WHO World Health Organization

To achieve the Fast-Track Targets and end the AIDS epidemic by 2030, new HIV infections among children must be eliminated. HIV can pass from mother to child during pregnancy, childbirth and breastfeeding, but with antiretroviral therapy mother-to-child transmission rates can fall to 5% or less.

The World Health Organization (WHO) promotes a comprehensive approach to preventing mother-to-child transmission of HIV. One important part of this strategy is to provide appropriate treatment, care and support to mothers living with HIV, their children and other family members.

Since 2005, owing to effective programmes that prevent mother-to-child transmission, the number of children born HIV-positive has dropped by about 70%. In 2015, around 1.4 million mothers living with HIV gave birth and 150 000 infants were infected with HIV globally. HIV-positive infants have their highest mortality in the first three months of life, so their HIV status must be diagnosed quickly in order that they can receive the treatment they need.

However, a serious diagnostics gap exists. Only 51% of infants exposed to HIV globally are tested by the time they are six weeks old, the age recommended by WHO. Half will never receive their results. Of those who do test positive and receive their results, only half are linked to care. So of the 150 000 babies born HIV-positive in 2015, only around half will be linked to care.

UNITAID is helping to close the diagnostics gap. Through its partners, UNITAID has invested more than US$ 300 million to widen availability to affordable, quality-assured diagnostic technologies in low- and middle-income countries. Crucially, UNITAID is making those tests available where people seek care, even in remote settings, to ensure that young patients quickly get the treatment they need.

Early infant diagnosis (EID) tests are suitable for infants, whereas rapid diagnostic tests are unsuitable for young infants, as a mother’s antibodies can be present in her child’s blood for up to 18 months after birth. UNITAID aims to make EID tests available for less than US$ 30. The test takes less than two hours to run, so infants can get same-day diagnosis and be linked immediately to care. This reduces the number of infants whose results are lost or delayed, and saves on the costs of later diagnosis.

With additional refinements, point-of-care testing of infants could further decrease infant mortality. UNITAID Operations Director Robert Matiru stresses the importance of regular testing. “Testing at birth can tell physicians if a baby was infected in utero,” he says. “But if a child is infected at birth, HIV seroconversion will not be detectable in the blood until weeks later. Re-testing at the recommended 6 weeks is essential.”  

UNITAID currently has projects under way to make point-of-care EID and viral load tests available and affordable in 16 African countries. Innovative platforms, tailored to decentralized health settings, make it easy for health workers to carry out several types of tests. UNITAID funds operational research to check that each health solution is cost-effective, appropriate to the setting and scalable. The insights gained from this work in turn inform treatment guidelines, national plans and policies for preventing and treating HIV, and global HIV strategies, feeding back into a cycle of ever-more effective programmes.

In the 2016 report on the state of the global tuberculosis (TB) epidemic and response, the World Health Organization announced that there were an estimated 10.4 million new TB cases in 2015, higher than previous estimates. However, only 6.1 million TB cases were detected and officially reported in 2015, demonstrating a major gap in finding and testing people who may have TB. Six countries accounted for 60% of the total global burden of TB—China, India, Indonesia, Nigeria, Pakistan and South Africa. Tuberculosis remains a leading cause of death among people living with HIV, despite being curable at low cost. The cost of not treating TB, however, is high in terms of disease spread and death.

In 2015, an estimated 1.8 million people died from TB—of these deaths, 0.4 million occurred among people who were also HIV-positive. More than 20% of people living with HIV and TB disease were not receiving life-saving antiretroviral medicines, a missed opportunity to deliver comprehensive and integrated care and treatment. TB can also be prevented among people living with HIV with early antiretroviral treatment and isoniazid preventive therapy, but uptake of preventive therapy remains inadequate.

A particularly worrying finding from the report is the inadequate response to the rising burden of multi-drug resistant (MDR) TB. Only one in five people who are eligible received treatment for MDR TB in 2015. Furthermore, the cure rate for MDR TB remains disappointingly low, at 52% globally, despite recent improvements in access to new treatments.

