The evolving HIV & AIDS pandemic: overall progress; more varied between countries; southern governments stepping up to fill aid gaps

November 26, 2013

     By Duncan Green     

Today the ONE campaign is issuing The Beginning of the End?, a report (+ exec sum) on the HIV/AIDS pandemic, with some important findings. They Aids and condomsinclude hitting the global tipping point on AIDS, probably next year; the increasing divergence in performance between African countries, and the fact that over half of global HIV/AIDS spending now comes from developing countries.

Excerpts from the Exec Sum, with a few additions from ONE’s press release, plus a final comment from Oxfam’s top HIV policy wonk:

“The world has achieved a marked acceleration in its progress towards the achievement of the beginning of the end of AIDS (defined as when the total number of people newly infected with HIV in a given year falls below the number of HIV-positive people newly receiving antiretroviral (ARV) treatment). Updated data shows that if current rates of acceleration in both adding individuals to treatment and in reducing new HIV infections continue, we will achieve the beginning of the end of AIDS by 2015 (see chart – click to enlarge).

HIV infections v treatment

Programmes to reduce mother-to-child transmission of HIV continued to scale up in 2012, particularly among the 22 high-burden countries. Seven countries in sub-Saharan Africa – Botswana, Ethiopia, Ghana, Malawi, Namibia, South Africa and Zambia – are driving much of this progress, having each reduced new HIV infections among children by 50% or more since 2009. But collectively the world is not on track to meet the virtual elimination goal by 2015, and a few countries, such as Nigeria and Angola, are holding back regional and global progress.

Real reductions have been made in new adolescent and adult HIV infections for the first time in years, which is encouraging, but progress to cut that figure by half is still dramatically off track, and marginalised populations are falling further behind. HIV prevention remains the area of least progress and least attention.

Unfortunately, the price of partial success is that HIV/AIDS is no longer perceived as a global health emergency, but rather a chronic and manageable disease, and the fight has lost some of its political momentum. UNAIDS estimates that global financing efforts for AIDS still fall $3–5 billion short of the $22–24 billion needed annually. In 2012, the US remained the clear global leader on total AIDS financing, and the UK, Australia, Japan, Italy and Sweden increased their contributions.

However, other countries including Denmark, Canada, France, Ireland, Norway and the Netherlands, along with the European Commission, decreased their overall contributions in 2012.

And developing countries are stepping up. More than two-thirds of low- and middle-income countries increased domestic spending on HIV last year, accounting for 53% of all HIV/AIDS resources globally – the second year in a row that these countries have supported more than half of the global response.

It is time to retire the phrase ‘AIDS in Africa’. Political will and financial investments have varied dramatically between countries; so too have countries’Aids outdated relative successes in making headway towards the beginning of the end of AIDS. 16 countries in sub-Saharan Africa have already reached the beginning of the end of AIDS, but others lag far behind.

The nine countries profiled in the report broadly exemplify three levels of progress:

Leading the Way: Ghana, Malawi and Zambia are great examples of how international donors, national governments and key civil society leaders can work together to achieve accelerated progress in the fight against AIDS.

Ones to Watch: South Africa, Tanzania and Uganda have shown real dynamism but erratic progress as they face massive disease burdens, shifting political landscapes and unique, country-specific challenges.

Urgent Progress needed: Cameroon, Nigeria and Togo have not made enough progress. Togo, in particular, reached the AIDS tipping point in 2010 but has slipped back since.

In all countries, a wealth of CSOs and individuals are actively engaged in their communities and countries in the fight against the disease. Some of these groups are supporting and bolstering broader country-level efforts, while some are actively driving progress in spite of challenging circumstances or government intransigence. Their commitment and advocacy have been critical to the progress achieved on the continent over the past two decades.”

And here’s a brief comment from Dr Mohga Kamal-Yanni, our health & HIV policy advisor (who asked me not to call her a guru, so I haven’t):

“The report clearly shows that good aid can save lives. National and international financial commitment, combined with reduced prices of medicines due to generic competition, have made it possible for countries to combat the plight of HIV.

While the report rightly focuses on financing the response to HIV, it misses emphasising the role of generic competition in reducing the prices of medicines and thus making it possible for donors and governments to finance treatment. This is important in the current and future situation, where new, effective medicines are under patent and thus difficult to produce in India (the main manufacturer of generic anti-HIV medicines) or in other countries. How would the world pay for expensive medicines?

It is also important for HIV reports to discuss how to ensure that HIV progress in treatment can strengthen and benefit from national systems e.g. drug procurement and supply chains, so that short-term achievements can be sustained in the long term. How to maintain and improve measures taken to provide HIV treatment despite the current health workers crisis? For example how to sustain and expand to other health issues measures like: task shifting from highly trained doctors to nurses, community health workers’ involvement, proper remuneration of health workers etc.’

And here’s the inevitable infographic:


November 26, 2013
Duncan Green