2008 Global AIDS Report: Substantial increases in HIV prevention efforts producing results

30 July 2008 – According to new data in the UNAIDS 2008 Report on the global AIDS epidemic there have been significant gains in preventing new HIV infections in a number of heavily affected countries. In Rwanda and Zimbabwe, changes in sexual behaviour have been followed by declines in the number of new HIV infections.

Condom use is increasing among young people with multiple partners in many countries. Another encouraging sign is that young people are waiting longer to have sexual intercourse. This has been seen in seven of the most affected countries: Burkina Faso, Cameroon, Ethiopia, Ghana, Malawi, Uganda and Zambia. In Cameroon the percentage of young people having sex before the age of 15 has gone down from 35% to 14%.

From 2005 to 2007 the percentage of HIV positive pregnant women receiving antiretroviral drugs to prevent mother-to-child transmission (PMTCT) went up from 14% to 33%. In this same period the number of new infections among children fell from 410,000 to 370,000.

Several countries such as Argentina, the Bahamas, Barbados, Belarus, Cuba, Botswana, Cuba, Georgia, Molodova, the Russian Federation and Thailand have achieved close to universal access with more than 75% coverage of PMTCT.

The report shows that the combined will and efforts of governments, donors, civil society and affected communities can make a difference. Some 105 countries have set goals and targets towards achieving universal access to HIV prevention, treatment, care and support by 2010.

“Gains in saving lives by preventing new infections and providing treatment to people living with HIV must be sustained over the long term,” said UNAIDS Executive Director Dr Peter Piot. “Short-term gains should serve as a platform for reinvigorating combination HIV prevention and treatment efforts and not spur complacency”.

The epidemic globally
From 2001 new HIV infections declined from 3 million to 2.7 million in 2007 [ranges: 2.6 –3.5 million to 2.2 – 3.2 million]. Although the number of new HIV infections has fallen in several countries the AIDS epidemic is not over in any part of the world.

Rates of new HIV infections are rising in many countries such as China, Indonesia, Kenya, Mozambique, Papua New Guinea, the Russian Federation, Ukraine, and Vietnam. Increases in new HIV infections are also being seen in some older epidemics and HIV incidence is increasing in countries such as Germany, the United Kingdom and Australia.

  • An estimated 33.0 million [30.3 – 36.1 million] living with HIV worldwide
  • 2.7 million [2.2 million to 3.2 million] newly infected in 2007
  • 2.0 million [1.8 million – 2.3 million] died of AIDS in 2007

The global epidemic has levelled off in terms of the percentage of people infected (prevalence) while the total number of people living with HIV has increased to 33 million people globally with nearly 7,500 new infections each day.

Treatment is saving lives
As reported earlier in 2008, some 3 million people are now receiving antiretroviral treatment in low and middle-income countries. Namibia scaled up treatment from 1% in 2003 to 88% in 2007. Similarly Cambodia scaled up treatment from 14% in 2004 to 67% in 2007. Other countries that have come close to achieving universal access to treatment are Botswana, Brazil, Chile, Costa Rica, Cuba and Lao People’s Democratic Republic. In most parts of the world more women are receiving antiretroviral treatment than men.

In part as a result of the scaling up in the past two years AIDS-related deaths have declined from 2.2 million to 2 million in 2007 [ranges: 1.9 – 2.6 million to 1.8 – 2.3 million].

However, AIDS continues to be the leading cause of death in Africa which is home to 67% of all people living with HIV. In Africa, 60% of people living with HIV in the region are women and three out of four young people living with HIV are female.

More attention for people most at risk
Since 2005 there has been a tripling of HIV prevention efforts focused on sex workers, men who have sex with men and injecting drug users. For example of the 39 countries reporting on access to HIV prevention services for sex workers, there was a 60% average coverage rate. Nearly 50% of people who inject drugs in 15 countries and 40% of men who have sex with men in 27 countries had access to HIV-prevention services.

In virtually all regions outside of sub-Saharan Africa, HIV infections have disproportionately affected injecting drug users, men who have sex with men, and sex workers. People most at risk have better access to HIV prevention services in countries that have laws to protect them against discrimination.

‘Knowing your local epidemic’ remains critical to effective prevention efforts. Over time trends have changed within regions and within countries. In Thailand the main mode of transmission was sex work and injecting drug use and now the main mode of transmission is among married couples.

