Some HIV Prevention Efforts Working, Major Challenges Remain

Jon is a staff writer for Science.

In one of the first signs that HIV prevention efforts have begun to make a dent on a global scale, new infections appears to have dropped by 17% over the past 8 years, according to a new report.

The marginally upbeat analysis appears in an update report released today by the Joint United Nations Programme on HIV/AIDS and the World Health Organization. “This is a sign that HIV prevention efforts are making a difference,” said epidemiologist Paul De Lay, deputy executive director of UNAIDS. “However, we’re still not moving fast enough to keep pace with this virus. We have yet to break the overall trajectory of the epidemic.”

The update, released before World AIDS Day on 1 December, estimates that 33.4 million people were living with HIV in December 2008. That number is a slight increase from the 33 million 1 year earlier. The estimated new infections remain stable at 2.7 million people, but dropped from 3.5 million in 1996, the year the global epidemic appears to have peaked.

UNAIDS for the first time has produced a slick magazine, Outlook, to accompany the update. With a cover that resembles Glamour and stories that feature everything from the anatomy of “bad” HIV/AIDS law to a profile of an HIV-infected South African who started the Positive Women’s Network (complete with a photo spread on the ingredients of her purse), the magazine hopes to reach an audience that likely would have little appetite for the more technical update report.

But it is the details in the update report that make it a must-read document for HIV/AIDS researchers and advocates.

As the update report notes, an increasing number of people now receive anti-HIV drugs: low- and middle-income countries have seen a 10-fold jump in treatment since 2003, which estimates suggest have averted more than 1 million deaths in sub-Saharan Africa alone. Yet as more people live longer with the virus, HIV prevalence will increase even if new infection rates remain stable or drop, making it difficult to sort out the impact of prevention efforts.

The update cautions that prevention programs often fail to target the populations that are most at risk. Specifically, stigma and local laws prevent many countries from tailoring prevention outreach to highly vulnerable groups like injecting drug users, men who have sex with men, commercial sex workers, and longterm couples in which only one partner is infected. And the sobering bottom line is that five people continue to be infected for every two who start treatment with anti-HIV drugs.

De Lay noted that prevention efforts similarly have had difficulty keeping up with the changing dynamics of epidemics in different locales. Asia, for example, once had an epidemic driven mainly by sex work and injecting drug use, but heterosexual sex in China and Indonesia, each of which has enormous populations, now has become a major mode of transmission. “The epidemic is in transition,” said De Lay. “HIV prevention programs are often not evolved to recognize the changing transmission dynamics.”

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