In his report to the UN General Assembly, UN Secretary-General Ban Ki-moon urges stakeholders to redouble efforts to meet the targets outlined in the 2011 Political Declaration on AIDS

GENEVA, 30 April 2012—The United Nations Secretary-General Ban Ki-moon has issued his first report on HIV to the UN General Assembly since the 2011 High Level Meeting on AIDS. In the report, he highlights the urgent need to achieve immediate, tangible results and for the AIDS response to be smarter, more strategic, more efficient, and grounded in human rights.

“I urge the international community to stand up to meet the commitments it has made. I call for a shift from the perception that aid is charity to an understanding that it is our shared responsibility and a smart investment that reaps dividends for all. Together, we must foster a more sustainable response to the HIV epidemic for the sake of our common future.”

Substantial gains have been achieved over the last decade and ground-breaking scientific advances have encouraged leaders to talk about the end of AIDS. The report, ‘United to End AIDS: Achieving the Targets of the 2011 Political Declaration’, outlines that 2.5 million deaths are estimated to have been averted since 1995 due to the increase in access to antiretroviral therapy—and 350 000 new HIV infections averted in children. It also underscores the gains made in HIV prevention with new infections at their lowest levels since the peak in the mid-2000s. 

However, the report also warns that considerable gaps persist in access to HIV services, particularly for people at higher risk of exposure to HIV. Punitive laws, gender inequality, violence against women and other human rights violations continue to undermine national AIDS responses and declines in funding have the potential to jeopardize the capacity to expand access to HIV services and sustain progress over the coming years.

“The fourth decade of AIDS has to be marked as the decade that ushered in the end of AIDS,” said Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). “We can make this a reality and seize the opportunity to secure a future free from HIV.”

At the 2011 High Level Meeting on AIDS, UN Member States adopted a Political Declaration on AIDS, providing a roadmap towards achieving the vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. The declaration set 2015 as the deadline for achieving a number of specific targets.

Through the Political Declaration, UN Member States pledged to deliver antiretroviral therapy to 15 million people by 2015, eliminate new HIV infections in children, achieve a 50% reduction in new HIV infections among adults, reduce transmission of HIV among people who inject drugs by 50% and reduce TB deaths in people living with HIV also by half.

Countries also committed to closing the resource gap, investing between US$ 22-24 billion each year by 2015, meeting the needs of women and girls, eliminating stigma and discrimination and promoting the integration of the HIV response into broader health and development efforts.

In his report, the Secretary-General underscores that achieving the 2015 goals will require a redoubling of efforts from all stakeholders and that if smarter and more efficient ways of working are not applied to the AIDS response, the goals will not be met.  

The Secretary-General outlines a number of recommendations that need to be implemented to reach the 2015 targets. For instance, to meet the target of reducing sexual transmission by 50%, the report outlines that the number of new sexually transmitted HIV infections will need to decline by at least 1 million by 2015. To achieve this, HIV prevention programmes need to enhance efforts to reinforce, sustain and extend behaviour change by promoting gender equality and mutual respect, as well as better focus on where the new infections are occurring.

To reduce HIV transmission among people who use drugs by 50%, the number of new HIV infections must fall by at least 120 000 per year. The Secretary-General encourages stakeholders to summon the wisdom, courage and commitment required to implement strong, evidence-informed prevention programmes that empower key populations including people who inject drugs.

At least 180 000 fewer TB-related deaths among people living with HIV will be required to achieve a 50% reduction by 2015. To realize this, from 2010 to 2015, TB cure rates need to increase from 70% to 85% and rates of TB detection among people living with HIV must rise from 40% to 80%. Achieving the target would reduce TB-related deaths by 80% and save a million lives.

In his recommendations, the Secretary-General urges countries to undertake immediate, comprehensive reviews of national, legal and policy frameworks to remove obstacles to effective and rights-based responses. He also calls for new partnerships and a new approach for HIV investment to mobilize necessary resources. In 2010, a total of US$ 15 billion was available for the AIDS response from all sources. The report highlights that to reach the 2015 target of US$22-24 billion for the response to HIV by 2015 an additional US$ 8 billion will be required.

