
Investments in HIV must be sustained
Investment in HIV is smart and proven.
At this turning point, flat-lining or reductions
in investments will hurt the AIDS
response. In 2010 an estimated US$ 26.8
billion is required to meet country-set
targets for universal access to HIV prevention,
treatment, care and support.
“The AIDS response needs a stimulus
package now. Donors must not turn back on
investments at a time when the AIDS
response is showing results,” said Sidibé.
“The 0.7% target on international aid and
the Abuja target of 15% for health cannot
be buried.”
UNAIDS recommends that national
HIV programmes invest between 0.5% and
3% of government revenue in the AIDS
response. In recent years many countries
have increased their domestic investments
in the AIDS response. For example, the
South African Government increased its budget for AIDS by 30% to US$ 1 billion
in 2010. However, for the majority of the
countries severely affected by AIDS,
domestic investments alone, even when
raised to optimal levels, will not suffice to
meet all their resource needs.
UNAIDS calls on richer developing
countries to meet a substantial proportion of
their resource needs from domestic sources.
Currently, 50% of the global resources
requirement for low- and middle-income
countries is in 68 countries where the
national need is less than 0.5% of their gross
national income. These countries have 26%
of the people living with HIV and receive
17% of international assistance for AIDS.
According to the report, current investments
in HIV can become more efficient, effective and
predictable. “We can bring down costs so investments
can reach more people,” said Sidibé.
“This means doing things better – knowing
what to do, channelling resources in the right
direction and not wasting them, bringing
down prices and containing costs. We must
do more with less.”

UNAIDS says urgent need to address
lack of monitoring in Middle East

According to the latest UNAIDS report – AIDS Epidemic
Update 2009 – in 2008, an estimated 35,000 [24,000-46,000]
people in the Middle East and North Africa became infected
with HIV, and 20,000 [15,000-25,000] AIDS-related deaths
occurred. The total number of people living with HIV in the
region at the end of 2008 was estimated to be 310,000
[250,000-380,000].
Although the prevalence is relatively low the report points
out that “the acute shortage of timely and reliable epidemiological
and behavioural data has long hindered a clear understanding
of HIV-related dynamics and trends in the Middle
East and North Africa.”
The report also notes that in the absence of strategic information
about the region, various theories about the status of
the epidemic in the Middle East and North Africa have been
put forward. While some have asserted that cultural values in
the region provide a sort of ‘immunity’ against HIV, others
have asserted that substantial HIV transmission is occurring,
but is unrecorded.
The report warns that although no country in the region is
likely to experience an epidemic comparable with the most
heavily affected countries of sub-Saharan Africa, current
trends underscore the need for a substantial strengthening of
AIDS responses in the region and says there is urgent need to
address the pervasive weakness of ongoing monitoring efforts
in the region.

 

18th International AIDS Conference

 

Funding protests, the drug war, new prevention and treatment
strategies come under spotlight at vibrant AIDS 2010

The 18th International AIDS Conference, also known as
“AIDS 2010”, opened on 18 July in Vienna under the
banner "Rights Here, Right Now". The 5-day conference
saw several key issues raised including universal
access to HIV prevention, treatment and care – a
deadline of December this year is highly unlikely to be
met as very few countries have achieved the universal
access targets set by the United Nations General
Assembly Special Session on HIV/AIDS in 2005.
The issue of reduced funding also took centre stage
as activists unfurled banners declaring “No Retreat,
Fund Aids”. The fall in funding threatens several AIDS
programmes.
UNAIDS released a report outlining “Treatment 2.0” – a new approach to simplify the way HIV treatment is
currently provided and to scale up access to life saving
medicines.
Researchers also released data on new prevention
strategies, including a positive result from CAPRISA, a
large South African trial of a microbicide gel containing
the ARV drug, tenofovir.
HIV and injection drug use also came under the spotlight
as one of the main modes of transmission in Asia,
Eastern Europe and Latin America. This saw the
drawing up of the Vienna Declaration which calls for
and end to the “drug war” in favour of policies that
recognise the human rights and medical needs of those
who use illicit drugs.