Shifting demographics of the AIDS epidemic demands a new focus to reach people above the age of 50––a population currently underserved by HIV services.

GENEVA, 1 November 2013—The United Nations Joint Programme on HIV/AIDS (UNAIDS) has released a supplement to the 2013 UNAIDS Report on the global AIDS epidemic focused on the issue HIV and aging.

The supplement reveals that out of the global total of 35.3 million [32.2 million – 38.8 million] people living with HIV, an estimated 3.6 million [3.2 million–3.9 million] are people aged 50 years or older. The majority––2.9 million [2.6 million–3.1 million]—are in low-and middle-income countries where the percentage of adults living with HIV who are 50 years or older is now above 10%. The supplement also reveals that in high-income countries almost one-third of adults living with HIV are 50 years or older.

“People 50 years and above are frequently being missed by HIV services,” said Michel Sidibé, UNAIDS Executive Director. “This is costing lives. Much more attention needs to be given to their specific needs and to integrating HIV services into other health services which people 50 years and over may already have access to.”

The “aging” of the HIV epidemic is due to three main factors: the success of antiretroviral therapy in prolonging the lives of people living with HIV, decreasing HIV incidence among younger adults––shifting the disease burden to older ages, and that people aged 50 and above are engaging in risk taking behaviour such as unprotected sex and injecting drug use which are leading to new HIV infections.

The supplement highlights that HIV prevention services, including HIV testing, tailored to the needs of people aged 50 and above, are essential and that these services should also reflect the needs of key populations in this age group. The supplement also outlines the importance of timely initiation of antiretroviral therapy as the immune system weakens with age.

The supplement concludes that HIV responses therefore need to adapt to this important demographic trend. It also underlines the need to integrate HIV services for people over the age of 50 with other health screening services available to this age group.

World closing in on Millennium Development Goal 6, globally the AIDS epidemic has been halted and reversed—race is on to reach universal access to HIV treatment.

GENEVA, 23 September 2013—As world leaders prepare to meet at the United Nations General Assembly to review progress towards the Millennium Development Goals—a new report from the Joint United Nations Programme on HIV/AIDS (UNAIDS) shows dramatic acceleration towards reaching 2015 global targets on HIV.  

New HIV infections among adults and children were estimated at 2.3 million in 2012, a 33% reduction since 2001. New HIV infections among children have been reduced to 260 000 in 2012, a reduction of 52% since 2001. AIDS-related deaths have also dropped by 30% since the peak in 2005 as access to antiretroviral treatment expands.

By the end of 2012, some 9.7 million people in low- and middle-income countries were accessing antiretroviral therapy, an increase of nearly 20% in just one year. In 2011, UN Member States agreed to a 2015 target of reaching 15 million people with HIV treatment. However, as countries scaled up their treatment coverage and as new evidence emerged showing the HIV prevention benefits of antiretroviral therapy, the World Health Organization set new HIV treatment guidelines, expanding the total number of people estimated to be in need of treatment by more than 10 million.

“Not only can we meet the 2015 target of 15 million people on HIV treatment—we must also go beyond and have the vision and commitment to ensure no one is left behind,” said Michel Sidibé, Executive Director of UNAIDS.

Significant results have also been achieved towards meeting the needs of tuberculosis (TB) patients living with HIV, as TB-related deaths among people living with HIV have declined by 36% since 2004.

Despite a flattening in donor funding for HIV, which has remained around the same as 2008 levels, domestic spending on HIV has increased, accounting for 53% of global HIV resources in 2012. The total global resources available for HIV in 2012 was estimated at US$ 18.9 billion, US$ 3-5 billion short of the US$ 22-24 billion estimated to be needed annually by 2015. 

As well as outlining new global HIV estimates, the 2013 UNAIDS Report on the global AIDS epidemic reviews progress on ten specific targets which were set by United Nations Member States in the 2011 UN Political Declaration on HIV and AIDS.

The report finds that progress has been slow in ensuring the respect of human rights, securing access to HIV services for people most at risk of HIV infection, particularly people who use drugs, and in preventing violence against women and girls––a key factor in vulnerability to HIV. Gender inequality, punitive laws and discriminatory actions are continuing to hamper national responses to HIV and concerted efforts are needed to address these persistent obstacles to the scale up of HIV services for people most in need.

