The World Health Organization (WHO) issued a report late last month, which showed that increased access to HIV services and drugs resulted in a 15% decline in new infections during the past decade and a 22% decline in AIDS-related deaths in the last five years. “It has taken the world 10 years to achieve this level of momentum,” said Gottfried Hirnshcall, director of WHO’s HIV Department.,” in a Nov. 30, 2011, WHO press release. “There is now a real possibility of getting ahead of this epidemic. But this can only be achieved by both sustaining and accelerating this momentum over the next decade and beyond.”
The WHO report noted that improved access to HIV testing services enabled 61% of pregnant women in eastern and southern Africa to receive counseling for HIV, up from 14% in 2005. Nearly half (48%) of pregnant women in need received effective medicines to prevent mother-to-child transmission of HIV in 2010. Antiretroviral therapy, which improves the health of infected people and also stops further transmission, is currently available for 6.65 million people in low- and middle-income countries, accounting for 47% of the 14.2 million people eligible to receive it. The improvement in health also has an improvement in economic development. The report says that investment in HIV services could lead to total gains up to $34 million by 2020 in increased economic activity and productivity, more than offsetting the cost of antiviral therapies.
Despite these gains, however, the WHO report acknowledges that more needs to be done and continued investment in HIV services and drugs is required. “2011 has been a game-changing year,” said Paul De Lay, deputy executive director with UNAIDS, in the WHO release. “With new science, unprecedented political leadership, and continued progress in the AIDS response, countries have a window of opportunity to seize this momentum and take their responses to the next level. By investing wisely, countries can increase efficiencies, reduce costs, and improve on results. However, gains made to date are being threatened by a decline in resources for AIDS.”
The report highlights certain key needs. More than half of the people who need antiviral therapy in low- and middle-income countries are still unable to access it or do not know if they are infected with HIV. Also, many countries are still not tailoring programs for at-risk groups, including adolescent girls. Worldwide, 64% of people aged 15-24 living with HIV are female. The rate is higher in Sub-Saharan Africa, where girls and women make up 71% of all young people living with HIV, according to the WHO analysis. The WHO report also points out that better services are needed to prevent mother-to-child transmission of HIV and to treat children. Only about one in four children in need of HIV treatment in low- and middle-income countries received it in 2010 as compared with one in two adults receiving treatment.
At the end of 2010, 6.66 million people were receiving antiviral therapy in low- and middle-income countries, an increase of more than 1.4 million people, or 27% from December 2009. Overall, the estimated treatment coverage of antiviral therapies among adults and children in low- and middle-income countries continued to increase and was 47% of the 14.2 million people eligible for treatment at the end of 2010, up from 39% in December 2009. As of December 2010, 10 low- and middle-income countries, including three countries with generalized epidemics (Botswana, Nambia, and Rwanda) had already achieved universal access to therapy, defined as providing antiviral therapy to at least 80% of the people eligible for treatment. Seven additional countries, including two countries with generalized epidemics (Swaziland and Zambia) had estimated coverage levels between 70% and 90%.
On a regional basis, however, there are mixed signs for increased access to antiviral therapies. Sub-Saharan Africa recorded the largest overall increase, 30% in the number of people accessing antiviral therapies. The regional coverage rate for antiviral treatment was 49% at the end of 2010 in Sub-Saharan Africa. It was 39% in Asia, 23% in Eastern Europe and Central Asia, only 10% in the Middle East and Africa, and 63% for adults and 39% for children in Latin America and the Caribbean.
On the research front, there are approximately 88 medicines and vaccines in development to treat or prevent HIV/AIDS and related conditions, according to a recent report by the Pharmaceutical Research and Manufacturers of America (PhRMA). Of the 88 medicines and vaccines in development, 49 are antivirals and 27 are vaccines. These medicines are either in clinical trials or awaiting review by FDA. The research efforts are focused in improving treatment regimes, more targeted therapies, and vaccines. The International AIDS Vaccine Initiative estimates that a vaccine that is 50% effective and given to only 30% of the population could reduce new HIV infections by 24% over 15 years, according to the PhRMA report.