amfAR, The Foundation for AIDS Research

Progress on AIDS Elusive Among Some Populations

UNAIDS report also shows dramatic decline in new infections among children

The UN’s annual report on the state of the global AIDS epidemic, released November 20 in advance of World AIDS Day, was a mixed bag of remarkable progress among some populations and rising rates of infection in others.

While the estimated number of people living with HIV/AIDS at the end of 2011, 34 million, remained the same as 2010, there were 700,000 fewer new HIV infections across the world in 2011 than in 2001. Among the most notable successes was a substantial decline—24 percent—in new infections among children in the last two years alone. Since 2003, new infections in children have dropped by 43 percent. One of the UN’s primary goals is to eliminate new infections among children by 2015.

 

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The number of people living with HIV who were receiving treatment rose by 21 percent in 2011 so that, for the first time, the majority (54 percent) of people eligible for antiretroviral therapy in low- and middle-income countries were receiving it. Additionally, 2011 was the first year in which domestic public and private funding available for HIV/AIDS around the globe eclipsed funding from international sources.

 

Despite these and other gains, challenges remain. New infections are on the rise in the Middle East and North Africa, Eastern Europe and Central Asia, Bangladesh, Indonesia, the Philippines, and Sri Lanka. While sub-Saharan Africa has seen a sharp decline in the number of new HIV infections (25 percent since 2001), it remains the most severely affected region, with nearly one in 20 adults living with HIV/AIDS. Mother-to-child-transmission also remains stubbornly high in the region.

The report stresses the need for broader community engagement to help alleviate HIV-related stigma and discrimination. There is a close link between stigma and the inability to access and remain engaged in HIV services. Nearly four in ten countries worldwide still lack any specific legal provisions to prevent or address HIV-related stigma. As the report states, “to end the AIDS epidemic, sex workers, MSM, and people who inject drugs cannot remain invisible. They have to be counted in.”

According to the report, “As global HIV prevalence trends appear to have stabilized there is disturbing evidence suggesting that global HIV prevalence among men who have sex with men (MSM) may have increased between 2010 and 2012.” HIV prevalence among gay men and other MSM surveyed in capital cities is on average 13 times higher than the general population. “Getting to zero will require better mapping and effective combination prevention,” says the report. “That means combined behavioral, biomedical and structural strategies, both intensively in specific populations in concentrated epidemics and across the whole population in generalized epidemics.”