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GLOBAL REPORT - UNAIDS REPORT ON THE GLOBAL AIDS EPIDEMIC | 2010 (WHO/UNAIDS, Foreword and Introduction, edited)
GLOBAL REPORT - UNAIDS REPORT ON THE GLOBAL AIDS EPIDEMIC | 2010 (WHO/UNAIDS, Foreword and Introduction, edited)
[Source: UNAIDS, full PDF document (LINK). Foreword and Introduction, edited. Open Report: (LINK).]
Copyright ? 2010
Joint United Nations Programme on HIV/AIDS (UNAIDS)
All rights reserved
The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of UNAIDS concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. UNAIDS does not warrant that the information published in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use.
WHO Library Cataloguing-in-Publication Data
Global report: UNAIDS report on the global AIDS epidemic 2010.
?UNAIDS/10.11E | JC1958E?
1.Acquired immunodefi ciency syndrome − epidemiology. 2.Acquired immunodefi ciency syndrome − prevention and control.
3.HIV infections − epidemiology. 4.HIV infections − prevention and control. I.UNAIDS.
ISBN 978-92-9173-871-7 (NLM classifi cation: WC 503.4)
GLOBAL REPORT - UNAIDS REPORT ON THE GLOBAL AIDS EPIDEMIC | 2010
FOREWORD
?No child should be born with HIV; no child should be an orphan because of HIV; no child should die due to lack of access to treatment,? urged Ebube Sylvia Taylor, an eleven year old born free of HIV, to world leaders gathered in New York to share progress made towards achieving the Millennium Development Goals by 2015.
We have halted and begun to reverse the epidemic. Fewer people are becoming infected with HIV and fewer people are dying from AIDS.
We must be proud of these successes and the potential of our shared future?breakthroughs in a prevention revolution are at hand with a new microbicide gel holding promise for a generation of women who will be able to initiate usage and take control of their ability to stop HIV. Political breakthroughs will be achieved as more countries abolish discriminatory practices led by voices of a new law commission, and Treatment 2.0?a breakthrough that could save an additional 10 million lives.
However we are not yet in a position to say ?mission accomplished?.
Growth in investment for the AIDS response has flattened for the first time in 2009. Demand is outstripping supply. Stigma, discrimination, and bad laws continue to place roadblocks for people living with HIV and people on the margins.
To fulfill Ebube?s hope, we must break the trajectory of the AIDS epidemic by redoubling our efforts to ensure countries meet their goals towards universal access to HIV prevention, treatment, care and support. We must leverage the growing integration of AIDS with maternal and child health and all of our MillenniumDevelopment Goals.
We know that there are solutions. We know that there is political and societal will to bring change. The real challenge is following through. Th is new fourth decade of the epidemic should be one of moving towards efficient, focused and scaled-up programmes to accelerate progress for Results. Results. Results.
Michel Sidib?
UNAIDS Executive Director
Under Secretary-General of the United Nations
INTRODUCTION
On the cusp of the fourth decade of the AIDS epidemic, the world has turned the corner?it has halted and begun to reverse the spread of HIV (Millennium Development Goal 6.A). The question remains how quickly the response can chart a new course towards UNAIDS? vision of zero discrimination, zero new HIV infections, and zero AIDS-related deaths through universal access to effective HIV prevention, treatment, care and support.
Since 1999, the year in which it is thought that the epidemic peaked, globally, the number of new infections has fallen by 19%. Of the estimated 15 million people living with HIV in low- and middle-income countries who need treatment today, 5.2 million have access?translating into fewer AIDS-related deaths. For the estimated 33.3 million people living with HIV after nearly 30 years into a very complex epidemic, the gains are real but still fragile.
Future progress will depend heavily on the joint efforts of everyone involved in the HIV response.
At a time of financial constraint, good investments are more important than ever. The evidence supporting increased investment in the HIV response has never been clearer or more compelling. New data from 182 countries, along with extensive input from civil society and other sources, clearly show that steady progress is being made towards achieving universal access to HIV prevention, treatment, care and support. HIV prevention is working. Treatment is working. Increasing evidence definitively demonstrates that investments in the HIV response can lead to clear reductions in discrimination and stigma, help people in accessing information and services to reduce their risk of HIV infection, and deliver the treatment, care, and support that will extend and improve the lives of people living with HIV.
More than 5 million people are now receiving HIV treatment
In 2009 alone, 1.2 million people received HIV antiretroviral therapy for the first time?an increase in the number of people receiving treatment of 30% in a single year. Overall, the number of people receiving therapy has grown 13-fold, more than five million people in low- and middle-income countries, since 2004. Expanding access to treatment has contributed to a 19% decline in deaths among people living with HIV between 2004 and 2009. Th is is just the beginning: 10 million people living with HIV who are eligible for treatment under the new WHO guidelines are still in need.
