Global Policy Forum

New Report Cites Positive Trends in HIV Prevention and Treatment;
Calls for Significant Acceleration of the AIDS Response

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According to new data in the UNAIDS 2006 Report on the global AIDS epidemic the AIDS epidemic appears to be slowing down globally, but new infections are continuing to increase in certain regions and countries. The report also shows that important progress has been made in country AIDS responses, including increases in funding and access to treatment, and decreases in HIV prevalence among young people in some countries over the past five years.

However AIDS remains an exceptional threat. The response is diverse with some countries doing well on treatment but poorly on HIV prevention efforts and vice-versa. The report indicates that a number of significant challenges remain. Among these are the need for improved planning, sustained leadership and reliable long-term funding for the AIDS response.

- An estimated 38.6 million [33.4 million – 46.0 million] living with HIV worldwide
- 4.1 million [3.4 million – 6.2 million] newly infected in 2005
- 2.8 million [2.4 million to 3.3 million] died of AIDS in 2005

An estimated 38.6 million people are living with HIV worldwide. Approximately 4.1 million people became newly infected with HIV, while approximately 2.8 million people died of AIDS-related illnesses in 2005. While the epidemic's toll remains massive, experts find reasons for optimism, as well as guidance for how to improve the AIDS response, in today's report.

"Encouraging results in HIV prevention and treatment indicate a growing return on investments made in the AIDS response," said UNAIDS Executive Director Dr. Peter Piot. "We are reaching a critical mass in terms of improvements in funding, political leadership and results on the ground, from which global action against AIDS can and must be greatly accelerated. The actions we take from here are particularly important, as we know with increasing certainty where and how HIV is moving, as well as how to slow the epidemic and reduce its impact."

The new report is being released in advance of the United Nations General Assembly 2006 High Level Meeting on AIDS, which will bring world leaders to New York from 31 May - 2 June to review progress made since the historic signing of the 2001 Declaration of Commitment, which established concrete, time-bound goals for improving the global AIDS response.

The report cites significant improvements in several elements of the global AIDS response. In the key area of financial resources, the US $8.3 billion available for the AIDS response in 2005 is more than five times the funding available in 2001, and is well within the Declaration of Commitment target range. The report also cites significant increases in global political leadership, which is key to maintaining the AIDS response at the centre of national and international development planning.

Dr. Piot was joined at the report launch by UNICEF Executive Director Ann Veneman, by United Nations Population Fund (UNFPA) Executive Director Thoraya Obaid representing the ten cosponsoring agencies of UNAIDS.

The report shows that young people and children are increasingly affected by the epidemic, and efforts to protect these and other vulnerable groups are not keeping pace with the epidemic's impact. "For too long, children have often been the missing face of the AIDS pandemic," said UNICEF Executive Director Ann Veneman. "It is critical that the impact of HIV/AIDS on children be addressed through programs to prevent mother to child transmission and to treat cases of paediatric AIDS."

On HIV prevention, the report documents behaviour changes including delays in first sexual experience, increasing use of condoms by young people, and resulting decreases in HIV prevalence in young people in some sub-Saharan countries. "Prevention remains our first and most effective line of defence," noted UNFPA Executive Director, Thoraya Ahmed Obaid. "In countries where HIV prevalence is declining among young people, there is behaviour change and comprehensive condom programming. This is encouraging proof that prevention works and saves lives. But women still remain disproportionately vulnerable and greater efforts must be made to give them methods of prevention they can control."

The report also makes clear that on many issues and in most regions of the world greater action against the epidemic is required now, and will be required long into the future. Today's speakers emphasized that upcoming goals related to universal access to HIV treatment and the 2010 UN goal of halting and beginning to reverse the epidemic will require much greater action moving forward.