The 2013 UNAIDS Report on the global AIDS epidemic is available on line at unaids.org

Donor disbursements in 2012 totalled US$ 7.86 billion

GENEVA/Washington D.C., 23 September 2013––As world leaders prepare to meet to review progress towards the Millennium Development Goals, a report from the Kaiser Family Foundation and the Joint United Nations Programme on HIV/AIDS (UNAIDS) evaluates international efforts to finance the response to the AIDS epidemic. The annual funding analysis finds donor governments disbursed US$ 7.86 billion toward the AIDS response in low-and middle-income countries in 2012, essentially unchanged from the US$ 7.63 billion level in 2011 after adjusting for inflation.

Overall, donor government funding for HIV has stayed at about the same level since 2008 - a plateau that followed a period of dramatic growth that saw donor nation support increase more than six-fold between 2002 and 2008. This flattening mirrors a similar trend in development assistance more generally, reflecting the economic and fiscal constraints of the post-financial-crisis period.

The United States government remains the largest donor to HIV efforts, contributing US$5 billion in 2012 towards the AIDS response in low-and middle-income countries and to the Global Fund, up slightly from the US$ 4.5 billion in 2011. The U.S. increase results from a quickened disbursement rate of previously approved funding.

"After years of sharp increases in donor government support which led to significant progress in the fight against the HIV epidemic, funding flattened after the worldwide recession and is likely to remain flat for the immediate future," said Kaiser Family Foundation President and CEO Drew Altman.

"We are at a critical moment in the AIDS response," said Luiz Loures, Deputy Executive Director, Programme, UNAIDS, "Scientific advances and new guidelines are providing opportunities to accelerate action and expand access to lifesaving HIV services. To take full advantage of these opportunities all efforts must be made to ensure the response to HIV is fully funded."

Five donor governments - Australia, Canada, Japan, Sweden, and the U.S. - reported increased total assistance for HIV in 2012, with U.S. assistance increasing by just more than US$ 500 million. Six decreased funding in 2012: Denmark, France, Ireland, the Netherlands, the U.K., and the European Commission. Three donor governments - Germany, Italy, and Norway - stayed constant in their support in 2012. The report found that the great majority, US$ 6 billion, of international HIV assistance is provided bilaterally.

The United States accounted for nearly two-thirds (63.9%) of disbursements from donor governments bilaterally and multilaterally. The United Kingdom was the second largest donor (10.2%), followed by France (4.8%), Germany (3.7%), and Japan (2.7%). When viewed as a share of national economies, Denmark provided the highest amount of resources for HIV in 2012, followed by the U.K, Sweden, the U.S., and Ireland.

The new report, produced as a partnership between the Kaiser Family Foundation and UNAIDS, provides the latest data available on donor funding based on data provided by governments.

This report is based on analysis of data of 24 donor government members of the Organization for Economic Co-operation and Development's Assistance Committee. It includes their combined bilateral assistance to low- and middle-income countries, and contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria, as well as to UNITAID. 

ABUJA, Nigeria, 15 July 2013—A report launched today at the Special Summit of the African Union on HIV/AIDS, Tuberculosis and Malaria highlights increased, targeted health spending as an essential foundation to greater economic growth and development in Africa. The report, Abuja +12: Shaping the future of health in Africa, published by the African Union (AU) and the Joint United Nations Programme on HIV/AIDS (UNAIDS), reviews progress made since the AU’s 2001 Abuja Declaration—in which leaders pledged to mobilize domestic and international resources for health and remove barriers to the AIDS response—highlights remaining gaps, and prioritizes next steps.

“Africa’s health and our prosperity are inextricably linked.  2001 was a turning point for Africa as African countries committed to take greater responsibility for the health and wellbeing of their citizens,” said Dr Mustapha Sidiki Kaloko, AU Commissioner for Social Affairs. “Since then, we have invested greater resources and efforts to address AIDS, TB and malaria which has produced exceptional results. We urge all AU member states to commemorate Abuja+12 with a renewed commitment to prioritize health and achieve their commitments and targets by 2015.”

The new report highlights five main recommendations for a healthier Africa: unifying leadership, generating innovative financing, making smarter investments in health, strengthening human resources and ensuring no one is left behind. Together, these recommendations aim to leverage health as a force for economic growth and social progress across Africa.