Report of the Secretary-General: United to end AIDS: achieving the targets of the 2011 Political Declaration

New guidelines released for couples HIV testing and counselling and for treatment and prevention in serodiscordant couples

GENEVA, 19 April 2012—New guidelines have been issued encouraging couples to go together for HIV testing in order to know their HIV status. The guidelines, released by the World Health Organization (WHO), also recommend that in couples who are serodiscordant—where one partner is living with HIV and the other not—antiretroviral therapy is offered to the person living with HIV to prevent his or her partner from becoming infected with the virus.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) strongly welcomes the new guidelines and calls on all countries to implement them to reach the targets set in the United Nations 2011 Political Declaration on AIDS.

“Couples can now reap the benefits of antiretroviral therapy, to improve their own health, and to protect their loved ones,” said UNAIDS Executive Director Michel Sidibé. “By encouraging couples to test together, we can provide comprehensive options for HIV prevention and treatment—that they can discuss and manage jointly.”

New evidence now shows that antiretroviral therapy reduces the risk of HIV transmission from a person living with HIV to their sexual partners. WHO recommends that antiretroviral therapy be offered to HIV-positive individuals in discordant relationships even when they do not require it for their own health. The guidance also states that it is possible for couples to stay HIV serodiscordant indefinitely if they consistently practice safer sex using condoms.

“I am excited that with the roll out of these new guidelines, millions of men and women have one additional option to stop new HIV infections,” said Mr Sidibé. “This development begins a new era of HIV prevention dialogue and hope among couples.”

According the new guidelines, “couples who test together and mutually disclose their HIV status are more likely than those testing alone to adopt behaviour to protect their partner. Another potential benefit of couples testing together and sharing their results is that they can support each other, if one or both partners are HIV-positive, to access and adhere to treatment and prevent transmission of HIV to children”.

UNAIDS recommends that HIV testing and counselling should always be confidential and initiation of treatment must always be voluntary and never mandatory or coercive. Couples should have access to the full range of HIV prevention options available including the use of male and female condoms and medical male circumcision. They should also be provided with access to health services such as tuberculosis screening and reproductive health services including family planning with access to effective contraceptives and conception counselling for sero-discordant couples.

According to UNAIDS estimates, around 14 million people are eligible for antiretroviral treatment. At the end of 2011, only 6.6 million people were receiving the life-saving medicines. The guidelines recommend that in situations of limited or inadequate resources, people who require antiretroviral therapy for their own health should always be given priority.

Dr Ibahim Assane Mayaki, CEO of NEPAD and UNAIDS Executive Director Michel Sidibé signing the collaboration agreement at the Africa Union Headquarters in Addis Ababa, Ethiopia 27 March 2012.
Credit: UNAIDS/Jiro Ose

ADDIS ABABA, 27 March 2012—The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the New Partnership for Africa’s Development (NEPAD) Agency today signed a memorandum of understanding (MoU) calling for strategic collaboration to advance sustainable responses to HIV, health and development across the African continent. The MoU was signed by UNAIDS Executive Director Michel Sidibé and Chief Executive Officer of NEPAD Agency, Dr Ibrahim Mayaki, on the sidelines of a colloquium marking the 10^th anniversary of NEPAD in Addis Ababa, Ethiopia.

Under the terms of the agreement, UNAIDS and the NEPAD Agency will work with partners to: support the development of common African positions for the AIDS response, with an emphasis on sustainable financing; address constraints in access to HIV medicines; facilitate policies and partnerships to eliminate new HIV infections in children and improve the health of mothers; enhance country ownership and accountability; and encourage South-South cooperation.

“This new partnership will bring us one step closer to our goal of zero new HIV infections, zero discrimination and zero AIDS-related deaths,” said the UNAIDS Executive Director, at a press conference on 27 March after the signing of the MoU. Mr Sidibé said that “getting to zero” would demand effective and inclusive partnerships, shared responsibility, greater transparency and a focus on results—areas in which NEPAD is known to excel.

Speaking alongside Mr Sidibé at the press conference, Dr Ibrahim Mayaki said that country ownership would be critical to advancing AIDS and development responses in the coming decade. “Partnerships for development can only succeed if they are led by developing countries,” said the Chief Executive Officer of NEPAD Agency. “AIDS programmes must be financially sustainable over the long term and tailored to specific national settings,” he added.

Sub-Saharan Africa carries the highest HIV burden of any region in the world. In 2010, about 68% of all people living with HIV resided in sub-Saharan Africa, a region with only 12% of the global population.

