How to Get to Zero: Faster. Smarter. Better. That's the title of a new report issued today by the Joint United Nations Programme on HIV/AIDS (UNAIDS) to update the status of the epidemic in preparation for World AIDS Day on 1 December. "We are on the verge of a significant breakthrough in the AIDS response," writes UNAIDS Executive Director Michel Sidibé in the foreword, which urges the world to "step on the accelerator" to meet prevention and treatment targets that together can bring the epidemic to a halt.
According to the latest UNAIDS analyses, the world now has an estimated 34 million HIV-infected people—700,000 more than in 2010. On the upside, 6.6 million infected people in low- and middle-income countries now receive antiretroviral (ARV) drugs, an increase of 1.3 million over the past year. "I think it's remarkable that despite the massive pressures of the national and international budgets we have seen a tremendous scale up and at the end of 2010, about half of all those people living with HIV who are eligible for treatment do have access," said Bernhard Schwartländer, UNAIDS's director of evidence, strategy, and results.
Schwartländer, who discussed the report on a press teleconference today, noted that there were an estimated 2.7 million new infections last year, the lowest since the epidemic peaked in 2001. In keeping with a landmark study this year that showed how treatment reduced viral load in infected people and made them less likely to transmit the virus, he said there is "emerging evidence" that the scale up of ARVs has had an impact on new infections in Botswana. This small, relatively prosperous country in southern Africa now has 90% of eligible HIV-infected on treatment, and the report says there are "early signs" that because of this, new HIV infections are 30% to 50% lower than they would have been in the absence of the drugs.
UNAIDS updates are typically a mix of good and bad news, and this one has its fair share of alarming findings. Eastern Europe and Central Asia, which is discussed as a region because most of the countries were formerly part of the Soviet Union, has suffered a 250% increase in the number of people living with HIV over the last decade. "There is little indication that the epidemic has stabilized in the region," the report states. The hardest hit countries in that region, Russia and Ukraine, have epidemics driven by injecting drug use, but the report notes that both of those countries fail to invest enough money into programs that can help the most at risk populations.
Paul De Lay, a deputy executive director at UNAIDS, told ScienceInsider that given the global financial crisis, he's particularly concerned about both donor countries cutting back on HIV/AIDS treatment and prevention investments and hard-hit countries not pulling more of their own weight. "We're worried about that and recognize how fragile all these systems are," said De Lay. "If we don't see investments keep up, we'll see all of this improvement fall apart."