UNAIDS and WHO Highlight Fast-Track Efforts to Expand HIV Prevention and Treatment

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In advance of World AIDS Day, UNAIDS and the World Health Organization (WHO) released new reports describing successful local efforts to reduce new HIV infections and get more people living with HIV on effective treatment. The global World AIDS Day theme for 2015 is the Fast-Track to ending the AIDS epidemic by 2030 as part of the United Nations Sustainable Development Goals.With progress to date exceeding expectations, world leaders are now calling for accelerated efforts to achieve more ambitious goals.

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UNAIDS launched its latest annual report Focus on location and population: on the Fast-Track to end AIDS by 2030, showing how many countries are getting on the fast-track to end the AIDS epidemic by 2030 as part of the United Nations Sustainable Development Goals. 

According to UNAIDS, 15.8 million of the estimated 36.9 million people living with HIV worldwide were receiving antiretroviral treatment by June 2015. Getting this many people on treatment is estimated to have already reduced new HIV infections by 35% since 2000 and AIDS-related deaths by 42% since their peak in 2004. But more needs to be done.

"Every five years we have more than doubled the number of people on life-saving treatment," said UNAIDS executive director Michel Sidibé. "We need to do it just one more time to break the AIDS epidemic and keep it from rebounding."

The report identifies 35 Fast-Track countries that account for 90% of new HIV infections. By focusing on locations, populations, and programs that deliver the greatest impact, the agency estimates that 28 million new HIV infections and 21 million AIDS-related deaths could be averted by 2030.

The report highlights how high-impact HIV prevention and treatment programs are being successfully implemented for different affected populations including adolescent girls and young women, pregnant women, men who have sex with men, sex workers, and people who inject drugs. Examples include comprehensive services for female sex workers in Kenya, increased access to secondary school education in Botswana (with each additional year of education associated with an 8% reduction in the cumulative risk of HIV infection), expanding methadone programs to more than 140 prisons in Iran, establishment of community centers to serve the transgender population in El Salvador, widespread HIV self-testing in Malawi, and immediate ART provision in Guangxi, China.

Likewise, concurrent with the International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2015) taking place this week in Harare, Zimbabwe, the World Health Organization also issues a new report, Global health sector response to HIV, 2000-2015, focusing on innovations in Africa.

The report notes that scale-up of ART has been most dramatic in Africa, where 11 million people are on treatment. In fact, people living with HIV in Africa are now more likely to receive antiretrovirals than those in many other parts of the world.

At the UN General Assembly in September world leaders endorsed a new set of Sustainable Development Goals, which call for ending the AIDS epidemic by 2030. Milestones include the UNAIDS 90-90-90 target of ensuring that 90% of people living with HIV know their status, 90% of those diagnosed are on treatment, and 90% of those on treatment have suppressed viral load by 2020, along with reducing the number of new infections by 75%, from the current 2 million per year to less than 500,000 by 2020 and 200,000 by 2030.

WHO has now issued the finalized version of its Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. As previously reported, WHO presented a preview of the guidelines at the International AIDS Society Conference this summer in Vancouver, and released a preliminary version in September. The new guidelines recommend ART for everyone diagnosed with HIV regardless of CD4 T-cell count and pre-exposure prophylaxis (PrEP) for people at substantial risk in infection.

The guidelines were influenced by a growing body of evidence, including findings from the START and Temprano trials, showing that starting treatment soon after diagnosis reduced the risk of disease progression and death.

"These new guidelines and recommendations are a highly significant moment in the AIDS response," said Sidibé of UNAIDS. "The medicines and scientific tools now at our disposal provide us with a real opportunity to save millions of lives over the coming years and to end the AIDS epidemic by 2030. We are at a crossroads in the response to AIDS. We know what works -- now we need to put people first and fully respect their right to health."

At ICASA WHO presented a set of further recommendations to help countries rapidly and efficiently expand treatment to everyone. These include using innovative testing strategies to help more people learn their status, moving testing and treatment services closer to where people live, starting treatment upon diagnosis for people with advanced stages of HIV infection, and reducing the frequency of clinic visits for people who are stable on ART.

"Despite the significant progress, half the people living with HIV globally do not know they have acquired the virus and do not receive treatment that can save their lives and avoid infecting others," said WHO Assistant Director General Winnie Mpanju-Shumbusho. "We must now step up our efforts to reach the missing half with testing and treatment and the prevention of new infections, or we will miss the unique opportunity to end the AIDS epidemic within a generation. The sense of urgency that was the norm during the disease’s most-destructive years must not be allowed to abate."

12/1/15

Sources

UNAIDS. Countries adopt UNAIDS Fast-Track Strategy to double number of people on life-saving HIV treatment by 2020. Press release. November 24, 2015.

UNAIDS. World AIDS Day 2015: On the Fast-Track to end AIDS by 2030: Focus on location and population. November 2015.

UNAIDS. UNAIDS welcomes release of new guidelines from the World Health Organization on the use of antiretroviral medicines. Press release. November 30, 2015.

World Health Organization. Global health sector response to HIV, 2000-2015: focus on innovations in Africa. November 2015.

World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: what’s new. November 2015.

World Health Organization. New recommendations show how to treat all people living with HIV and decrease new infections. Press release. November 27, 2015.

World Health Organization. Accelerate expansion of antiretroviral therapy to all people living with HIV: WHO. World AIDS Day statement. November 30, 2015.