Sustaining current efforts against AIDS not enough, epidemic may rebound in five years

Experts have warned that existing efforts against AIDS and HIV aren't enough and if the countries, which are most affected, do not amp up their efforts to curb the spread of AIDS, the epidemic may rebound in just five years time.

Report from the UNAIDS and Lancet Commission showed that the rate of new HIV infections was not falling fast enough even though unprecedented progress has been made to increase access to HIV treatment globally.

This, combined with high demographic growth in some of the most affected countries, has been increasing the number of people living with HIV who would need antiretroviral therapy to stay alive.

While there is scope in many countries for greater shared responsibility by increasing funding for HIV, the report clearly showed the urgent need for substantial global solidarity to front-load investments. The need for investment was particularly acute in low-income countries with a high HIV burden.

Among the sobering findings from the report is that sustaining current HIV treatment and prevention efforts would require up to 2 percent of GDP, and at least a third of total government health expenditure, in the most affected African countries from 2014 to 2030 to fund HIV programmes.

This clearly demonstrated that international support to the AIDS efforts in these countries would be needed for many years to come. However, there was also a pressing need to ensure that people are not left behind in middle-income countries, which can and must do more to sustain their HIV prevention and care programming in higher risk, often marginalised populations.

If the most is made of this five-year window of opportunity, HIV transmission and AIDS-related deaths could be greatly reduced and mother-to-child transmission virtually eliminated by 2030. This will not only require an increase in resources, but also a more strategic and efficient use of those resources.

HIV programmes have a maximum effect when used in combinations that are tailored to the needs and contexts of populations at higher risk and in geographical locations with high HIV prevalence, as is now the policy in countries such as Kenya. At the same time, synergies with mainstream health services are needed, and a long-term view to ensure sustainability of achievements, including high quality antiretroviral treatment.

Also recognising extraordinary innovation in the AIDS response, the Commission calls for leveraging lessons learned in the AIDS response to be applied to new and existing global health challenges.

The report made seven key recommendations, leading with the urgent need to scale up AIDS efforts, get serious about HIV prevention, and continue expanding access to treatment.

Other recommendations include efficient mobilisation of more resources for HIV prevention, treatment, and research, and for robust, transparent governance and accountability for HIV and health.

The AIDS response must continue to be grounded in human rights, and practical solutions are needed to expedite changes in laws, policies, and attitudes that violate the rights of vulnerable populations, and that stand in the way of an effective AIDS response.

The study is published in Lancet.