After years of major gains against HIV/AIDS, the global fight against the virus faces a “growing sense of complacency and fatigue” that “threatens to derail the progress,” according to a new report by the ONE Campaign. New projections show that the epidemic could come to an end if we accelerate progress – or regress if nothing changes. Meanwhile funding over the past year has slowed.
“If we could actually mobilize a really aggressive scaled-up response to HIV, we are not only going to save billions of dollars, we are going to avoid new infections and deaths,” said Erin Hohlfelder, policy director with ONE and author of the report, in an interview with Humanosphere. “If we stay at the status quo, it is going to cost many more lives and money.”
Global spending on AIDS flatlined in recent years. It is projected that $21.7 billion will be spent this year, but that must grow to $32 billion by 2020, according to UNAIDS. The ONE report is concerned that donors are tiring after decades of fighting AIDS and may lose sight of the need to continue doing more.
Ending AIDS means reaching the tipping point: when the number of people receiving treatment exceeds the number of new infections, according to ONE. And we’re close, specifically in sub-Saharan Africa. Roughly 1.9 million people were placed on antiretroviral treatments in 2014 and there were 2 million new cases.
If cases keep falling and more people are being treated, the end of AIDS is a real possibility. Continued gains over the past decade, particularly on getting more people on treatment, have led to a focus on the need to do more to speed up progress. The difference now is new research shows that staying the course is not enough.
“We have a fragile five-year window to ensure that the world is on track to end the AIDS epidemic. Seizing this opportunity to fast track the response to HIV will save millions of lives – and the costs of not doing so are unthinkable,” said Michel Sidibé, head of UNAIDS.
Last year’s report championed the achievement of reaching the tipping point and the “beginning of the end of AIDS.” But new data on infections, treatment and population growth show that the world is not there yet. The revision is cause for concern. With a growing world and the persistence of AIDS, the rate of infection has the potential to increase after years of reductions. ONE joins the U.N. and others in warning that the steps taken by 2020 will set the course for the next 10 years. They say the end of AIDS by 2030 is possible, but urgency is needed.
“We are definitely in some ways victims of our own success,” said Hohlfelder. “Because more people are on treatment and fewer people are dying, it does not seem as urgent as it really is. The more people we can get on treatment immediately the healthier they will be and the less likely they will be to pass it on to someone else.”
Getting more financing for AIDS will be a difficult task. More than $11 billion of global health funding went toward HIV/AIDS in 2014 – accounting for roughly 30 percent of all global health spending. The majority of the money comes from the United States, through its PEPFAR program, and the Global Fund. The latter will hold a replenishment meeting in mid-2016, an important inflection point, Hohlfelder said.
Next year will also see a U.N. high-level special session on AIDS and the International AIDS conference in Durban, South Africa. The three events will help AIDS advocates get more attention and serve as the bellwether for the future of global funding for the epidemic.
Not to be forgotten are the countries themselves. Only a handful of African countries are living up to the Abuja Declaration pledge to allocate 15 percent of their budgets to health. Meeting those goals or even increasing spending could have a major impact on AIDS treatment and prevention, as well as improving other areas of health.
“Even countries increasing spending on health by one or two percentage points will see major positive impacts on their citizens,” said Hohlfelder.
These efforts are helped by a recent decision by the World Health Organization to recommend putting people who test positive for HIV on antiretroviral medicines immediately following diagnosis. Before, positive individuals had to wait for immune system tests (CD4 count) to determine the appropriate treatment. But with evidence building that early treatment can prevent the spread of HIV and save lives, it is widely accepted to get people on antiretrovirals as soon as possible.
“It is hard to sustain the momentum and support for something like this over three decades. If investment can step up, we have the data and information to bend the trajectory of the epidemic to elimination and control,” said Hohlfelder. “We are sounding the alarm because of the opportunity ahead of us.”