We Told You So—New UNAIDS report shows missing focus on rights and evidence-based responses hurting prevention

May 31, 2016

Earlier today UNAIDS released its Global AIDS Update ahead of next week’s UN High-Level Meeting on Ending AIDS in New York. The highlight of this year’s update was the news that across the globe 17 million people who are living with HIV are on antiretroviral treatment (ART), an increase of two million from 2014 to 2015. While there is clearly still work to do in closing the treatment gap (17 million is still a little less than half of the total number of people living with HIV all of whom are eligible for treatment per updated WHO guidelines), this recent accomplishment is ahead of the 15 million target set within the 2011 UN Political Declaration on HIV and AIDS.

This is welcome news, but unfortunately the news is not all good. The report also reveals that declines in rates of HIV acquisition have “slowed alarmingly” with the overall rates of new infections largely unchanged. These rates continue to be disproportionately high among young women, and key populations and their sexual partners.

While the annual number of new infections has changed little from the previous year, the data that make up that total have changed. Rates are on the decline in eastern and southern Africa—4 percent since 2010—while new infections in eastern Europe and central Asia are up 57 percent over the same period. Any decline, even a modest one, indicates progress, but prevention advocates are left to wonder what could have been had countries reached the 80 percent coverage of voluntary medical male circumcision (VMMC) targets. Some models predicted 10–15, even 25, percent declines if VMMC targets were reached. So yes, overall decline is good but this modest number represents a missed opportunity to do much much better.

And speaking of VMMC, the report didn’t speak to it much at all, or any of the prevention targets outlined in UNAIDS’ 2016 – 2021 Strategy, released last October. There is a section of the 12-page update on prevention, the title of which points to the need for a “reinvigoration of HIV prevention” but the update misses the mark, leaving out the targets completely and reporting only on successes in ART coverage.

And prevention was dealt another setback today with the National Health Service England confirming its decision not to fund PrEP—and somehow it’s still a surprise when reports like the one released today show that global HIV rates aren’t declining.

UNAIDS comments that “Fast-Track approach to HIV treatment is working. Global consensus and leadership have driven greater investment of financial and human capital, and mounting clinical experience and research, improved treatment regimens and diagnostics and reductions in the price of medicines have created gains in efficiency and effectiveness.” This is certainly true, but AVAC calls for—and looks forward to—future reporting where the “Fast-Track” approach to treatment AND prevention is the global success we all know it can—and has to—be.