New report from UNAIDS shows that the number of people accessing antiretroviral medicines has more than doubled since 2010

GENEVA/NAIROBI, 31 May 2016—An estimated 17 million people were accessing life-saving antiretroviral medicines at the end of 2015, with an additional 2 million people gaining access over a 12-month period. The announcement, made in a new UNAIDS report entitled Global AIDS update 2016, comes as world leaders prepare to gather for the United Nations General Assembly High-Level Meeting on Ending AIDS, to take place in New York, United States of America, from 8 to 10 June 2016.

The extraordinary scale-up of antiretroviral treatment since 2010 by many of the world’s most affected countries has reduced AIDS-related deaths from 1.5 million in 2010  [1.3 million–1.7  million] to 1.1 million [940 000–1.3 million]  in 2015. As more countries adopt new guidelines from the World Health Organization to treat everyone diagnosed with HIV immediately, public health benefits are being realized for individuals and for wider society.

“The full potential of antiretroviral therapy is being realized,” said Michel Sidibé, Executive Director of UNAIDS. “I urge all countries to seize this unprecedented opportunity to put HIV prevention and treatment programmes on the Fast-Track and end the AIDS epidemic by 2030.”

Global coverage of antiretroviral therapy reached 46% [43–50%] at the end of 2015. Gains were greatest in the world’s most affected region, eastern and southern Africa, where coverage increased from 24% [22–25%] in 2010 to 54% [50–58%] in 2015, reaching a total of 10.3 million people. In South Africa, 3.4 million people had access to treatment, followed by Kenya with nearly 900 000. Botswana, Eritrea, Kenya, Malawi, Mozambique, Rwanda, South Africa, Swaziland, Uganda, the United Republic of Tanzania, Zambia and Zimbabwe all increased treatment coverage by more than 25 percentage points between 2010 and 2015.

The report was launched in Nairobi, Kenya, one of the countries showing the most remarkable progress in expanding access to antiretroviral medicines and reducing the number of new HIV infections.

“The Kenyan government, in partnership with UNAIDS and other development partners, is committed to the Fast-Track approach to ending AIDS as a public health threat by 2030,” said Cleopa Mailu, Kenya’s Cabinet Secretary for Health. “We must catalyse investments across different sectors, with a focus on cost-effective and socially inclusive programmes, if we are to succeed.”      

The UNAIDS Fast-Track approach to treatment is proven to work in countries adopting it. The momentum must continue to achieve the UNAIDS 90–90–90 treatment target by 2020, whereby 90% of people living with HIV know their status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads. Reaching the 2020 treatment target will set the world on course to end the AIDS epidemic by 2030 as part of the Sustainable Development Goals.

Reinvigorating HIV prevention

Preventing new HIV infections by countering stigma and discrimination and ensuring that 90% of people have access to HIV combination prevention services will also be crucial to ending the AIDS epidemic.

The UNAIDS report shows that declines in new HIV infections among adults have slowed alarmingly in recent years, with the estimated annual number of new infections among adults remaining nearly static at about 1.9 million [1.7 million–2.2 million]. The global figure masks striking regional disparities that must be addressed to achieve the reductions required to end the AIDS epidemic by 2030.  

The largest reduction in new adult infections occurred in eastern and southern Africa. There were about 40 000 fewer adult HIV infections in the region in 2015 than in 2010, a 4% decline. More gradual declines were achieved in the Asia and Pacific region and western and central Africa. Rates of new adult HIV infections were relatively stable in Latin America and the Caribbean, western and central Europe, North America, the Middle East and North Africa. However, the annual number of new HIV infections in eastern Europe and central Asia increased by 57%.    

People being left behind

In the report, UNAIDS urges countries to continue to scale up HIV prevention efforts while continuing to roll out treatment, since many people are still not being reached. Young people and adolescents, especially young women and girls, are still being left behind in the AIDS response. Adolescent girls and young women 15–24 years old are at higher risk of HIV infection globally, accounting for 20% of new HIV infections among adults globally in 2015, despite accounting for just 11% of the adult population. In sub-Saharan Africa, adolescent girls and young women account for 25% new HIV infections among adults. Harmful gender norms and inequalities, obstacles to education and sexual and reproductive health services, poverty, food insecurity and violence are the key drivers of this increased vulnerability.

