main article image
(nito100/iStock)

The HIV Epidemic Is Not Over, And We're Not as Prepared as We Need to Be

There could be a resurgence.

MIKE MCRAE
20 JUL 2018
 

Authors of a commission into the state of the global AIDS epidemic warn policy makers and researchers to do a better job of collaborating if we're to have a hope of meeting targets.

 

More concerning still is their prediction that persistence of high HIV rates in many populations could spark a resurgence, and current funding and practices just aren't up to the challenge of dealing with it.

A Lancet Commission led by the International AIDS Society has published a report combining the expertise of more than 40 experts from around the globe, providing a snapshot of where we're currently at with one of history's most notorious epidemics.

And the news could be better. A lot better.

It's been roughly 40 years since acquired immunodeficiency syndrome – or AIDS – made the leap from being a rare and obscure illness to the start of a global pandemic.

Progress in prevention and treatments has been hampered by its stigma as a disease associated with vice, and in spite of a pharmacopeia of life-prolonging drugs and prophylactics, we still don't have an effective vaccine.

Based on figures collected between 2015 and 2016, just under 40 million people worldwide are infected with the virus, with 2 million newly diagnosed in 2016 alone.

Tragically, more than 35 million people have succumbed to the virus's debilitating effects on the immune system, a number that rises in spite of treatments that keep the virus's progress under control.

 

Thankfully, the rate of new infections is dropping. But for the Joint United Nations Programme on HIV/AIDS (UNAIDS), the decline is not fast enough. Right now its target is to see just 500,000 new cases per year by 2020, with an end goal of a complete eradication by 2030.

"The HIV pandemic is not on track to end," says the report.

The commission points the finger at complacency that "may have hastened the weakening of global resolve to combat HIV."

Putting it another way, the fear has died down and the drive to solve the crisis has waned.

"Global health is beginning to falter as democracy, civil society, and human rights deteriorate in many countries, and as development assistance for health has stalled," says lead commissioner and president of the International AIDS Society, Linda-Gail Bekker.

In some ways, the age old problem of AIDS as a stigmatised condition is still responsible.

Just under half of all new infections occur in people from marginalised groups, such as gay and bisexual men and intravenous drug users, and healthcare systems often struggle to reach and engage with these communities.

 

In sub-Saharan Africa, HIV infection rates peak in adolescent girls. There, AIDS is the fourth highest cause of death for young women.

Reaching young and diverse demographics with advice they trust is a challenge. The commission warns as the population gets older, we could see a resurgence in the number of new infections. Added to that is a rise in other complications.

Between 2012 and 2016, the number of people over the age of 50 living with HIV jumped by more than a third. Where communicable diseases were once the big problem, anti-retroviral therapies have extended the life of those living with HIV to the extent that other health conditions become a concern.

Recent research has found that HIV puts people at more than double the risk of cardiovascular disease, for example.

To meet these changes in the future and have a hope of meeting the UNAIDS targets, the commission suggests we need to step beyond what they refer to as an 'exceptionalist' approach.

In the past, funding and programs have targeted HIV in isolation.

While this has no doubt proven useful in cutting the rates of infection, the commission refers to models that demonstrate there is a greater benefit in combining HIV testing and treatment with other health services, such as screening for diabetes.

 

HIV funding has flat-lined in recent years, falling well short of the some US$26 billion estimated as necessary to meet targets.

Finding new ways to pool efforts and develop new strategies is vital if we're to finally see an end to the AIDS pandemic, something that might only be possible if we develop and successfully distribute an effective vaccine.

"The HIV response and the broader global health field must work together," says Bekker.

"Despite the remarkable progress of the HIV response, the situation has stagnated in the past decade. Reinvigorating this work will be demanding, but the future health and wellbeing of millions of people require that we meet this challenge."

The commission's report has been published in The Lancet.

 

More From ScienceAlert

ScienceAlert Deal: Don't miss out on this awesome top rated VPN

Here's why you should go with Disconnect VPN.

23 days ago
Leading UK ethics council thinks genetically enhancing babies is ok
25 days ago