HIV rate falls but work isn’t finished

By David Brown
Washington Post / November 24, 2010

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WASHINGTON — The AIDS epidemic has crested and started to recede almost everywhere in the world, but it has left behind millions of people who urgently need treatment if they are going to avoid adding to the disease’s toll of 30 million dead over the past 30 years.

That is the gist of the annual portrait of the global AIDS epidemic, released yesterday by UNAIDS, an agency of the United Nations and World Bank.

While AIDS incidence and mortality has been declining for several years, the new report, which includes data through the end of 2009, confirms that the trend is clear and undeniable.

“We can say with confidence and conviction that we have broken the trajectory of the HIV/AIDS epidemic,’’ said Paul De Lay, the deputy director of UNAIDS, which is headquartered in Geneva. “There are fewer people infected, and there are fewer people dying.’’

The downward decline is the consequence of many forces, including sexual behavior change among young people, success in preventing mother-to-child transmission of the virus, and the lower infectious risk of people who are successfully taking AIDS drugs. It also reflects the epidemic’s natural history, in which the annual number of new infections peaks and then declines as the disease saturates high-risk groups in the population.

In 2009 there were 33.3 million people living with HIV infection, compared to 26.2 million in 1999. However, the number of new infections in 2009 was nearly one-fifth lower than a decade ago — 2.6 million versus 3.1 million. The number of AIDS-related deaths peaked in 2004 at 2.1 million, and last year was down to 1.8 million.

Among the hopeful trends is the rapid increase in the number of people in the developing world taking the combination antiretroviral therapy that since 1996 has revolutionized AIDS care in rich countries.

In 2009 there were 5.2 million people in the developing world on the drugs, a 30 percent increase over the previous year. (Treatment of about 2.5 million of those people is paid for by the US government.) Another 10 million people need treatment but aren’t getting it.

Sub-Saharan Africa is home to about two-thirds of the people in the world living with HIV. The continent’s total number of infected, about 22.5 million, continues to grow, in part because of the longer survival of people who are taking antiretroviral drugs.

In 22 of the region’s nations, the annual number of new infections has dropped by more than 25 percent in the past decade.

The report also described some discouraging developments.

In more than a half-dozen countries, HIV infection rates went up more than 25 percent in the past decade. In the United States and Western Europe, an epidemic among gay and bisexual men continues to grow unabated. There are still two new people becoming infected for every one person who starts treatment (although that is better than two years ago, when there were five new infections for every two people starting treatment).

In Eastern and Central Europe, the number of people with HIV tripled since 2000, with the most infections acquired through drug use. In Ukraine, 1.1 percent of people age 15 to 49 are infected with the virus, the highest prevalence in the region.

In 2009, about $15.9 billion was spent on the global AIDS response, with slightly more than half the money provided by low- and middle-income countries themselves. However, much more money, about $26.8 billion, is needed annually to fully fund treatment, care, and prevention, the report said.

Equally troubling, according to the report, was that in 2009 the amount of money — $7.6 billion — provided by wealthy countries to treat and prevent AIDS overseas was a tad lower than in the previous year.

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