About two-thirds of all AIDS investments in Africa currently come from external sources. According to UNAIDS estimates, Africa will require between US$ 11-12 billion for its regional AIDS response by 2015—US$ 3-4 billion more than the current expenditure.

Message from UNAIDS Executive Director Mr. Michel Sidibé

UNAIDS Executive Director (center) visited the Prince Cyril Zulu TB and STD Clinic and the CAPRISA eThekwini Research Clinic on September 2011 during an official visit to South Africa. The Prince Cyril Zulu clinic treats about 8 000 new TB patients a year with an HIV prevalence of 74%. The SAPiT TB-HIV trial which provided the evidence for the current WHO TB-HIV co-treatment guidelines was conducted in the adjoining CAPRISA clinic.
Credit: UNAIDS/A. Debiky

GENEVA, 22 March 2012—On World TB Day, let’s celebrate a partnership, which in just a few years is helping to transform the AIDS epidemic.

By improving collaboration between HIV and TB services almost one million lives around the world have been saved in the past six years.

The number of people living with HIV screened for TB increased almost 12-fold from 2005 to 2010.

For patients, integrating HIV and TB services means a better quality of life. They spend less time going from clinic to clinic and waste less money on visits to multiple care providers.

It can also mean the difference between life and death.

Together we can be proud of our achievements.

But we haven’t reached our goal of stopping TB-related HIV deaths.

Every day a thousand people living with HIV die of TB.

These deaths just aren’t acceptable when TB is preventable and curable with inexpensive drugs.

We need to intensify the integration of HIV and TB services at every level of the health system.

We need a stronger focus on preventing, diagnosing and treating TB in children living with HIV, who are particularly vulnerable to TB infection.

All TB patients living with HIV must be put on antiretroviral therapy as quickly as possible.

Last year countries committed for the first time to cut in half the number of deaths among people living with HIV by 2015.

Having travelled so far together, I am sure we will reach the final mile.

GENEVA, 8 March 2012—On this International Women's day the world has a lot more to do if it is to be a place where:

• Women and men, girls and boys are treated as equal
• Girls shape their own future
• Boys challenge social norms that block opportunities
• HIV does not take away people’s dignity and rights.

The reality is very different:

• Every minute, a young woman is newly infected by HIV
• At the same time, girls lack equal access to education
• Far too many women lack control over their finances and assets
• And too many women continue to lack control over their bodies and lives.

It is clear, governments and communities are failing women and girls. There are few sustainable solutions that enable women and girls to protect themselves from HIV, violence and poverty. This is grossly unacceptable, particularly because the world can do much better.

Empowered women and girls are critical agents of change in reversing the epidemic. If society invests in the health of women and girls, it is possible for them to have the future they want.

This is why UNAIDS prioritizes gender equality and why UNAIDS is calling for zero tolerance for violence. Together, we will reach the future we want: zero new HIV infections, zero discrimination and zero AIDS-related deaths among women and girls.

WHO recommendations related to use of hormonal contraceptives remain unchanged. The use of condoms—male and female—is a reliable method of HIV prevention.

GENEVA, 16 February 2012—A stakeholder consultation convened by the World Health Organization (WHO) in Geneva has reviewed recent epidemiological studies related to HIV transmission and acquisition by women using hormonal contraceptives. After careful review of all available evidence, the stakeholders found that the data were not sufficiently conclusive to change current guidance.

In light of this review, WHO today announced that its current recommendation­­—no restrictions on the use of hormonal contraceptives to avoid unintended pregnancies—remains unchanged. They also recommend that women using progestogen-only injectable contraceptives also use condoms or other measures to prevent HIV infection. This information must be communicated to sexually active women and girls by health workers pro-actively.

About half of the 34 million people living with HIV are women. In sub-Saharan Africa, the region most affected by the epidemic, nearly 60% of all new HIV infections occur in women.

The level of unmet family planning need among the 1.18 billion women aged 15–49 worldwide is estimated to be 11%. Among the 128 million women (married or in a union) aged 15–49 in sub-Saharan Africa, the estimated unmet need for family planning is more than twice as high, at 25%. This highlights the urgency of finding innovative solutions that address the dual needs of women in preventing HIV and stopping unintended pregnancies.

While a range of contraceptives protect against unintended pregnancies, only condoms, male and female, provide dual protection by stopping HIV transmission and preventing unintended pregnancies.  

