Globally 770 000 people died of HIV in 2018. This, in spite of the fact AIDS-related deaths continue to decline as access to treatment continues to expand, and more progress is made in improving the delivery of HIV/ tuberculosis services. This according to the UNAIDS 2019 Global AIDS Update released last month.

SA has made huge advances and has successfully reduced new HIV infections by more than 40% and aids-related deaths by around 40% since 2010.

Since 2010, AIDS-related deaths have fallen by 33% in 2018. However, that’s only 30 000 less than 2017, and down only 16% since 2010. Worldwide, around 1.7 million people became newly infected with HIV in 2018. This raises concerns about reaching the 90-90-90 targets launched by UNAIDS in 2014. 90-90-90 is an ambitious treatment target to help end the aids epidemic.

The aim is to diagnose 90% of all HIV-positive persons, provide antiretroviral therapy for 90% of those diagnosed, and achieve viral suppression for 90% of those treated by 2020.

SA ON THE RIGHT PATH

There was an important reason that Eshowe, KwaZulu-Natal was chosen for the launch of the global report. “In one of the places hardest hit by the HIV epidemic, antiretroviral therapy has transformed a dire situation – where an HIV diagnosis once meant certain death – into one of life and hope,” UNAIDS said. Earlier this year, Doctors Without Borders (MSF) and the SA Department of Health demonstrated it is possible to achieve the 90-90-90 targets and a possible reduction of incidence in Eshowe with intensive community-based services linked to primary care facilities supported by training, mentoring and monitoring.

While encouraging, Eshowe remains an exception and few other districts, provinces or countries will reach the 90-90-90 targets in 2020. “We cannot celebrate or talk of success while hundreds of thousands continue to die of AIDS every year because they do not have access basic HIV care, either because they live in countries that are neglected, because they are part of neglected population groups, or because of policies that chose to ignore them,” said Dr Gilles Van Cutsem, leader of the MSF HIV/AIDS Working Group.

“Preventing, detecting, and treating advanced HIV and AIDS, demands more attention and funding, especially in low coverage settings such as West and Central Africa, and in neglected populations.” “The major difference between Eshowe and SA’s (overall) achievements lies in the second 90 – linkage to care: 94% of patients diagnosed in Eshowe were linked to care compared to 74% in SA.

“Projects such as Eshowe show that 90-90-90 can be achieved but with more resources. It’s all good and well to celebrate, but the reality of the future is that if there’s no increased international funding, Eshowe will remain a lone island of success,” said Dr Cutsem. SA & 90-90-90 According to the UNAids report SA manages the world’s largest antiretroviral therapy programme, aiming to provide treatment, suppress viral loads and secure the health of 19% of the world’s people living with HIV.

“SA has made huge advances and successfully reduced new HIV infections by more than 40% and AIDS-related deaths by around 40% since 2010,” said UNAIDS. Speaking at the launch SA Deputy President David Mabuza acknowledged that SA has the world’s largest HIV epidemic. “We take the fight against HIV very seriously,” he said. “We recognise that unless we deal decisively with the challenges of unemployment, poverty, gender-based violence, substance abuse, and poor housing, among others, we will not be able to heal our society.

The success of the work done by Doctors without Borders here at Eshowe reminds us of the social capital vested in our communities. This social capital needs to be harnessed to help guide the response.” The SA government aims to have 6.1-million people on treatment by 2020 as part of its efforts to try to bring the epidemic under control. The pace of progress in reducing new HIV infections, increasing access to treatment, and ending AIDS-related deaths is slowing down according to the report.

“SA, for example, has made huge advances and has successfully reduced new HIV infections by more than 40% and Aids-related deaths by around 40% since 2010,” said UNAids. However, this massive infectious disease response contends with significant challenges. Although steady progress has been achieved in recent years, 46% of people living with HIV in SA had unsuppressed viral loads in 2018.

FINANCIAL INVESTMENT FAILING

Progress against the epidemic tracks closely with the investments made in national HIV responses. Disconcertingly, the report shows that the gap between resource needs and resource availability is widening. “For the first time, the global resources available for the Aids response declined significantly, by nearly $1bn,” said UNAIDS. “Donors disbursed less, and domestic investments did not grow fast enough to compensate for inflation.

In 2018, $19bn (in constant 2016 dollars) was available for the AIDS response, $7.2bn short of the estimated $26.2bn needed by 2020. “Financial data reported to UNAIDS show one-year declines across all sources of investment in HIV responses, including domestic resources, multilateral and bilateral donor programmes, philanthropic organisations, and other international sources.

Although the SA government funds the bulk of the HIV/Aids programmes, due to the sheer size of the epidemic, it requires significant funding from donors. Warning that the increasing funding gap threatens global progress towards ending the HIV/AIDS pandemic, UNAIDS executive director, Gunilla Carlsson, called the decline a collective failure. “We urgently need increased political leadership to end AIDS.

This starts with investing adequately and smartly and by looking at what’s making some countries so successful. “While considerable progress has been made, there is a risk that we will lose momentum. If the world is to be on track to end AIDS by 2030, there must be adequate and predictable financing for development. But, for the first time since 2000, the resources available for the AIDS response globally have declined,” said Carlsson.

In 2018, an estimated:

  • 37.9 million people globally were living with HIV
  • 23.3 million people were accessing antiretroviral therapy
  • 1.7 million people became newly infected with HIV
  • 770 000 people died from AIDS-related illnesses.