UNAIDS Gap Report: “The beginning of the end of the AIDS epidemic

In advance of the 20th International AIDS Conference in Melbourne 20th-24th July, UNAIDS has published its Report entitled The Gap.  This offers a panoramic survey of progress and challenges to date, graphically presented.

The general sense of a tide having at last turned in the global battle against HIV is borne out by the Report’s account of the increased concentration of the epidemic on certain key fronts where the struggle will henceforth need to be carried on.  Overall, it points to a global decline – and a swiftly accelerating decline – in HIV incidence and AIDS related mortality globally.  New infections have fallen 38% from 2001, 13% over the last three years; mortality has declined 35% since 2005, 19% over the last three years.  The Middle East and North Africa (see STIs/blog;  STIs/Saba & Abu-Raddad; Abu-Raddad & Riedner), and Eastern Europe and Russia constitute the sole exceptions to this pattern (with increases in mortality of 66%, and 5% respectively).

The “flip-side” is an increasingly visible concentration of the epidemic.  Fifteen countries (with Nigeria and S. Africa generally topping the list) account for 75% of the global HIV burden, 76% of last year’s (2013) new infections, and 74% of last year’s AIDS-related mortality.  In view of this, it is no surprise that the major part of the Gap report consists in a series of profiles: first, of the principal world regions, and second key populations (prisoners, transgender etc.).  These recurrently pose the question: “Why am I being left behind?”

Three aspects of the situation as described by the report strike this reader as particularly telling:

–          the proportion of those living with HIV who are still not accessing ART: three in every five.  In Nigeria 80% have no access to treatment.

–          the vulnerability of adult women in sub-Saharan Africa, who alone account for 80% of the 16 million women aged 15 yrs and older who live with HIV.

–          the appallingly low proportion of children living with HIV who receive ART: a mere 24%.

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