Written by Nicole Scholz,
Every year, 1 December marks World AIDS Day, proclaimed by the United Nations (UN) in 1988, aiming mainly at raising awareness. This year’s specific theme is ‘Hands up for #HIVprevention‘. In the global campaign timeline leading up to World AIDS Day 2016, nine weekly topics were highlighted:
- use of condoms as a means to prevent infection with human immunodeficiency virus (HIV), as well as other sexually transmitted infections, which has averted an estimated 45 million HIV infections globally since 1990;
- harm reduction for people who inject drugs, one of the populations most at risk for HIV, e.g. through needle-syringe programmes (the provision of sterile injecting equipment and its safe disposal) and opioid-substitution treatment (replacing injected, illicit drugs with non-injected medications);
- voluntary medical male circumcision, an intervention that affords lifelong partial protection against HIV transmission from women to men;
- eliminating new HIV infections among children by providing antiretroviral therapy (an anti-HIV treatment that does not cure HIV, but that can keep the virus under control, allowing the immune system to stay strong) to pregnant or breastfeeding women living with HIV;
- pre-exposure prophylaxis (PrEP), a new HIV prevention strategy that involves people who are HIV-negative but at a high risk of becoming infected, taking HIV medicines on a regular basis to effectively protect them from the virus;
- empowerment of young women and girls, given that young women aged 15-24 years are at particularly high risk of HIV infection globally, and that gender inequalities, including gender-based violence, increase young women’s and girls’ vulnerability, especially in sub-Saharan Africa;
- testing viral suppression so that people living with HIV know their HIV status (‘viral load’), people who know their HIV status are accessing treatment, and people on treatment have suppressed viral loads, which greatly reduces the risk of transmitting the virus to others;
- HIV prevention among key populations (including sex workers, people injecting drugs, transgender people, prisoners, gay men and other men who have sex with men, and their sexual partners), who, in many countries, remain among the most vulnerable to HIV, with extremely high infection rates, as well as being confronted with stigma and discrimination;
- investing in HIV prevention to close the prevention gap, since ‘strengthened global political commitment to HIV prevention must be followed by strengthened financial commitment’: in June 2016, UN Member States committed to ensuring that financial resources for prevention are adequate (‘no less than a quarter of AIDS spending globally on average’) and targeted to evidence-based measures reflecting the specific nature of each country’s epidemic.
Global fight: positive trend continues
Ending the HIV/AIDS epidemic by 2030 counts among the targets under Goal 3 of the Sustainable Development Goals (SDGs), adopted by the UN in September 2015. Although the SDGs are not legally binding, governments are expected to set up a national framework for achieving them. According to data from 2015 by UNAIDS (the Joint United Nations Programme on HIV/AIDS), 36.7 million people live with HIV. New HIV infections have decreased by 6 % overall since 2010 and by as much as 50 % among children. Some 17 million people living with HIV are now receiving antiretroviral therapy. AIDS-related deaths have fallen by 45 % since 2005. Moreover, the number of deaths from tuberculosis (TB) has decreased by 32 % since 2004: TB is one of the most common, life-threatening ‘co-infections’ (concurrent infections by separate pathogens) of HIV and a leading cause of death among people living with HIV/AIDS – a person with HIV is at high risk of developing TB, and when a person has both HIV and TB, each disease speeds up the progress of the other.
HIV still a major public health concern in Europe
Despite the encouraging worldwide trend, HIV transmission remains a problem in Europe and neighbouring countries (i.e. the WHO European Region spanning Europe and central Asia), especially in the eastern part of the region. In its HIV/AIDS surveillance report 2014, the European Centre for Disease Prevention and Control (ECDC) concludes that, despite widely varying trends and patterns across Europe, HIV transmission is continuing in most of the countries. According to the report, over 142 000 people were newly diagnosed with HIV in 2014 – 77 % in the eastern part of the region. The number of infections there has mainly increased among people infected heterosexually, notably women, and among people who inject drugs and their sexual partners.
EU is maintaining momentum to curb HIV/AIDS
Two bodies set up by the European Commission – the HIV/AIDS Think Tank and the HIV/AIDS Civil Society Forum – aim to strengthen cooperation between the EU and its neighbourhood, and to foster the involvement of NGOs and other stakeholders in the development of policies. The Commission’s current action plan on HIV/AIDS in the EU and neighbouring countries 2014-2016 prolongs the previous action plan with an increased focus on areas such as HIV treatment as prevention, particularly in heterosexual transmission, and on HIV co-infections such as TB and viral hepatitis. According to the action plan, access to integrated prevention and treatment needs to be increased, particularly in Eastern European countries. This includes measures such as harm-reduction and antiretroviral treatment, especially in prisons. Moreover, in January this year, a three-year joint action on HIV and co-infections (HA-REACT) was launched with funding from the EU health programme. This addresses gaps in the prevention of HIV and co-infections (especially TB and viral hepatitis), among drug users. The EU is also financing HIV/AIDS projects in the framework of the EU’s programme for research and innovation, Horizon 2020. At international level, the EU supports the global fund to fight AIDS, TB and malaria, a partnership between governments, civil society, the private sector as well as people affected by these diseases.