Jamra primary scholl for children affected by HIV/AIDS, drugs or poverty, Senegal (c) Nell Freeman/Alliance Participants in the Photovioce project, Ecuador © Marcela Nievas for the Alliance
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International HIV/AIDS Alliance response to the UNAIDS World AIDS Day report


Aids Alliance

The Alliance today welcomes the UNAIDS World AIDS Day report on the HIV epidemic, How to get to zero: Faster. Smarter. Better. We are encouraged that the collective efforts of governments, civil society, communities, scientists and healthcare workers continue to show progress in tackling the epidemic.

You can read the report here.

The report presents an encouraging picture of new HIV infections at their lowest levels since 1997, a further 1.35 million people receiving treatment in just one year and the possibility that we could eliminate new HIV infections in children.

It outlines the life-saving power of antiretroviral drugs. In 2010 alone, more than 700,000 AIDS deaths were averted and more than 2.5 million deaths have been averted since the advent of ARVs in 1995.

This is all good news but we also need to look behind the figures at the reality.

Falling funding

In these challenging economic times there is a real danger that this progress is at risk if we do not continue to make the right investments.  Funding from donor countries for HIV/AIDS has reduced by 10% in 2010. This raises grave concerns.

Will this mean that 50% of people who can’t get treatment will continue to miss out? The numbers of people dying from AIDS related causes fell from 2.2 million in the mid-2000s to 1.8 million in 2010. Will this figure increase again in future if funding for HIV/AIDS falls away?

We are faced with a very clear imperative to make the money work harder and more effectively. We welcome UNAIDS’ endorsement of a more evidence based approach to tackling the epidemic, as described in the Investment Framework. The Alliance has been working with UNAIDS and others on this model for better HIV investment and HIV programming. If we invest properly now we can see a reduction in the financial and human cost of AIDS. There is the potential to prevent 12.2 million new HIV infections and prevent 7.4 million deaths due to AIDS by 2020.

Translating new science into reality

We must capitalise on recent scientific developments. The report highlights that treatment can have a powerful HIV prevention effect by reducing the infectiousness of HIV positive people. This is exciting news. The imperative to improve access to HIV treatment is increasing.  However outside of clinical trial settings we need to see how this will translate from scientific findings into reality and getting more people onto HIV treatment is difficult.

We need cheaper medicines. We need better supply systems so clinics don’t run out. We need more people to know their HIV status by increasing HIV testing.  We need to deal with the barriers that people encounter when they try to access HIV treatment. Health services, including HIV treatment centres, can be a problem. We need an environment where a gay man in Uganda can find a doctor to talk about his needs and not feel threatened; where a person who uses drugs in Indonesia can get an HIV test and be assured that their drug use won’t be reported to the authorities and that sex workers get equal access to HIV treatment.

Proven methods of HIV prevention such as increasing condom use and harm reduction approaches to injecting drug must not be abandoned in the rush to biomedical solutions. The benefit of HIV treatment as an HIV prevention tool will depend on sustaining and increasing safe sex, safe injecting and more people knowing their HIV status. The challenges of treatment access and adherence must also be seriously considered.

In short, lets not forget what we have learnt – there is no silver bullet and combination prevention works. Treatment as prevention, we hope will add another dimension to these efforts.

Community mobilisation

Throughout the report, UNAIDS recognises community mobilisation as a key way of overcoming many of these barriers. Our evidence shows that community mobilisation transforms attitudes and behaviours. In Cambodia where Alliance partner KHANA works we have witnessed an increase in regular condom use among sex workers and their clients; in Ukraine we see reductions in levels of unsafe injecting among drug users and decreases in HIV rates linked to these changing behaviours.

Community mobilisation can help improve behaviours, social norms and practices. When we invest in community education we can address violence towards women and improve sexual and reproductive health. These changes will stop HIV as well.  With fewer than half of people living with HIV not knowing they are infected, community mobilisation is a key way of increasing voluntary HIV testing and counselling.

We welcome the ongoing commitment of UNAIDS to changing behaviours, changing social norms and changing laws, alongside efforts to improve access to HIV treatment. For bigger and better impact though, we must not become complacent. There is still much more to do.