Efforts are now underway for Treatment 2.0, a new approach to simplify the way HIV treatment is currently provided and to scale up access to life-saving medicines. Using a combination of efforts, this new approach could bring down treatment costs, make treatment regimens simpler and smarter, reduce the burden on health systems, and improve the quality of life for people living with HIV and their families. Modelling suggests that, compared with current treatment approaches, Treatment 2.0 could avert an additional 10 million deaths by 2025.
In addition, the new platform could reduce the number of people newly infected with HIV by up to one million annually if countries provide antiretroviral therapy to all people in need, following revised WHO treatment guidelines.
HIV prevention works?new HIV infections are declining in many countries most affected by the epidemic
In 33 countries, HIV incidence has fallen by more than 25% between 2001 and 2009. Of these countries 22 are in sub-Saharan Africa. The biggest epidemics in sub-Saharan Africa?Ethiopia, Nigeria, South Africa, Zambia, and Zimbabwe?have either stabilized or are showing signs of decline.
Howevever, several regions and countries do not fit the overall trend. In seven countries, five of them in Eastern Europe and Central Asia, HIV incidence increased by more than 25% between 2001 and 2009.
These figures demonstrate that positive behaviour change can alter the course of the epidemic?while stigma and discrimination, lack of access to services and bad laws can make epidemics worse. In both cases, the effects are often profound.
Among young people in 15 of the most severely affected countries, HIV prevalence has fallen by more than 25% as these young people have adopted safer sexual practices. Similar to treatment access, the room for continued improvement on this success is great. Young people?s knowledge about HIV is increasing but needs to grow further.
Virtual elimination of mother-to-child transmission of HIV is possible
In 2009, an estimated 370 000 children [220 000?520 000] contracted HIV during the perinatal and breastfeeding period, down from 500 000 [320 000?670 000] in 2001.
(...)
Although this is a significant reduction, HIV continues to weigh heavily on maternal and child mortality in some countries. But in South Africa, which achieved almost 90% coverage of treatment to prevent mother-to-child transmission of HIV, transmission to infants has been drastically reduced. In many communities, countries and regions of the world, however, access to services to halt mother-to-child transmission needs to be scaled up.
In 2009, UNAIDS called for the virtual elimination of mother-to-child transmission of HIV by 2015 (Figure 1.1). In the 10 most severely affected countries, this is a realistic aim and can be achieved with significantly increased action to implement proven strategies to eliminate HIV transmission to young people.
Women and girls need support
Slightly more than half of all people living with HIV are women and girls. In sub-Saharan Africa, more women than men are living with HIV, and young women aged 15?24 years are as much as eight times more likely than men to be HIV positive. Protecting women and girls from HIV means protecting against genderbased violence and promoting economic independence from older men.
Human rights are increasingly a part of national strategies
Human rights are no longer considered peripheral to the AIDS response.
Today, the vast majority of countries (89%) explicitly acknowledge or address human rights in their national AIDS strategies, with 92% of countries reporting that they have programmes in place to reduce HIV-related stigma and discrimination.
At the same time, however, criminalization of people living with HIV still presents significant challenges to the AIDS response. More than 80 countries across the world have laws against same-sex behaviour, and the free travel of people living with HIV is restricted in 51 countries, territories and areas. Such laws are not only discriminatory and unjust?they also drive HIV underground and inhibit efforts to expand access to life-saving HIV prevention, treatment, care and support.
Financing the response is a shared responsibility
Increasingly, countries with heavy HIV burdens are assuming their responsibilities to resource the response to the degree that their means permit.
Domestic expenditure is the largest source of HIV financing globally today, accounting for 52% of resources for the HIV response in low- and middleincome countries. Improving financing for the global response will require ongoing efforts to mobilize domestic resources among countries that appear to be under-investing in the HIV response, increasing the efficient use of funds for HIV and other related health and development programmes, and increasing external aid in a global environment of constrained resources.
A fragile progress
Despite extensive progress against a number of indicators on the global scale, many countries will fail to achieve Millennium Development Goal 6: halting and reversing the spread of HIV (Figure 1.2 and Figure 1.3).
(...)
Having more than 5 million people receiving treatment is a major public health achievement?but still represents only 35% of the people who need HIV therapy now, according to WHO guidelines issued in early 2010. Reaching the two thirds of people who need treatment, but are not yet receiving it, and financing this expansion in access to HIV therapy will require a continued and expanded global commitment to providing high quality HIV care for all.