Increasing drug resistance is one of the greatest threats to reducing the burden of illness and deaths from infectious diseases, such as HIV, TB and malaria, that prevent many people living in low- and middle-income countries from achieving their full potential. Urgent action is needed to prevent the development and spread of drug resistance, and investment in research to find new therapies to replace those rendered ineffective through drug resistance is critical.

People living with HIV have been at the forefront of the AIDS response from the beginning, as equal partners providing solutions on how to provide services and demanding the respect and rights of everyone affected by HIV.

“LIVING 2016: positive leadership summit” saw 300 people living with HIV from all around the world gather together on 16 and 17 July in Durban, South Africa, ahead of the 21st International AIDS Conference.

The participants discussed the needs of people living with HIV and the community-led response to access to quality and rights-based services, stigma and discrimination, criminalization and violence, access to treatment and sexual and reproductive health and rights

The meeting reviewed the successes since AIDS 2000, held in Durban, but highlighted the remaining challenges: only half of people living with HIV have access to treatment, more than 1 million people living with HIV die every year, resources for the AIDS response are declining, stigma and discrimination remain barriers to access to services and inequities in access are costing lives.

The greater and meaningful involvement of people living with HIV was a cross-cutting theme throughout the two-day meeting.

The participants reaffirmed the diversity of people living with HIV and asserted the need to work together with networks of key populations as advocates to mobilize the resources for an effective AIDS response, to demand and support legal and policy reform that respect everyone’s rights and to hold governments, donors, the United Nations and networks of people living with HIV accountable.

Two innovative technologies for early infant diagnosis of HIV newly prequalified by WHO will allow many more infants to be diagnosed quickly and placed on life-saving treatment.

At a high-level ministerial meeting convened by the Minister of Health of Zimbabwe, David Parirenyatwa, in partnership with UNAIDS, more than 11 ministers of health from eastern and southern Africa called for both policy and programmatic action in order to revitalize HIV prevention, with a continued focus on the scale-up of HIV treatment. The meeting took place at UNAIDS headquarters in Geneva, Switzerland, on 25 May, on the sidelines of the 69th session of the World Health Assembly. 

The ministers called for renewed commitment and accountability on HIV prevention by countries in eastern and southern Africa. They noted that increased investment in HIV prevention, in particular for primary prevention at the local level, is required. The ministers committed to further scaling up effective combination prevention packages and launching a regional leadership platform with both health and non-health sector leaders to drive the agenda on revitalizing HIV prevention in the region. 

Countries in eastern and southern Africa have made progress in reducing new HIV infections among adults, from 1.3 million new HIV infections in 2000 to 840 000 in 2014. However, there were 100 000 more new HIV infections in 2014 among females 15 years and older than among their male counterparts.

The participants also included representatives of the Southern African Development Community, the East African Community, United Nations agencies and development partners. 

In collaboration with UNAIDS and other partners, the United Nations Development Programme (UNDP) and IRTG, a Global Network of Trans Women and HIV, have released a new publication today entitled Implementing comprehensive HIV and STI programmes with transgender people: practical guidance for collaborative interventions. The publication presents concrete steps that public health officials, health workers and nongovernmental organizations can adopt to implement HIV and sexually transmitted infection (STI) programmes with transgender people.

Topics covered in the publication include community empowerment and human rights, addressing violence, stigma and discrimination, and delivering transgender-competent services, especially for HIV and STI prevention, diagnosis, treatment and care. The publication also covers community-led outreach, safe spaces and the use of information and communications technology in service delivery. It describes how to manage programmes and build the capacity of organizations led by transgender people and shows how services can be designed and implemented to be acceptable and accessible to transgender women. Wherever possible, it gives particular attention to programmes run by transgender organizations.

