AIDS: prevention is a success … at the edge of the crisis

More and more HIV-positive people are being treated, but this progress is now fragile according to the UN.
  

The fight against AIDS is in a paradoxical situation. The proportion of HIV-positive people who have access to treatment has never been higher: 21.7 million out of 36.9 million in total take antiretroviral therapy, the highest proportion ever, according to a UNAIDS report released on Wednesday . "No one would have thought we could have put 22 million people on treatment in 2018. It was a dream," said UNAIDS Executive Director Michel Sidibé at a press conference in Paris.

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But "unfortunately, we are a little victims of these results", he qualified, deploring a "crisis of prevention ". Entitled "UNAIDS warns that progress is slowing and time is running out to reach the 2020 targets for HIV", the report warns of a loosening in prevention and decreasing funding that fears a rebound of the epidemic .

"$ 7 billion a year is missing"

This undermines the UN's 2020 target of 90 per cent of people living with HIV knowing their status, 90 per cent of those living with HIV the last ones are under treatment, and of these, 90% have an undetectable viral load. "We are not going at the pace we have set ourselves, to break the backbone of this epidemic we must reach 30 million patients treated in 2020," hammered the Malian boss of UNAIDS.

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At the forefront of concerns, the question of funding. "It is missing 7 billion dollars a year (…) to allow us to maintain our results," said Mr. Sidibé to AFP. Last year, € 20.6 billion was spent on AIDS programs in low- and middle-income countries, which themselves account for 56 percent, according to the report.

"The fear is that the decrease in international donor contributions will lead to a decrease in the internal investments of the affected countries," Sidibé said. Yet "at least 44 countries are 75% dependent on international aid to fight the epidemic". The United States of Donald Trump, who is historically the major contributor to the fight against AIDS, for example have planned cuts.

Disparities in places of infection

There were 1.8 million new infections last year, a stable number compared to previous years. But the global results released on Wednesday hide strong disparities. In West and Central Africa in particular, only 40% of the carriers of the virus have access to treatment.

"Some countries continue to worry, like Nigeria, which alone accounts for about half of all new infections in West Africa," Sidibé said. Another source of concern is that "the epidemic in Russia is becoming more widespread, and while it is focused on people who inject drugs, it is increasingly affecting the general population."

And "although we have avoided 1.4 million new infections among children since 2010, we unfortunately find that we have not made enough progress," he noted. "We continue to have more than 50% of children who do not have access to treatment, and last year there were 110,000 deaths and 180,000 new infections, which is unacceptable."