World AIDS Day: 18 Million Now on HIV Treatment but Many Still Lack Access

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Thursday, December 1, is World AIDS Day, an opportunity to remember those lost to the epidemic and to focus on the continuing challenges of universal HIV prevention and treatment. According to a new report from UNAIDS, approximately 37 million people are living with HIV worldwide -- of whom more than 18 million are receiving antiretroviral therapy -- and there were about 2 million new infections in 2015.

In advance of World AIDS Day the Centers for Disease Control and Prevention (CDC) also released new data about the HIV epidemic in the U.S. and the World Health Organization launched new guidelines on HIV self-testing.

"Every World AIDS Day provides a time to remember and renew the commitments that brought us to this point of enormous opportunity and challenge, at home and abroad," Infectious Diseases Society of America president William Powderly said in a World AIDS Day statement. "Those commitments have included investments in scientific research, resulting in lifesaving treatments and prevention technologies and to knowledge towards discovering a vaccine and a cure. They include the strides in strengthening health care systems in countries around the world that have advanced global health security, and health reforms at home that have made primary and preventive care available to millions of people for the first time. They include the recognition that human rights are inextricably linked to health, and that proven interventions must be available to all people who need them. And they include the acknowledgement that much remains to be done, when tuberculosis, a curable disease, continues to be the leading killer of people living with HIV worldwide, and 50,000 new HIV infections occur in this country each year."

"In a changing political environment, we will stand up for proven and essential interventions, including syringe access programs, comprehensive sexual education and preventive and health care services for women," added HIV Medicine Association chair Wendy Armstrong. "We must recognize and address the conditions that keep too many individuals at risk for HIV and those living with HIV from benefiting from effective prevention and treatment interventions."

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On November 21, UNAIDS launched its new report, Get on the Fast-Track: the life-cycle approach to HIV,which looks how people are affected by HIV at different stages of their lives. The report shows that 36.7 million people were living with HIV at the end of 2015. The number of new HIV infections fell to 2.1 million in 2015 -- a 35% decrease since 2000 -- and deaths due to HIV/AIDS dropped to 1.1 million -- a 45% decrease since 2005.

Approximately 18.2 million people -- were on antiretroviral therapy (ART) by June 2016, up 2.4 million from the year before. If this progress continues, the world will be on track to achieve the target of 30 million people on treatment by 2020, according to the report. However, the number of people on ART is still slightly exceeded by the number not yet on treatment, many of whom are unaware they're infected.

The report divides the life-cycle into 4 segments -- birth to 14 years, 15-24 years, 35-49 years, and 50 and older -- and looks at the threat of HIV and the needs of people at risk for and living with HIV at each stage.

Childhood and Adolescence

Some of the greatest progress in curbing the HIV epidemic has come from reducing mother-to-child transmission during pregnancy and breastfeeding. Globally, 77% of pregnant women now have access to antiretroviral medications that can prevent transmission, and new HIV infections among children have declined by about 50% since 2010. But some areas are lagging behind: more than a quarter of all new HIV infections among children occur in Nigeria, for example, where only half of pregnant women are tested for HIV.

Around half of the 150,000 infants newly infected in 2015 are thought to have contracted the virus through breastfeeding, highlighting the importance of ongoing ART for women after giving birth, both for their own health and to prevent post-natal transmission without losing the benefits of breastfeeding.

HIV in Adulthood

Young women in the 15-24 age range are particularly vulnerable to HIV in certain parts of the world. Around 7500 young women became infected with HIV every week in 2015, according to the report, and in southern Africa around 90% of newly infected teens are female. Over the past half decade new infections among young women fell by just 6%, much less than for other age groups.

At the International AIDS Conference this summer researchers reported that in South Africa many young women in their teens or twenties acquire HIV from men who are on average 8 years older. These older men were themselves infected by women in their own age group, and in an ongoing cycle the younger women grow up to pass the virus on to men their own age.

"Young women are facing a triple threat," UNAIDS executive director Michel Sidibé said in a UNAIDS press release. "They are at high risk of HIV infection, have low rates of HIV testing, and have poor adherence to treatment. The world is failing young women and we urgently need to do more."

This age group also includes many people born with HIV who are now entering adulthood. The transition from pediatric to adult care can be difficult -- adolescents have the highest likelihood of poor adherence and treatment failure -- and many teens are dying from AIDS-related causes.

The latest numbers show that HIV prevention efforts are not working for many adults. The UNAIDS HIV prevention gap report, released this summer, showed that new HIV infections have stopped declining overall worldwide, and are in fact rising in some areas.

Adult men are especially likely to be missing out on HIV prevention, testing, and treatment services, which in many resource-limited settings are focused on women of reproductive age. One study in KwaZulu-Natal, South Africa, found that only 26% of men were aware of their HIV status and only 5% were on treatment, according to the report.

Aging with HIV

Looking at older individuals, the report shows that an estimated 5.8 million people living with HIV are over age 50 thanks to effective antiretroviral treatment -- more than ever before. If treatment targets are reached, that number could approach 9 million by 2020. In addition to HIV-positive people living longer, an estimated 100,000 people in this age group are newly infected each year in low- and middle-income countries, underlining the need to include older people in HIV prevention efforts.

Worldwide, people over age 50 accounted for around 17% of adults living with HIV in 2015. In high-income countries nearly a third of people living with HIV are over 50, and in early epicenters of the HIV/AIDS epidemic in the U.S. and Europe, more than half are over 50. Older people with HIV have high rates of chronic non-AIDS conditions such as cardiovascular disease, and a comprehensive strategy will be needed to respond to increasing long-term healthcare costs. 

At all ages, it is critical to reach key affected populations with prevention and treatment programs that meet their needs throughout their lives. New HIV infections are continuing to rise among people who inject drugs (by 36% from 2010 to 2015) and among gay men and other men who have sex with men (by 12% from 2010 to 2015), and are not declining among sex workers or transgender people, according to the report.

"Just under 2 years ago, 15 million people were accessing antiretroviral treatment -- today more than 18 million are on treatment and new HIV infections among children continue to fall," said Hage Geingob, president of Namibia, who launched the report with Sidibe. "Now, we must ensure that the world stays on the fast-track to end the AIDS epidemic by 2030 in Namibia, in Africa, and across the world."

11/29/16

Sources

UNAIDS. Get on the Fast-Track: the life-cycle approach to HIV. November 2016.

UNAIDS. UNAIDS announces 18.2 million people on antiretroviral therapy, but warns that 15-24 years of age is a highly dangerous time for young women. Press release. November 21, 2016.

UNAIDS. Global HIV Statistics fact sheet. November 2016.