The report also shows that more than 90% of new HIV infections in central Asia, Europe, North America, the Middle East and North Africa in 2014 were among people from key populations and their sexual partners, including gay men and other men who have sex with men, sex workers and people who inject drugs. In sub-Saharan Africa, key populations accounted for more than 20% of new HIV infections. These groups of people are still not being reached with HIV prevention and treatment services despite having the highest rates of HIV prevalence.

The report urges countries to work closely with partners, particularly civil society, communities and people living with HIV, to ensure that they know where their epidemics are concentrated and that they have the right services in the right places. 

“We need a people-centred response to the AIDS epidemic that removes all obstacles in the path of people’s access to HIV prevention and treatment services,” said Mr Sidibé. “These services must be fully funded and appropriate to people’s needs so that we can end the AIDS epidemic for everybody.”   

The report outlines that science, evidence and policy have opened up a unique opportunity to end the AIDS epidemic by 2030 as part of the Sustainable Development Goals. The global community has to unite around this common goal to realize the full potential of the opportunities or risk the epidemic being prolonged indefinitely.

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.

The First Lady of Panama, Lorena Castillo de Varela, said that accelerating the AIDS response and empowering women and girls is key to ending the AIDS epidemic

GENEVA, 23 May 2016—At a high-level side event held during the 69th session of the World Health Assembly, taking place in Geneva, Switzerland, delegates have urged countries to end gender inequity in the response to HIV by putting women and adolescent girls on the Fast-Track to ending the AIDS epidemic. Lorena Castillo de Varela, First Lady of Panama and UNAIDS Special Ambassador for AIDS in Latin America, hosted the event. Ms Castillo de Varela stressed the importance of women assuming leadership roles to ensure the development of programmes and policies fitting to their needs.

“Limited access to health care and education, coupled with systems and policies that do not address the needs of young people, are obstacles that block adolescent girls and young women from being able to protect themselves against HIV, particularly as they transition into adulthood,” said Ms Castillo de Varela. “To reduce HIV infections and AIDS-related deaths, we must advance gender equality, women’s empowerment and autonomy to ensure that girls and young women make independent decisions about their own health and are able to live free from all forms of violence.”

The high-level side event focused on three topics, the elimination of new HIV infections among children, HIV prevention in adolescent girls and young women and access to HIV treatment for all.

The engagement and empowerment of women as leaders, policy makers, implementers and peer supporters combined with increased access to effective HIV treatment and prevention has proved essential in the success of global efforts to eliminate new HIV infections among children, which have decreased by more than half, from 520 000 a year in 2000 to 220 000 in 2014. This comprehensive and inclusive approach now has to be widened to include all people living with HIV, including young women and girls.

“We need a combined, holistic approach and interventions that support adolescent girls and women,” said HIV activist of the Salamander Trust, Angelina Namiba. “It is crucial that women living with HIV are meaningfully involved at all stages of these interventions right from design to delivery.”

Globally, AIDS remains the leading cause of death among women of reproductive age. In 2014, there were around 220 000 new HIV infections worldwide among adolescents (aged 15 to 19 years), with adolescent girls accounting for 62% of new HIV infections among this age group. In 2014, AIDS was the leading cause of death in adolescents in sub-Saharan Africa.

Gender-based violence, gender inequity, harmful gender norms, stigma and discrimination often prevent women and girls from knowing their HIV status and accessing appropriate HIV prevention and treatment services. It is estimated that of 670 000 adolescent girls aged 15 to 19 living with HIV, only one in five knows she is HIV-positive.

The UNAIDS Fast-Track approach focuses on ensuring that at least 90% of adolescents and young women and men (as well as other groups at higher risk of HIV infection) have access to combination HIV prevention and sexual and reproductive health and rights services and that they are empowered with the skills, knowledge and capability to protect themselves from HIV by 2020.

