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Ending AIDS by 2030 a distant prospect, global HIV incidence, prevalence, treatment coverage and mortality figures suggest
Michael Carter, 2016-08-07 07:30:00
progress has been made towards curbing the global HIV epidemic, but there is
little chance of achieving the UNAIDS goal of “ending AIDS” by 2030, according
to data published in The Lancet.
Investigators found that global HIV incidence peaked in 1997 and fell steadily
until 2005. However, for the past ten years there have been only modest annual
falls in the rate of new infections. Of the 195 countries included in the
study, 102 experienced an increase in the annual number of new HIV infections
between 2005 and 2015.
No country has yet
achieved the UNAIDS 90-90-90 target of having 90% of people with HIV diagnosed, 90% of
diagnosed people on therapy and 90% of treated people virally suppressed. Globally
only 41% of people living with HIV are receiving antiretroviral therapy (ART), and coverage of treatment
remains low in many healthcare settings.
“This study shows
that the AIDS epidemic is not over by any means and that HIV/AIDS remains one
of the biggest public health threats in our time,” said Professor Peter Piot of
the London School of Hygiene and Tropical Medicine. “The continuing high rate
of over 2 million new HIV infections represents a collective failure which must
be addressed through intensified prevention efforts and continued investment in
HIV vaccine research.”
Since the mid
1990s, there have been concerted efforts to curb the global HIV epidemic.
UNAIDS has set the 90-90-90 target for 2020, an essential step to achieving the end of AIDS by 2030. Surveillance
data illustrating the global burden of HIV are needed to inform policy and
programming and to determine if the 2020 and 2030 targets are achievable.
therefore analysed data collected via the Global Burden of Disease study
between 1980 and 2015 to elucidate trends in HIV incidence, prevalence,
treatment coverage and mortality.
information was obtained from antenatal and population-based prevalence
studies. Data from 195 countries covering all world regions were included.
incidence peaked in 1997, at 3.3 million new infections, then decreased by
4.8% per year until 2005. Between 2005 and 2015, global incidence remained
relatively stable with between 2.5 and 2.6 million new infections annually.
people with HIV increased rapidly, from 2.4 million in 1985 to 28 million in
2000. Thereafter, prevalence increased by 0.8% each year, reaching 38.8 million
continues to be badly hit by the epidemic, with 1.8 million new infections (75% of
incident infections globally) in that region in 2015.
Russia had the
highest HIV incidence in Europe and Cambodia the highest rate of new infections
in Asia. Between 2005 and 2015, rates of new infections increased in numerous
countries, including Egypt, Pakistan, Kenya, the Philippines, Cambodia, Mexico
at 1.8 million deaths in 2005, falling to 1.2 million in 2015. Tuberculosis
continues to be a major cause of mortality in people with HIV, accounting for
almost 20% of all deaths in 2005 and 18% of HIV-related mortality in 2015.
Access to ART
remains limited in many settings, and globally only 41% of people were in
receipt of therapy.
“Meeting the needs
of people living with HIV will require a combination of concentrating
development assistance for HIV on…low income countries, improving the
efficiency of HIV programmes, increasing domestic financing, lowering the cost
of treatment…and reducing future incidence through more concerted efforts,”
comment the authors. “Development assistance efforts will also need to be
scaled up if the free-flow of low-cost generic drugs is hampered.” Further
collaboration between the public and private sectors is needed to devise
effective prevention initiatives.
An estimated $36
billion funding annually is needed to achieve the 90-90-90 goal. The authors
note that since 2010, donor funding for global AIDS projects has stagnated and
is well short of this figure.
has been made in reducing HIV deaths, especially in low income countries,”
conclude the authors. “However, achievement of the UNAIDS 90-90-90 targets will
require major changes in how programmes are delivered and financed. Global
efforts have had less impact on
incidence of new infections than on HIV mortality. Ending the AIDS epidemic by
2030 will require a dramatic change in how HIV prevention is pursued.”