CECHE Center for Communications, Health and the Environment
Winter 2004 Vol. 12, Issue 2
New Challenges Confront Global Fight
Against AIDS


Changing the Course of the AIDS Epidemic Requires Action on All Fronts

This is a decisive moment in the global response to AIDS. Growing rates of infection and death are finally being met with the commitment to mount a truly comprehensive response. In fact, given recent statistics, AIDS is now understood as much more than a health catastrophe; it has become a long-term development crisis, and a serious security concern.

In 2003, 4.8 million people were newly infected with HIV, more than in any previous year, and nearly 3 million people died of the disease. Currently, 38 million people are living with HIV or AIDS, and infection rates are on the rise in many areas, including Eastern Europe and Asia. There is also an increasing feminization of the epidemic: Today, about half of all people infected with HIV are women, and young women in sub-Saharan Africa are 3.4 times more likely to be HIV-positive than their male counterparts.

As AIDS grows in magnitude, so does our capacity to tackle the crisis. A wealth of programs has proven effective at reducing HIV infection rates, even among the most vulnerable groups, and delivering treatments, even in the poorest settings. Substantial funding is becoming available from donor governments and multilateral organizations, including the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank. The World Health Organization and UNAIDS have set an ambitious goal of placing 3 million people on AIDS treatment by the end of 2005.

The future course of the epidemic depends largely on how well current resources are applied. Delivery of vital AIDS services remains extremely limited. In Africa, only one pregnant woman out of 20 has access to prevention of mother-to-child transmission services, and only 3 percent of people who need antiretroviral therapy receive it. In many of the most heavily affected countries, a shortfall in trained staff seriously impedes expansion of AIDS services.

AIDS Is a Global Disease…
AIDS is truly a global disease; no region has escaped its devastation. In Asia, an estimated 1.1 million people were newly infected in 2003, and there is concern that a disastrous epidemic could unfold on the continent. Sub-Saharan Africa remains the most seriously affected region, with 25 million people living with HIV. In Eastern Europe and Central Asia, diverse epidemics continue to spread, and 1.3 million people are now living with HIV, more than 80 percent of them under the age of 30. In Latin America, 1.6 million people have HIV, and serious, concentrated epidemics remain in several urban areas. In the Caribbean, three countries have national prevalence levels of 3 percent or greater, and approximately 430,000 people are infected. In Oceania, high sexually transmitted infection rates are raising concerns. In North Africa and the Middle East, inadequate surveillance may be failing to capture the extent of the epidemic, but it is estimated that 480,000 people are infected with HIV. In the United States and Western Europe, where most people have access to antiretroviral therapy, as many as 1.6 million people now live with HIV, and some areas have seen increased infection rates.

There’s an Urgent Need to Scale Up HIV Prevention
Global AIDS treatment has emerged as a major international focus in the last few years. While the crucial effort to expand AIDS treatment access continues, we must not lose sight of the equally urgent priority of increasing delivery of HIV prevention. We know how to bring HIV infection rates down, but too often our resources and knowledge are not applied in the most effective ways.

We need to do several things. First, fund prevention adequately so that appropriate prevention services can reach everyone at risk. Today, fewer than one in five people who need HIV prevention programs have access to them.

Second, ensure that prevention programming is based on viable evidence and is tailored to meet the needs of those who are particularly vulnerable to infection, including youth, women, men who have sex with men, injection drug users and sex workers. Social conventions must not get in the way of saving lives. Just as we need combination therapy, we need combination HIV prevention. Prevention programs for young people should encourage abstinence and delayed onset of sexual behaviour, as well as teach the importance of condom use. Clean needles should be available to injection drug users.

Third, tackle societal factors such as stigma and unequal social and legal status, which make people particularly vulnerable. For example, traditional prevention strategies often fail to protect women and girls because these at-risk populations may not have the option to abstain from sex or to negotiate condom use. To this end, UNAIDS has launched the Global Coalition on Women and AIDS, which promotes prevention programming, legal reforms and access to schooling to help protect females from infection.

HIV prevention works. Countries such as Uganda, Thailand and Cambodia have already succeeded in significantly reducing their HIV infection rates. Thailand did this through a combination of leadership from the top, mass media campaigns, and condom promotion among sex workers and their clients.

It is estimated that global delivery of HIV prevention could avert 29 million, or more than 60 percent, of the 45 million new infections projected by 2010. Unless HIV infection rates are significantly reduced, the AIDS epidemic will continue to spin out of control, and widespread AIDS treatment will not be achievable.

Priorities for Action
Control of AIDS requires decisive action on several fronts, including:

  • Bolstering human and institutional capacity. Community members must be better utilized in the provision of AIDS services, and incentives are needed to keep health care expertise in heavily affected countries.
  • Providing adequate funding for prevention and treatment. $12 billion will be needed in 2005 for a comprehensive response to AIDS that includes quality HIV prevention programs and expanded access to AIDS treatment. Less than half of that amount was available in 2004.
  • Combating stigma and discrimination. Legal protections, education campaigns and political leadership are needed to reduce stigma against people living with HIV and AIDS, and members of particularly vulnerable groups.
  • Addressing the needs of women and girls. Programs to reduce violence against women, promote legal equality, ensure universal education for girls, and increase access to HIV and reproductive health care services are essential.
  • Promoting country ownership. The “Three Ones” advance coordination, harmonization of funding and country ownership of the AIDS response. These principles call for one national AIDS plan, one national AIDS authority, and one monitoring and evaluation system in each country.
  • Accelerating research efforts. Improved treatments, as well as vaccines and microbicides, are imperative.
  • Involving people living with HIV. Including HIV-infected individuals in programs and partnerships makes use of their expertise and helps combat stigma.

AIDS is an exceptional problem, but it is a problem with a solution. A major challenge today is to transform our knowledge and commitments into actions that can change the course of the epidemic for generations to come.[back to front page....]

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