AIDS Pandemic at Beginning of the End ?

In a new report to mark World AIDS Day on December 1st, leading campaign and advocacy group ONE declare that for the first time in 30 years, the world has reached a "tipping point" in the global AIDS pandemic.

In a report to mark World AIDS Day, campaigners say we have passed the tipping point in the global pandemic because more people are now signing up for AIDS treatment than are being infected with HIV.

The tipping point is where more people are being added to life-saving AIDS treatment than are becoming infected with HIV.

The report notes that 2.3 million people worldwide were newly added to AIDS treatment in 2013 - a dramatic rise from 1.6 million in 2012.

At the same time, the total number of people newly infected with HIV fell - less dramatically - from 2.2 million in 2012 to 2.1 million in 2013.

However, although we appear to be at "beginning of the end of AIDS," progress is still fragile.

Report author Erin Hohlfelder, director of Global Health Policy at ONE, says:

"Despite the good news, we should not take a victory lap yet. We've passed the tipping point in the AIDS fight at the global level, but not all countries are there yet, and the gains made can easily stall or unravel."

The report highlights three major threats to global progress against AIDS.

The first threat is lack of funds. There is an annual shortfall of $3 billion a year needed to control the disease. The report says many African countries are not meeting their own promises on health spending and the international donor fund is unsustainable - with most funds coming from just three contributors: the US, the UK and France.

The second threat is more and more of HIV/AIDS is concentrated in groups that are hardest to reach, who are often stigmatized, and find it difficult to access treatment and prevention services.

The report shows that HIV prevalence is roughly 28 times higher among people who inject drugs; 19 times higher among men who have sex with men; and 12 times higher among sex workers. Adolescent girls are another group that is hard to reach.

The third threat to winning the global fight against HIV/AIDS is the fragility of progress - sometimes one step forward is followed by two steps back. 

The current Ebola crisis shows how disease can weaken fragile health systems and reverse hard-won progress.

A country can pass the tipping point, and then suffer a setback. For example in 2012, Ghana reached the tipping point - but then slid backward in 2013.

Target HIV 'where it is, not where it is easy to reach'

The report makes three recommendations to address these threats:

1. Funding needs to come from a diverse base - "including more from African domestic budgets," says Hohlfelder - and deployed more boldly. Progress will be delayed if shortfalls continue and the same, few donors keep paying out, even with incremental increases
2. Target HIV where it is, not where it is easy to reach. This means, for example, tailoring strategies and applying more political pressure so they reach marginalized groups more effectively
3. Improve health infrastructure where it is weak. Health systems need to be resilient - not just to tackle AIDS but also other challenges like Ebola.

Meanwhile, another of researchers recently stated that HIV is not under control among most infected Americans. According to a new report from the Centers for Disease Control and Prevention (CDC) - based on data for 2011 - only 3 out of 10 people in the US infected with HIV have the virus in check.

There are more than 1.2 million people living with HIV in the US, and with new infections arising at a rate of around 50,000 a year, the virus continues to pose a threat to public health and well-being, note the CDC.

References:

1. ONE, At the tipping point - tracking global commitments on AIDS, accessed 1 December 2014.
2. ONE news release accessed 1 December 2014.