The report also highlights recent successes in the HIV, TB and malaria responses in Africa, including substantial reductions in the number of new HIV and TB infections and deaths from malaria. There is now much broader access to antiretroviral and TB medications and use of malaria control strategies such as insecticide-treated bed nets and indoor residual spraying are becoming more widespread.

“Twelve years ago, African leaders pledged to unite in addressing the health crises which were devastating the continent—and succeeded in making historic progress,” said Michel Sidibé, Executive Director of UNAIDS. “A renewed and bold commitment here in Abuja is essential as drawing from experiences in the AIDS response, we know that smart investments will save lives, create jobs, reinvigorate communities and further boost economic growth in Africa.”

The report cites a number of approaches pioneered as part of the AIDS response that can help improve returns on health investments. These include using investment frameworks to prioritize spending on the most cost-effective interventions; focusing efforts on people most in need; and reducing front-line health care costs by shifting tasks, where appropriate, from physicians to nurses, community health workers or other health practitioners. On strengthening health governance in Africa, the report notes that the principles that have been fundamental to the success of the AIDS response can be leveraged for the post-2015 agenda to advance coordination, innovation and commitment.

A central element of the 2001 Abuja Declaration was the commitment to allocate at least 15% of public expenditures to health by 2015. Over the last five years, health spending in Africa has risen by about 10% annually. However, spending is still nowhere near where it needs to be—just six AU member states (Liberia, Madagascar, Malawi, Rwanda, Togo, and Zambia) have achieved the 15% Abuja target, and an additional US$ 31 billion is required to close the funding gap.

ABUJA, Nigeria /GENEVA, 13 July 2013—The Joint United Nations Programme on HIV/AIDS (UNAIDS) has launched a new framework to accelerate action in reaching 15 million people with antiretroviral treatment by 2015––the goal set by United Nations Member States in 2011. 

The framework, entitled Treatment 2015, offers countries and partners both practical and innovative ways to increase the number of people accessing antiretroviral medicines. These medicines will not only enable people living with HIV to live longer and healthier lives, they will also help prevent new HIV infections.

“Reaching the 2015 target will be a critical milestone,” said Michel Sidibé, Executive Director of UNAIDS. “Countries and partners need to urgently and strategically invest resources and efforts to ensure that everyone has access to HIV prevention and treatment services.” 

Developed in consultation with a range of stakeholders, Treatment 2015 takes into account the new Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection released last month by the World Health Organization (WHO). The guidelines recommend that people living with HIV start antiretroviral therapy (ART) much earlier.

"The scale up of ART is an unprecedented global success story for public health. Maintaining this momentum will require earlier treatment and innovative ways for enabling more people to take the medicine such as the one-pill daily regimen recommended by the new WHO guidelines," said Dr Margaret Chan, Director-General of WHO. "Substantial further scale-up of access to these medicines provides us with a unique opportunity to push this epidemic into irreversible decline."

“Scaling up access to antiretroviral treatment is critical to achieving an AIDS-free generation,” said Ambassador Eric Goosby, U.S. Global AIDS Coordinator. “PEPFAR is firmly committed to continue working with partner countries and other stakeholders to help make this vision a reality, but we all must share in the responsibility to get there.”

Treatment 2015 emphasizes the importance of HIV testing and counselling as a gateway to expanding access to antiretroviral therapy and that further efforts are required to normalize HIV testing. It highlights that community testing campaigns have proven to be particularly effective in Kenya, Malawi, South Africa, Uganda, the United Republic of Tanzania and Zambia.

“We have to work hard to defeat HIV and end it as a public health threat, and it will require concerted effort from all partners to get there,” said Mark Dybul, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Treatment 2015 outlines three fundamental pillars essential to reaching the 2015 target; Demand––increasing demand for HIV testing and treatment services; Invest––mobilizing resources and improving the efficiency and effectiveness of spending; and Deliver––ensuring more people have access to antiretroviral therapy.

The report notes that just 30 countries* account for 9 out of 10 people who are eligible for antiretroviral therapy but who do not have access. Treatment 2015 stresses that intensive focus on scaling up HIV services in the 30 countries would have a significant impact on the trajectory of the global AIDS epidemic. The framework also calls for all countries to use the best available data to identify key geographical settings and populations with high HIV prevalence and disproportionate unmet need for antiretroviral therapy.

