Bad news first: The estimate of the number of people living with HIV has slightly increased from 33. 3 million to just over 34 million, says a new report from the Joint United Nations Programme on HIV/AIDS (UNAIDS). But by the end of last year, antiretroviral drugs that extend lives reached more people in resource-constrained countries—6.6 million—than ever before. As the report also details, new infection rates plummeted 25% worldwide between 2001 and 2009. "Now the world has reached a crossroads," writes the U.N. secretary-general in the preface to AIDS at 30, a reference to the fact that the epidemic first surfaced in 1981. "The number of people becoming infected and dying is decreasing, but the international resources needed to sustain this progress have declined for the first time in 10 years, despite tremendous unmet needs."
UNAIDS issued the report today to coincide with the U.N. General Assembly High-Level Meeting on AIDS, which will gather member nations in New York City from 8 to 10 June to hammer out a new declaration about how best to address the epidemic. Michel Sidibé, executive director of UNAIDS, told ScienceInsider that he has high hopes for the meeting. "This is an unprecedented meeting, and it is a defining moment," says Sidibé. "We have millions of people waiting for treatment. We don't know what will be the next generation of our response, and we never have had so many heads of states engaging on these issues at this level."
Even though the world now spends $15.9 billion a year combating the epidemic, 9 million people who need treatment still have no access to antiretroviral drugs, the report says. Sidibé contends that in the past, the world singled out a few wealthy countries to fund the response, but today, developing countries must increase their financial commitments, too. "I don't see how we'll be able to move forward without looking at sharing the burden between the developed world and emerging nations," he says.
In the lead-up to the meeting, much debate has centered on whether the declaration will make a bold enough commitment to expanding the number of people on treatment by 2015. "We're pushing for a minimum of 15 million," says Sidibé. "I know that activists want even more, but being realistic, if we can move from the number we have today to reach 15 million in 2015, it will be huge, huge, huge success."
UNAIDS estimates the expanded treatment will cost $22 billion a year by 2015. Sidibé stresses that expanding treatment is a critically important investment. In addition to preventing disease and death, treatment is also a key prevention tool: abundant evidence now shows that infected people on treatment are less likely to transmit HIV.
While AIDS at 30 praises many countries for ramping up their response to HIV/AIDS, it also has scorecards that starkly detail shortcomings in different locales. More than two dozen countries, for example, only offer antiretrovirals to fewer than 20% of their citizens who need treatment. "We have to make the world accountable," says Sidibé, who singles out Russia and Ukraine as two countries that concern him the most.