The publication was developed in collaboration with transgender people and advocates, service providers, researchers, government officials and representatives of nongovernmental organizations from all over the world. UNDP and IRTG coordinated its production, with the support of the United Nations Population Fund, the University of California, San Francisco, Center of Excellence for Transgender Health, the Johns Hopkins Bloomberg School of Public Health, the World Health Organization, the United States Agency for International Development, the United States President’s Emergency Plan for AIDS Relief and UNAIDS.

The document is based on recommendations included in the Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations, published in 2014 by the World Health Organization.

Transgender women continue to be heavily affected by HIV, being 49 times more likely to become infected with HIV than non-transgender adults.

The World Health Organization (WHO) hosted a briefing in Geneva, Switzerland, on 1 February on the United Nations Secretary-General’s High-Level Panel on Access to Medicines. Representatives of United Nations missions, international organizations, civil society and the private sector were provided with information on the context for the panel and on opportunities to interact with and submit contributions to its work.

The panel was appointed by Secretary-General Ban Ki-moon in November 2015 to support the attainment of Sustainable Development Goal 3: ensuring healthy lives and promoting the well-being of all. The key outcome of the panel’s work will be an evidence-informed, rights-based analysis of proposals and recommendations to promote the development and production of health technologies in a way that balances trade, human rights and public health.

Through a call for contributions and a series of hearings and global dialogues, the 16 members of the panel and its expert advisory group will consider a number of proposals and recommendations across all diseases, technologies and populations in low-, middle- and high-income countries in order to ensure that no one is left behind.

The United Nations Development Programme, in collaboration with UNAIDS, will serve as the secretariat for the panel, which will present its final report to the Secretary-General in June 2016.

New guidelines are a major step towards achieving UNAIDS Fast-Track Targets

GENEVA, 30 November 2015—UNAIDS has welcomed the release by the World Health Organization (WHO) of new guidelines on the use of antiretroviral medicines as a significant step towards improving the lives of people living with HIV and reducing the transmission of the virus.

The guidelines recommend that antiretroviral medicines be prescribed to people as soon as possible after their HIV diagnosis regardless of their CD4 count (CD4 is a measure of immune system health).The guidelines also recommend that people at higher risk of HIV infection be given access to pre-exposure prophylaxis (PrEP) as part of a combined HIV prevention strategy.

“These new guidelines and recommendations are a highly significant moment in the AIDS response,” said Michel Sidibé, Executive Director of UNAIDS. “The medicines and scientific tools now at our disposal provide us with a real opportunity to save millions of lives over the coming years and to end the AIDS epidemic by 2030.”

The WHO guidelines, produced with the support of UNAIDS, are being released following the increased weight of research evidence that has emerged over the past 12 months. This included data from the international randomized clinical trials Temprano and START (Strategic Timing of Antiretroviral Treatment), which found compelling evidence of the benefits of immediately starting antiretroviral therapy. The data from Temprano and START followed a series of research findings over several years demonstrating the health benefits of starting HIV treatment earlier.

Several research studies among groups at higher risk of HIV infection have also indicated the significant efficacy of PrEP in reducing new HIV infections. The new guidelines recommend that PrEP be offered to anybody at substantial risk of HIV exposure.            

The guidelines will also help reinforce the UNAIDS Fast-Track approach, which encompasses a set of targets to be reached by 2020. The targets include 90% of all people living with HIV knowing their HIV status, 90% of people who know their HIV-positive status having access to treatment and 90% of people on treatment having suppressed viral loads. They also include reducing new HIV infections by 75% and achieving zero discrimination.

“We are at a crossroads in the response to AIDS,” said Mr Sidibé. “We know what works – now we need to put people first and fully respect their right to health.”

UNAIDS reaffirms the importance of respecting a person’s right to know their HIV status and to decide whether and when to begin antiretroviral therapy. HIV prevention and treatment decisions must be well-informed and voluntary. Wider and more equitable delivery of antiretroviral therapy and PrEP will require increased efforts to address the social and legal barriers that inhibit access to health services for people living with HIV and for key populations at higher risk of infection. 

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.