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Experts warn approach to HIV/AIDS is complacent

Resurgence of the disease could emerge, say experts

Adrian O'Dowd

Friday, 20 July 2018

The global response to handling HIV/AIDS is at risk of “dangerous complacency” with an urgent change in approach needed, says a new report* published today in The Lancet.

The report by the Lancet Commission led by the International AIDS Society says the HIV pandemic is not on track to end by 2030 – a target set by UN member states – and current approaches to HIV control are not enough to control it.

An estimated 38.8 million people were living with HIV worldwide in 2015-16, and around two million new cases were diagnosed in 2015. There were one million AIDS-related deaths in 2016, and overall, more than 35 million people have died of AIDS-related causes since the start of the epidemic.

The report combines the expertise of more than 40 international experts who make recommendations for how HIV and global health can work together to advance global health and improve the HIV response.

It also models the impact of combining HIV within other health services in five countries, and is being presented at the AIDS 2018 conference taking place in Amsterdam next week.

The report authors argued that changes to the HIV response were vital to win the global fight against HIV, and they proposed that HIV researchers and health care professionals should work more closely with their counterparts in global health, while HIV services needed to be included into wider health services and global health policies.

Globally, 44% of all new HIV infections occurred in people from marginalised groups (such as gay and bisexual men, people who inject drugs, sex workers, transgender people, and the sex partners of people in these groups), and health systems were struggling to reach and engage these groups, said the authors.

Additionally, as health systems struggled to provide adolescent-friendly services, adolescents were at risk of HIV infection, particularly girls and young women. The HIV epidemic remained prevalent in these populations and in countries where health systems struggled to provide the necessary services.

Although new infections were declining, this was happening at too slow a rate to reach the UNAIDS target of 500,000 new infections by 2020, they warned.

From 2010-2017, new infections declined by 16% to 1.8 million per year worldwide, but remained substantially higher for younger women then young men.

The Commission authors warned that a resurgence of the epidemic was likely as the largest generation of young people aged into adolescence and adulthood.

HIV funding had remained flat in recent years, at about US $19.1bn – US $7bn short of the estimated amount needed to achieve UNAIDS targets on HIV care.

Lead commissioner Dr Linda-Gail Bekker, president of the International AIDS Society and professor at University of Cape Town, South Africa, said: “Global health is beginning to falter as democracy, civil society, and human rights deteriorate in many countries, and as development assistance for health has stalled.

“This loss of momentum comes as health systems need to become stronger to contend with the growing numbers of non-communicable diseases. The HIV response and the broader global health field must work together.

“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.”

*Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society-Lancet Commission report. The Lancet. DOI:10.1016/S0140-6736(18)31466-1.

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