In the more than three decades since HIV/AIDS was first discovered, the disease has taken the lives of 35 million people around the world. In 2015 alone, AIDS killed 1.1 million people, 800,000 of whom were living in sub-Saharan Africa. Though life-saving antiretroviral treatment is available, millions of people still cannot access it: just 46% of people who are HIV-positive are currently on treatment.
Because people in their most productive years (15-49 years old) are most commonly infected with HIV/AIDS, the disease threatens broader development progress in many low-income countries, including in those in sub-Saharan Africa hit heavily by the disease. In 2015, UNAIDS reported that 13.4 million children around the world were orphans due to HIV/AIDS. Within countries, HIV is increasingly concentrated among vulnerable populations, including men who have sex with men, female sex workers, injection drug users and adolescent girls – and in many countries, political dynamics and legislation have made it increasingly difficult to reach them.
In 2016, world leaders pledged to end the AIDS epidemic by 2030 with a global mandate to Fast-Track the AIDS response by 2020. We are still far from achieving the Fast-Track goals to reduce new HIV infections to fewer than 500,000 globally, reduce AIDS-related deaths to fewer than 500,000 globally and eliminate HIV-related stigma and discrimination—each by 2020.
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. Since 2000, new HIV infections have fallen by 34%, with infections among children dropping by 69%; AIDS-related deaths have also decreased by 45% since their peak in 2004. The number of people newly added to AIDS treatment has never been greater than the number of people newly infected with HIV, but we are getting close. In 2015, new infections (2.1 million) barely surpassed the number of people newly added to treatment (2 million).
As we continue to improve access to treatment (with over 17 million people on treatment in 2015, up from 770,000 in 2000), we must speed up our prevention efforts, using existing and new tools more effectively. It is now possible to prevent the transmission of HIV from mother-to-child in 95% or more of cases. New research has also provided ground-breaking data on two fronts: the impact of treatment as prevention and the role of male circumcision in prevention strategies. Clinical trials have shown 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 in men by up to 60%.
In 2015, global funding for HIV/AIDS was $19 billion, dipping below the historic high of $20.2 billion spent in 2014. Low and middle income countries continue to account for the majority of HIV/AIDS spending, spending 60% ($11.5 billion) in 2015, while international assistance accounted for 40% ($7.5 billion) in 2015. For the first time in five years, funding disbursed by donor governments for HIV declined. Yet there is still over a $7 billion gap in funding to reach the UNAIDS estimated $26.2 billion needed annually by 2020 to end AIDS as a global public health threat by 2030.
These resources, channelled through governments and programs such as The Global Fund and PEPFAR, have helped save millions of lives and bend the curve of the pandemic. Since 2002, Global Fund grants have supported 9.2 million people on HIV treatment and provided 509 million HIV counselling and testing sessions. As of September 2015, PEPFAR is providing treatment support for 9.5 million people, including direct support for 5.7 million people and indirect, but essential, technical support for another 3.8 million. In FY2015 alone, PEPFAR reached more than 82.9 million people with HIV testing and counselling.
The world must accelerate its progress—including among the most marginalised and difficult-to-reach populations. We must finish the job of virtual elimination of mother-to-child transmission, continue scaling up treatment and deploy smarter preventions strategies. To be effective, these goals cannot be achieved in isolation from one another, or be the sole responsibility of a small number of donor countries. Only when donors, African governments, international organisations and the private sector work together will the path towards the end of AIDS become a reality.