Treatment 2015 encourages countries to enhance public health programmes and leverage services provided by civil society and community based groups. It outlines that community health workers have the capacity to provide almost 40% of HIV service-related tasks and that HIV testing and treatment services need to be decentralized to promote easier access. The framework also underscores the need to ensure that underserved key populations have equitable access to HIV testing and treatment services.

*Angola, Brazil, China, Cameroon, Central African Republic, Chad, Colombia, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana, India, Indonesia, Kenya, Lesotho, Malawi, Mozambique, Myanmar, Nigeria, Russian Federation, South Africa, South Sudan, Thailand, Togo, Uganda, Ukraine, United Republic of Tanzania, Viet Nam, Zambia and Zimbabwe.

NAIROBI, Kenya, 1 July 2013—In a joint visit to Kenya, the leaders of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Global Fund to Fight AIDS, Tuberculosis and Malaria signaled strong partnership to defeat infectious diseases including HIV and tuberculosis (TB).

Michel Sidibe, Executive Director of UNAIDS and Mark Dybul, Executive Director of the Global Fund, met with leaders in Kenya’s new government, as well as civil society organizations and other partners.

At a signing ceremony in Nairobi, two new grant agreements demonstrated a commitment to work together with partners. The grants, worth US$ 27 million, will support programmes implemented jointly by the Ministry of Finance of Kenya and the African Medical and Research Foundation (AMREF) which that has been working with African communities for more than 50 years.

“In Kenya, and in other countries, the most effective prevention often comes by reaching those most vulnerable to infection,” said Dr. Dybul. “We can be most effective when all partners are moving in the same direction.”

The new grants will support programmes that improve the quality of diagnosis and treatment of TB, reduce diagnostic delays in vulnerable populations and provide nutritional support to TB patients. The grants will also cover TB/HIV co-infected patients and particularly vulnerable populations including prisoners, people living in informal settlements and mobile populations.

“Kenya can have a profound effect on the AIDS response if it continues to lead in a people-centred approach to health,” said Mr. Sidibe. “If all people in Kenya can access essential health services with dignity and without fear—then surely this country can tip the balance of the epidemic in Africa.”

The UNAIDS Country office has spent US$ 420 000 on Global Fund-related work since 2010 with a focus on supporting the governance and oversight of the Kenya Coordinating Mechanism, as well as through technical support to develop future grants and unblock barriers in the flow of funds. UNAIDS’ support helped to ensure the successful agreement between the Government of Kenya and the Global Fund for the implementation of its Round 10 grants of US$ 483 million.

UNAIDS, the Global Fund and the President's Emergency Plan For AIDS Relief (PEPFAR) are working closely to support the Government of Kenya to eliminate new HIV infections among children and keep their mothers alive. Since 2009, Kenya has reduced new HIV infections among children by 44% but still reported 13 000 new infections among children in 2012.

Kenya is ranked 13th among the 22 high-burden TB countries in the world. Since 1990, the absolute number of reported TB cases increased ten-fold in Kenya––from below 50 per 100 000 people in 1990 to 329 per 100 000 people in 2008. The HIV epidemic is the most significant driver of the increase in the TB burden in Kenya.  In 2008, HIV testing among TB patients increased to 83%, with 45% being dually infected.

Commissioners conclude that defeating the AIDS epidemic and delivering good health and rights are non-negotiable pillars in the post-2015 development agenda

Lilongwe/Geneva, 1 July 2013—Strategic challenges for the future of the AIDS response and global health were discussed at the first meeting of The UNAIDS and Lancet Commission: Defeating AIDS – Advancing Global Health, which was held in Lilongwe, Malawi from 28 – 29 June 2013. 

Three main issues were debated during the two days: the need to harness shifting global and domestic resource flows for health; trade, innovation and commodity security; and the democratization of global health.

President Joyce Banda of Malawi and Co-chair of the Commission said, “I call upon my fellow leaders in Africa, and indeed the world, to unite and work together to realize our goal of moving from AIDS to sustainable health.”

The meeting brought together prominent leaders, thinkers, and activists to identify lessons learned from the AIDS response to advance the future of global health and development, while ensuring that AIDS remains a top priority in the post-2015 agenda.

