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UNAIDS Reports Progress Ahead of World AIDS Day

Sunday, December 1, is the 26th annual observance of World AIDS Day. In advance of the commemoration, UNAIDS issued its 2013 annual report, AIDS by the numbers, showing that most areas of the world have seen accelerated progress against the epidemic, but some are falling behind. The U.S. Congress last week passed the PEPFAR Stewardship and Oversight Act of 2013, extending international HIV/AIDS funding for another 5 years.

World AIDS Day Resources

• AIDS.gov -- World AIDS Day
• CDC -- World AIDS Day
• NIH AIDSinfo -- World AIDS Day
• World AIDS Campaign
• World AIDS Day UK
• Twitter: #WorldAIDSDay, #WAD2013

According to the latest UNAIDS figures, at the end of 2012 approximately 35.3 million people were living with HIV worldwide, with an estimated 2.3 million new infections annually. Areas of progress include a 33% decrease in new HIV infections since 2001, a 52% decline in new infections among children over the past decade, and a 29% drop in AIDS-related deaths since the peak in 2005 (down to 1.6 million), largely attributable to expanded access to antiretroviral treatment.

The epidemic is growing, however, in Eastern Europe and Central Asia, where the number of new infections has increased by 13% since 2006, and in the Middle East and North Africa, where incidence has doubled since 2001, according to the new report. But for the first time in 2012, Ukraine reported a decline in the number of newly identified HIV cases, a turning point for that country.

In many areas progress has been stymied by inadequate access to essential HIV/AIDS services for key affected populations including gay and bisexual men, transgender people, sex workers, and people who use drugs -- groups that also bear the brunt of stigma and criminalization.

"Every person counts," said UNAIDS Executive Director Michel Sidibé. "If we are going to keep our pledge of leaving no one behind, we have to make sure HIV services reach everyone in need."

According to the report, approximately 9.7 million people in low- and middle-income countries were receiving antiretroviral therapy (ART) at the end of last year, an increase of nearly 20% in a single year.

As new evidence has emerged about the benefits of early treatment -- as well as the recognition that treatment also serves as prevention -- the World Health organization (WHO) this summer revised its guidelines to recommend ART starting at a CD4 count of 500 cells/mm³, up from a previous threshold of 350 cells/mm³.

The report states that just 3 in 10 eligible children in priority countries were receiving ART in 2012 based on the old WHO guidelines, and children under the age of 15 were about half as likely as adults to be on treatment (34% vs 64%, respectively).

"We have seen tremendous political commitment and results to reduce mother-to-child transmission of HIV, but we are failing the children who become infected," added Sidibé. "We urgently need better diagnostic tools and child-friendly medicines -- irrespective of the market size."

The report also notes the aging of the global epidemic, with a growing number of people with HIV being age 50 and older (now estimated at around 3.6 million worldwide).

Global Funding and PEPFAR

International donor funding for HIV/AIDS has remained flat over the past several years, but domestic spending in individual countries has picked up some of the slack, accounting for just over half of global HIV resources, which totaled about $18.9 billion in 2012.

On November 19, the U.S. House of Representatives passed the PEPFAR Stewardship and Oversight Act of 2013, extending the President’s Emergency Plan for AIDS Relief, initially instituted by George Bush in 2003, for an additional 5 years. The legislation, approved the previous day by the Senate, now awaits President Barack Obama's signature.

"A mere decade ago, AIDS was a death sentence in Africa...Today, the picture has changed dramatically, with millions of lives being saved and people with HIV being empowered to lead long and productive lives," said acting U.S. Global AIDS Coordinator Deborah von Zinkernagel. "The passage of the PEPFAR Stewardship and Oversight Act demonstrates the United States’ sustained commitment to fighting this deadly disease, but the U.S. cannot do it alone. Achieving an AIDS-free generation is a shared responsibility."

"I’m proud of this compromise bill, and pleased that it has passed," said Rep. Barbara Lee (D-CA) of Oakland. "In the current political climate, where partisanship splits us apart, this is a true bipartisan effort that saves millions of lives all around the world."

PEPFAR supports antiretroviral treatment for approximately 6 million people worldwide. In 2011 the UN member states agreed to a target of 15 million people on treatment by 2015, based on the old WHO guidelines. But raising the threshold for ART initiation to 500 cells/mm³ expanded the total number of people eligible for treatment by more than 10 million.

The PEPFAR extension passed last week does not include specific dollar amounts. Lee and Sen. Tom Coburn (R-OK), along with 38 other legislators, have requested that the U.S. double the number of people provided ART through PEPFAR to 12 million by the end of 2016.

Replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malariais also coming up, with a meeting of stakeholders scheduled for December 3 in Washington, DC. The new PEPFAR legislation continues to limit the U.S. contribution to the Fund to less than one-third of its total funding.

"At this critical juncture, scaling up to capitalize on scientific advances, while expanding deployment of proven-effective prevention tools that are already available to us, will not only save millions of lives but will also significantly reduce human suffering, new HIV infections, and healthcare costs in the years to come," the legislators stated in a letter to President Obama.

11/27/13

Sources

UNAIDS. AIDS by the numbers. November 2013.

UNAIDS. Ahead of World AIDS Day 2013 UNAIDS reports sustained progress in the AIDS response. Press release. November 20, 2013.

U.S. State Dept. Press Office. Statement from Acting U.S. Global AIDS Coordinator Deborah von Zinkernagel on Passage of the PEPFAR Stewardship and Oversight Act of 2013. Blog.AIDS.gov. November 20, 2013.

Rep. Barbara Lee. Congresswoman Barbara Lee Hails Passage of Bipartisan PEPFAR Stewardship Act. Press release. November 19, 2013.

Rep. Barbara Lee. Congresswoman Barbara Lee and Senator Coburn Call for New AIDS Treatment Goal. Press release. November 14, 2013.