Knowledge of the epidemic and how to prevent HIV infection has increased among young people aged 15?24 years?people frequently at the highest risk for infection. Six countries have achieved greater than 80% condom use at last higher-risk sex among males, and two countries have achieved this high level of condom use among females (see the HIV prevention scorecard).
Young people still lack knowledge and, importantly, oft en lack the tools they need to practice HIV risk-reduction strategies, however. Many people still lack ready access to condoms and lubrication, and people who inject drugs also lack sufficient access to sterile needles.
A new vision
Fulfilling the UNAIDS vision of zero new infections will require a hard look at the societal structures, beliefs and value systems that present obstacles to effective HIV prevention efforts. Poverty, gender inequity, inequity in health and the education system, discrimination against marginalized people, and unequal resource pathways all affect?and oft en slow?the HIV response. In a world that has had to learn to live with an evolving and seemingly unstoppable epidemic over the course of three decades, UNAIDS? vision of zero discrimination, zero new infections and zero AIDS-related deaths poses a challenge. But it is not a hopeless challenge. Th e vision of eliminating the toll that HIV imposes on human life can be made real using the knowledge and resources available today. Planners, programme administrators and implementers must make a sustained and dedicated effort to use the best social and scientific knowledge available. Strengthened programming using the latest knowledge and best practices to deliver effective prevention, treatment and care services to people in need, or at risk, is highly effective.
Building social coalitions to reduce vulnerability to HIV infection supports individuals and strengthens communities. Safeguarding the health of mothers and infants and optimizing infant feeding provides a strong basis for the growth of new generations. Investing in health care and social support systems, working to eliminate violence against women and girls and promote gender equality and working to end stigma and discrimination against people living with HIV and members of other marginalized groups help to provide social environments that are effective against the spread of HIV and promote more general mental and physical well-being. And in providing HIV-specific services with an awareness of other health and social issues and forging appropriate linkages, the response to HIV can make an important contribution to global health.
(...)
The Millennium Development Goals are intertwined. Without achieving substantive progress towards the HIV-specific Goal 6, few other Goals are likely to be reached; likewise, without integration and significant progress towards most other Goals being made, Goal 6 will probably not be achieved.
Stopping infections, saving lives and improving the quality of life of people living with HIV have always been at the heart of the global AIDS response. The successes and continuing challenges described in this report should serve as catalysts for continued action.
(...)
-
------
[Source: UNAIDS, full PDF document (LINK). Foreword and Introduction, edited. Open Report: (LINK).]
Copyright ? 2010
Joint United Nations Programme on HIV/AIDS (UNAIDS)
All rights reserved
The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of UNAIDS concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. UNAIDS does not warrant that the information published in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use.
WHO Library Cataloguing-in-Publication Data
Global report: UNAIDS report on the global AIDS epidemic 2010.
?UNAIDS/10.11E | JC1958E?
1.Acquired immunodefi ciency syndrome − epidemiology. 2.Acquired immunodefi ciency syndrome − prevention and control.
3.HIV infections − epidemiology. 4.HIV infections − prevention and control. I.UNAIDS.
ISBN 978-92-9173-871-7 (NLM classifi cation: WC 503.4)
GLOBAL REPORT - UNAIDS REPORT ON THE GLOBAL AIDS EPIDEMIC | 2010
FOREWORD
?No child should be born with HIV; no child should be an orphan because of HIV; no child should die due to lack of access to treatment,? urged Ebube Sylvia Taylor, an eleven year old born free of HIV, to world leaders gathered in New York to share progress made towards achieving the Millennium Development Goals by 2015.
We have halted and begun to reverse the epidemic. Fewer people are becoming infected with HIV and fewer people are dying from AIDS.
We must be proud of these successes and the potential of our shared future?breakthroughs in a prevention revolution are at hand with a new microbicide gel holding promise for a generation of women who will be able to initiate usage and take control of their ability to stop HIV. Political breakthroughs will be achieved as more countries abolish discriminatory practices led by voices of a new law commission, and Treatment 2.0?a breakthrough that could save an additional 10 million lives.
However we are not yet in a position to say ?mission accomplished?.
Growth in investment for the AIDS response has flattened for the first time in 2009. Demand is outstripping supply. Stigma, discrimination, and bad laws continue to place roadblocks for people living with HIV and people on the margins.
To fulfill Ebube?s hope, we must break the trajectory of the AIDS epidemic by redoubling our efforts to ensure countries meet their goals towards universal access to HIV prevention, treatment, care and support. We must leverage the growing integration of AIDS with maternal and child health and all of our MillenniumDevelopment Goals.
