In July, the global community convened in Paris to assess the most recent data on the HIV pandemic. UNAIDS (United Nations Programme on HIV/AIDS) and World Health Organization (WHO) figures showed that, for the first time, the scales have tipped: more than half of all people living with HIV, 53 per cent, now have access to HIV treatment and AIDS-related deaths have almost halved since 2005.

More effective, cheaper treatment; improved access to testing – including self-testing kits – greater availability of antiretroviral treatment; better ongoing care/monitoring and a genuine global commitment to fight HIV have all contributed to outcomes.

 

A million people are still dying each year

 

The optimism surrounding the figures is encouraging, but Dr Gottfried Hirnschall, Director for HIV and Hepatitis at the World Health Organization (WHO), adds a note of caution: “We need to remember that a million people are still dying each year and 15.8 million still in need of treatment. We won’t achieve the 2030 goal of eliminating AIDS if we simply continue with business as usual.”

A global scale-up of the current services is important, but new solutions need to be found to address specific areas of concern, namely, HIV services for children and adolescents, better care for those with advanced HIV disease and access to testing, treatment and prevention services for key populations.

 

HIV-related Tuberculosis deaths are high

 

In a bid to ramp up their HIV treatment programmes, many countries have not sufficiently addressed the comorbidities that often come with HIV. The need is pressing, as a third of all people who start antiretroviral therapy present with advanced HIV disease. “We know HIV and tuberculosis (TB) overlap and 390,000 people die each year from HIV-related TB in sub-Saharan Africa,” says Dr Hirnschall. “Cryptococcal meningitis is also a major cause of death – up to 15 per cent of AIDS-related deaths ­– in Africa, South-East Asia, Latin America and the Caribbean.”

Earlier and more strategic testing would certainly help address the problem, but Dr Hirnschall is also urging greater integration of HIV and health services, so support can be tailored around the unique needs of each individual as soon after diagnosis as possible.  

 
 

Over 50% of HIV-positive children have no access to antiretrovirals

 

Another group that needs specific attention is children and young people. WHO reports that only 43 per cent of children living with HIV are accessing antiretroviral treatment, and in 2016, 260,000 adolescents became infected with HIV. There are major issues that need to be addressed around early infant diagnosis, the development of more age-appropriate and child-friendly formulations and improved care for adolescents. Young people themselves have a powerful role to play in creating an AIDS-free future and it’s important they are part of the discussions taking place right now.

 

Increase in AIDS in Africa, Europe and Asia

 

Within the last year, research has also identified key geographical regions and populations where infection rates continue to rise. There has been insufficient scale-up of HIV services in West Central Africa, and in Eastern Europe and Central Asia. Here, treatment access remains low, and the rate of new infections continues to rise rapidly – with discrimination and stigma  preventing key populations receiving appropriate services.

“Men who have sex with men, transgender people, sex workers, people who inject drugs, and migrants continue to be excluded,” says Dr Hirnschall. “It’s not just a health issue, it’s a human rights issue. Unless stigma, discrimination, and exclusion are addressed, we cannot end AIDS.”

 

The end of AIDS

 

The challenges are certainly significant, but they are not insurmountable. Back in July, WHO reported that in six of eleven countries surveyed in Africa, Latin America and Asia, more than ten per cent of people starting antiretroviral therapy had a strain of HIV that was resistant to some of the widely-used HIV medicines. “While this is not yet alarming, it has to be taken seriously. Drug resistance can largely be prevented - it needs to be monitored by countries, and we do have solutions, if indeed it occurs, substituting with new drugs,” says Dr Hirnschall.

The fact that we can respond confidently to the threat of resistance is a sign that the world has never been more equipped to respond to HIV. While we still have not found that elusive AIDS vaccine, we do have the knowledge and the tools to bring an end to AIDS.