World AIDS Day 2020: Global solidarity, shared responsibility
The human immunodeficiency virus (HIV) targets the immune system and weakens people's defense against many infections and some types of cancer. As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient. Immune function is typically measured by CD4 cell count.
Immunodeficiency results in increased susceptibility to a wide range of infections, cancers and other diseases that people with healthy immune systems can fight off.
The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS), which can take many years to develop if not treated, depending on the individual. AIDS is defined by the development of certain cancers, infections or other severe long term clinical manifestations.
Key facts, according to WHO
- HIV continues to be a major global public health issue, having claimed almost 33 million lives so far. However, with increasing access to effective HIV prevention, diagnosis, treatment and care, including for opportunistic infections, HIV infection has become a manageable chronic health condition, enabling people living with HIV to lead long and healthy lives.
- There were an estimated 38.0 million people living with HIV at the end of 2019.
- As a result of concerted international efforts to respond to HIV, coverage of services has been steadily increasing. In 2019, 68% of adults and 53% of children living with HIV globally were receiving lifelong antiretroviral therapy (ART).
- A great majority (85%) of pregnant and breastfeeding women living with HIV also received ART, which not only protects their health, but also ensures prevention of HIV transmission to their newborns.
- At the end of 2019, an estimated 81% of people living with HIV knew their status. 67% were receiving antiretroviral therapy (ART) and 59% had achieved suppression of the HIV virus with no risk of infecting others; about 30 million adolescent boys and men in East and Southern Africa had received VMMC services.
- By June 2020, 26 million people were accessing antiretroviral therapy, marking a 2.4% increase from an estimate of 25.4 million at the end of 2019. By comparison, treatment coverage increased by an estimated 4.8% between January and June of 2019.
- The number of new people starting treatment is far below expectation due to the reduction in HIV-testing and treatment initiation and ARV disruptions that occurred during the COVID-19 pandemic. By end 2020, testing and treatment rates showed steady but variable recovery.
- Nevertheless, between 2000 and 2019, new HIV infections fell by 39% and HIV-related deaths fell by 51%, with 15.3 million lives saved due to ART. This achievement was the result of great efforts by national HIV programmes supported by civil society and international development partners.
- But success has been variable by region, country and population; However, not everyone is able to access HIV testing, treatment and care. Notably, the 2018 Super-Fast-Track targets for reducing new paediatric HIV infections to 40 000 was not achieved. Geven prior to the COVID-19 pandemic, reduction of new infections and deaths had plateaued; global 90/90/90 targets for 2020 are at risk of beingwill be missed unless rapid action is taken.
- Due to gaps in HIV services, 690 000 people died from HIV-related causes in 2019 and 1.7 million people were newly infected.
- To reach the new proposed global 95/95/95 targets, we will need to redouble our efforts to avoid the worst-case scenario a half million excess deaths in Sub Saharan Africa, increasing HIV infections due to HIV service disruptions during COVID-19, and the slowing public health response to HIV.
- Interventions will need to focus on the populations left-behind: Key population groups and their sexual partners accounted for over 6620% of all new HIV infections globally among the age group 15-49 years in 2019. In eastern European and central Asia, Asia and the Pacific, western and central Europe, and north America, and the Middle East and north Africa, these groups accounted for over 95% of new HIV infections in each of these regions.
- WHO defines key populations as people in populations who are at increased HIV risk in all countries and regions. Key populations include: men who have sex with men; people who inject drugs; people in prisons and other closed settings; sex workers and their clients; and transgender people.
- Increased HIV vulnerability is often associated with legal and social factors, which increases exposure to risk situations and creates barriers to accessing effective, quality and affordable HIV prevention, testing and treatment services. Prioritising key populations in the HIV response with appropriate interventions would have the biggest impact on the epidemic and reduce new infections.
- In addition, given their life circumstances, a range of other populations may be particularly vulnerable, and at increased risk of HIV infection, such as adolescent girls and young women in southern and eastern Africa and indigenous peoples in some communities.
- Over two thirds of all people living with HIV live in the WHO African Region (25.7 million). While HIV is prevalent among the general population in this region, an increasing number of new infections occur among key population groups.
- HIV can be diagnosed through rapid diagnostic tests that can provide same-day results. HIV self-tests are increasingly available and provide an effective and acceptable alternative way to increase access to people who are not reached for HIV testing through facility-based services. Rapid test and self-tests have greatly facilitated diagnosis and linkage with treatment and care.
- There is no cure for HIV infection. However, effective prevention interventions are available: preventing mother-to-child-transmission, male and female condom use, harm reduction interventions, pre-exposure prophylaxis, post exposure prophylaxis, voluntary medical male circumcision (VMMC) and antiretroviral drugs (ARVs) which can control the virus and help prevent onward transmission to other people.
- Science is moving at a fast pace, and there have been two people who have achieved a ‘functional cure’ by undergoing a bone marrow transplant for cancer with re-infusion of new CD4 T cells that are unable to be infected with HIV. However, a neither a cure nor a vaccine is available to treat and protect all people currently living with or at risk of HIV.
What is World AIDS Day?
World AIDS Day is held on 1 December each year. It raises awareness across the world and in the community about HIV and AIDS. It is a day for the community to show their support for people living with HIV and to commemorate people who have died of AIDS related conditions or other conditions associated with HIV.Even today, more than 12 million people are still waiting to get on HIV treatment and 1.7 million people became infected with HIV in 2019 because they could not access essential services.
Only ‘global solidarity and shared responsibility’ will help us beat the coronavirus, end the AIDS epidemic and guarantee the right to health for all.
No individual, organization, or country can eliminate on its own the existing inequalities that fuel the AIDS epidemic today. By ending disparities together, we can re-energize the AIDS movement and set the world back on the path to ending AIDS by 2030.