The ambitious target of ending the AIDS epidemic within a generation is looking increasingly like an unattainable dream, with plans to scale-up treatment and prevention sputtering, and funding stagnating.
“We are not on track to end the HIV epidemic,” Dr. Peter Piot, director of the London School of Hygiene & Tropical Medicine, told more than 15,000 delegates to the International AIDS Conference in Amsterdam on Thursday.
“We’ve made tremendous progress, but the discourse on ending AIDS has bred a dangerous complacency,” he said.
In 2014, UNAIDS, unveiled a plan to end the spread of HIV by 2020, and eliminate the disease altogether by 2030. It goes by the moniker 90-90-90.
What that means, practically, is:
- Ensuring 90 per cent of the infected are tested and diagnosed; currently that number is about 79 per cent;
- Getting 90 per cent of those who are diagnosed on treatment with antiretroviral drugs; that number is currently 59 per cent;
- Aiming to have at least 90 per cent of those infected attain an undetectable level of virus in their bodies (essentially a functional cure); currently that rate is 47 per cent, though it varies widely by country.
Dr. Piot said data demonstratex that “the existing tools and resources are inadequate to end the epidemic.”
The 22nd International AIDS Conference has largely been a sombre affair because there is little dramatic scientific progress to report, and a lot of grim political news, notably increasing crackdowns on some groups hardest hit by HIV-AIDS such as drugs users, sex workers and gay men, especially in Eastern Europe and Central Asia.
Meanwhile, funding for proven health promotion and harm reduction measures has flatlined.
About US$20-billion is spent on HIV prevention and treatment worldwide, but it is estimated that US$26-billion will be needed annually if there is going to be any hope of meeting the 90-90-90 targets in the year 2020.
“There’s a $6-billion gap between what’s needed and where we are,” said Dr. Jennifer Kates, director of Global Health & HIV Policy at the Kaiser Family Foundation. “It’s not clear how it will be made-up in the short-term.”
UNAIDS estimates, if that gap is not bridged, the funding shortfall will result in an additional 2.1 million HIV infections and one million more deaths.
There are currently 21.7 million people worldwide taking antiretroviral drugs that suppress the symptoms of HIV infection. But there are 36.9 million people who are infected with HIV. That means that about 15 million people – including 800,000 children – are not getting life-extending treatment.
A report prepared by the Kaiser foundation found eight of the 14 largest donor countries reduced their HIV funding to low- and middle-income countries last year. (Canada increased its funding to US$119.4-million.)
While international donors are important, the bulk of HIV funding (56 per cent) comes from domestic governments, which face many demands for how limited resources should be spent.
The problem with antiretrovirals is that, while they are effective, people with HIV will have to keep taking them for life.
That means that, even if transmission is stopped by 2030, funding of drugs will be needed for tens of millions of people for decades, which will strain health budgets, especially in countries where the infection rate is high.
So much has been spent on treatment, that prevention is underfunded, Dr. Piot noted.
While there is no magic bullet, he said: “But let’s not fool ourselves: The end of AIDS will not be possible without a vaccine.”
Despite the grim state of affairs, there have been advances. New HIV infections are down 47 per cent since their peak in 1996 (the year antiretrovirals were introduced) and deaths are down 51 per cent since their peak in 2004.
But Dr. Piot cautioned that, those numbers could bounce back quickly if the world does not continue to take the pandemic seriously.
André Picard