We know that there are solutions. We know that there is political and societal will to bring change. The real challenge is following through. Th is new fourth decade of the epidemic should be one of moving towards efficient, focused and scaled-up programmes to accelerate progress for Results. Results. Results.
Michel Sidib?
UNAIDS Executive Director
Under Secretary-General of the United Nations
INTRODUCTION
On the cusp of the fourth decade of the AIDS epidemic, the world has turned the corner?it has halted and begun to reverse the spread of HIV (Millennium Development Goal 6.A). The question remains how quickly the response can chart a new course towards UNAIDS? vision of zero discrimination, zero new HIV infections, and zero AIDS-related deaths through universal access to effective HIV prevention, treatment, care and support.
Since 1999, the year in which it is thought that the epidemic peaked, globally, the number of new infections has fallen by 19%. Of the estimated 15 million people living with HIV in low- and middle-income countries who need treatment today, 5.2 million have access?translating into fewer AIDS-related deaths. For the estimated 33.3 million people living with HIV after nearly 30 years into a very complex epidemic, the gains are real but still fragile.
Future progress will depend heavily on the joint efforts of everyone involved in the HIV response.
At a time of financial constraint, good investments are more important than ever. The evidence supporting increased investment in the HIV response has never been clearer or more compelling. New data from 182 countries, along with extensive input from civil society and other sources, clearly show that steady progress is being made towards achieving universal access to HIV prevention, treatment, care and support. HIV prevention is working. Treatment is working. Increasing evidence definitively demonstrates that investments in the HIV response can lead to clear reductions in discrimination and stigma, help people in accessing information and services to reduce their risk of HIV infection, and deliver the treatment, care, and support that will extend and improve the lives of people living with HIV.
More than 5 million people are now receiving HIV treatment
In 2009 alone, 1.2 million people received HIV antiretroviral therapy for the first time?an increase in the number of people receiving treatment of 30% in a single year. Overall, the number of people receiving therapy has grown 13-fold, more than five million people in low- and middle-income countries, since 2004. Expanding access to treatment has contributed to a 19% decline in deaths among people living with HIV between 2004 and 2009. Th is is just the beginning: 10 million people living with HIV who are eligible for treatment under the new WHO guidelines are still in need.
Efforts are now underway for Treatment 2.0, a new approach to simplify the way HIV treatment is currently provided and to scale up access to life-saving medicines. Using a combination of efforts, this new approach could bring down treatment costs, make treatment regimens simpler and smarter, reduce the burden on health systems, and improve the quality of life for people living with HIV and their families. Modelling suggests that, compared with current treatment approaches, Treatment 2.0 could avert an additional 10 million deaths by 2025.
In addition, the new platform could reduce the number of people newly infected with HIV by up to one million annually if countries provide antiretroviral therapy to all people in need, following revised WHO treatment guidelines.
HIV prevention works?new HIV infections are declining in many countries most affected by the epidemic
In 33 countries, HIV incidence has fallen by more than 25% between 2001 and 2009. Of these countries 22 are in sub-Saharan Africa. The biggest epidemics in sub-Saharan Africa?Ethiopia, Nigeria, South Africa, Zambia, and Zimbabwe?have either stabilized or are showing signs of decline.
Howevever, several regions and countries do not fit the overall trend. In seven countries, five of them in Eastern Europe and Central Asia, HIV incidence increased by more than 25% between 2001 and 2009.
These figures demonstrate that positive behaviour change can alter the course of the epidemic?while stigma and discrimination, lack of access to services and bad laws can make epidemics worse. In both cases, the effects are often profound.
Among young people in 15 of the most severely affected countries, HIV prevalence has fallen by more than 25% as these young people have adopted safer sexual practices. Similar to treatment access, the room for continued improvement on this success is great. Young people?s knowledge about HIV is increasing but needs to grow further.
Virtual elimination of mother-to-child transmission of HIV is possible
In 2009, an estimated 370 000 children [220 000?520 000] contracted HIV during the perinatal and breastfeeding period, down from 500 000 [320 000?670 000] in 2001.
(...)
Although this is a significant reduction, HIV continues to weigh heavily on maternal and child mortality in some countries. But in South Africa, which achieved almost 90% coverage of treatment to prevent mother-to-child transmission of HIV, transmission to infants has been drastically reduced. In many communities, countries and regions of the world, however, access to services to halt mother-to-child transmission needs to be scaled up.