"I see two major opportunities: first galvanizing political and moral commitments, particularly from rich countries, to overcome the global commercial barriers for generic production and second, to link the AIDS movement with efforts to end hunger and poverty,” said the former President of Brazil Luiz Inacio Lula da Silva. “I want the Commission to draw on the lessons we have learned in Brazil in seizing these opportunities."

The AIDS response has been a leading force in expanding access to affordable, quality-assured medicines. The commissioners recognized the importance of price reductions of AIDS medicines and the production of cheaper generic versions as critical to health advances in low- and middle-income countries. They also underscored the need to stimulate innovation in production and delivery of medicines.

The First Lady of Gabon, Sylvia Bongo Ondimba, said, “We must reflect and act with bold determination so that health is a right for everyone.”

“We must be remembered as the generation that gave its all so that everyone that comes after us will be spared the stigma and anguish of AIDS,” said the First Lady of Rwanda, Jeanette Kagame.

Solidarity, participation, equality and sustained support have transformed the AIDS response into a global movement for universal access to HIV treatment. The AIDS response has also drawn attention to social and legal issues, including sexuality, gender inequality, violence against women, drug use and the use and misuse of criminal law. 

"Sustaining and expanding the progress made in the AIDS response will require new implementation and political strategies, countering complacency, and continuous investment in research and innovation," said Professor Peter Piot, Director of the London School of Hygiene and Tropical Medicine and Commission Co-chair. 

Helen Clark, UNDP Administrator said, “The UNAIDS and Lancet Commission will play a key role in feeding into the debate on the shape of development goals beyond 2015.”

Commissioners stressed that the current global health architecture must adapt to a changing world. They outlined the need for an informed and empowered constituency as well as a grass-root led demand for services. They also acknowledged need to address social and legal barriers to health and discrimination and the need to ensure inclusive systems for priority-setting and accountability.

“Over the next six months, the UNAIDS and Lancet Commission can play a key role in complimenting high level strategy with concrete recommendations,” said Sir Andrew Witty, CEO of GlaxoSmithKline. “It’s ultimately about helping the on-the-ground healthcare workers, people in communities, people at risk, to really get into a better position so that we can truly take another step forwards in stopping HIV.”

Commissioners also looked at the need for redistribution of opportunity through human rights, gender equality and focusing on youth.

“Today's HIV-positive youth need to have an active role formulating and implementing policy that will lead the world toward a dynamic, sustainable and AIDS-free tomorrow," said Cristina Jade Peña, Ambassador for the Elizabeth Glaser Pediatric AIDS Foundation.

Commissioners agreed that the opportunity must be seized to protect and accelerate progress towards ending the AIDS epidemic, and that a new era of social justice, health and sustainable development must be ushered in.

“The bold, out-of-the-box ideas debated by these exceptional global leaders give the world hope we will defeat the AIDS epidemic and deliver on global health,” Michel Sidibé, UNAIDS Executive Director. “The Commissioners have planned concrete steps to ensure that AIDS and global health are at the core of post-2015 agenda.”

The next meeting of The UNAIDS and Lancet Commission: Defeating AIDS – Advancing global health will be held in London on 13-14 February 2014.

Biggest year on year increase as numbers of people accessing antiretroviral therapy increase by 1.6 million from 2011 to 2012

GENEVA, 30 June 2013—A new report from the Joint United Nations Programme on HIV/AIDS (UNAIDS), the World Health Organization (WHO) and UNICEF, Global update on HIV treatment 2013: results, impact and opportunities, shows a huge acceleration in the roll out and uptake of antiretroviral therapy since 2011. A record 9.7 million people living with HIV were accessing treatment in 2012 compared to just over 8.1 million in 2011––an increase of 1.6 million in one year alone.

New guidelines from WHO, issued together with the report, give clear recommendations that people living with HIV should start antiretroviral therapy much earlier, and immediately in some instances. Under this new guidance some 26 million (25.9 million) people will now be eligible for antiretroviral therapy, an additional 9.2 million from the previous 2010 guidance.

“It is our moral and scientific obligation to reach as many people as we can with antiretroviral therapy” said Michel Sidibé, Executive Director of UNAIDS. “This is what we will continue to strive for and we believe that we can significantly scale up access to treatment even within the current financial envelope.”

