AIDS status & challenges of the epidemic
Context - In just 25 years, HIV has spread relentlessly from a few widely scattered “hot spots”
to virtually every country in the world, infecting 65 million people and killing 25
What has been done since 2001 and what can be done in the future to halt the spread of
Note: Figures have been updated in 2008.
1. Introduction: global targets on HIV/AIDS
In 2001, leaders of 189 nations recognized that
was one of the most urgent issues of national and international
development, and they agreed to a set of global targets to halt and
begin to reverse the
These targets focus on funding, prevention, and access to
for the general
and specific population groups.
2. What are the worldwide trends in the HIV/AIDS epidemic?
At the end of 2005, about 38.6 (32*) million people were living with
worldwide. That year, 4.1 (2.9*) million became newly infected and 2.8 (2.2*) million
died because of
the overall number of people living with HIV has continued to rise.
Today, about one adult in a hundred is living with HIV, but the extent
varies greatly across countries and regions.
Note: The 2008 Report on Global AIDS epidemic by UNAIDS/WHO provides better
estimates of the number of people living with AIDS. Better data collecting
and estimation methods led to revised figures : the total estimated number
of people living with AIDS at the end of 2007 is 33.2 millions, with 2.5
million new infections and 2.1 million deaths (see the 2008 UNAIDS report ). This
decrease from previous numbers does not represent a trend in the epidemic,
which is still progressing, but a refinement in the data. For example, the
new estimate puts the number of people that were living with AIDS in 2005 at
around 32 million. The new estimates show the same general trend in the
epidemic than previous ones: a leveling off of the increase in prevalence
since the late 90's, but with a continuing increase in the number of people
living with AIDS.
The following world regions are heavily affected by the
Sub-Saharan Africa, where nearly one adult in 16 is
HIV, is by
far the most affected region, though the situation varies from country
to country. In most Southern African countries, the share of people
living with HIV has reached exceptionally high levels (up to one adult
in three), though it seems to be levelling off everywhere except in
South Africa. (2007 UNAIDS update: the epidemic in the South African area now seems to have leveled off, but the region is still the most severly affected.)
The Caribbean is the second-most affected region in
the world. Nearly one adult in 62 is living with
and AIDS is
the leading cause of death among adults.
In certain countries of these two regions, however, changes in
behaviour have reduced the share of people living with
In each of the following world regions, on average, less than one
adult in 100 is living with
In Eastern Europe and central Asia,
is still spreading, especially in Ukraine and the Russian Federation,
and the number of people living with
has increased twenty-fold in less than a decade.
In Latin America, most infected people are living in
large countries such as Brazil. However, smaller countries such as
Belize and Honduras have a larger share of people living with
among their adult
Overall, in North America, Western and Central
deaths in 2005 were comparatively few as a consequence of widespread
the United States of America and in some countries of Europe, the
seems to be increasing again among men who have sex with men.
In Asia, the share of
people is decreasing in Cambodia, Thailand, and in parts of India, but
is increasing in countries such as China, Indonesia, Viet Nam, and Papua
infection levels are low but persistent.
In the Middle East and North Africa, the proportion
of adults infected with
very low, except in Sudan, but seems to be growing in several countries,
including Algeria, Iran, Libya and Morocco.
3. How has HIV prevention and treatment evolved since 2001?
HIV positive man and antiretroviral medicines,
Credit: UNAIDS/O. O'Hanlon
Overall, governments are now combating
much more actively. Indeed, there is more coordination between countries
and most now have a national plan to deal with AIDS, though systems to
implement these plans are still inconsistent.
In some countries, there is now much better access to
prevention services, such as HIV counseling and testing, prevention
education for young people, provision of condoms to those who are
of other sexually transmitted diseases and programmes to reduce
HIV-related stigma and discrimination. Still, such services only reach a
small minority of those in need, and not enough young people and other
groups. Programmes aimed at changing risky sexual behaviour have shown
some success but progress is still needed in several areas.
A combination of
effective in preventing or delaying
illness and death. However, such lifelong
are complex and expensive to deliver. In recent years there has been a
worldwide revolution in improving access to
including in low-and middle-income countries. As a result of increased
commitment, five times more people had access to antiretroviral
in 2005 than in 2001. Nonetheless, access to treatment is still
insufficient as antiretroviral drugs only reach one in five of those who
need them worldwide. The expansion of treatment access is hindered by
the treatment costs and distance to treatment centres.
