The pace of progress in reducing new HIV infections, increasing access to treatment and ending AIDS-related deaths is slowing down according to a new report announced by UNAIDS, a global effort to end AIDS as a public health threat by 2030.
UNAIDS’ Global AIDS Update shows a mixed picture, with some countries making impressive gains while others are experiencing rises in new HIV infections and AIDS-related deaths.
Key populations and their sexual partners now account for more than half (54 percent) of new HIV infections globally, including people who inject drugs, gay men and other men who have sex with men, transgender people, sex workers and prisoners - which accounted for around 95 percent of new HIV infections in eastern Europe and central Asia and in the Middle East and North Africa.
The report also shows that less than 50 percent of key populations were reached with combination HIV prevention services in more than half of the countries that reported. This highlights that key populations are still being marginalized and being left behind in the response to HIV.
Globally, around 1.7 million people became newly infected with HIV in 2018, a 16 percent decline since 2010, driven mostly by steady progress across most of eastern and southern Africa. South Africa, for example, has made huge advances and has successfully reduced new HIV infections by more than 40 percent and AIDS-related deaths by around 40 percent since 2010.
However, there is still a long way to go in eastern and southern Africa, the region most affected by HIV, and there have been worrying increases in new HIV infections in eastern Europe and central Asia (29 percent), in the Middle East and North Africa (10 percent) and in Latin America (7 percent).
Key findings include:
Financing: For the first time, the global resources available for the AIDS response declined significantly, by nearly $1 billion, as donors disbursed less and domestic investments did not grow fast enough to compensate for inflation. In 2018, $19 billion (in constant 2016 dollars) was available for the AIDS response, $7.2 billion short of the estimated $26.2 billion needed by 2020.
Treatment and the 90–90–90 targets: Progress is continuing towards the 90–90–90 targets. Some 79 percent of people living with HIV knew their HIV status in 2018, 78 percent who knew their HIV status were accessing treatment and 86 percent of people living with HIV who were accessing treatment were virally suppressed, keeping them alive and well and preventing transmission of the virus.
Communities at the center shows however that progress towards the 90–90–90 targets varies greatly by region and by country. In eastern Europe and central Asia for example, 72 percent of people living with HIV knew their HIV status in 2018, but just 53 percent of the people who knew their HIV status had access to treatment.
HIV prevention: Communities at the center shows that the full range of options available to prevent new HIV infections are not being used for optimal impact. For example, pre-exposure prophylaxis (PrEP), medicine to prevent HIV, was only being used by an estimated 300,000 people in 2018, 130,000 of whom were in the U.S. In Kenya, one of the first countries in sub-Saharan Africa to roll out PrEP as a national program in the public sector, around 30,000 people accessed the preventative medicines in 2018.
People who inject drugs accounted for 41 percent of new HIV infections in eastern Europe and central Asia and 27 percent of new HIV infections in the Middle East and North Africa, both regions that are lacking adequate harm reduction programs. Men remain hard to reach. Viral suppression among men living with HIV aged 25–34 years is very low, less than 40 percent in some high-burden countries with recent surveys, which is contributing to slow progress in stopping new HIV infections among their partners.
Children: Around 82 percent of pregnant women living with HIV now have access to antiretroviral medicines, an increase of more than 90 percent since 2010. This has resulted in a 41 percent reduction in new HIV infections among children, with remarkable reductions achieved in some regions. Yet there were nearly 160,000 new HIV infections among children globally, far away from the global target of reducing new HIV infections among children to fewer than 40,000 by 2018. More needs to be done to expand access to treatment for children. The estimated 940 000 children (aged 0–14 years) living with HIV globally on antiretroviral therapy in 2018 is almost double the number on treatment in 2010. However, it is far short of the 2018 target of 1.6 million.
Women and adolescent girls: Although large disparities still exist between young women and young men, with young women 60 percent more likely to become infected with HIV than young men of the same age, there has been success in reducing new HIV infections among young women. Globally, new HIV infections among young women (aged 15–24 years) were reduced by 25 percent between 2010 and 2018, compared to a 10 percent reduction among older women (aged 25 years and older). But every week 6,200 adolescent girls and young women become infected with HIV. Sexual and reproductive health and rights programs for young women need to be expanded and scaled up in order to reach more high-incidence locations and maximize impact.
AIDS-related deaths: AIDS-related deaths continue to decline as access to treatment continues to expand and more progress is made in improving the delivery of HIV/tuberculosis services. Since 2010, AIDS-related deaths have fallen by 33 percent, to 770, 000 in 2018. Global declines in AIDS-related deaths have largely been driven by progress in eastern and southern Africa. In eastern Europe and central Asia however, AIDS-related deaths have risen by 5 percent and in the Middle East and North Africa by 9 percent.