By making strategic efficiencies in HIV programming, UNAIDS estimates that expansion of treatment can be accelerated within the existing resource needs of between US$ 22-24 billion for 2015. “With smart planning, we estimate that cost savings of around 20% could be made by 2015 which, if invested smartly, would allow us to reach yet more people with lifesaving antiretroviral therapy.”

UNAIDS estimates that cost savings could be achieved through three main areas; a reduction in costs of medicines and medical supplies, particularly as volumes increase; simplifying delivery systems; and increasing efficiencies within the overall AIDS response.

Significant successes in reducing costs have been achieved in recent years. For example the price of medicines to prevent mother to child transmission of HIV was reduced from US$ 800 in 2011 to below US$ 100 in 2013. Through a more competitive bidding process, South Africa has reduced the cost of procurement of antiretrovirals to the lowest price anywhere in the world at US$ 113 per person per year for the fixed dose combination recommended in the new guidelines. This has resulted in a 53% reduction in expenditure on antiretroviral treatment for South Africa.

The report also highlights that the United States President’s Emergency Fund for AIDS Relief (PEPFAR) estimates that by leveraging existing opportunities for cost efficiencies it has more than halved the average cost per person receiving treatment in PEPFAR supported programmes––from more than US$ 1000 per person per year in 2004 to less than US$ 400 per person per year in 2011.

Additional savings are expected as methods of testing for HIV become simpler and easier to administer (a fingerpick HIV test for example can now give results in 30 minutes). Other efficiencies are being made as more and more HIV services are being integrated into existing structures such as antenatal clinics and TB facilities.

The challenge set by the new guidelines will encourage countries, donors and partners in the AIDS response to strive for even greater results. If the recommendations in the new guidelines are implemented they would avert an estimated 13.5 million deaths and 19 million new HIV infections by 2025.

New global report released at IAS 2013 highlights funding trends, opportunities and challenges for HIV prevention R&D

KUALA LUMPUR, 30 June 2013—Recent breakthroughs in HIV prevention research have confirmed the promise of new options to help end the AIDS epidemic and highlight the urgent need for ongoing research to develop additional prevention options and support rapid rollout of proven ones. However, continued progress requires a broader base of funders committed to sustained support according to the new report From Research to Reality: Investing in HIV Prevention Research in a Challenging Environment released today at 7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013) in Kuala Lumpur.

Steady progress in research and development for HIV vaccines, pre-exposure prophylaxis using antiretroviral drugs (PrEP), and treatment as prevention have confirmed the critical role science has to play in providing solutions to end the AIDS epidemic, yet the ninth annual report from the HIV Vaccines and Microbicides Resource Tracking Working Group shows that funding has essentially plateaued.

In 2012, funders invested a total of US $1.31 billion across R&D for six key prevention areas: preventive HIV vaccines, microbicides, PrEP (pre-exposure prophylaxis) using antiretroviral drugs, treatment as prevention, operations research related to voluntary medical male circumcision and prevention of vertical transmission. This is a six percent increase over funding in 2011. However, a significant portion of this increase is likely due to improved reporting by several donors.

“Science has a critical role to play in ending the AIDS epidemic,” said Luiz Loures, Deputy Executive Director, Programme, UNAIDS. “The potential returns on investments are hugely important and I strongly urge donors to make funding for research and development a top priority.”  

This report comes as new guidelines are being released from the World Health Organization (WHO) on when to start taking antiretroviral therapy (ART) for HIV. These new guidelines recognize recent advances made in HIV prevention R&D and will help countries maximize the impact of antiretroviral therapy on keeping people alive and well ad helping prevent new infections.  It is too early to tell what additional resources will be needed to support countries and programs in adopting the new WHO guidelines and effectively rolling out these proven prevention options, which represents an investment opportunity for countries heavily impacted by HIV, particularly emerging economies.

According to the report, the United States remained the largest public sector funder of HIV prevention research, spending a total of US$925 million in 2012—70 percent of the total investment in HIV prevention R&D—and underscoring the importance of fostering broader commitments by additional global partners.