To improve access to
countries need to train more medical staff, avoid drug shortages,
care with care for other health problems, reduce HIV stigma and
discrimination and make sure that more people use HIV counselling and
4. Are human rights and vulnerable populations sufficiently protected?
A commercial sex worker in Cambodia
Although many countries now have laws and regulations to promote human
rights and to protect people living with
from discrimination; efforts to fight
are still insufficiently based on human rights. In many cases the laws
are not fully enforced, often because there is no money set aside for
it. Moreover, some countries have laws that make it more difficult for
such as sex workers, men who have sex with men, injecting drug users,
prisoners, and refugees to get access to prevention services and
In recent years, more money has been available for
prevention. However, many countries focus prevention programmes on the
general public rather than on vulnerable
groups, which would be more cost-effective and more likely to have an
impact on the
Further attention should be given to preventing children from dropping
out of school and to offering prevention services to injecting drug
users, sex workers, men who have sex with men, and people affected by
wars and disasters.
5. What has been done in terms of funding and research?
Though the money available to fight
has increased significantly since 2001, it is still insufficient.
Furthermore, it is expected that in the years ahead, the needs will
increase more rapidly than the money raised. To plan the long-term fight
against AIDS, funding needs to be managed in a better way so that
countries can plan ahead knowing how much money they will receive each
year, and systems must be in place to check that the promised money is
In recent years, research for preventive vaccines and
has increased. Within a few years funding nearly doubled for research
into the development of preventive vaccines and more than doubled for
research into the development of microbicides that kill microbes in the
vagina and prevent
transmission by sexual route. Human trials are under way on the
effectiveness of microbicides and other methods in preventing
and ethical questions need to be taken into account in the conduct of
6. What strategies are recommended by UNAIDS to halt and reverse the epidemic?
HIV positive mother and child, Ukraine
exceptional and the response to AIDS must be equally exceptional. The
considerable efforts made since 2001 are insufficient and uneven, and
national long term plans are needed.
UNAIDS makes a series of recommendations for slowing and halting the
Commitment and leadership must be sustained and
increased. Governments and heads of state need to be active and
outspoken about their commitment to implement strategies that involve
multiple sectors, including civil society and the private sector.
Financing must be sustained and increased and the
money should be used as efficiently as possible to reach the people in
need. International financing mechanisms should ensure that money for
will be available in the future for an even stronger response to the
stigma and discrimination must be aggressively addressed.
Governments and all sectors of society should support measures to
empower and protect women, to remove discrimination against vulnerable
groups, and to help all children stay in school.
7. What should be done to improve prevention and access to treatment?
Community Self Help programme, Kenya
To get as close as possible to the goal of offering
to all those who need it by 2010, a series of key areas require
commitment and action.
prevention should be strengthened and continuously
emphasized to prevent millions of new infections each year. Access to
clear, factual HIV prevention information and to HIV testing should be a
right. HIV prevention services and education should particularly target
young people, HIV-infected pregnant women and vulnerable groups,
including sex workers, injecting drug users, men who have sex with men,
needs to continue growing rapidly. This involves broadening access to
HIV testing, building more treatment sites, increasing access to drugs
that prevent HIV-related infections, reducing HIV stigma and
discrimination, recruiting more medical staff, and keeping a constant
and reliable supply of drugs.
Human resources and systems should be strengthened
because the shortage of skilled workers in many developing countries is
a major obstacle in the fight against
Therefore, efforts must be made to recruit and train health-care
workers, encourage them to stay and work in their own countries, support
the provision of
services by locals where needed, and integrate AIDS services into other
primary health care programmes.
products such as condoms and
drugs should be made more available and affordable, for instance by
removing taxes, laws, or regulations that might hinder access to these
products, allowing medicines into the market as soon as they are
approved by the WHO, ensuring that children in need receive suitable
drugs, and addressing the issues of pharmaceutical patents.
Substantially more money should be invested in research and
development, especially by the private sector, in order to
develop a preventive vaccine,
and new drugs, including those created specifically for children with
In addition, greater cooperation between governments, civil society, and
the private sector is needed.
Efforts should be made to counter the social impact of
focusing first on people who are infected and their families and on
children who have lost one or both parents to AIDS. They should be given
other forms of assistance.
8. Conclusion on progress made in the fight against AIDS
In 2001, leaders of 189 nations recognized that
is among the greatest development crises in human history and they
agreed to a set of targets to halt and begin to reverse the
Since 2001 important progress has been made in the fight against
Political commitment, coordination among partners, and money available
prevention and care have all increased significantly; access to
testing and counselling has greatly improved globally; and blood for use
in transfusions is now routinely screened for
in most countries.
However, progress is very uneven across the world and many more
efforts are still needed in the fight against
For instance, most people at high risk of HIV infection have no access
to prevention services, a large number of babies are born with HIV, and
huge numbers of children orphaned or made vulnerable by the
have no proper care and support. In addition, there are other barriers
to the effective fight against AIDS; for instance, stigma,
discrimination and denial about issues such as sexuality and drug use.
The objective of halting and beginning to reverse the
by 2015 is achievable, but success will require unprecedented long-term
efforts and strong leadership at every level of society.