A huge new report on the global HIV/AIDS epidemic celebrates the “extraordinary progress” in both treatment and prevention over the past 15 years. But “How AIDS Changed Everything” also has “heart-breaking stories about the challenges that still remain,” wrote the director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), Michel Sidibé, in an introduction.
The 515-page report by UNAIDS includes new estimates of infections for each country, “lessons of hope,” details on shortcomings, and essays from health officials, politicians, disease advocates, and celebrities. “If we’ve learned anything, it’s that when we neglect lethal infectious diseases, the problem will become bigger, more costly and more difficult to solve in the long run,” wrote former U.S. President Bill Clinton, whose foundation helps people receive treatment.
In 2014, the report estimates that 36.9 million people were living with the virus, some 70% of them in sub-Saharan Africa, and that number continues to increase because 15 million of them now are taking lifesaving antiretroviral drugs. South Africa alone has 6.8 million HIV-infected people—more than any other country.
Between 2000 and 2014, annual new infections dropped from 3.1 million to 2 million, and AIDS deaths dropped from 2 million to 1.2 million. Global investments in the AIDS response during those 15 years jumped from $4.9 billion to $21.7 billion—57% of which now comes from domestic sources. “If we had stayed complacent 30 more million people would have been infected with HIV, 7.8 million more would have died and 8.9 million more children would have been orphaned due to AIDS,” Sidibé wrote.
The flip side is that many more gains are needed if the world hopes to meet the UNAIDS goal of “ending” the global epidemic by 2030, which the agency defines as reducing new HIV infections and AIDS deaths by 90% from today’s numbers. Among the challenges highlighted in the report: In sub-Saharan Africa, more than 70% of the adults have never had an HIV test, and Eastern Europe, Central Asia, the Middle East, and North Africa saw increases of more than 25% in new HIV infections between 2000 and 2014. The report estimates that the world will need to spend $8 billion to $12 billion more each year by 2020.
The report decries the persistence of a “punitive legal environment” in many countries, including 76 that criminalize same-sex sexual acts (punishable by death in seven locales). In 17 countries, foreigners can be deported if they test positive for HIV. Five countries, all in the Middle East, bar entry to HIV-infected people.
Mark Dybul, head of The Global Fund to Fight AIDS, Tuberculosis and Malaria, wrote in his essay that too many places are complacent. He urges countries to compile clear data to convince leaders that they can and should do more. “The calendars of policy-makers are filled with a revolving door of people who bring them big problems,” Dybul wrote. “What political leaders want is a problem they can do something about. And to keep the funding flowing, it is essential to set clear targets and show progress towards achieving them.”
In concert with the report’s release, UNAIDS has added a new “data visualization” feature to its website that graphically displays detailed information about each country.