HIV/AIDS: FAST TRACK TO 2030: GRANULARITY AT A GLOBAL SCALE

Thursday, 1st of January 2015

FAST TRACK TO 2030: GRANULARITY AT A GLOBAL SCALE

The Lancet HIV, Volume 2, No. 1, e1, January 2015

Editorial

Also at http://dx.doi.org/10.1016/S2352-3018(14)00040-X

The annual World AIDS Day on December 1 is both an opportunity to raise public awareness about HIV/AIDS and to promote global prevention efforts, and a chance for the global HIV/AIDS community of patients groups, activists, legislators, health workers, scientists, and politicians to reflect and take stock of what has been achieved. Perhaps most importantly the yearly event provides an opportunity when the world, as one, can look forward to what has yet to be done, and to reflect on progress to its goals and to set new targets. 2014 was no different, with mayors from cities around the world launching the 2014 Paris Declaration Fast-Track Cities: Ending the AIDS Epidemic—an extension of the 90-90-90 targets aimed at achieving 90% viral suppression by 2020 and bringing the annual numbers of new infections down to 200 000 by 2030.

Since the peak of the epidemic in the early 2000s, each years accounting has given an encouraging picture. The general trends have been for declines in the number of deaths related to AIDS and the number of new infections. Moreover, substantial gains have been made in the number of people accessing treatment. The figure of 1·5 million AIDS-related deaths worldwide in 2013 is down 35% on the peak of 2·4 million in 2005 and down from 1·7 million in 2012. New infections have fallen 38% from 3·4 million in 2001 to 2·1 million in 2013 (down from 2·2 million in 2012). The number of people accessing treatment rose from 10·6 million in 2012 to 12·9 million at the end of 2013, and estimates for June 2014 suggest that 13·6 million people—almost 40% of the 35 million people living with the virus—are receiving antiretroviral therapy. Such progress makes the target of 15 million people receiving treatment by the end of 2015 seem eminently achievable.

To achieve that 2015 treatment goal, the greatest progress will have to be made in sub-Saharan Africa. 24·7 million of the 35 million living with HIV live in the region. Three of every four people receiving antiretroviral therapy live in the region, but 67% of men and 57% of women are not receiving treatment. And although new infections in the region have fallen by 33% from 2005 to 2013, sub-Saharan Africa accounts for 70% of new infections and 73% of AIDS-related deaths worldwide.

Although sub-Saharan Africa dominates the global epidemic by sheer weight of numbers, other regions are a serious cause for concern as they buck the generally positive trends. In Indonesia, new infections have risen by 48% since 2005, with men who have sex with men facing the brunt of the disease—prevalence in this group has reached almost 20% in Jakarta and Bali. In eastern Europe and central Asia, new infections and AIDS-related deaths both rose by 5% from 2005 to 2013. And in the Middle East and north Africa new infections rose by 7% between 2005 and 2013—AIDS-related deaths rose by a staggering 66% in the same period.

In the first Paris Declaration in 1994, world leaders and communities formally recognised the importance of involving people living with HIV in responses to the epidemic. 20 years on, at a World AIDS Day event hosted by the new Mayor of Paris Anne Hildago, the 2014 Paris Declaration acknowledges the disproportionate effect that HIV has on urban areas and the importance of municipal authorities in combating the virus. If the ambitious targets of 90% of people living with HIV being aware of their diagnosis, 90% of those being on antiretroviral therapy, and 90% of those being virally suppressed are to be reached much of the work will have to take place in cities. In Africa, 45% of people living with HIV reside in cities. The 200 cities most affected by the epidemic are estimated to be home to a quarter of all people affected by HIV; and in many places, HIV epidemics are concentrated in key populations, members of which often congregate in urban centres.

The 2014 Paris Declaration recognises that each city will have its own social structure, its own specific problems related to HIV treatment and prevention, and its own particular infrastructure to address the epidemic. In acknowledging the key role of urban centres in achieving ambitious targets and encouraging municipal authorities to take the reins, it should not cut cities adrift from their within-country context or from each other internationally. It is important that the declaration fosters a network by which, although the cities have different problems and different solutions, they are all focused on a common goal—connected with, supported by, and accountable to each other.

For the Paris Declaration see http://www.unaids.org/sites/default/files/media_asset/20141201_Paris_Declaration_en.pdf