The Joint United Nations Programme on HIV/AIDS (UNAIDS) recommends that people who are sexually active—particularly women and girls—have full access to information and counselling to make evidence informed choices about their sexual and reproductive health needs. Women and girls must also have access to the widest range of contraceptive and HIV prevention options. Such services must be provided in an integrated manner by health workers.

The lack of female controlled methods of HIV prevention and low levels of condom use place women and girls at increased vulnerability to HIV infection. “Women need safe contraceptive and HIV prevention options that they can own and manage,” said Michel Sidibé, Executive Director of UNAIDS. “New investments into research for female controlled HIV prevention options and safe contraceptive methods are essential.”

From left to right: UNAIDS Executive Director Michel Sidibé, former president of Botswana, Mr Festus Gontebanye Mogae, Ambassador Eric Goosby, United States Global AIDS Coordinator call for accelerated access to voluntary medical male circumcision in eastern and southern Africa, at ICASA 2011. 5 December 2011.
Credit: UNAIDS/ P. Wiggers

ADDIS ABABA, 5 December 2011—The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) today launched a five-year action framework to accelerate the scale-up of voluntary medical male circumcision (VMMC) for HIV prevention. The framework—developed by the World Health Organization (WHO), UNAIDS, PEFPAR, the Bill & Melinda Gates Foundation and the World Bank in consultation with national Ministries of Health—calls for the immediate roll-out and expansion of VMMC services in 14 priority countries of eastern and southern Africa.

“Voluntary medical male circumcision is a high-impact and cost-effective prevention tool that will bring us one step closer to our goal of an HIV-free generation," said UNAIDS Executive Director Michel Sidibé, who unveiled the action framework at the 16th International Conference on AIDS and STIs in Africa (ICASA), together with partners. “Each HIV infection averted is money in the bank and fiscal space for the future,” he added. Joining Mr Sidibé at the launch in Addis Ababa, Ethiopia, were the U.S. Global AIDS Coordinator Dr Eric Goosby and the former President of Botswana, Festus Mogae.

There is compelling evidence that VMMC, when provided by well-trained health professionals, reduces the risk of sexual transmission of HIV from women to men by approximately 60 per cent. Since 2007, WHO and UNAIDS have urged countries with high HIV prevalence and low levels of male circumcision to expand access to safe VMMC services.

VMMC offers excellent value for money. Recent modelling commissioned by PEPFAR and UNAIDS found that reaching 80% coverage of adult VMMC in the 14 priority countries would entail performing approximately 20 million circumcisions on men aged 15-49 by the year 2015. Such a scale-up would cost a total of US$1.5 billion and would result in a net savings of US$16.5 billion by 2025 due to averted treatment and care costs. An estimated 3.4 million new HIV infections would be averted through 2025.

To date, the scale-up of VMMC has been modest in most countries. According to the joint framework, more than 550 000 men aged 15-49 had been circumcised in the 14 priority countries by the end of 2010. The greatest success in scaling up adult VMMC has occurred in Kenya, particularly in Nyanza Province. While progress in implementing VMMC programmes has been more limited in the other priority countries, nearly all countries saw the pace of scale-up quicken in 2010.

Acknowledging the important role of country ownership and accountability in health systems, U.S. Global AIDS Ambassador Dr Eric Goosby stated, “PEPFAR strongly supports heightened and immediate national ownership in all priority countries to implement safe, efficient voluntary medical male circumcision scale-up strategies. VMMC offers men an unprecedented opportunity to assume a proactive role in reducing their risk of contracting HIV, empowering them to protect their health and the health of their partners."

The new framework proposes strategic and coordinated action among partners at local, national and global levels to harness resources and focus on reaching adult and adolescent men with VMMC services as quickly and safely as possible. It underscores that country leadership is critical to the success and sustainability of this initial phase of VMMC programmes. The longer-term goal is to offer VMMC for all infants in the priority countries—replacing the need for adolescent and adult VMMC.

Innovation in service delivery, supply chain logistics, human resource deployment and medical devices is encouraged to improve efficiency, access, and safety, while creating demand for VMMC services. The framework urges governments in the 14 priority countries to seek funding from a range of domestic and international sources—with a view, over time, to a greater reliance on national on and local resources.

