What's happening with AIDS?

Nearly four decades after the virus which would later become known as Human Immunodeficiency Virus (HIV) was first isolated (in 1983), over 25 million people have lost their lives to this disease; one that progressively reduces the effectiveness of the immune system, leaving individuals highly susceptible to developing infections that a non-infected person would be able to resist.

Using data gathered from 182 countries, as well as extensive input from civil society and other sources, the World Health Organization (WHO) has published up-to-date findings in their 2010 UNAIDS report on the global Acquired Immune Deficiency Syndrome (AIDS) epidemic. Using these statistics, we’re going to explore the latest developments in the HIV/AIDS crisis and the progress being made to eradicate their devastating effects.

Overall Statistics

HIV has now spread to the point where one per cent of sexually active adults around the globe have the virus. The WHO estimates that there are over 32.8 million people worldwide living with HIV/AIDS, and (of that total) 22.5 million individuals living with AIDS reside in Sub Saharan Africa, proving that this region continues to bear an immense 69% share of the world’s HIV burden.

However, amidst these staggering statistics, the good news is that fewer people overall are becoming infected with HIV and fewer people are dying from the disease. The global report noted that since 1999, the year in which it is believed that the epidemic peaked, the number of new infections globally has fallen by 19%. Of the estimated 15 million people living with HIV in low and middle income countries who need treatment, 5.2 million have access to it, which means fewer AIDS-related deaths overall. Such expanded access has contributed to a 19% decline in deaths among people living with HIV between 2004 and 2009, but for those living with the disease who continue to go on without treatment, it is clear that much more needs to be done to deliver the same care.

Infection and Transmission

Initially thought to be a mysterious ‘gay plague’, researchers now know that HIV is transmitted through the following means:

• Unprotected sex (heterosexual and homosexual);
• Sharing of needles for injecting drugs;
• Transfusions of contaminated blood; and
• Breast feeding by infected mothers.

Each of these factors poses an enormous threat, both to individual health and public health safety; they serve as critical barriers to be overcome in curbing the further spread of the disease.

Among young people between the ages of fifteen to twenty four (the age bracket believed to have the highest risk of infection), statistics show that in fifteen of the most heavily affected regions HIV prevalence has actually fallen by more than twenty five percent. This improvement is believed to be largely due to HIV awareness campaigns and the resulting safer sex practices. However, it is believed that younger people in some areas still lack the education and/or access to the tools needed to practice HIV risk-reduction strategies, and this means continued effort from communities and their leaders in public education strategies is still very much needed.

As the AIDS epidemic has matured, injection-drug use by contaminated equipment has emerged as a major factor in the rising spread (and in some cases, severe increase) of HIV transmission in a number of countries. For example, the number of people living with HIV in Eastern Europe and Central Asia has almost tripled since 2000, while in Africa AIDS remains a mainly heterosexual epidemic; in Eastern Europe many infections occur among drug users, especially among sex workers. The UNAIDS report noted at least 30% of sex workers in the Russian Federation have injected drugs and the high HIV infection levels found among sex workers in Ukraine (14% to 31% in various studies) are almost certainly due to the overlap of paid sex with injecting drug use.

In many countries, HIV weighs heavily on the mortality rates of mothers and their children. However, the transmission of AIDS from mother to child has shown a decrease and new HIV infections among children are also decreasing. As access to services for preventing the mother-to-child transmission of HIV improves, there is a strong case for the total number of children being born with HIV to drop further. For example, in 2009, there was an estimated 370,000 children who were newly infected with HIV (a drop of 24% from five years earlier). The trend reflects the steady expansion of services to prevent transmission of HIV to infants as well as an increase in access to treatment for children.

Life Expectancy

Findings of a study in the medical journal ‘The Lancet’ found that a “combination of anti retro-viral therapy has led to significant increases in survival and quality of life, but at a population-level the effect on life expectancy is not well understood.” The study, published in July 2008, discovered that these drugs can increase the life expectancy of HIV patients in high income countries by more than 13 years and that, over the last decade, combination therapy regimens have become more effective, better tolerated and simplified in terms of dosing. Clinical trials and observational studies have shown a profound reduction in mortality and sickness in HIV infected patients as a result of these therapies, and the improvements to mortality is very apparent in industrialized, high income countries where access to health care and drug treatments are readily available.

Medicines

Scientists are still exploring ways to treat the disease, but currently there is no known cure or vaccine. In the meantime, death rates have fallen as medical advances have been able to increase the life expectancy of infected people. Between 2003 and 2010, the number of patients receiving life-saving medicines has increased many fold - but as noted in the WHO report, being able to reach the remaining two thirds of people who still require treatment, but are not yet receiving it, is a challenge that will require a continued and expanded global commitment to providing high quality HIV care for all.

Future Outlook

Prevention is a key aim in controlling the AIDS pandemic, particularly with the help of health organizations promoting safe sex and providing access to clean needles slowing the spread of the virus. Progress in the fight against AIDS will depend on the efforts of all stakeholders involved and will require more change in societal structures, cultural/religious beliefs and value systems to help remove the stigma and discrimination attached to the individuals who suffer from the disease. Future investment in achieving universal access to HIV prevention by governments and advocacy groups will also play a critical role in achieving a positive outlook.