The global response to HIV/AIDS: where are we now?
The 1st December 2008 marks the 20th anniversary of World AIDS Day; a commemorative day aimed at raising public awareness about HIV and AIDS, including the need for support and understanding for people living with HIV.
World AIDS Day provides an opportunity to take a look at the HIV response to date and to understand what must be done to ensure that nations and the international community are on course to meet the HIV commitments that they have made and to ‘Keep their Promise’.
According to UNAIDS although the global percentage of people living with HIV has stabilised over the last eight years, the overall number of people living with HIV has increased because of the ongoing number of new infections each year and the wider availability of antiretroviral therapy. Currently there are an estimated 33 million people living with HIV - 67% of who live in Sub-Saharan Africa - and approximately 2.7 million become newly infected each year.
The UNGASS High Level Meeting on HIV and AIDS in June and, more recently, the XIV international AIDS Conference in Mexico have left no doubt that at the current rate international commitments, such as MDG 6, will not be met. The stark fact remains that the number of new HIV infections continues to outstrip the advances made in treatment numbers—for every two people put on antiretroviral drugs, another five become newly infected.
Continuing Challenges
While advances have been made in the roll out of treatment with nearly 3 million people receiving antiretroviral treatment in low- and middle-income countries at the end of 2007, this represents less that a third of estimated global need. Access to treatment is also unequal; children living with HIV in Sub-Saharan Africa are only about one third as likely to receive antiretroviral therapy as their adult counterparts.
Furthermore, while globally treatment coverage is higher for women than men, women and girls continue to be disproportionately affected by the epidemic, accounting for 61% of HIV infections in Sub-Saharan Africa. Gender equality remains a key driver of the AIDS epidemic and will not be contained until injustices related to gender are adequately addressed.
However, although the roll-out of treatment is key, treatment alone cannot halt and begin to reverse the spread of HIV. A scaled-up response to combined prevention, based on individual contexts and realities, remains critical. This is true now more than ever as the latest UNAIDS data collected from 64 countries indicate that fewer than 40% of young people have basic information about HIV and that discrimination remains a barrier to prevention access for most at risk populations.
The need for strong and committed leadership
The technology and know-how exist to meet MDG 6 and other international commitments on HIV such as Universal Access by 2010 and the UNGASS declaration on HIV however global resourcing continues to fall far short of what is needed. While in 2007, US$10 billion was made available for HIV, almost double that was needed. If we are to ‘Keep the Promise’, significantly increased financial support is needed from donors, domestic and private sources. Moreover, much greater leadership from the international community will be required to deliver on promises made and resources pledged.
In a climate of competing development demands, we need to continue to keep pressure on world leaders and highlight the need for renewed high-level political leadership to sustain the response to the AIDS pandemic; to ‘lead, empower and deliver’.