Speaking at today’s press briefing, Mr Festus Mogae called on leaders to support and scale up VMMC programmes in the 14 priority countries. “Strong collaboration between political, traditional and religious leadership will be critical to the safe and effective scale up of VMMC services,” said Mr Mogae, who is the chairman of Champions for an HIV-Free Generation, a non-governmental organization. “The key role of religious and traditional leaders is to ensure that there is a working partnership with the communities so that while the circumcision is done medically as an add-on HIV prevention strategy, it still retains its religious or cultural significance to the communities,” he added.

VMMC is an important component of a comprehensive HIV prevention package. WHO, UNAIDS and PEPFAR recommend a combination approach to HIV prevention that includes the correct and consistent use of male and female condoms; treatment for sexually transmitted infections; the promotion of safer sexual practices such as avoidance of penetrative sex; the provision of antiretroviral therapy for HIV-positive people who are eligible for treatment; and voluntary medical male circumcision in certain settings. 

VMMC is a life-saving HIV intervention with major cost benefits. A one-time health intervention, VMMC confers life-long partial protection against HIV. The joint framework launched today embraces urgent and widespread scale-up of VMMC in all priority countries through a coordinated, country-driven effort.

China calls for shared responsibility in achieving zero new HIV infections, zero discrimination, zero AIDS-related deaths

UNAIDS Executive Director Michel Sidibé and China’s Premier H.E. Wen Jiabao at a World AIDS Day event in Beijing.

BEIJING/GENEVA, 1 December 2011—China has pledged to fill its HIV resource gap by increasing domestic investments. This pledge was made China’s Premier H.E. Wen Jiabao at a World AIDS Day event in Beijing. The Premier also called on the international community to fully meet its commitments and achieve a world with zero new HIV infections, zero discrimination and zero AIDS-related deaths.

“I see no reason for the Global Fund to withdraw its support to China,” said Premier Wen Jiabao at the AIDS roundtable in Beijing. “I have asked the Minister of Finance to close the gap left by the Global Fund. We will rely on our own efforts.”

This new commitment from China comes at a crucial moment as resources for AIDS are declining and the Global Fund to Fight AIDS, Tuberculosis, and Malaria is facing a major setback in resource mobilization, leading to the cancellation of its next call for country proposals (Round 11), putting millions of lives at risk. 

"China's voice could not have come at a more critical time in the AIDS response. We are in a period of high risk and welcome this bold decision," said Michel Sidibé, Executive Director of UNAIDS, when thanking the Premier of China. "I am confident that a new socially sustainable agenda can be forged that promotes country ownership and shared responsibility.”

More than 6.6 million people are on HIV treatment in low- and middle-income countries and rates of new HIV infections have fallen in most parts of the world. Domestic investments have steadily increased, but the magnitude of the epidemic in Africa means that continued international solidarity and investments are vital.

“Getting Round 11 back on track is a top priority especially as Africa is leading the world in reducing new HIV infections and AIDS-related deaths. Its international partners must come forward and help countries multiply their success,” said Mr Sidibé. “This call is not just about shared responsibility but also of shared values.”

China has scaled up its AIDS response in a short timespan, including its evidence-informed HIV prevention services. By rapidly scaling up access to drug substitution therapies, it has reduced new HIV infections among people using these services to close to zero. China has also made important advances in its anti-discrimination programmes and support for civil society organizations. 

“To defeat AIDS, it will take the whole society,” said Premier Wen Jiabao. “China is willing to play its part.” China’s rapid scale up model can be replicated in other countries—especially in strengthening the capacity of community health workers to deliver HIV services. In addition, China can provide vital technology transfer in key areas of innovation of HIV treatment, including development of new antiretroviral medicines, investing in research and development, telecommunications, e-health infrastructure and supply chain management.

Korean footballer Myung-Bo Hon with the UNAIDS Executive Director Michel Sidibé. Seoul, 28 November 2011.

SEOUL, Republic of Korea, 28 November 2011— Iconic Korean football star, Myung-Bo Hong, was appointed as a UNAIDS International Goodwill Ambassador during a press conference held at Yonsei University in Seoul. In this capacity, Myung-Bo Hong will raise awareness on HIV prevention among young people and help break down the barriers of stigma and discrimination surrounding HIV, particularly within the Republic of Korea and across Asia.

“As one of the greatest Asian football players of all time, Myung-Bo Hong will be a compelling advocate on HIV prevention for young people and football fans worldwide,” said Michel Sidibé, UNAIDS Executive Director. “I am honoured UNAIDS will work with such an inspiring athlete to disseminate vital messages about HIV to young people.”

