In the run-up to the 2013 General Assembly of the UN in New York, a new report from the Joint United National Program on HIV/AIDS seeks to give an overview of progress to date towards Millenium Goal 6 – the goal of halting and beginning to reverse the HIV/AIDS epidemic by 2015 (UNAIDS Report 2013). Progress is evaluated in terms of the ten targets and elimination commitments established by the 2011 UN Political Declaration.
The headline figures relate largely to the targets involving specific health outcomes (5 targets out of 10l). At 33%, the decline between 2001 and 2013 from 3.4 to 2.3 million in annual new HIV infections is perhaps within striking distance of the 50 % target (no.1) set by the Declaration, and at 36%, the reduction in HIV-related TB deaths is similarly within reach of an identical 50% target (no.5). A sharp reduction – of 35% between 2009 and 2012 – in mother-to-child transmission is also encouraging, though, say the authors, the target (no. 3) of “elimination” will require greater integration of HIV and antenatal care than has so far been achieved. As regards ART, the world looks set to achieve the regard of 15 million in treatment by 2015 (no.4), with 61% of those eligible under WHO guidelines already receiving treatment. Efforts fall woefully short, however, in respect to the target (no.2) of halving HIV transmission in injecting drug users.
The remaining five targets include: closing the “resources gap” (no.6); service integration (no.10); various “elimination” targets involving structural change – i.e. gender inequality (no.7); stigma (no.8); entry and residence restrictions (no. 9). So far as resources are concerned (no.6), the available US$18.9 billion for 2012 is up by an encouraging 10% on 2009, though still short of the target of US$22-24 for 2015. On integration (no.10), things are also moving in the right direction, with 53% reporting integration of HIV and TB services, and an encouraging two thirds already integrating HIV and sexual and reproductive services. However, on all the elimination targets (no.7-9), progress seems very slow: <50% of countries allocate funds for women’s organizations, integrate HIV and antenatal services, or engage men in national responses (no.7); 60% of countries report laws which present obstacles to effective HIV prevention (no.8); only eight countries have eliminated restrictions on freedom of movement (no.9).
It is interesting to read this report in the light of the concerns widely voiced prior to, and contemporaneously with, the 2011 UN Political Declaration, that the Millennium Goals risked favouring an “outcomes-based” emphasis on “quick-fix” interventions – and that a more “holistic” approach was needed, along with “smarter metrics”( STI blog: Right Way Forward?; STI blog: MDGs Bad for your Health?) . These concerns seem to be reflected in the formulation of the 2011 targets, with their emphasis on holistic factors (no.s 7-9), and on service integration (UNAIDS Report 2011). It is precisely in these latter areas that the progress noted by the recent UNAIDS report seems slowest, and is hardest to evaluate. Regarding HIV integration (no. 10), however, the authors note that “a clear trend towards integration of HIV with diverse systems and sectors apparent”, though they also call for “greater efforts”.