A new report from UNAids shows the number of deaths has dropped to 1.8
million a year from 2.2 million in the mid-2000s. But funding
shortfall to tackle the epidemic is a concern
Sarah Boseley
guardian.co.uk, Monday 21 November 2011 12.31 GMT
The changing shape of the Aids epidemic is revealed in a new report
from UNAids, which shows more people than ever living with HIV, but
deaths and new infections steadily dropping.
There are now 6.6 million people on Aids drugs in low and middle-
income countries, says the report, published on Monday, thanks to a
dramatic 20% increase between 2009 and 2010. Some 34 million people
are living with HIV. Deaths have dropped to 1.8 million a year, down
from 2.2 million in the mid-2000s. About 2.5 million deaths have been
averted in poor countries by the treatment roll-out. The report,
published ahead of World Aids Day on 1 December, celebrates the
progress against the virus and the possibility on the horizon of what
US secretary of state Hillary Clinton recently called "an Aids-free
generation".
But funding, which is now dropping for the first time since Aids
appeared in New York and San Francisco 30 years ago, will be critical
to maintaining progress, say experts. The UN estimates that $22bn is
needed, but this year only $16bn was forthcoming from donors. UNAids
has published a framework for action to focus funds where they are
most needed, but its executive director, Michel Sidibé, told the
Guardian money was a concern.
"I think it is the wrong moment [to reduce funding]," he said. "It has
been a game-changing year. It is not a time to flatten or reduce
funding."
Scientific studies have shown this year that antiretroviral drugs
given to keep people alive also make them less infectious – the
transmission rate dropped by 96%. Evidence in the report from some sub-
Saharan countries where the drugs have become widely available also
shows that infection rates have dropped. In Botswana, where more than
80% of those who need treatment are on the drugs, HIV infection
appears to be down by 30% to 50% from pre-2009 levels, even though
sexual behaviour and condom use has not changed in recent years.
Behaviour change has brought infection rates down, as more people have
practised safe sex and had fewer partners, but the impact tends to
level off after a while, says the report. Changes in sexual behaviour
brought infection rates down in Zimbabwe between 1995 and 2000, but
then they plateaued at around 1%, around 50,000 new infections a year.
But in recent years, as drugs have been rolled out, infections have
started to drop again. The biggest impact is likely to be seen in
South Africa, the country with the highest numbers infected in the
world – 5.6 million in 2009, including nearly 18% of people aged 15 to
49. By the end of 2010, the report says, more than half of those who
needed drugs were on them.
Circumcision is also credited with bringing infection rates down in
those areas where it is now being widely offered. It reduces female to
male infection by 60%.
Médecins sans Frontières, whose volunteer doctors pioneered the
treatment of HIV in Africa in 2000, said reducing deaths represented
important progress, but the new scientific findings that the drugs
prevent infection meant that more people must get them, and sooner.
Yet the decline in funding put the scale-up in jeopardy.
"Never, in more than a decade of treating people living with HIV and
Aids, have we been at such a promising moment to really turn this
epidemic around," said Dr Tido von Schoen-Angerer, executive director
of MSF's access campaign. "Governments in some of the hardest-hit
countries want to act on the science, seize this moment and reverse
the Aids epidemic. But this means nothing if there is no money to make
it happen."
The Global Fund to fight Aids, TB and Malaria, which has provided much
of the money for Aids drugs in sub-Saharan Africa, has a major
shortfall as donor governments have switched their attention
elsewhere. It has been forced to reduce the grants it can make from
next year. Many campaigners hope that the US government will put more
money into Pepfar, the president's emergency plan for Aids relief,
following Clinton's speech, in which she cited drug treatment, male
circumcision and the end of mother to child transmission at birth as
the three scientifically proved interventions that could bring an end
to Aids.
© 2011 Guardian News and Media Limited or its affiliated companies.
All rights reserved.
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