In addition to scaling up HIV prevention, the roll-out of access to HIV treatment is critical. The World Health Organization’s global health sector strategy on HIV, 2016–2021, being discussed at this week’s World Health Assembly reiterates UNAIDS’ 90–90–90 treatment target. This will require that 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing antiretroviral treatment and 90% of people on treatment have suppressed viral loads. To achieve this, innovative models of service delivery will be critical to ensuring that adolescents and young people are diagnosed early, rapidly linked to treatment services, helped to adhere to treatment and retained in care to make sure they stay healthy. These services must be accessible, affordable and sensitive to the needs of women and girls. Other Fast-Track targets include achieving fewer than 500 000 new HIV infections a year by 2020 and reaching zero discrimination.

Switzerland and Zambia, who were among the sponsors of the event in Geneva, are co-facilitators of the United Nations General Assembly High-Level Meeting on Ending AIDS. As co-facilitators they will take forward the summary outcomes of this World Health Assembly side event to help inform discussions at the High-Level Meeting, which will take place in New York, United States of America, from 8 to 10 June 2016.

Quotes

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.

Antiretroviral therapy to be offered to all people living with HIV as soon as possible after HIV-positive diagnosis

GENEVA, 13 May 2016—The Government of South Africa has announced a major policy shift that will move the world faster towards the global 90–90–90 treatment target. On 10 May 2016, the South African Minister of Health, Aaron Motsoaledi, announced in his Health Budget Vote Speech to the Parliament of South Africa that the country will implement a new evidence-based policy of offering HIV treatment to all people living with HIV by September 2016. This ground-breaking announcement brings South Africa, which already has the world’s largest HIV treatment programme, in line with the latest World Health Organization guidelines on HIV treatment. South Africa is among the first countries in Africa to formally adopt this policy.

South Africa already encourages everyone who is HIV-negative or who does not know their HIV status to be tested for HIV at least once a year. However, instead of having to undergo an additional test of the immune system (the CD4 cell count) to determine eligibility for treatment, people who are diagnosed HIV-positive will be offered HIV treatment as soon as possible after diagnosis.

“South Africa takes another bold step towards ending its AIDS epidemic by 2030, once again demonstrating that scientific evidence, paired with political will, saves lives,” said UNAIDS Executive Director Michel Sidibé.

This major advance comes only months after the government announced that it will provide pre-exposure prophylaxis (PrEP) to sex workers in 10 sex worker programmes from June this year. South Africa is also considering whether to expand the offer of PrEP to prevent HIV in vulnerable young women, based on the lessons learned from demonstration projects.

These combined efforts demonstrate the South African Government’s commitment to maximizing the benefits of antiretroviral medicines for both the prevention and treatment of HIV. This approach has proved to be highly effective in reducing new HIV infections and AIDS-related deaths in high-prevalence settings, such as South Africa.

Provision of HIV treatment for all is estimated to cost an additional US$ 66 million per year and will be paid for by South Africa from domestic resources in this year’s budget.

While much success has been achieved by the country’s HIV treatment programme, with approximately 3.5 million people on HIV treatment today, the number of new HIV infections is unacceptably high, with an estimated 340 000 new HIV infections in 2014.

“The United Nations has a vision to transform the world through the 2030 Agenda for Sustainable Development,” said Mr Motsoaledi. “Ending the AIDS epidemic as a public health threat by 2030 is among the Sustainable Development Goals. The South African Department of Health is committed to this goal and achieving a long and healthy life for all South Africans.”

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.

New report from the United Nations Secretary-General warns that major gains could be lost if action does not accelerate over the next five years and urges countries to react by front-loading investments and increasing action

NEW YORK, 06 May 2016—A new report released by the United Nations Secretary-General, Ban Ki-moon, warns that the AIDS epidemic could be prolonged indefinitely if urgent action is not implemented within the next five years. The report, On the Fast-Track to end the AIDS epidemic, reveals that the extraordinary acceleration of progress made over the past 15 years could be lost and urges all partners to concentrate their efforts to increase and front-load investments to ensure that the global AIDS epidemic is ended as a public health threat by 2030.

“The AIDS response has delivered more than results. It has delivered the aspiration and the practical foundation to end the epidemic by 2030,” said Mr Ban in the report. “But if we accept the status quo unchanged, the epidemic will rebound in several low- and middle-income countries. Our tremendous investment, and the world’s most inspiring movement for the right to health, will have been in vain.”

