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.
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.”