Ahead of the IAS conference in Brisbane from 23 to 26 July, UNAIDS published a comprehensive report (195 pages) on progress and obstacles to eliminating HIV infection as a public health threat.
With numerous numbers, notes and graphics, the UN organization provides very interesting information about the AIDS planet. A treasure trove of data, some of which deserves to be better known or recognized, and which provides food for thought about what has been achieved and what remains to be overcome.
It is difficult to report exhaustively: this report presents the epidemiological data, identifies the gaps that should be closed and the different possible scenarios: combined prevention, targeted prevention programs, mobilization of the most effective measures to reduce exposure and new infections in different population groups . UNAIDS is also reviewing the financial efforts that remain necessary: spending on HIV human immunodeficiency virus. In English: HIV (Human Immunodeficiency Virus). Isolated at the Pasteur Institute in Paris in 1983; most recent discovery (2008), rewarded with the Nobel Prize in Medicine, awarded to Luc Montagnier and Françoise Barré-Sinoussi. Countries with low or limited resources increased sharply between 2010 and 2013, then remained relatively constant at around $21 billion between 2012 and 2022 (note that a large portion of these funds earmarked for programs comes from international aid: 26% in the poorest countries). , 32% for those with an intermediate level and 15% for the best. However, to meet demand, 9 billion will have to be added by 2025, billions that are still far from being sourced. The Covid Health Crisis Coronavirus disease, sometimes referred to as Covid (after the English acronym for coronavirus disease), is a disease caused by a coronavirus (CoV). The term can refer to the following diseases: severe acute respiratory syndrome (SARS), caused by the SARS-CoV virus, Middle East Respiratory Syndrome (MERS), caused by the MERS-CoV virus, coronavirus disease 2019 (Covid- 19), caused by the SARS-CoV-2 virus. has gone through this and national resources, such as those provided under various bilateral or international assistance, are declining.
UNAIDS report 2023
Decrease in new infections
At the epidemiological level, antiretroviral treatment prevented 20.8 million deaths between 1996 and 2022, with a significant increase since 2005. Since 2000, 3.4 million infections in newborns have been prevented.
New infections are estimated at 1.3 million in 2022, the lowest level since 2010, with particularly sharp declines in regions with the highest HIV burden, led by South and Central Africa. and the West respectively – 57% and – 49%. The decline is smaller in “Western” countries (-23%), the Caribbean and Asia. The epidemic continues to grow slowly in South America, but it is increasing significantly in Eastern Europe (non-EU) and Central Asia (+ 49%), in the Middle East and North Africa (+ 61%).
In any case, the successes in sub-Saharan Africa should be highlighted, where the countries achieve 95-95-95: Botswana, Eswatini, Rwanda, Tanzania and Zimbabwe.
UNAIDS
The groups where strengthening structural policies and public health measures are considered necessary include women and adolescents, mothers and children, as well as key population groups who, despite screening and treatment, are still too neglected or even sacrificed. We need to employ more effective prevention based on the different narratives of PrEP pre-exposure prophylaxis. PrEP is a strategy that allows an HIV-negative person exposed to HIV to eliminate the risk of infection by taking Truvada®-based antiretroviral treatment continuously or “as needed.” and about structural measures for real progress in gender relations. In sub-Saharan Africa, the efforts that need to be made with programs targeting men remain significant: 79% of men with HIV know their serological status, 78% have access to treatment and 73% have a viral load. Plasma viral load is the number of viral particles contained in a blood sample or other container (saliva, cerebrospinal fluid, semen, etc.). In HIV, viral load is used as a marker to monitor disease progression and measure the effectiveness of treatments. The level of viral load, but especially the CD4 count, contributes to the decision for treatment with antiretroviral drugs. controlled, while for women these indicators are 93%, 86% and 80%, respectively.
Human rights policy
We focus here on the measures for key population groups and the important bibliography cited to support the data and positions on the increase in risk arising from population attitudes towards rejection and discrimination, repressive legislation and its associated consequences, the underfunding of recognized programs, results in effectiveness.
Repressive laws and inadequate measures to reduce risks for drug users: In the available data on around thirty developing countries, only three (Malaysia, Seychelles and Mauritius) exceed the 50% of drug users in substitution treatment, but their syringe distribution programs remain minimal (with the exception of Mauritius) . In three other countries (Burma, India, Bangladesh) the distribution of syringes is quite large, but it is not a replacement. The other twenty African, European or Asian countries for which information is available are poor on both counts. Risk mitigation programs remain scattered, far below optimal coverage, and largely underfunded.
The report recalls, with supporting references, the part of the risk of contracting HIV that is due to stigmatization and discrimination against people living with HIV, sex workers, drug users, transgender people and people in homosexual relationships. Some countries are adopting slightly more liberal legislation on gender identity and sexual orientation diversity, but others are moving in the opposite direction: Hungary, Peru, the Russian Federation, but also the United Kingdom and the United States.
Typical of reports from UN agencies that may mix overstated successes and colossal challenges to be overcome, structural problems surrounding big ideas and intervention techniques, this report could be perceived as overly optimistic and overly full of wishful thinking. It shows how resource-poor countries affected by massive HIV epidemics reorganized themselves and drastically changed the situation by mobilizing their internal resources and some external aid. UNAIDS recalls what has been achieved by demanding justice for the least resourced countries and populations in the face of the great pandemic of the 20th century and what must always be defended through uncompromising advocacy.