The review of progress looks at the gains made, particularly since the 2011 United Nations Political Declaration on HIV and AIDS, which accelerated action by uniting the world around a set of ambitious targets for 2015. “The progress made has been inspiring,” said Mr Ban in the report. “Reaching 15 million people with antiretroviral therapy nine months before the December 2015 deadline is a major global victory.” The report outlines that the rapid treatment scale-up has been a major contributing factor to the 42% decline in AIDS-related deaths since the peak in 2004 and notes that this has caused life expectancy in the countries most affected by HIV to rise sharply in recent years.

The report underlines the critical role civil society has played in securing many of the gains made and the leadership provided by people living with HIV. Community efforts have been key to removing many of the obstacles faced in scaling up the AIDS response, including reaching people at risk of HIV infection with HIV services, helping people to adhere to treatment and reinforcing other essential health services.

A major area of success has been in reducing new HIV infections among children. In 2011 UNAIDS and partners launched the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive at the UN General Assembly High-level meeting on AIDS and in just five years, from 2009 to 2014, new HIV infections have been halved in the countries that account for 90% of all pregnant women living with HIV. Some around 85 countries are now poised to virtually eliminate new HIV infections among children.

In the report, however, Mr Ban also calls the shortfalls in the implementation of the 2011 Political Declaration on HIV and AIDS distressing, revealing that even as new HIV prevention tools and approaches have emerged, HIV prevention programmes have weakened in recent years owing to inadequate leadership, weak accountability and declining funding. He notes that new HIV infections declined by just 8% between 2010 and 2014.

The report draws attention to regions where new HIV infections are continuing to rise—eastern Europe and central Asia, where new HIV infections rose by 30% between 2000 and 2014, mostly among people who inject drugs, the Middle East and North Africa and the Asia–Pacific region.

It notes that gender norms that perpetuate inequality continue to prevail across many societies and that girls and young women remain particularly affected by HIV. Of the 2.8 million young people aged 15–24 years living with HIV in sub-Saharan Africa, 63% were female.

The report highlights that despite the progress made on expanding access to antiretroviral therapy, around 22 million people still do not have access to treatment. The report attributes the most substantial barrier to scaling up HIV treatment as late diagnosis, highlighting that around half of all people living with HIV are unaware of their HIV status—this underscores the urgency of increasing access to HIV testing, particularly for people at higher risk of infection.

Despite the challenges outlined in the report, it does offer substantial hope for the future, stating that if the world can alter the status quo, the AIDS epidemic can be ended as a public health threat by as soon as 2030. To do this, the report outlines that the response needs to be inclusive, accessible and grounded in human rights and that it must focus on scaling up services for the people and places most in need. The report also emphasizes the necessity of repealing punitive laws and repressive policies that criminalize same-sex sexual relations, people who use drugs and sex workers, since they impede access to services. 

“We must reinforce rights-based approaches, including those that foster gender equality and empower women,” said Mr Ban in the report. “Access to services must be ensured for the people most affected, marginalized and discriminated against including people living with HIV, young women and their sexual partners in sub-Saharan Africa, children and adolescents everywhere, and gay men and other men who have sex with men, sex workers and their clients, people who inject drugs, transgender people, people in prison, people with disabilities, migrants and refugees.”  

The report gives strong emphasis to the links between the response to HIV and the success of the Sustainable Development Goals (SDGs), underlining the strong links to SDG 3 (ensure healthy lives and promote well-being for all), SDG 5 (achieve gender equality and empower women and girls), SDG 10 (reduce inequality in access to services and commodities), SDG 16 (promote just, peaceful and inclusive societies) and SDG 17 (revitalize the partnership for sustainable development).  

The report notes that the scale-up of resources in recent years has been a strong driving force behind the progress made in responding to HIV. It estimates that in 2014 US$ 19.2 billion was available in low- and middle-income countries for the response to HIV and that by 2020 resources need to increase to an estimated US$ 26.2 billion to achieve the 2030 target of ending the AIDS epidemic.

The report urges countries to embrace the UNAIDS Fast-Track approach to ending the AIDS epidemic, which will require reaching an ambitious set of goals by 2020, including reducing the numbers of people newly infected with HIV and people dying from AIDS-related causes to fewer than 500 000 per annum and eliminating HIV-related discrimination. Targets to reach these goals include reaching the 90–90–90 treatment target for 2020, which calls for 90% of people living with HIV to know their status, 90% of people who know their HIV-positive status to access treatment and 90% of people on treatment to have suppressed viral loads.

