Although no vaccine against HIV exists, advances in prevention and treatment have led to a growing conviction among researchers, public health officials, and politicians that the HIV/AIDS epidemic can be brought to a halt with existing tools. Fast-Track: ending the AIDS epidemic by 2030, a report released yesterday by the Joint United Nations Programme on HIV/AIDS (UNAIDS), spells out how this ambitious aim could be achieved. “HIV infections may not disappear in the foreseeable future, but the AIDS epidemic can be ended as a global health threat,” the report asserts.
Fast-Track updates UNAIDS estimates about the epidemic today. Some 35 million people were living with HIV at the end of 2013, 2.1 million new infections occurred during that year, and AIDS-related deaths totaled 1.5 million. These were slight drops from 2012 and are mainly the result of a big jump in the number of people in low- and middle-income countries receiving antiretroviral treatment, which went from 9.7 million in 2012 to 13.6 million by June 2014. (Treatment both saves lives and makes infected people less likely to transmit the virus.) “It’s amazing the acceleration that happened,” UNAIDS Executive Director Michel Sidibé told ScienceInsider. “In 3 years we’re doing what we used to do in 20 years.”
But the report notes that if treatment and prevention efforts remain at 2013 levels, the epidemic will continue to grow and an estimated 41.5 million people will be living with HIV in 2030. Fast-Track sets the “visionary goal” of cutting that number to 29.3 million, which would avert some 28 million infections.
Sidibé says a window of opportunity exists today that will not last. “We have 5 years to leverage and break the trajectory,” Sidibé says. UNAIDS says the key is to increase three things to 90% levels: people who know their HIV status, receive treatment, and adhere to the medication so that the amount of virus in their blood drops below detectable levels.
Fast-Track explicitly recognizes that these ambitious targets will be difficult to hit, especially given funding limitations, but contends they have an inherent value. “As previous experience in the AIDS response has demonstrated, time-bound targets drive progress, promote accountability and unite diverse stakeholders in pushing towards common goals,” the report says.
In a first, Fast-Track notes that 89% of all new HIV infections occur in 30 countries. It also breaks down by income status of these locales how much money will be required by 2020 to meet the 90-90-90 goals. Low-income countries will need $9.7 billion, lower-middle-income $8.7 billion, and upper-middle-income $17.2 billion. This is roughly double the amount invested today, but UNAIDS estimates that expenses will drop after a peak in 2020. “To end the AIDS epidemic by 2030, the global community will need again to defy expectations,” the report states.
Low-income countries will have to dip more into their own coffers: Fast-Track notes that only six governments in Africa have lived up to a commitment made in 2001 to devote 15% of their budgets to health. “We have failed in those countries to show that health is an investment,” Sidibé says. “It’s seen as a cost expenditure by the ministers of finance.” He says countries like China, India, and Brazil also can do more to help sub-Saharan Africa. “Emerging countries should start going beyond just the responsibility of taking care of themselves,” he says. “They need to start building the bridge with the most left-behind countries.”
Only four high-income countries are contributing enough compared with their gross domestic products, the report contends. “There is an enormous gap in per capita contributions among donor countries—providing a significant opportunity for many donors to increase their contributions,” it concludes.