PRB

(December 2010) A new report from the international organization UNAIDS has good news about progress in fighting the global HIV/AIDS epidemic. Although the number of people living with HIV remains high—33.3 million in 2009—fewer people are becoming infected with HIV. Four decades into the seemingly intractable epidemic, UNAIDS reports that “the world has turned the corner—it has halted and begun to reverse the spread of HIV.”¹ Since peaking at about 3.2 million in 1997, the number of new annual infections has fallen 19 percent to 2.6 million. The number of AIDS-related deaths fell from a peak of 2.1 million in 2004 to an estimated 1.8 million in 2009.

In all but a few world regions, the prevalence of HIV/AIDS has declined. In sub-Saharan Africa, where more than two-thirds of the world’s HIV-positive people live, the percent of adults living with HIV fell from 5.9 percent in 2001 to 5.0 percent in 2009. Prevalence also slipped slightly in South/Southeast Asia and in East Asia, as well as the Caribbean. In contrast to the general trend, the HIV prevalence rate rose a bit in Eastern Europe and Central Asia. Five countries in this region (Armenia, Georgia, Kazakhstan, Kyrgyzstan, and Tajikistan) saw the incidence of new cases increase more than 25 percent between 2001 and 2009.

Although far from the ultimate goal of preventing any new infections and protecting the rights and well-being of those with HIV, this progress, especially in Africa, suggests that the multifaceted approach to fighting the epidemic has made a difference. The international response includes a wide range of prevention efforts, including educating the public about the risks of unsafe sex; encouraging sexually active people to get tested for HIV; counseling those who test positive for the virus; reducing the stigma and discrimination associated with HIV infection; making the blood supply HIV-free; and widely distributing condoms. In addition, antiretroviral therapy became available for millions of people with HIV in low-income countries in recent years, reducing HIV-related deaths. Transmission of HIV from mother to infant was significantly reduced by the timely administration of antiretroviral therapy for HIV-positive women and their newborn babies.

Declines in New Infections in Major AIDS Countries

The combination of prevention and treatment efforts—along with the natural cycle of epidemics—contributed to significant declines in new infections in some of the world’s major AIDS countries, including Botswana, South Africa, Tanzania, and Zimbabwe. South Africa, the country with the largest number of people living with HIV/AIDS, saw the rate of new infections cut in half between 2001 and 2009. For some countries, the improvement was significant for men and not women, or vice versa, revealing that this progress was not shared equally and underscoring the work still to be done.

HIV and AIDS Indicators in Selected World Regions, 2009

Note: Limited to regions with 1 million or more people living with HIV.
Source: Joint United National Programme on HIV/AIDS, UNAIDS Report on the Global AIDS Epidemic 2010 (Geneva: UNAIDS, 2010).

More Practice Safe Sex

The decline in new infections among young people in several African countries show that more people are practicing safer sexual behavior, in what UNAIDS calls a “revolution in HIV prevention.” Several national surveys in high-HIV African countries indicate that teenagers are waiting longer to have sex, and that sexually active adults have fewer sexual partners and are more likely to use condoms. In Zimbabwe, for example, surveys show that men are now less likely to have casual sex partners than in the past. These are welcome findings because HIV prevention requires people to change their sexual behavior—which often means modifying well-established patterns.

Expanded Treatment Reduces Deaths

In the past decade, the international response to the HIV/AIDS epidemic in less developed countries expanded to include antiretroviral therapy. These medicines do not cure the disease, but had been used successfully in wealthier countries to slow the progression of the disease and allow those with HIV to live longer and more active lives. Although many public health experts were skeptical that this therapy could be successfully used in poor countries with limited health infrastructures, UNAIDS reports that expanding access to treatment contributed to a 19 percent decline in deaths among people living with HIV/AIDS between 2004 and 2009.

By 2009, an estimated 5.5 million people were receiving antiretroviral therapy; another 10 million were eligible for treatment but not receiving it. The international community hopes to expand the reach and success of treatment with the introduction of a new approach which could avert an additional 10 million AIDS-related deaths by 2025, compared with current treatment approaches.

Continuing Challenges

The good news about progress against HIV/AIDS is tempered by the magnitude of the existing problems: More than 30 million people live with an incurable disease that is transmitted primarily through sexual contact and injecting drug use. The epidemic has had a devastating effect on the economic and social lives of tens of millions of families, especially in southern and eastern Africa. More than 2 million more people are infected with the virus each year. But the mounting evidence of successful approaches to stopping the spread of HIV, even in the poorest countries, offers hope.

Reducing HIV infection and improving the lives of people living with HIV required extensive national and international resources and political commitment. These resources and commitments will need to continue, even in a time of economic downturn, to halt the epidemic.

Mary Mederios Kent is senior demographic writer at the Population Reference Bureau.

References

1. Joint United Nations Programme on HIV/AIDS (UNAIDS), UNAIDS Report on the Global AIDS Epidemic 2010 (Geneva: UNAIDS, 2010), accessed at www.unaids.org/GlobalReport/default.htm, on Dec. 1, 2010.