 “As the report highlights, the HIV vaccine field has been a leader in catalyzing innovative partnerships across the public, private, philanthropic and academic sectors. Such partnerships can help integrate new funders and help enhance the information exchange and collaboration that is required as we tackle remaining critical questions in immunology as we move forward to develop even more effective prevention options,” said Margaret McGlynn, President and CEO of the International AIDS Vaccine Initiative, IAVI.

For the first time this year, the report includes the critical investment made by HIV prevention research trial participants. In 2012, there were 99,931 participants in HIV prevention research trials, primarily based in sites with high HIV burden in South Africa, Uganda and the United States. As more efficacy trials are planned, tens of thousands more women and men in the communities hardest hit by HIV will take time from their daily lives to participate in clinical trials and to help end the epidemic, representing a significant, ongoing investment in prevention R&D.

Following the scientific breakthroughs of 2011, during which preventive HIV vaccines, PrEP, and treatment as prevention all advanced faster and further along the scientific path, 2012 was largely a year of follow-up research seeking to confirm results of past studies, move forward with new clinical research and roll out proven new prevention modalities. Even though 2012 brought steady progress, it also brought results that have both challenged the resiliency of the HIV prevention research field and raised new questions that the field is compelled to answer.

• Additional data from the RV144 vaccine trial in Thailand has provided new clues about why and how the vaccine worked and has helped to pave the way for trials set to begin in Thailand and South Africa in 2016. At the same time, researchers are developing other vaccine candidates and also learning more about broadly neutralizing antibodies, which may form the basis of future clinical trials.
• 2012 saw intensified focus on faster rollout of adult male circumcision for maximum prevention impact. Funding for R&D and operations research increased, with an emphasis on research that would better inform delivery and demand and enhance understanding of current constraints.
• Planning for demonstration projects of daily oral PrEP among a range of populations moved forward in 2012, following the US Federal Drug Administration (FDA) approval of Gilead Science Inc.’s daily oral TDF/FTC as PrEP and World Health Organization (WHO) guidance for PrEP demonstration research trials.
• Large-scale trials of treatment as prevention are now taking place in more than 40 countries around the world, demonstrating a global commitment to explore the potential of this intervention. At the same time, implementers and normative agencies continued their efforts to add treatment as prevention to HIV prevention agendas and the national strategies.
• Following flat results from the VOICE (MTN 003), which was testing daily oral tenofovir, daily oral TDF/FTC and daily 1% tenofovir gel, data from the trial are being examined, and preliminary results suggest that too few women in the trial adhered to prescribed use of the trial products to allow for evaluation of their effectiveness. The ongoing FACTS trial of 1% tenofovir gel as well as microbicide ring trials are working to incorporate lessons learned from the VOICE trial around understanding and supporting participant adherence.

There is a growing consensus that we can begin to end the AIDS epidemic if we develop and deploy the right tools,” said Mitchell Warren, executive director of AVAC. “But we won’t be able to make a sustained impact on the cycle of new infections without aggressive roll out of new prevention options – voluntary medical male circumcision, PrEP, treatment as prevention, microbicides and eventually vaccines. We need sustained and flexible funding to ensure that we efficiently deliver what we know works, demonstrate how proven options can be rolled out, and develop new options.”

The report is available online at: www.hivresourcetracking.org.

Financial support for this project was provided by AVAC: Global Advocacy for HIV Prevention (AVAC), the International AIDS Vaccine Initiative (IAVI), and the Joint United National Programme on HIV/AIDS (UNAIDS). In prior years, support was also provided by the Alliance for Microbicide Development (AMD) and the International Partnership for Microbicides (IPM).

New report also shows that access to treatment remains unacceptably low for children––only 3 in 10 children in need of treatment have access in most of the ‘Global Plan’ priority countries

GENEVA, 25 June 2013—A new report on the Global Plan towards elimination of new HIV infections among children by 2015 and keeping their mothers alive (Global Plan) has revealed a marked increase in progress in stopping new infections in children across the Global Plan priority countries in Africa.

The report outlines that seven countries in sub-Saharan Africa—Botswana, Ethiopia, Ghana, Malawi, Namibia, South Africa and Zambia—have reduced new HIV infections among children by 50% since 2009. Two others—the United Republic of Tanzania and Zimbabwe—are also making substantial progress. It highlights that there were 130 000 fewer new HIV infections among children across the 21 Global Plan priority countries in Africa––a drop of 38% since 2009. 

