For the first time in the world’s history, more than half the people living with HIV are on treatment, according to the latest Ending AIDS report by the Joint UN Programme on HIV/AIDS (UNAIDS).
Health-e News reports that the UNAIDS targets are that, by 2020, 90% of people living with HIV should know their status, 90% of these people should be on ARVs and 90% of people on treatment should have suppressed viral loads. The report notes that as of 2016, 19.5m people were on antiretroviral treatment (ART), up from 17.1m in 2015. Six out of 10 people on ART live in eastern and southern Africa.
“With science showing that starting treatment as early as possible has the dual benefit of keeping people living with HIV healthy and preventing HIV transmission, many countries have now adopted the gold-standard policy of treat all,” said UNAIDS executive director Michel Sidibé. He said these efforts are bringing “a strong return on investment”. “Aids-related deaths have been cut by nearly half from the 2005 peak. We are seeing a downward trend in new HIV infections, especially in eastern and southern Africa, where new HIV infections have declined by a third in just six years.”
The southern and eastern African region is the most affected by HIV. Despite having the largest ART programme in the world, South Africa’s treatment coverage – 56% of all people living with HIV – was below the regional average of 60%. Botswana (83%) and Rwanda (80%) had the highest treatment coverage in the region.
The report says although South Africa has some way to go to increase access to treatment, the country has played a significant role in making viral load testing available in developing countries, according to the report. This test is important to check that the HIV medication is working to suppress the virus in the blood.
“This expansion is partly the result of South Africa leveraging its market weight to reduce viral load test prices globally,” noted the report. An agreement entered into between the South African government and the drug company Roche has led to a number of different countries being able to afford to buy the technology including Ethiopia, Kenya and Nigeria.
“But our quest to end Aids has only just begun. We live in fragile times, where gains can be easily reversed,” said Sidibé. “The biggest challenge to moving forward is complacency.”
Donor government funding to support HIV efforts in low- and middle-income countries has, meanwhile, decreased by $511m from $7.5bn in 2015 to $7bn in 2016, a new report from the the Kaiser Family Foundation and UNAIDS has found. This marks the second successive year of declines, and is the lowest level since 2010.
The decrease stems from actual cuts in funding (accounting for an approximate net 50% of the decline), exchange rate fluctuations (20%), and the timing of US contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria (30%), due to US law that limits its funding to one-third of total contributions to the Global Fund.
In 2016, bilateral funding decreased by slightly more than $100m, falling for nine of 14 donors profiled (seven of which declined in currency of origin). Multilateral contributions fell by $400m. As noted above, some of this was due to US legislative limitations on Global Fund contributions. However, some was due to donor decisions to front-load their funding early in the 2014-2016 Global Fund pledge period.
“Aids investments provide exceptional value for money. We have wisely invested in providing life-saving HIV treatment and prevention services for millions of people and are seeing the results of those investments today,” said Sidibé. “Declining international resources will hamper our ability to reach the 17m people who still need treatment.”
“Donor government funding for HIV continues to be on the decline,” said Kaiser Family Foundation vice president Jen Kates, director of global health and HIV policy. “Recent proposed cuts from the US, amidst other competing demands on donor budgets, will likely contribute to an ongoing climate of uncertainty around funding for HIV going forward.”
The US continued to be the largest donor to HIV efforts, providing $4.9bn in 2016, followed by the UK, France, the Netherlands, and Germany. When standardised by size of its economy, however, the US ranked third.
The new report, produced as a partnership between the Kaiser Family Foundation and UNAIDS, provides the latest data available on donor government funding based on data provided by governments. It includes their bilateral assistance to low- and middle-income countries and contributions to the Global Fund as well as UNITAID. “Donor government funding” refers to disbursements, or payments, made by donors. Donor contributions to multilateral organisations are counted as part of their disbursements.