“Accelerated efforts are needed on HIV to ensure zero new HIV infections, zero discrimination and zero deaths,” said Mr Byeongleul Jun, Director of the Korean Centre for Disease Control and Deputy Minister of Health and Welfare. “The involvement of a sporting hero as great as Myung-Bo Hong can greatly advance this important agenda and make a difference in the AIDS response around the world,” he said.

Myung-Bo Hong joins prominent individuals from the world of arts, science, literature, entertainment as an advocate for zero new HIV infections and zero discrimination. Other UNAIDS Goodwill Ambassadors include Naomi Watts, Annie Lennox, and Michael Ballack.

“People living with HIV are people like you and me,” said Myung-Bo Hong during the appointment ceremony. “They have rights and should not be discriminated against. I am delighted to be working with UNAIDS to use sport to help bring an end to AIDS.”

Currently Korea’s National Olympic Football Team Manager, Myung-Bo Hong, played for the country’s national football team in four consecutive World Cups (1990-2002) and was chosen among the “FIFA 100”, a selection of the 125 greatest living footballers in the world made by Brazilian football legend Pelé. He was the first Asian footballer to receive FIFA’s World Cup Bronze Ball in 2002.

“We are very glad UNAIDS has recognized Myung-Bo Hong as both a sports celebrity and a prominent humanitarian. Mr. Hong has established a great level of influence in football worldwide, and his appointment as the UNAIDS Goodwill Ambassador has great potential to make a critical push against HIV infections and discrimination,” said Mr Soo-Gil Park, President of World Federation of United Nations Associations.

Globally there are more than 5 million young people living with HIV and every day 2400 young people become infected with the virus. Although young people are increasingly learning how to protect themselves, only one-third of young people globally have accurate and comprehensive knowledge of how to protect themselves from HIV.

Substantial scale up, even during the financial crisis, highlights country driven commitments—new investment framework will help countries save more lives and money

L to R: German Federal Minister of Health (BMG), Daniel Bahr, UNAIDS Executive Director Michel Sidibé, German Federal Minister for Economic Cooperation and Development (BMZ), Dirk Niebel.
Photo credit: UNAIDS/ C. Koall

BERLIN/GENEVA, 21 November 2011—A new report by the Joint United Nations Programme on HIV/AIDS (UNAIDS), released today shows that 2011 was a game changing year for the AIDS response with unprecedented progress in science, political leadership and results. The report also shows that new HIV infections and AIDS-related deaths have fallen to the lowest levels since the peak of the epidemic. New HIV infections were reduced by 21% since 1997, and deaths from AIDS-related illnesses decreased by 21% since 2005.

“Even in a very difficult financial crisis, countries are delivering results in the AIDS response.” said Michel Sidibé, Executive Director of UNAIDS. “We have seen a massive scale up in access to HIV treatment which has had a dramatic effect on the lives of people everywhere.”

According to UNAIDS and WHO estimates, 47% (6.6 million) of the estimated 14.2 million people eligible for treatment in low- and middle-income countries were accessing lifesaving antiretroviral therapy in 2010, an increase of 1.35 million since 2009. The 2011 UNAIDS World AIDS Day report also highlights that there are early signs that HIV treatment is having a significant impact on reducing the number of new HIV infections.

In Botswana, patterns in sexual behaviour have remained relatively stable since 2000. The country scaled up access to treatment from less than 5% in 2000 to over 80% which it has maintained since 2009. The annual number of new HIV infections has declined by over two thirds since the late nineties and data suggests that the number of new HIV infections in Botswana is 30% to 50% lower today than it would have been in the absence of antiretroviral therapy. As treatment reduces the viral load of a person living with HIV to virtually undetectable levels, it also reduces the risk of transmitting the virus to an uninfected partner. Recent studies show that treatment can be up to 96% effective in preventing HIV transmission among couples.

