30 years of AIDS
and the way forward
Sidibι, executive director, Joint United Nations Programme on HIV/AIDS (UNAIDS)
and Under Secretary General of the United Nations, looks back at the
last 30 years of AIDS, so that we can shape the future of the
About 65 million people have been
infected by HIV (human immunodeficiency
virus) since it was first reported
and nearly 30 million people have lost
their lives to it.
Global reaction was slow at first. Then
in 2001 world leaders signed the
Declaration of Commitment on AIDS at
the United Nations. The intervening years
have seen goals set, breakthroughs
announced, and progress made.
In 2006, countries committed to
reaching goals towards universal access to
HIV prevention, treatment, care and
support today more than 6.5 million
people are alive thanks to access to antiretroviral
therapy. Investments for AIDS
have increased by more than 900% since 2001. Prevention is working, with a 25%
drop in the rate of new HIV infections.
The news has gotten better and better.
New HIV prevention options such as
Treatment for Prevention, CAPRISA
gel a female controlled microbicide,
and iPreX a pre-exposure prophylaxis
have emerged adding hope to
people who want to protect themselves
and their loved ones from the virus. Firmly
held ideologies have in many places been
replaced with compassion and doors have
opened for dialogue. Evidence is being
embraced by political leaders when
making policy decisions. It is no longer
uncommon for activists, communities
affected by HIV and policy makers to
plan together, ironing out differences and
exploring new frontiers. The global solidarity
for the AIDS response has shown
what humanity can achieve when they
We need more of the above, a lot more.
Today, the AIDS response is bursting at
the seams. The demand for prevention and
treatment is increasing. Opportunities
abound and we can seize them if we
move on five fronts.
First embrace the benefits of Treatment
for Prevention. People living with HIV
can, for the first time, choose a method
that is 96% effective and which they can
initiate and manage with respect and
confidence. Treatment for Prevention
must be an option for all people living with
HIV. But this should not have to come at
the cost of the nine million people who are
eligible and waiting for treatment for their
immediate survival. Additional Treatment for Prevention must be made available.
Second, pregnant women living with
HIV need to have access to the best
possible treatment regimen to protect
themselves and their children. Some 31
countries still use sub-optimal regimens to
prevent mother-to-child transmission of
HIV. In high-income countries few children
are born with HIV. There is no reason
why it cannot be the same everywhere.
The life of a child and a mother has the
same value, irrespective of where she or he
is born and lives. We can eliminate new
HIV infections among children by 2015.
Third, there has to be space for community
dialogue and social transformation.
Violence against women and girls, intergenerational
sex, homophobia, gender
inequity and criminalisation of people
living with HIV, people who inject drugs
or sell sex must end. Without such transformation,
HIV prevention measures will
only be partially effective. This will
require the leaders in village and urban
communities and capitals to break the
silence about these issues and act boldly,
Fourth, AIDS investments must be made in full. This
should be through a new shared responsibility agenda, where
every country, rich or poor, puts in its fair share no exceptions,
no excuses. A deferred investment today will have a
multiplier effect on investment needs in the future: a prospect
no finance minister will like to face. At the same time, the
health community must accelerate innovation in diagnostics
and treatment, reduce unit costs, increase efficiencies and
invest in programmes that work so that there is more value for
the money invested.
Finally, the AIDS response has to integrate with broader
health and development programmes. The AIDS response has
to come out of isolation and become the catalyst for achieving
the Millennium Development Goals related to health especially
reducing infant and maternal mortality as well tuberculosis.
Healthcare delivery must not remain in silos.
World leaders must act on these five frontiers and set clear
targets and milestones for the next five years. The 34 million
people living with HIV and their families deserve nothing
Middle East and North Africa
Increasing HIV prevalence,
infections and AIDS-related deaths
Reliable data on HIV epidemics in the Middle East and
North Africa remain in short supply, making it difficult to
track trends with confidence.
According to available evidence, an estimated 460,000
[400,000530,000] people were living with HIV in the
Middle East and North Africa at the end of 2009, up from
180,000 [150,000200,000] in 2001.
The number of new HIV infections in the region
increased from 36,000 [32,00042,000] in 2001 to 75,000
[61,00092,000] in 2009.
AIDS-related deaths in the region rose from 8,300
[6,30011,000] in 2001 to 23,000 [20,00027,000] in 2009.
In Djibouti and southern Sudan, HIV prevalence among
pregnant women using antenatal services exceeds 1%.
HIV prevalence in other countries across the region
The HIV epidemic in the Islamic Republic of Iran is
centred largely among people who inject drugs; an estimated
14% of this population was living with HIV in 2007.
In Egypt, an estimated 6% of men who have sex with men
are living with HIV. Surveys in Sudan have found that
between 8% and 9% of this population is HIV-positive.
In 2006, about 1% of female sex workers in Egypt were
living with HIV, compared to an estimated 2%4% in
Algeria, Morocco and Yemen. Source: UNAIDS
of upload: 15th Aug 2011