A new UNAIDS report says insufficient coverage of harm reduction programmes and policies that criminalize and marginalize people who inject drugs are failing to reduce new HIV infections

GENEVA, 15 April 2016—Ahead of the United Nations General Assembly Special Session on the World Drug Problem, which will take place from 19 to 21 April in New York, United States of America, UNAIDS has released a new report entitled Do no harm: health, human rights and people who use drugs.

The report shows that the failure of many countries to adopt health- and rights-based approaches resulted in no reduction in the global number of new HIV infections among people who inject drugs between 2010 and 2014. The world has missed the United Nations General Assembly’s target set in 2011 to reduce HIV transmission among people who inject drugs by 50% by 2015. 

“Business as usual is clearly getting us nowhere,” said Michel Sidibé, Executive Director of UNAIDS. “The world must learn the lessons of the past 15 years, following the example of countries that have reversed their HIV epidemics among people who inject drugs by adopting harm reduction approaches that prioritize people’s health and human rights.”  

The UNAIDS report presents the evidence base for five policy recommendations and 10 operational recommendations that countries should apply to turn around their HIV epidemics among people who inject drugs. These recommendations include the implementation of harm reduction programmes to scale and the decriminalization of the consumption and possession of drugs for personal use.

Data demonstrate that countries implementing health- and rights-based approaches have reduced new HIV infections among people who inject drugs. In other countries, strategies based on criminalization and aggressive law enforcement have created barriers to harm reduction while having little or no impact on the number of people who use drugs. Imprisoning people for the consumption and possession of drugs for personal use also increases their vulnerability to HIV and other infectious diseases, such as hepatitis B, hepatitis C and tuberculosis, while incarcerated.

UNAIDS has developed the UNAIDS 2016–2021 Strategy to put the world on track to ending the AIDS epidemic as a public health threat by 2030—a target within the Sustainable Development Goals. A critical target within this Fast-Track approach is the expansion of a combination of HIV prevention and harm reduction services to reach 90% of people who inject drugs by 2020.

Achieving this target would require annual investment in outreach, needle–syringe distribution and opioid substitution therapy in low- and middle-income countries to increase to US$ 1.5 billion by 2020—a fraction of the estimated US$ 100 billion already spent each year to reduce the supply of and demand for narcotic drugs. In many middle-income countries with large populations of people who inject drugs, harm reduction is funded predominantly by international donors and private foundations.

The UNAIDS report provides many examples of countries that are delivering better outcomes for people who inject drugs by adopting a health-centred approach.

• The free voluntary methadone programme piloted in China in the early 2000s now serves more than 180 000 people. People who inject drugs accounted for less than 8% of people newly diagnosed with HIV in the country in 2013, compared with 43.9% in 2003.
• In prisons in the Islamic Republic of Iran, health clinics provide integrated services for the treatment and prevention of sexually transmitted infections and for injecting drug use and HIV, including the distribution of condoms, sterile injecting equipment and opioid substitution therapy. At the end of 2014, 81.5% of people who inject drugs surveyed reported the use of sterile injecting equipment the last time they injected. Newly reported HIV cases among people who inject drugs in the Islamic Republic of Iran fell from a peak of 1897 in 2005 to 684 in 2013.
• A peer-to-peer outreach programme in five cities began in 2011 in Kenya encouraging people to use sterile equipment when injecting drugs. At the beginning of the pilot, 51.6% of people who inject drugs reported the use of a sterile syringe the last time they injected; this had risen to 90% by 2015.
• In the Republic of Moldova, the prison system has gradually expanded a comprehensive harm reduction programme started in 1999 that includes needle, syringe and condom distribution as well as opioid substitution therapy. Coverage of antiretroviral therapy among prisoners living with HIV increased from 2% in 2005 to 62% in 2013.
• In 2000, Portugal passed a law that downgraded the purchase, possession and consumption of small amounts of narcotic drugs from criminal to administrative offences while increasing investment in health-based programmes. In 2013, among a total of 1093 new HIV infections reported, just 78 were related to drug use; in 2000 there were 1497 new HIV infections among people who use drugs among a total of 2825 new HIV infections. A similar downward trend among drug users has been observed for new infections of hepatitis C and B.  

