HIV/AIDS

The Challenge

In the 30 years since HIV/AIDS was first discovered, the disease has become a devastating pandemic, taking the lives of 30 million people around the world. In 2010 alone, HIV/AIDS killed 1.8 million people, 1.2 million of whom were living in sub-Saharan Africa. Though life-saving antiretroviral treatment is available, access is not yet widespread; of the estimated 14.2 million HIV-positive individuals in need of treatment, nearly 8 million are not currently able to access it.

Even more troublesome, new HIV infections continue to outpace those added onto antiretroviral treatment. More than 390,000 infants and children were newly infected with HIV in 2010, and 2.7 million total new HIV infections occurred in the same year—a rate that has held relatively constant since 2006.

Because individuals in their most productive years (15-49 years old) are most commonly infected with HIV/AIDS, the disease has a wide socioeconomic impact that threatens development progress in many poor countries, especially those in sub-Saharan Africa. 14.8 million children in the region have already lost one or more parents to the disease. In South Africa alone, 1.9 million children have been orphaned due to AIDS, exacerbating a social dynamic that is already deeply challenged by crime, violence and unemployment. HIV/AIDS targets people during their most productive years, making economic progress in many sub-Saharan African countries even more of a challenge. Some estimates suggest that annual GDP growth in highly affected countries can be 2-4% lower than in countries with the absence of AIDS.

In 2005, world leaders at the G8 summit in Gleneagles and at the U.N. World Summit in New York pledged to reach universal access to prevention, care and treatment by 2010. Though this target was not achieved, leaders recommitted to the fight against AIDS in 2011 by agreeing to work toward achieving universal access to HIV prevention, treatment, care and support by 2015. Delivering these essential services will require a strengthening of health systems, especially in Africa, which is home to two-thirds of those requiring antiretroviral (ARV) treatment, but only 3% of the global health care workers to provide it.

The Opportunity

We are at a critical moment in the fight against HIV/AIDS. The world has made incredible progress in its efforts to understand, prevent and treat this disease, and progress has been particularly rapid during the last ten years. But by the end of 2010 more than 6.6 million people were on life-saving antiretroviral treatment, up from just 300,000 in 2002; of that 6.6 million more than 5 million were living in sub-Saharan Africa. Botswana, Rwanda, and Namibia have already achieved universal access to ARVs, while Benin, Guinea, Kenya, Lesotho, Senegal, South Africa, Swaziland, Togo, Zambia, and Zimbabwe have coverage rates between 50 to 80% and are making progress towards universal access.

Though we have not made enough progress on the prevention of HIV, we now have impactful new data and technologies to help us better prevent new infections in the years to come. More sophisticated treatment regimens now make it possible to prevent the transmission of HIV from mother-to-child in as many as 98% of cases. Nearly half of all pregnant women with HIV can now receive ARV prophylaxis for PMTCT and a global effort co-led by UNAIDS and the US Office of the Global AIDS Coordinator (OGAC) has called for leadership from the 22 highest-burden MTCT countries to help virtually eliminate transmission from mother-to-child by 2015.

New research over the last two years has also provided groundbreaking data on two fronts: the impact of treatment as prevention, and the role of male circumcision in prevention strategies. The HPTN 052 clinical trial showed that treatment acts as prevention, reducing the likelihood of an HIV-positive individual on treatment passing HIV on to others by up to 96%. Voluntary medical male circumcision, another powerful tool, was shown to reduce the likelihood of HIV infection by up to 60%. Combination prevention, including treatment-as-prevention and other strategies such as PMTCT, the ABC strategy to prevent sexual transmission (Abstain, Be faithful, & correct and consistent use of Condoms), male circumcision, and reduction of unsafe blood and medical injections, will play a central role in moving us towards ending the pandemic.

Now, for the first time in history, the world can look ahead to the beginning of the end of the AIDS pandemic. We have the tools necessary to achieve an AIDS-free generation if we focus our efforts on three interim goals: virtual elimination of mother-to-child transmission by 2015, expansion of antiretroviral treatment to 15 million people by 2015, and implementation of innovative prevention techniques to stop new infections. To bend the curve of the AIDS pandemic, these goals cannot be achieved in isolation from one another, nor can their achievement be the sole responsibility of a small number of donor countries. Only when working in parallel--through the broad support of donors, African governments, international organizations, and the private sector--will the beginning of the end of AIDS become a reality.

During a time of financial austerity and economic crisis in many parts of the world, it is essential for both donor and recipient countries to reaffirm their commitments to combating HIV/AIDS while making strategic investments. From 2002 to 2009, global funding for HIV/AIDS increased dramatically from $800 million to $6.8 billion annually, and these international investments are paying off: the Global Fund to Fight AIDS, Tuberculosis, and Malaria has helped 3.3 million people receive ARV treatment and conducted 190 million HIV counseling and testing sessions, while the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has directly supported 3.9 million people on ARV treatment and reached more than 13 million people with care services, including more than 4.1 million orphans as of 2011.

Sustaining our current progress, with an aim towards beginning to end AIDS, will require increased focus on prevention, expanded ARV treatment, and continued scientific research. At this critical juncture, it is imperative for all of us to make strategic investments and to keep an eye on the finish line.