Key Findings

Key findings in the 2006 Report on the global AIDS epidemic include the following:

Funding

Resources for the AIDS response have grown from US$1.6 billion in 2001 to US$8.3 billion in 2005, a significant increase that highlights the need to coordinate, monitor and evaluate spending to ensure maximum impact for people in need. In addition to donor funding, domestic public expenditure in heavily impacted countries grew to US$2.5 billion in 2005. At the same time, the report notes that funding gap continues to increase, it is estimated that over US$20 billion will be needed annually as from 2008.

HIV prevention

In an encouraging development, six of 11 African countries reported declines of 25% or more in HIV prevalence among 15-24 year-olds in capital cities. Rates of sex among young people declined in nine of 14 sub-Saharan countries. Condom use with a non-regular partner increased in eight out of 11 countries here, although overall use of condoms remains below 50%. Use of HIV testing and counselling, an important tool for facilitating both treatment and prevention, quadrupled to 16.5 million people tested in 2005. In 58 countries reporting, 74% of primary schools and 81% of secondary schools now provide AIDS education. While this progress is notable, the HIV prevention response falls short in many areas. The Declaration of Commitment calls for 90% of young people to be knowledgeable about AIDS by 2005, yet surveys indicate that fewer than 50% of young people achieved comprehensive knowledge levels. An area of exceptional concern is the ongoing shortfall in care to prevent mother-to-child HIV infection, in which just 9% of pregnant women are currently covered.

Reducing vulnerability

While some countries, notably Iran, Malaysia and the Kyrgyz Government are adopting more progressive approaches to reducing HIV among injection drug users, overall fewer than 20% of people who inject drugs received HIV prevention services. Coverage is less than 10% in Eastern Europe and Central Asia. Only 10 of 24 countries that reported data for sex workers achieved at least 50% coverage of prevention services for this population. Only 9% of men who have sex with men received any type of HIV prevention service in 2005. Civil society reports indicate that stigma and discrimination remain pervasive. Half of all reporting countries said that they have laws and policies that interfere with the accessibility and effectiveness of HIV prevention and care. Care and support for the 15 million children orphaned by AIDS, and for millions of other vulnerable children, lag far behind the need.

Treatment

Access to antiretroviral treatment has expanded significantly, from 240,000 people in 2001 to 1.3 million people in low- and middle-income countries in 2005; 21 countries met or exceeded "3 by 5" treatment targets. ARV prices dropped significantly and procurement systems have improved, as has generic drug availability. Still, HIV treatment coverage varies considerably within regions. In sub-Saharan Africa, treatment coverage ranges from 3% in the Central African Republic, to 85% in Botswana.

Leadership

Leadership and political action on AIDS have also increased significantly since 2001. Ninety percent of reporting countries now have a national AIDS strategy; 85% have a single national body to coordinate AIDS efforts; and 50% have a national monitoring and evaluation framework and plan. Yet, systems to implement these plans remain inconsistent, as does civil society involvement and, specifically, involvement of people living with HIV. "We must move to build upon an increasingly strong foundation by transforming the AIDS response from a year-to-year crisis management approach to one of long-term strategic planning that includes sustained leadership and funding to reduce the epidemic and its impact," said Dr. Piot.

The 2006 Report on the global AIDS epidemic, prepared by UNAIDS including its cosponsoring agencies, is the most comprehensive report on the response to AIDS ever compiled. Utilizing data from 126 countries and more than 30 civil society organizations, the UNAIDS report assessed country progress toward the six global targets set in the UN Declaration of Commitment on HIV/AIDS, adopted by 189 UN Member States in 2001. The 2005 targets are based on the goal of halting and reversing the global epidemic by 2015. Progress toward those goals was measured against an agreed set of indicators of action developed by UNAIDS in consultation with member states and civil society.

"We are well into an important phase of the global response to AIDS in which deeds and results count more than statements or speeches," said Dr Piot. "These agreed indicators of progress on AIDS cut through rhetorical responses and put results on display, so they can be reviewed, evaluated, learned from and improved upon."

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