In brief: Important HIV-related developments
Several important HIV-related announcements were made in the last few weeks. We provide short summaries.
“The scales have tipped”
UNAIDS announced on 20 July 2017 that in 2016, for the first time, more than half of the people living with HIV (19.5 million of the 36.7 million living with HIV) were able to access HIV treatment. In addition, AIDS-related deaths have almost halved since 2005 – from 1.9 million to 1.0 million.
UNAIDS said that provided scale-up continues, this progress puts the world on track to reach the global target of 30 million people on treatment by 2020.
The region showing the most progress is eastern and southern Africa, which has been most affected by HIV and which accounts for more than half of all people living with HIV. Since 2010, AIDS-related deaths in this region have declined by 42%. New HIV infections have declined by 29%, including a 56% drop in new HIV infections among children. UNAIDS referred to this as “a remarkable achievement” and said that HIV treatment and prevention efforts are putting eastern and southern Africa on track towards ending its AIDS epidemic.
A report, a news release and various other documents are available here.
“Unacceptable death tolls” – MSF
The tide may have turned in the global fight against AIDS, but too many people in sub-Saharan Africa are developing and dying of AIDS-related diseases due to limited testing and problems with treatment, Medecins Sans Frontieres (MSF) told the Thomson Reuters Foundation on 25 July.
Despite much improved access to ARVs in sub-Saharan Africa, an “unacceptably” high number of people are developing AIDS and dying due to drug resistance, treatment being interrupted and late diagnoses, MSF said.
Donor funding for HIV dips
Donor government funding to support HIV efforts in low- and middle-income countries decreased by $511 million from $7.5 billion in 2015 to $7.0 billion in 2016, according to a report produced by the Kaiser Family Foundation and UNAIDS.
“Donor government funding for HIV continues to be on the decline,” said Kaiser Family Foundation Vice President Jen Kates, director of global health and HIV policy. “Recent proposed cuts from the U.S., amidst other competing demands on donor budgets, will likely contribute to an ongoing climate of uncertainty around funding for HIV going forward.”
According to a news release from UNAIDS, this marks the second successive year of declines, and is the lowest level since 2010. UNAIDS said that the decrease stems from actual cuts in funding (accounting for about half of the decline); exchange rate fluctuations (20%); and the timing of U.S. contributions to the Global Fund (30%), due to U.S. law that limits its funding to one-third of total contributions. Some of the decline was due to donor decisions to front-load their funding early in the 2014-2016 Global Fund pledge period.
Swaziland: major strides
Dramatic new data from Swaziland provide some of the most convincing evidence yet that aggressively ramping up treatment for HIV works on a population level to cut the rate of new infections, according to an article in Science Magazine published on 24 July. The data was presented in Paris at the international conference of the International AIDS Society.
The kingdom had one of the worst HIV/AIDS epidemics in the world, but since 2011 a massive scale-up of testing and treatment has slashed the rate of new infections by 44%.
A survey in 2011 showed that 32% of the Swazi population between the ages of 18 and 49 was living with HIV – the highest prevalence of any country in the world. At the time, only 72,402 of those people were receiving ARV treatment. Only 34.8% of the infected population had suppressed the virus. The rate of new infection, or incidence, was 2.5% per year.
Today, 171,266 HIV-infected people in Swaziland receive ARVs, thanks to support from the Global Fund and PEPFAR. A 7-month survey, funded by PEPFAR and completed last March, found that 73.1% of the infected population now has fully suppressed virus, and the HIV incidence had dropped to 1.4%—a 44% decrease. In addition to ramping up treatment, the country also has seen big increases in men opting to be circumcised.
When the survey results were presented at the conference, the room erupted into hoots and applause.
“These findings are cause for celebration,” said Wafaa El-Sadr, an epidemiologist at Columbia University whose group helped Swaziland conduct the surveys. “It’s a dramatic blunting of new infections.”
Undetectable viral load = zero transmission
Another study whose results were presented at the IAS conference in Paris found that no transmissions occurred in encounters between HIV-positive men with an undetectable viral load. The Opposites Attract study, led by professor Andrew Grulich from the Kirby Institute, followed a cohort of 358 gay male couples – one partner HIV-positive, the other HIV-negative – in Australia, Thailand and Brazil.
Not a single HIV transmission occurred across the almost 17,000 times participants reported having anal sex without a condom; 12,000 of those sexual encounters were protected solely by the HIV-positive partner's undetectable viral load.
See also here.