As well as being humane and health-oriented, people-centred programmes are also cost-effective and deliver wider social benefits, such as lower levels of drug-related crime and reduced pressure on health-care systems. For example, each dollar spent on Australia’s needle–syringe programme has an estimated lifetime return on investment of up to US$ 5.50 in averted health-care costs. Opioid substitution therapy has been shown to be cost-effective in its capacity to reduce HIV infections—its cost-effectiveness substantially increases when its wider health, economic, psychological and social benefits are taken into account. 

“Health is a human right. Investment in people-centred policies and programmes for people who use drugs is the crucial foundation for a global drugs policy that not only saves lives but is also cost-effective,” said Mr Sidibé.

The UNAIDS Fast-Track approach has a set of targets for 2020 that include reducing new HIV infections to fewer than 500 000. It also calls on countries to ensure that 90% of the more than 12 million people who inject drugs worldwide have access to combination HIV prevention services, including needle–syringe programmes, opioid substitution therapy, condoms and access to counselling, care, testing and treatment services for tuberculosis and bloodborne viruses such as HIV and hepatitis B and C.. Achieving these targets will be a significant step towards ending the AIDS epidemic as a public health threat by 2030. 

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.

GENEVA/DAR ES SALAAM, 12 April 2016—UNAIDS International Goodwill Ambassador Her Royal Highness Crown Princess Mette-Marit of Norway has completed a mission to the United Republic of Tanzania to assess progress made in eliminating mother-to-child transmission of HIV and to see how young people are engaging in the country’s AIDS response.

During her visit, Her Royal Highness the Crown Princess visited facilities providing services for women and young people living with HIV and also met with mothers living with HIV whose children have been born free from the virus. She went to one of the 26 PASADA (Pastoral Activities and Services for People with AIDS Dar es Salaam Archdiocese) clinics operating in the Dar es Salaam and Pwani regions that provide HIV prevention, treatment and support services for people and communities most in need. The Crown Princess also engaged with youth activists at the Stepping Stones Community of Practice, which offers life-skills training for adolescents and young people, including comprehensive sexuality education and programmes relating to HIV and gender equality.

“It is moving to meet mothers who are in good health and caring for children born free from HIV thanks to antiretroviral medicines,” said Crown Princess Mette-Marit. “It is also particularly rewarding for me to see young people taking up leadership roles in the AIDS response and being equipped with the skills to guide the United Republic of Tanzania towards an AIDS-free generation.”   

At the end of 2014, there were around 1.5 million people living with HIV in the United Republic of Tanzania. The number of new HIV infections declined by more than 50% between 2000 and 2014 and the number of new HIV infections among children dropped by around 70% between 2009 and 2014 as access to HIV services increased.

Crown Princess Mette-Marit has been engaged in the AIDS response since 2003 and advocates for the empowerment of women and young people at events and speaking engagements all over the world.  

“The Crown Princess is compassionate and committed to improving the lives of young people living with and affected by HIV around the world,” said UNAIDS Executive Director Michel Sidibé. “Her engagement and sincerity are inspiring and we look forward to continuing to work together to achieve our common goal of ending the AIDS epidemic.”

The Crown Princess was accompanied on the visit by the United Republic of Tanzania’s Minister of Health, Community Development, Gender, Seniors and Children, Ummy Mwalimu. Also on the delegation was the Senior Adviser at the Norwegian Ministry of Foreign Affairs, Section for Global Initiatives, Stein Inge Nesvåg, the Norwegian Ambassador to the United Republic of Tanzania, Hanne-Marie Kaarstad, and the Director General of the Norwegian Agency for Development Cooperation, Jon Lomøy.

Her Royal Highness Crown Princess Mette-Marit of Norway is marking 10 years as an International Goodwill Ambassador for UNAIDS.

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.

Civil society urges United Nations Member States to include financing, services and rights commitments as priorities in the 2016 Political Declaration on Ending AIDS

NEW YORK, 6 April 2016—At the Informal Interactive Civil Society Hearing on HIV, civil society organizations have called on United Nations Member States and partners to ensure that the response to HIV is fully funded and that financing for community-led action is increased significantly over the next few years. They also called for 30 million people to have access to life-saving HIV treatment by 2020 and for ambitious HIV prevention targets to be met.