In 2009, UNAIDS called for the virtual elimination of mother-to-child transmission of HIV by 2015 (Figure 1.1). In the 10 most severely affected countries, this is a realistic aim and can be achieved with significantly increased action to implement proven strategies to eliminate HIV transmission to young people.
Women and girls need support
Slightly more than half of all people living with HIV are women and girls. In sub-Saharan Africa, more women than men are living with HIV, and young women aged 15?24 years are as much as eight times more likely than men to be HIV positive. Protecting women and girls from HIV means protecting against genderbased violence and promoting economic independence from older men.
Human rights are increasingly a part of national strategies
Human rights are no longer considered peripheral to the AIDS response.
Today, the vast majority of countries (89%) explicitly acknowledge or address human rights in their national AIDS strategies, with 92% of countries reporting that they have programmes in place to reduce HIV-related stigma and discrimination.
At the same time, however, criminalization of people living with HIV still presents significant challenges to the AIDS response. More than 80 countries across the world have laws against same-sex behaviour, and the free travel of people living with HIV is restricted in 51 countries, territories and areas. Such laws are not only discriminatory and unjust?they also drive HIV underground and inhibit efforts to expand access to life-saving HIV prevention, treatment, care and support.
Financing the response is a shared responsibility
Increasingly, countries with heavy HIV burdens are assuming their responsibilities to resource the response to the degree that their means permit.
Domestic expenditure is the largest source of HIV financing globally today, accounting for 52% of resources for the HIV response in low- and middleincome countries. Improving financing for the global response will require ongoing efforts to mobilize domestic resources among countries that appear to be under-investing in the HIV response, increasing the efficient use of funds for HIV and other related health and development programmes, and increasing external aid in a global environment of constrained resources.
A fragile progress
Despite extensive progress against a number of indicators on the global scale, many countries will fail to achieve Millennium Development Goal 6: halting and reversing the spread of HIV (Figure 1.2 and Figure 1.3).
(...)
Having more than 5 million people receiving treatment is a major public health achievement?but still represents only 35% of the people who need HIV therapy now, according to WHO guidelines issued in early 2010. Reaching the two thirds of people who need treatment, but are not yet receiving it, and financing this expansion in access to HIV therapy will require a continued and expanded global commitment to providing high quality HIV care for all.
Knowledge of the epidemic and how to prevent HIV infection has increased among young people aged 15?24 years?people frequently at the highest risk for infection. Six countries have achieved greater than 80% condom use at last higher-risk sex among males, and two countries have achieved this high level of condom use among females (see the HIV prevention scorecard).
Young people still lack knowledge and, importantly, oft en lack the tools they need to practice HIV risk-reduction strategies, however. Many people still lack ready access to condoms and lubrication, and people who inject drugs also lack sufficient access to sterile needles.
A new vision
Fulfilling the UNAIDS vision of zero new infections will require a hard look at the societal structures, beliefs and value systems that present obstacles to effective HIV prevention efforts. Poverty, gender inequity, inequity in health and the education system, discrimination against marginalized people, and unequal resource pathways all affect?and oft en slow?the HIV response. In a world that has had to learn to live with an evolving and seemingly unstoppable epidemic over the course of three decades, UNAIDS? vision of zero discrimination, zero new infections and zero AIDS-related deaths poses a challenge. But it is not a hopeless challenge. Th e vision of eliminating the toll that HIV imposes on human life can be made real using the knowledge and resources available today. Planners, programme administrators and implementers must make a sustained and dedicated effort to use the best social and scientific knowledge available. Strengthened programming using the latest knowledge and best practices to deliver effective prevention, treatment and care services to people in need, or at risk, is highly effective.
Building social coalitions to reduce vulnerability to HIV infection supports individuals and strengthens communities. Safeguarding the health of mothers and infants and optimizing infant feeding provides a strong basis for the growth of new generations. Investing in health care and social support systems, working to eliminate violence against women and girls and promote gender equality and working to end stigma and discrimination against people living with HIV and members of other marginalized groups help to provide social environments that are effective against the spread of HIV and promote more general mental and physical well-being. And in providing HIV-specific services with an awareness of other health and social issues and forging appropriate linkages, the response to HIV can make an important contribution to global health.
(...)
The Millennium Development Goals are intertwined. Without achieving substantive progress towards the HIV-specific Goal 6, few other Goals are likely to be reached; likewise, without integration and significant progress towards most other Goals being made, Goal 6 will probably not be achieved.
Stopping infections, saving lives and improving the quality of life of people living with HIV have always been at the heart of the global AIDS response. The successes and continuing challenges described in this report should serve as catalysts for continued action.
(...)
-
------