Prevention revolution led by 15- to 24-year-olds hailed by UN as
breakthrough in fight against Aids
Sarah Boseley, health editor
Wednesday July 14 2010
The Guardian
http://www.guardian.co.uk/world/2010/jul/13/hiv-rates-fall-young-people
The United Nations hailed a breakthrough in the fight against Aids
with the release of figures showing that the prevalence of HIV has
fallen among young people in 15 of the most affected countries.
The news was even better in 12 of those countries, where HIV levels
have decreased by 25% among 15- to 24-year-olds. This in response,
UNAids believes, to dogged prevention campaigns warning of the dangers
of HIV/Aids and the need for people to change their sexual behaviour.
The head of UNAids, which released the report ahead of next week's
International Aids conference in Vienna, said young people were
leading a badly needed prevention revolution. But a change in tack was
needed in the battle against the virus.
"We are at the defining moment now, where we need to reshape
completely the Aids response," said Michel Sidib?. Rising treatment
costs for HIV and the global economic crisis means "the world is
demanding change. We cannot continue with the same response. It is not
sustainable. It is very clear from public opinion region by region
that Aids continues to be a top priority, but they are calling for a
paradigm shift."
The costs of antiretroviral drugs for the millions who need them was
going through the roof, he said. Even countries like Brazil, which
successfully made cheap Aids drugs available to all, were now hitting
financial problems because the first-line drugs were no longer
effective enough ? the virus becomes resistant over time. Third line
drugs in Brazil now cost $19,000 (?12,500) a person a year.
UNAids also launched a new treatment manifesto, with the aim of saving
10 million more lives by reaching everybody who currently needs it.
But drugs alone, even if they were affordable, would not be enough,
said Sidib?. "While we were trying to push the treatment, we were
seeing that new infections are growing and growing and we were not
convinced we were making progress with young people."
The Outlook report offers rare hope for a new strategy with prevention
at its heart, even while efforts to make simpler, cheaper treatment
available continue.
"Young people are taking the lead, which is progress," said Sidib?.
"For the first time there is a correlation between that [declining
prevalence] and behaviour, which for me is very important news in
terms of dealing with the epidemic."
The biggest drop was in Kenya, where HIV in 15- to 24-year-olds fell
60% between 2000 and 2005 to 5.4% in urban areas and to 3.6% in rural
ones. Among young pregnant women in Ethiopia, the report shows a 47%
decrease among in urban areas and 29% in rural areas. In urban areas
of Malawi and C?te d'Ivoire, the prevalence in the same group fell 56%
and in Burundi and Haiti it dropped by nearly half. Reductions of more
than a third took place in Namibia, Zimbabwe, Botswana, Cote d'Ivoire,
Rwanda and Lesotho.
Most of the figures come from antenatal clinics, where pregnant young
women are tested. Mathematical modelling shows they are a good
indicator of trends across the whole age group. But population surveys
are better, and were available in seven countries. Six saw a drop in
prevalence among young women ? but in only four was there a fall among
young men.
UNAids believes the progress is down to efforts to persuade young
people to change their sexual behaviour. In 13 countries where
research was carried out, young people were reported to be waiting
longer before first having sex. Usually this was young women rather
than young men, but in Cameroon, Ethiopia, Malawi and Zambia, both
sexes were waiting longer.
The study also found that both were having fewer sexual partners and
that condom use has increased among young women as well as among young
men.
UNAids' proposed treatment approach is called Treatment 2.0 and could
prevent 10 million deaths by 2025, it says. Only a third of the 15
million people who need Aids drugs have them and this strategy is
intended to enable everybody to have access ? in line with the G8
Gleneagles pledge. UNAids also calculates the plan would cut new HIV
cases by one million a year, because the drugs make those taking them
less infectious.
The goal is simpler, more available treatment but getting there could
be complex. UNAids is calling for drug companies to work on producing
a "smarter, better pill" than the complex and often toxic three-drug
combinations currently available. Sidib? said that he believed the
patent pool launched by the Geneva-based donor organisation Unitaid
would help. It hopes to get permission from drug manufacturers for
their medicines to be combined with those of others, royalty free, by
generic companies based probably in Asia.
But the cost of drugs was not the only problem, Sidib? said. "We need
to look at how we can make gains on reducing non drug-related costs
like hospitalisation and monitoring equipment. That is twice the cost
of the drugs themselves."
guardian.co.uk Copyright (c) Guardian News and Media Limited. 2010
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