At the end of 2010 an estimated:

• 34 million [31.6 million – 35.2 million] people globally living with HIV
• 2.7 million [2.4 million – 2.9 million] new HIV infections in 2010
• 1.8 million [1.6 million – 1.9 million] people died of AIDS-related illnesses in 2010

Treatment has averted 2.5 million deaths since 1995

People living with HIV are living longer and AIDS-related deaths are declining due to the lifesaving effects of antiretroviral therapy. Globally there were an estimated 34 million people [31.6 million – 35.2 million] living with HIV in 2010, and since 2005, AIDS-related deaths decreased from 2.2 million [2.1 million – 2.5 million] to 1.8 million [1.6 million – 1.9 million] in 2010. Around 2.5 million deaths are estimated to have been averted in low- and middle-income countries due to increased access to HIV treatment since 1995.

Progress in HIV prevention

New HIV infections have been significantly reduced or have stabilized in most parts of the world. In sub-Saharan Africa the number of new HIV infections has dropped by more than 26%, from the height of the epidemic in 1997, led by a one third drop in South Africa, the country with the largest number of new HIV infections in the world.

In the Caribbean, new HIV infections were reduced by a third from 2001 levels—and by more than 25% in Dominican Republic and Jamaica. Similarly the number of new HIV infections in South and South-East Asia dropped by more than 40% between 1996 and 2010. In India new HIV infections fell by 56%.

However, the number of new HIV infections continues to rise in Eastern Europe and Central Asia, Oceania and Middle-East and North Africa, while it has remained stable in other regions of the world.

Declines in new HIV infections are also being spurred by changes in sexual behaviour, particularly in young people, as people reduce their numbers of sexual partners, increase condom use and are waiting longer before becoming sexually active. HIV prevalence declined among young people in at least 21 of 24 countries with national HIV prevalence of 1% or higher. Five additional countries, Burkina Faso, Congo, Ghana, Nigeria, and Togo have seen HIV prevalence decline by more than 25% between 2001 and 2010 among young people.

The rate of new HIV infections in urban Zimbabwe fell from almost 6% in 1991 to less than 1% in 2010. Without changes in behaviour, studies estimate that there would have been an additional 35 000 new infections annually.

The report highlights that an increase in uptake of male circumcision is also starting to contribute to declines in new HIV infections. Studies show that 2000 new HIV infections were averted among men in Kenya’s Nyanza province after scale up of voluntary male circumcision. Estimates in the report highlight that circumcising 20 million more men across Eastern and Southern Africa would avert around 3.4 million new HIV infections by 2015.

Around 400 000 new HIV infections in children are estimated to have been averted since 1995 due to increased access to effective antiretroviral regimens in low- and middle income countries by 2010, almost half (48%) of all pregnant women living with HIV were able to access effective regimens to prevent their child from becoming infected with the virus.

Smarter investments to deliver a better package

UNAIDS has mapped a new framework for AIDS investments which are focused on high-impact, evidence-based, high-value strategies.

"The investment framework is community driven not commodity driven. It puts people at the centre of the approach, not the virus," said Mr Sidibé.

This new strategic approach to investments would achieve extraordinary results; at least 12.2 million new HIV infections would be averted, including 1.9 million among children between 2011 and 2020; and 7.4 million AIDS-related deaths would be averted between 2011 and 2020.

The framework is based on six essential programme activities: focused interventions for key populations at higher risk (particularly sex workers and their clients, men who have sex with men, and people who inject drugs); prevention of new HIV infections in children; behaviour change programmes; condom promotion and distribution; treatment, care and support for people living with HIV; and voluntary medical male circumcision in countries with high HIV prevalence.

For the framework to be effective, programme activities must recognise critical enablers, such as reducing stigma, respect for human rights, creating a protective legal environment and capacity building for community based organizations, which are crucial to overcoming the barriers to successful programme outcomes.

Using the framework to achieve universal access to HIV prevention, treatment, care and support by 2015 requires a scaling up of funding to US$ 22-24 billion in 2015, in line with the targets in the 2011 United Nations Political Declaration on HIV/AIDS. If full implementation of the new framework is achieved in the next four years, global resource needs would peak in 2015 and decline gradually thereafter; making the AIDS response an excellent investment opportunity where returns will offset the upfront cost in less than one generation.

At the end of 2010 around US$ 15 billion was available for the AIDS response in low- and middle-income countries. Donor funding has been reduced by 10% from US$ 7.6 billion in 2009 to US$ 6.9 billion in 2010. In a difficult economic climate the future of AIDS resourcing depends on smart investments.

To rapidly reduce new HIV infections and to save lives, the 2011 UNAIDS World AIDS Day report underscores that shared responsibility is needed.