The hearing, convened at the United Nations Headquarters in New York, United States of America, by the President of the United Nations General Assembly, is part of the groundwork for the United Nations General Assembly High-Level Meeting on Ending AIDS, which will take place from 8 to 10 June 2016 in New York. The hearing provides an opportunity for civil society organizations to fully contribute to the preparations, to ensure that their voices are heard and that their interests are reflected, and that their recommendations are taken forward in the drafting of the new Political Declaration on Ending AIDS.

“We are aligned in our objectives of ending the AIDS epidemic by 2030,” said Mogens Lykketoft, President of the United Nations General Assembly. “Now we must work together to ensure a strong Political Declaration on Ending AIDS with clear targets that will lead the world to ending the AIDS epidemic as part of the Sustainable Development Goals.”

Representatives of civil society emphasised the need to reach the people most affected by HIV, who continue to be left behind in the AIDS response including sex workers, men who have sex with men, transgender people and people who inject drugs. The representatives also discussed the importance of ensuring a rights-based approach that is inclusive, based on evidence and people-centred during the interactive panel discussions with Member States.

“To end the AIDS epidemic, no one can be left behind,” said Michel Sidibé, Executive Director of UNAIDS. “Civil society advocacy, engagement and service delivery will play a critical role in translating the targets of the Political Declaration on Ending AIDS into real action on the ground to reach even the most marginalized people with life-saving HIV services.”

Community efforts have proven to be essential in overcoming many of the major challenges in the AIDS response, including reaching people most affected by HIV with life-changing HIV services, providing support to help people adhere to their treatment and bolstering other essential health services. Civil society engagement has also been critical in advocating for new resources, improving HIV programming and making progress on human rights issues.

“The cost of inaction is extremely high,” said Marama Pala, of the International Indigenous Working Group on HIV/AIDS and Co-Chair of the Stakeholder Task Force. “Individual communities are where the work gets done. There is no ending AIDS without us.”

UNAIDS estimates that US$ 26.2 billion will be needed for the AIDS response in low- and middle-income countries in 2020—up from the US$ 19.2 billion available in 2014. UNAIDS also underlines that greater investment in civil society advocacy and community-based service delivery will be critical.

By 2020, UNAIDS estimates that investment in community mobilization needs to increase threefold, to 3% of total HIV resources in low- and middle-income countries. Outreach to key populations in low- and middle-income countries is estimated to need to grow to about 7.2% of total HIV investments by 2020, and the estimated resource needs for community-based delivery of antiretroviral therapy need to increase to about 3.8% of total investment for HIV.

The Informal Interactive Civil Society Hearing on HIV included representatives of nongovernmental organizations, the private sector, organizations and networks representing people living with HIV, women, adolescents and young people, and other stakeholders.

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.

Projected price drops for life-saving HIV treatment and streamlined delivery are driving down costs—investment needs for 2020 are US$ 26 billion

GENEVA, 1 April 2016—Ahead of the United Nations General Assembly High-Level Meeting on Ending AIDS, UNAIDS announced new investment needs to Fast-Track the AIDS response. The projected need of US$ 26.2 billion in 2020 is down from a previous estimate of US$ 30 billion. New findings suggest that the world can reach ambitious Fast-Track targets for preventing new HIV infections, AIDS-related deaths and discrimination with fewer resources.

“Under the Fast-Track approach the world is driving down costs quickly to close the gap between people who have services and people being left behind,” said Michel Sidibé, Executive Director of UNAIDS. “Urgently and fully funding and front-loading investments will save lives and lead us to ending the AIDS epidemic by 2030.”

The new UNAIDS reference document entitled Fast-Track—update on investments needed in the AIDS response explains improvements to the investment model with critical new inputs from the revised 2015 World Health Organization guidelines on HIV treatment. The guidelines recommend HIV treatment for all people living with HIV to reduce illness and deaths, which will increase the total cost of treatment. The guidelines also recommend streamlining care and support services that will contribute to lower costs per patient per year compared to earlier guidelines while retaining quality standards.