“Countries need to focus HIV prevention programmes to where the new infections are occurring,” said UNFPA Executive Director Dr Thoraya Obaid. “Knowing the epidemic and choosing the right combination of interventions are critical for an effective response. In many contexts, young people and women need special attention.”

Prevention efforts paying off in Viet Nam
Viet Nam has increasingly focused its efforts in reaching most-at-risk populations. In 2007, an estimated 65% of female sex workers, 26% of men who have sex with men, and 43% of male injecting drug users were reached by prevention programmes.

Condom promotion projects at the community level in five provinces have resulted in safer behavior among street-based sex workers and their clients with condom use tripling from 20% in 2001 to 60% in 2004, while condom use with husbands and boyfriend almost doubled over the same period.

“In the last few years Viet Nam has expanded its targeted HIV prevention programs and antiretroviral therapy treatment,” says Jean-Marc Olive, Viet Nam representative of WHO. “Just last year more than 11 million needles and syringes were distributed to injecting drug users (IDU) and around 30% of those in need are now receiving life-saving antiretroviral drugs,” he adds.

“Prevention is our most effective line of defense and we are already seeing a return on the investments made. However, we need continuous strong leadership from the government, party and the people of Viet Nam to achieve universal access for all and reverse the spread of the epidemic,” says UNAIDS Country Director Eamonn Murphy.

Looking ahead
The new report is being launched ahead of the XVII International AIDS Conference in Mexico. This event will bring together leaders, policymakers, academics, activists, community groups and other key stakeholders to review lessons learnt and build momentum towards achieving universal access goals by 2010 and the Millennium Development Goals by 2015.

“Responding to AIDS is an important Millennium Development Goal which also has a direct impact on meeting the other Goals by 2015,” said UNDP Administrator Kemal Dervis. “The progress we make in addressing AIDS will contribute to our efforts to reducing poverty and child mortality, and to improving nutrition and maternal health. At the same time, progress towards the other Goals, such as tackling gender inequality and promoting education, is required if we are to halt and reverse the spread of AIDS.”

Long-term response
AIDS is a long-term issue and that requires a response that is grounded in evidence and human rights. It requires strong leadership that can sustain commitments over time. The report calls for leaders to approach issues of human sexuality and drug use with a human rights perspective.

HIV responses require long-term sustained financing. As more people go on treatment and live longer, budgets for HIV will have to increase over the next few decades. Donors will have to provide the majority of the funding required for the AIDS responses in low- and some middle-income countries, even as domestic spending on HIV has increased in these countries. The response will be helped by commitments such as the recent reauthorization of US$ 48 billion by the United States Government. The G8 at its recent summit in Japan also agreed to honour in full its commitments to continue working towards the goal of universal access to HIV prevention and treatment by 2010.

“The scaling up of the AIDS response towards universal access must be based on four key values—a rights-based approach, multisectoralism, results for people, and community engagement. These are not negotiable,” said Dr Piot.

Eamonn Murphy, murphye@unaids.org, +84-4 3734 2824, mob: (84) 91 87 62 620
Nguyen Thi Phuong Mai, nguyenm@unaids.org, +84-4 3734 2824, mob: (84) 91 21 40 645

Sophie Barton-Knott, bartonknotts@unaids.org, tel. +41 22 791 1697

Jonathan Rich, jonathan@jcrcommunications.com, tel. +1 347 262 9115

About the UNAIDS 2008 Report on the Global AIDS epidemic
The 2008 Report on the global AIDS epidemic, prepared by UNAIDS and its Cosponsoring agencies, is the most comprehensive report on the response to AIDS. It uses data from 147 countries against 25 core targets set in the UN declaration of Commitment on HIV/AIDS adopted in 2001, and the political declaration adopted at the 2006 High Level Meeting on AIDS. The information presented in the report enables readers to assess progress made since 2001 and identify the strengths and weaknesses of the AIDS response to date.

UNAIDS is an innovative joint venture of the United Nations, bringing together the efforts and resources of the UNAIDS Secretariat and ten UN system organizations in the AIDS response. The Secretariat headquarters is in Geneva, Switzerland—with staff on the ground in more than 80 countries. Coherent action on AIDS by the UN system is coordinated in countries through UN theme groups, and joint programmes on AIDS. UNAIDS’ Cosponsors include UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, ILO, UNESCO, WHO and the World Bank. Visit the UNAIDS Web site at www.unaids.org

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