Annual global study reports progress against HIV

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Annual global study reports progress against HIV

http://www.latimes.com/health/la-he-aids-report-20101123,0,820736.story

More people have access to treatment and new infections have fallen, UNAIDS

says, but the global economic crisis could reverse the trend.

By H. Maugh II, Los Angeles Times

November 23, 2010

More than 1.2 million people began taking anti- HIV therapy in 2009, a 30%

increase that brings the worldwide total to 5.2 million, UNAIDS said Monday in

its annual report, but that still leaves 10 million people in the developing

world in need of access to the lifesaving drugs.

Since the pandemic peaked in 1999, new infections have fallen by 19% — in some

key countries by 25% or more. Expanding access to treatment has yielded a 19%

decline in deaths since 2004.

" That clearly demonstrates that with confidence and conviction we have broken

the trajectory of the AIDS epidemic, " Dr. De Lay, deputy executive director

of the UNAIDS program branch, said at a news conference Monday. " Fewer are

infected, fewer are dying. "

But those gains are at risk because of the economy, Bernhard Schwartlander,

chief epidemiologist at UNAIDS, said at the news conference. " In 2009, for the

first time, the funds available for fighting the epidemic were less than in the

previous year. "

In 2008, international funding was $7.7 billion. The next year, it dropped to

$7.6 billion. The United Nations estimates that achieving its goal of universal

access to AIDS drugs will require at least $15 billion a year.

Goosby, U.S. global AIDS coordinator, said in a statement that this country

has been stretching its funding through a variety of approaches, including

switching from air transportation for medications to ocean and land transport

and increasing the use of generic drugs.

In a report last week in the British Medical Journal, Dr. Eran Bendavid of

Stanford University Medical School and his colleagues said it has been possible

to continue expanding treatment programs amid slow funding growth because of

substantial declines in drug prices brought about by the use of generics: a drop

from $1,177 per year per patient in 2003 to $96 in 2008. But they said those

price drops are unlikely to continue and that further expansion will require new

infusions of funds.

Schwartlander called on low-income countries to carry a bigger share of the

burden, noting that " 90% of AIDS spending in low-income countries now comes from

international sources. That creates a dependency we must overcome. "

But A. Cornelius Baker, an AIDS expert on the Presidential Advisory Council on

HIV/AIDS, cautioned that it was important to continue to provide support for

people in the poorest countries. " People should not have to spend themselves

into poverty to stay alive, " he said.

" Even when drugs are made available much more cheaply than in the United States,

when they are living on $2 a day, " it is simply not feasible for them to pay for

the drugs, he said.

Some of the most impressive gains noted in the new report have been in

sub-Saharan Africa, which has borne the brunt of the AIDS pandemic. In 22

countries in the region, the incidence of HIV infections fell by at least 22%

from 2001 to 2009 as a result of education and prevention programs. Nearly 37%

of adults and children in the region who were eligible for antiretroviral

therapy in 2009 received it, compared with just 2% seven years earlier.

Not all the news is good. In Eastern Europe and Central Asia, the number of

people living with HIV almost tripled from 2000 to 2009, climbing to 1.4 million

people. Russia and Ukraine are particular problem areas, accounting for nearly

90% of all new infections in the region.

The epidemic there is concentrated primarily among drug abusers, sex workers

and, to a lesser extent, gay males.

Authorities are also seeing a resurgence in HIV infections among gay males in

the United States and Europe, according to the report. The total number of

people living with HIV in the two regions grew from 1.8 million in 2001 to 2.3

million in 2009, with about 35,000 deaths in 2009, compared with 37,000 in 2001.