Other inputs include new evidence that projects lower costs for HIV medicines and supplies particularly in high burden countries that will further offset the increased investment associated with expanded treatment coverage.

Failure to Fast-Track would translate into an additional 17.6 million HIV infections worldwide and an additional 10.8 million AIDS-related deaths globally between 2016 and 2030.

“The cost of inaction is too high. We have a real opportunity to end the AIDS epidemic by 2030,” said Mr Sidibé. “If we do not quicken the pace of action, millions of people will die needlessly. Failure to Fast-Track risks prolonging the epidemic indefinitely.”

Global solidarity and shared responsibility

The report shows that countries from all economic levels will be required to invest more. Resources available for the AIDS response in low- and middle-income countries were US$ 19.2 billion in 2014. The new projections in the report show that combined domestic and international investment in HIV will need to increase by about one third, to US$ 26.2 billion in 2020. After this peak, projected investments steadily decrease to US$ 22.3 billion in 2030. The Global Fund to Fight AIDS, Tuberculosis and Malaria has announced that it requires US$ 13 billion from 2017 to 2019 to close the investment gap for the three diseases.

To reach the Fast-Track targets, total annual international assistance for HIV must increase by US$ 2.8 billion compared with 2014 levels. This includes an additional US$ 1.8 billion for low-income countries and an additional US$ 1.9 billion for lower-middle-income countries, while upper-middle-income countries' international assistance declines. The remaining annual international investment in upper-middle-income countries of US$ 0.5 billion in 2020 is required for countries with a particularly high burden of HIV, and challenges are expected regarding the transition to self-reliance and the provision of services to key populations.

Building on the principles of global solidarity and shared responsibility, the report includes the results of an analysis of the fiscal space of Fast-Track countries. This analysis indicates that the largest potential increase in future financing for the AIDS response could be achieved by increasing domestic health budgets, with the allocation for HIV services proportional to national disease burden. This would enable the majority of countries to finance the Fast Track approach. However, countries with the lowest income and highest burden of HIV will continue to require international support.

Investing in communities

Greater investment in civil society and community-based service delivery is critical to the Fast-Track approach. Outreach to key populations in low- and middle-income countries should grow to 7.2% of total investments by 2020, and the estimated resource needs for community-based delivery of antiretroviral therapy should grow to 3.8% of total investment. Social enablers—including advocacy, political mobilization, law and policy reform, human rights, and stigma reduction—should reach 8% of total expenditure by 2020.

Investment needs for HIV prevention—including condom promotion, prevention of mother-to-child transmission, pre-exposure prophylaxis, voluntary medical male circumcision and a proportion of outreach to key populations—increase from US$ 4.5 billion in 2016 to US$ 7.3 billion in 2020.

Data show early indications that country adoption of the Fast-Track approach is working. Since 2012, levels of HIV service coverage have increased and over the same time period there has been a decline in new HIV infections and AIDS-related deaths. Between the end of 2012 and the end of 2014, HIV treatment coverage increased by 3.6 million (37%) and the annual coverage of services to prevent mother-to-child transmission of HIV increased by 140 000 (16%) in low- and middle-income countries. During the same time period, annual coverage of voluntary medical male circumcision increased by 1.4 million (82%) in 14 priority countries.

Ending AIDS as a public health threat by 2030

The new projections bring the world closer to the Sustainable Development Goal target of ending AIDS as a public health threat by 2030. The annual global number of new HIV infections will fall by nearly 90% compared to 2010, and AIDS-related deaths will fall by 79% compared to 2010. Scientific advances in the next few years are expected to push future projections to attain the targeted 90% reduction in AIDS-related deaths.

The UNAIDS 2016–2021 Fast-Track Strategy has established a set of three people-centred goals and 10 measurable targets that must be met by 2020 to end the AIDS epidemic by 2030. This includes achieving the 90–90–90 treatment target for 2020 whereby 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing antiretroviral treatment and 90% of people on treatment to have suppressed viral loads. Other targets include zero infections among children and that 90% of women and men, especially young people and people living in high-prevalence settings, have access to HIV combination prevention and sexual and reproductive health services. The targets are firmly based on an approach that leaves no one behind and that is grounded in human rights. If achieved, global health outcomes will be significantly improved.

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.