Significant strides have been made in the global fight against HIV, but major gaps remain that could prevent many countries from achieving UN Millennium Development Goal (MDG) six relating to HIV/AIDS, malaria and other diseases.
IRIN/PlusNews examines global efforts to halt and begin to reverse the spread of HIV/AIDS.
Access to treatment - More than five million people currently have access to life-prolonging antiretroviral drugs, a 12-fold increase over the past six years. However, this still represents just one third of people who need HIV treatment.
In 2008, 38 percent of the 730,000 children estimated to need antiretrovirals (ARVs) in low- and middle-income countries had access to them.
UNAIDS is calling for the implementation of a new treatment approach called "Treatment 2.0", to drastically scale up testing and treatment; it estimates that successful implementation of "Treatment 2.0" could avert 10 million deaths by 2025, and reduce new infections by a third.
New infections - Twenty-two of the worst affected countries in sub-Saharan Africa have reduced HIV incidence by more than 25 percent in the last eight years, according to UNAIDS. Some of the best performers in reducing new infections are Ethiopia, Nigeria, Zambia and Zimbabwe; HIV incidence is on the rise in Uganda, once a leader in the fight against HIV.
Eastern Europe and Central Asia remain the only regions where incidence is increasing.
Globally, there are still five new infections for every two people put on ARVs.
Prevention of mother-to-child transmission - According to the UN World Health Organization's (WHO) 2009 report, Towards Universal Access, the 20 countries with the highest burden of HIV among pregnant women have scaled up HIV counselling and testing to at least 75 percent of their antenatal care facilities.
Kenya, Malawi, Mozambique, South Africa, Tanzania and Zambia are among the countries that provided HIV testing to 60-80 percent of pregnant women, while Botswana, Namibia and São Tomé and Principe exceeded the 80 percent mark.
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In 2008, 45 percent of pregnant women living with HIV in low- and middle-income countries received ARVs to prevent HIV transmission to their infants - up from just 10 percent in 2004.
HIV-related maternal and child mortality - In 2008, 9 percent of all maternal deaths in sub-Saharan Africa were HIV related, according to a new report, Trends in Maternal Mortality: 1990-2008 by WHO and the UN Children's Fund, UNICEF. In Latin America and the Caribbean, HIV/AIDS was responsible for 5.2 percent of maternal deaths.
The report notes that there is evidence that women with HIV infection have a higher risk of maternal death.
Access to prevention of mother-to-child-transmission (PMTCT) improves outcomes for children as well, with studies showing that in KwaZulu Natal, South Africa, child mortality declined by 34 percent following improvement in PMTCT. According to UNICEF, HIV is one of four diseases that accounted for 43 percent of all deaths in children under five worldwide in 2008.
Condom availability and use - Globally, condom use has doubled over the past five years, according to UNAIDS. An estimated 13 billion condoms per year will be needed by 2015 to help halt the spread of HIV, but only four condoms were available for every adult male of reproductive age in sub-Saharan Africa.
Female condoms are even less accessible. According to the UN Population Fund, UNFPA, in 2009, one female condom was distributed for every 36 women worldwide.
Condom use remains low in many high prevalence countries. According to UNAIDS, in South Africa, the proportion of adults reporting condom use during last sex rose from 31 percent in 2002 to 65 percent in 2008, but in Burundi, only about one in five people reported using a condom during commercial sex episodes.
New prevention technologies - The first positive results from a microbicide trial have injected fresh hope into efforts to halt the spread of the virus; the gel, containing the ARV Tenofovir, was found to be 39 percent effective in reducing a woman's risk of becoming infected with HIV.
"Treatment 2.0" also promises benefits for prevention, with evidence showing that people on ARV treatment are much less likely to transmit the virus.
A Thai vaccine trial completed in 2009 also provided the first evidence that a vaccine can provide some protection against HIV.
Photo: International Partnership for Microbicides (IPM)
|The first positive results from a microbicide trial have injected fresh hope into HIV prevention efforts|
Several trials are under way to test the efficacy of pre-exposure prophylaxis (PrEP) whereby HIV-negative people take a single ARV drug or a combination of drugs with the hope that it will lower their risk of infection if exposed to HIV.
Male circumcision, proven to reduce men's risk of infection through sexual intercourse by up to 60 percent, is being rolled out in several African countries.
Tuberculosis - TB remains a major cause of death for people living with HIV. WHO estimates that in 2008, there were 1.4 million TB cases among people living with HIV and over 500,000 deaths. Drug-resistant TB is on the rise in several countries, but diagnosis remains very low.
TB research remains under-funded and the most widely used TB diagnostics are over 100 years old. For many co-infected patients in the developing world, late diagnosis leads to death.
The authors of a recent article published in medical journal The Lancet argue that TB control is crucial to achieving the MDGs, given its link to HIV mortality as well as maternal and child mortality.
Recent developments such as a new drug to treat TB and rapid, more accurate TB tests could lead to improvements in the diagnosis and management of the highly infectious disease.
New research showing that starting TB patients on ARVs earlier leads to better outcomes could also reduce mortality in co-infected patients.
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions