There is new evidence that adult HIV infection rates have decreased in certain countries and that changes in behaviour to prevent infection—such as increased use of condoms, delay of first sexual experience and fewer sexual partners—have played a key part in these declines. The new UN report also indicates, however, that overall trends in HIV transmission are still increasing, and that far greater HIV prevention efforts are needed to slow the epidemic.
Kenya, Zimbabwe and some countries in the Caribbean region all show declines in HIV prevalence over the past few years with overall adult infection rates decreasing in Kenya from a peak of 10% in the late 1990s to 7% in 2003 and evidence of drops in HIV rates among pregnant women in Zimbabwe from 26% in 2003 to 21% in 2004. In urban areas of Burkina Faso prevalence among young pregnant women declined from around 4% in 2001 to just under 2% in 2003.
These latest findings were published in AIDS Epidemic Update 2005, the annual report by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO). The joint report, which this year focuses on HIV prevention, was released today in advance of World AIDS Day, marked worldwide on the first of December.
Several recent developments in the Caribbean region (in Bahamas, Barbados, Bermuda, Dominican Republic and Haiti) give cause for guarded optimism—with some HIV prevalence declines evident among pregnant women, signs of increased condom use among sex workers and expansion of voluntary HIV testing and counselling.
Despite decreases in the rate of infection in certain countries, the overall number of people living with HIV has continued to increase in all regions of the world except the Caribbean. There were an additional five million new in fections in 2005. The number of people living with HIV globally has reached its highest level with an estimated 40.3 million people, up from an estimated 37.5 million in 2003. More than three million people died of AIDS-related illnesses in 2005; of these, more than 500000 were children.
According to the report, the steepest increases in HIV infections have occurred in Eastern Europe and Central Asia (25% increase to 1.6 million) and East Asia. But sub-Saharan Africa continues to be the most affected globally?with 64% of new infections occurring here (over three million people).
“We are encouraged by the gains that have been made in some countries and by the fact that sustained HIV prevention programmes have played a key part in bringing down infections. But the reality is that the AIDS epidemic continues to outstrip global and national efforts to contain it,?said UNAIDS Executive Director Dr Peter Piot. “It is clear that a rapid increase in the scale and scope of HIV prevention programmes is urgently needed. We must move from small projects with short-term horizons to long-term, comprehensive strategies,?he added.
Impact of HIV treatment
The report recognizes that access to HIV treatment has improved markedly over the past two years. More than one million people in low-and middle-income countries are now living longer and better lives because they are on antiretroviral treatment and an estimated 250 000 to 350 000 deaths were averted this year because of expanded access to HIV treatment.
Commenting on the potential enhanced impact of integrating prevention and treatment, the 2005 report emphasizes that a comprehensive response to HIV and AIDS requires the simultaneous acceleration of treatment and prevention efforts with the ultimate goal of universal access to prevention, treatment and care.
"We can now see the clear benefit of scaling up HIV treatment and prevention together and not as isolated interventions," said WHO Director-General Dr LEE Jong-wook. "Treatment availability provides a powerful incentive for governments to support, and individuals to seek out, HIV prevention information and voluntary counselling and testing. Effective prevention can also help reduce the number of individuals who will ultimately require care, making broad access to treatment more achievable and sustainable."
Future challenges for strengthening HIV prevention
New data show that in Latin America, Eastern Europe and particularly Asia, the combination of injecting drug use and sex work is fuelling epidemics, and prevention programmes are falling short of addressing this overlap. The report shows how sustained, intensive programmes in diverse settings have helped bring about decreases in HIV incidence—among young people in Uganda and Tanzania, among sex workers and their clients in Thailand and India, and among injecting drug users in Spain and Brazil.
The report notes that, without HIV prevention measures, about 35% of children born to HIV-positive women will contract the virus. While mother-to-child transmission has been virtually eliminated from industrialized countries and service coverage is improving in many other places, it still falls far short in most of sub-Saharan Africa. An accelerated scale-up of services is urgently needed to reduce this unacceptable toll.
Levels of knowledge of safe sex and HIV remain low in many countries ?even in countries with high and growing prevalence. In 24 sub-Saharan countries (including Cameroon, Côte d’Ivoire, Kenya, Nigeria, Senegal and Uganda), two-thirds or more of young women (aged 15-24 years) lacked comprehensive knowledge of HIV transmission. According to a major survey carried out in the Philippines in 2003, more than 90% of respondents still believed that HIV could be transmitted by sharing a meal with an HIV-positive person.
Finally, weak HIV surveillance in several regions including in some countries in Latin America, the Caribbean, the Middle East, and North Africa is hampering prevention efforts and often means that people at highest risk ?men who have sex with men, sex workers, and injecting dug users ?are not adequately covered or reached through HIV prevention and treatment strategies.
The annual AIDS Epidemic Update reports on the latest developments in the global AIDS epidemic. With maps and regional estimates, the 2005 edition provides the most recent estimates on the epidemic’s scope and human toll, explores new trends in the epidemic’s evolution, and features a special section on HIV prevention.