The complacency in the response to the global HIV pandemic might risk a resurgence of the disease as the largest generation of young people transition into adolescence and adulthood.
HIV is a virus that attacks the immune system. The virus destroys a type of white blood cell in the immune system called a T-helper cell, and makes copies of itself inside these them. If too many T-helper cells are destroyed, the body can no longer defend itself against infection which can be fatal. The last stage of HIV infection is AIDS (acquired immunodeficiency syndrome). People with AIDS have a lower number of T-helper cells, and get deadly infections. The drugs used to treat HIV are called antiretrovirals (ARV), which are given in combination with other ARVs in a therapy called antiretroviral therapy (ART).
HIV is transmitted by three main routes: sexual contact, significant exposure to infected body fluids or tissues, and from mother to child during pregnancy, delivery, or breastfeeding (known as vertical transmission). More than three decades of research have yet to yield a cure or vaccine for HIV that has infected nearly 80 million people since the epidemic began in the early 1980s. About 36.9 million people were living with the virus in 2017, and only 60% of people with HIV know their status. The remaining 40% (over 14 million people) lack access to HIV testing services. Most of the people who have been living with HIV come from poor income nations. A large portion of the population are from sub-Saharan African nations.
World AIDS Day, designated on 1 December every year since 1988, is dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection.
Experts at the Lancet, the world’s oldest and most prestigious medical journal, have stated that a stalling of HIV funding in recent years has endangered efforts to control the illness. They have called for urgent changes in how the disease is treated and controlled. The target undertaken by UN members to eliminate the disease as a public health threat by 2030 is not on track, with a shortage of about $US 7 billion in global HIV funding.
"The encouraging reductions in new HIV infections that occurred for about a decade has emboldened some to declare that we are within reach of ending AIDS," said Peter Piot, a veteran virus researcher and founder of the UNAIDS agency. “However, there is absolutely no evidence to support this conclusion.”
An estimated 1.8 million new cases of HIV emerge every year. According to the Lancet Commission, new cases have been falling in recent years but the rate is too slow to reach the UNAIDs target of 500,000 new infections by 2020. They remain persistent in marginalized groups particularly women, gay and bisexual men, transgender people, sex workers, younger people and in developing countries where access to treatment can be difficult.
Dr. Linda-Gail Bekker, president of the International Aids Society said, “Despite the remarkable progress of the HIV response, the situation has stagnated in the past decade. Reinvigorating this work will be demanding - but the future health and wellbeing of millions of people require that we meet this challenge."
According to the Commission, there is a need to end HIV exceptionalism – wherein specific funding and services have been provided for HIV alone. This can be achieved by increasing collaboration between health professionals to incorporate HIV screening into other areas of healthcare such as diabetes and high blood pressure. They estimate that if HIV testing and treatments were combined with those for syphilis among women sex workers and gay men in India, it might reduce the number of new HIV cases at a national-level by 7% between 2018 and 2028. Ending stand-alone AIDS clinics will also reduce the stigma surrounding the disease.
"Health systems must be designed to meet the needs of the people they serve, including having the capacity to address multiple health problems simultaneously," Professor Chris Beyrer said. “No one can be left behind in our efforts to achieve sustainable health."
The Commission's recommendation that AIDS services be offered alongside other health services might prove risky. If the testing and treatment of AIDS is integrated into general health care, the laser focus might be lost.
Our assessment is that the declining trend in HIV infections might not last very long. We believe that apart from increasing funding, there is a need to renew focus on preventive measures with affordable and accessible treatment therapies. We strongly feel that the final frontier in the eradication against AIDS would be development of a vaccine.