“The progress in the majority of countries is a strong signal that with focused efforts every child can be born free from HIV,” said Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). “But in some countries with high numbers of new infections progress has stalled. We need to find out why and remove the bottlenecks which are preventing scale-up.”  

With a 76% decline since 2009, Ghana showed the greatest decline in the rate of new infections among children and South Africa showed a 63% decline (24 000 fewer new HIV infections in 2012 than in 2009). However, the pace of decline in some of the Global Plan priority countries has been slow and in Angola, new HIV infections have even increased. New infections among children in Nigeria––which has the largest number of children acquiring HIV (nearly 60 000 new HIV infections among children in 2012)––remained largely unchanged since 2009. Without urgent action in Nigeria the global target for 2015 may not be reached.

More pregnant women living with HIV were receiving antiretroviral medicines to prevent HIV from being transmitted to their children and for their own health in 2012 than in 2009, with coverage levels exceeding 75% in many countries. Increased coverage has reduced HIV transmission rates from mother to child in most countries. Botswana and South Africa have reduced transmission rates to 5% or below.

“We have the tools required to reach the Global Plan’s goals, and recent data show that we are moving ever closer to their realization,” said Ambassador Eric P. Goosby, U.S. Global AIDS Coordinator. “This month, as U.S. Secretary of State John Kerry announced, the one millionth baby will be born HIV-free due to PEPFAR’s support. Now, we must all continue working together to see the day when no children are born with HIV, which is within our reach,” he added.

The report however also reveals that only half of all breastfeeding women living with HIV or their children receive antiretroviral medicines to prevent mother-to-child transmission of HIV. It outlines that breastfeeding is critical to ensuring child survival and strongly emphasizes the urgent need to provide antiretroviral therapy during the breastfeeding period.

More than half of the children eligible for treatment in South Africa and Swaziland now have access. Chad, Ethiopia, Ghana, Kenya, Malawi, Nigeria, South Africa, United Republic of Tanzania and Zimbabwe have doubled the numbers of children accessing treatment from 2009 to 2012. While the report outlines that the number of children requiring HIV treatment will reduce as new HIV infections decline, urgent steps need to be taken to improve early diagnosis of HIV in children and ensure timely access to antiretroviral treatment.

The number of pregnant women living with HIV receiving antiretroviral therapy for their own health has increased since 2009. In Botswana, Ghana, Malawi, Namibia, South Africa, Swaziland and Zambia, more than 75% of the pregnant women eligible receive antiretroviral therapy and more than 50% in Kenya, Lesotho, the United Republic of Tanzania and Zimbabwe. Increasing access to antiretroviral therapy for pregnant women living with HIV for their own health is critical.

The Global Plan towards elimination of new HIV infections among children by 2015 and keeping their mothers alive is an initiative spearheaded by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United States Presidents Emergency Plan for AIDS Relief (PEPFAR)  which was unveiled in June 2011 at the UN General Assembly High Level Meeting on AIDS. It has two main targets for 2015: a 90% reduction in the number of children newly infected with HIV and a 50% reduction in the number of AIDS-related maternal deaths. The Plan focuses on the 22* countries which account for 90% of new HIV infections among children.

This second progress report presents the progress made by the 21 countries in sub-Saharan Africa and some of the challenges they face in meeting the agreed targets for 2015.

* Angola, Botswana, Burundi, Cameroon, Chad, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana, India, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, South Africa, Uganda, United Republic of Tanzania, Swaziland, Zambia and Zimbabwe.

PEPFAR

The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is the U.S. Government initiative to help save the lives of those suffering from HIV/AIDS around the world. This historic commitment is the largest by any nation to combat a single disease internationally, and PEPFAR investments also help alleviate suffering from other diseases across the global health spectrum. PEPFAR is driven by a shared responsibility among donor and partner nations and others to make smart investments to save lives. Learn more at www.pepfar.gov.

UNICEF

UNICEF works in more than 190 countries and territories to help children survive and thrive, from early childhood through adolescence. The world’s largest provider of vaccines for developing countries, UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments. For more information about UNICEF and its work visit www.unicef.org  Follow us onTwitter and Facebook

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 to maximize results for the AIDS response. Learn more at unaids.org and connect with us on Facebook and Twitter.