Sixteen years after a groundbreaking conference shocked the world into the realization that thousands of Africans were dying of AIDS because they did not have access to life-saving drugs, campaigners and scientists meeting once again in Durban this week are to warn that the progress made since 2000 is not enough to end the epidemic.
Although the argument for drugs for Africa was won and 17 million people are now on treatment that keeps the virus at bay, there are 36.7 million people living with HIV, according to the Joint UN Programme on HIV/AIDS (UNAIDS), meaning that fewer than half of those who need the drugs are getting them.
The WHO recommends that anybody diagnosed with HIV should be put on antiretroviral drugs as soon as possible, to keep them well and because the medication prevents them infecting others.
Meanwhile, the number of people becoming infected every year, which had been dropping, has stalled and is rising in some countries. Just less than 2 million people become HIV-positive every year, so the epidemic continues to grow and the cost of keeping people alive continues to rise.
There is mounting anxiety among the experts and the activists at this year’s Durban International AIDS Conference that the epidemic might slip out of control once more.
The WHO is among those flagging up serious issues that could put in jeopardy the UN’s plans to end the epidemic.
In a statement at the start of the week-long conference, the WHO called for new attention to prevention and warned of growing resistance to antiretroviral drugs used to control HIV, which could mean that newer, more expensive versions will be needed in the developing world.
“The enormous progress on HIV, particularly on treatment, is one of the big public health success stories of the century, but this is no time for complacency. If the world is to achieve its goal of ending Aids by 2030, it must rapidly expand and intensify its efforts,” WHO Director-General Margaret Chan (陳馮富珍) said.
Money is a growing concern. A report from the US-based Kaiser Family Foundation and UNAIDS this weekend said that funding from donor governments had last year fallen for the first time in five years from US$8.6 billion in 2014 to US$7.5 billion.
“[Last year] marked a drop in donor funding for HIV,” said Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation. “Donors faced many competing funding demands, including humanitarian emergencies and the refugee crisis, all against a backdrop of fiscal austerity in a number of countries. Looking ahead, donor funding for HIV remains uncertain, as leading donors face changes in political leadership and the world is still digesting the effects of Brexit.”
The US put in the biggest proportion, as it always has, at 66.4 percent, followed by the UK with 13 percent. France provided 3.7 percent of funding, Germany 2.7 percent and the Netherlands 2.3 percent.
UNAIDS Deputy Executive Director Luiz Loures said the decline in funding was worrying.
“Countries still need urgent support over the next few years to fast-track their responses to HIV, enabling them to end the AIDS epidemic by 2030 and save millions of lives. Diverting resources from the HIV response now will mean much greater human and financial costs over the long term,” Loures said.
In recent years, there have been many optimistic pronouncements about innovations that might help end the pandemic, from circumcision to microbicides that allow women to protect themselves from HIV to drugs used for treatment that also prevent infection.
The results of further studies showing that these things can work will be presented at Durban. However, the major hurdle might be making them routinely available — particularly in the case of drugs that can be taken by people without HIV to protect themselves.
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