Emerging Trends in the Global HIV/AIDS Epidemic

In anticipation of the XIX International AIDS Conference to be held in Washington DC next week, UNAIDS released its much-anticipated AIDS report. Together we will End AIDS is a comprehensive 140-page report, reflecting on the global status of HIV/AIDS, current responses to the virus, and concludes with a series of recommendations for future action. The observations of the report were mixed: it found some commendable efforts to combat AIDS in many parts of the world, but found other areas that need considerable improvement.

Better access to treatment has prolonged the survival of AIDS victims.

First, the good news: there was a decline in the rate of new infections, resulting in fewer deaths from AIDS-related causes. In 2005, the virus killed 2.3 million; in 2011, the number of deaths dropped to 1.7 million. The reason attributed to these improvements was increased public and private expenditures in HIV treatment and prevention, a sum total that amounted to $16.8 billion, much of it focused on providing increased access to life-sustaining pharmaceuticals. In the short span of two years, the number of people on HIV drugs has surged 21%, adding some 8 million people to the ranks of the treated.

A particularly encouraging case has been that of Botswana. Only a decade ago, the situation in the Sub-Saharan African nation was dire: 37% of the adult population was infected with AIDS, and treatment options were severely limited. In response to the crisis, the Botswana government formed partnerships with the President’s Emergency Plan for AIDS Relief (PEPFAR), the Center for Disease Control,  Merck, and the Bill and Melinda Gates Foundation. Now, 95% of Botswana Citizens that need treatment have access to drugs, and the Botswana government has been able to assume a greater amount of responsibility for the costs.

Treating HIV/AIDS has gotten a lot cheaper as well. The cost of a year’s supply of antiretroviral drugs has plummeted from $10,000 a person in 2000 to less than $100 in 2011. With the same amount of capital, it has become possible to treat 100 patients for the former price of one—nothing short of spectacular.

BRICS countries have become largely self-sustainable in combatting AIDS.

Another positive trend is the increasing self-sustainability of AIDS programs in BRICS countries. According to the report, Brazil and Russia pay for almost all of their HIV response already, spending $1 billion and $31 million respectively. India is planning to fund 90% of its $2.3 billion program for 2012-2017, and China funds 80% of its $530 million per year program. Not to be outdone, South Africa has increased its AIDS response five-fold over the last five years, bringing its total spending to an estimated $2 billion a year. All five countries are weaning themselves off foreign aid, focusing on becoming net donors of financial assistance. BRICS is rapidly closing the gap between developed nations, growing their foreign assistance programs ten times faster than the G7 countries.

The message of the report, however, was not entirely positive. While conditions have improved in the center of the AIDS epidemic, particularly in Africa, the capacity to treat AIDS on the periphery has declined. Eastern Europe, Central Asia, and North Africa, lag significantly behind Africa’s 62% treatment rate for AIDS; consequentially, the number of AIDS related deaths continues to rise in those regions. In these areas, the sex industry and drug use are responsible for a large number of new cases. Reducing consumption of both and redoubling treatment efforts will be necessary to reduce new AIDS cases.

Funding also remains an issue. Although funding for AIDS prevention, research, and treatment has drastically increased, the report notes that the need is still greater. A study by the Lancet found that if a $22 billion per year funding target was achieved between 2011 and 2020, 12.2 million HIV infections would be prevented, 7.4 million lives would be saved, and 29.4 million life-years would be gained. AIDS funding is already composed of pharmaceutical donations, other private sector funds, charities, official donor aid, and now governments are beginning to take on larger portions of the cost. Contributions from all these actors is what has driven much of the achieved success thus far.