AIDS awareness groups have called for better prevention programmes after a report revealed that many schemes are not reaching the people most at risk from infection in some countries such as gay men.
The global AIDS epidemic continues to grow and there is concerning evidence that some countries are seeing a resurgence in new HIV infection rates which were previously stable or declining, the UNAIDS/WHO 2006 AIDS Epidemic Update states.
New data suggests that where HIV prevention programmes have not been sustained and/or adapted as epidemics have changed-infection rates in some countries are staying the same or going back up.
According to the report, there is increasing evidence of HIV outbreaks among gay men in Cambodia, China, India, Nepal, Pakistan, Thailand and Vietnam as well as across Latin America but most national AIDS programmes fail to address the specific needs of these people.
New data also show that HIV prevention programmes are failing to address the overlap between injecting drug use and sex work within the epidemics of Latin America, Eastern Europe and particularly Asia.
“It is imperative that we continue to increase investment in both HIV prevention and treatment services to reduce unnecessary deaths and illness from this disease,” said WHO Acting Director-General, Dr Anders Nordström. “In sub-Saharan Africa, the worst affected region, life expectancy at birth is now just 47 years, which is 30 years less than most high-income countries.”
Nick Partridge, chief executive of Terrence Higgins Trust called for greater effort towards HIV prevention, “People have gained two million life years since 2002 because HIV drugs have got through to some of those who need them. But only a fraction of people worldwide who want an HIV test can easily get one, and work to prevent new infections is reaching only a fifth of those at risk of the virus. “We have to put the same sustained drive and focus into prevention and diagnosis as we are into making drugs available if we’re going to save more lives in the future.”
Deborah Jack, chief executive of the National AIDS Trust agrees, she said: “HIV is preventable and we are encouraged to see some countries are successfully reducing their HIV rates by implementing comprehensive prevention programmes including
targeting resources at people at high risk.
“But sadly many countries, including the UK, are not sustaining HIV prevention programmes and are seeing rises in new infections. If resource poor countries are able to
reduce their HIV rates there are clearly lessons to be learnt.”
In North America and Western Europe, HIV prevention programmes have often not been sustained and the number of new infections has remained the same. Similarly in low- and middle-income countries, there are only a few examples of countries that have actually reduced new infections. And some countries that had showed earlier successes in reducing new infections, such as Uganda, have either slowed or are now experiencing increasing infection rates.
“This is worrying-as we know increased HIV prevention programmes in these countries have shown progress in the past-Uganda being a prime example. This means that countries are not moving at the same speed as their epidemics,” said UNAIDS executive director Dr Peter Piot. “We need to greatly intensify life-saving prevention efforts while we expand HIV treatment programmes.”
The report also outlines how the issue of women and girls within the AIDS epidemic needs continued and increased attention. In sub-Saharan Africa for example, women continue to be more likely than men to be infected with HIV and in most countries in the region they are also more likely to be the ones caring for people infected with HIV.
New data from the report show that increased HIV prevention programmes that are focused and adapted to reach those most at risk of HIV infection are making inroads.
Positive trends in young people’s sexual behaviours-increased use of condoms, delay of sexual debut, and fewer sexual partners-have taken place over the past decade in many countries with generalized epidemics.
Declines in HIV prevalence among young people between 2000 and 2005 are evident in Botswana, Burundi, Côte d’Ivoire, Kenya, Malawi, Rwanda, Tanzania and Zimbabwe.
In other countries, even limited resources are showing high returns when investments are focused on the needs of people most likely to be exposed to HIV. In China, there are some examples of focused programmes for sex workers that have seen marked increases in condom use and decreases in rates of sexually transmitted infections, and programmes with injecting drug users are also showing progress in some regions. In Portugal, HIV diagnoses among drug injectors were almost one third (31%) lower in 2005, compared with 2001, following the implementation of special prevention programmes focused on HIV and drug use.
The report also highlights that levels of knowledge of safe sex and HIV remain low in many countries, as well as perception of personal risk. Even in countries where the epidemic has a very high impact, such as Swaziland and South Africa, a large proportion of the population do not believe they are at risk of becoming infected.
“Knowing your epidemic and understanding the drivers of the epidemic such as inequality between men and women and homophobia is absolutely fundamental to the long-term response to AIDS. Action must not only be increased dramatically, but must also be strategic, focused and sustainable to ensure that the money reaches those who need it most,” said Dr Piot.
Responding to the report, International Development Secretary Hilary Benn said: “The new UNAIDS report tells us very clearly that tackling AIDS isn’t only about money and improving access to treatment services. It’s also about tackling stigma, discrimination against marginalised groups most at risk of HIV and the unequal position of women and girls in many societies. More adult women than ever before are now living with HIV. This is unacceptable. Women and girls need more choices and the power to decide how, when and with whom to have sex. That’s why the UK supports greater access to male and female condoms and funds research into microbicides and vaccines which could revolutionise the global fight against AIDS.
“UNAIDS says countries need to know their epidemic. This is crucial; and while most countries now recognise the existence of AIDS, too many countries ignore the reality. The report shows clearly that HIV prevention must be targeted at the people most at risk of infection – young people, women and young girls, men who have sex with men, commercial sex workers and injecting drug users. As I said at the UN in June, this is not a time for embarrassment, this is about telling it straight because it is about saving people’s lives.”