Aids: the pandemic is officially in decline

UN and World Health Organisation hail steep fall in number of new HIV infections

The HIV pandemic which started 28 years ago is officially in decline, two of the world's leading health organisations said yesterday.

The number of new HIV infections peaked in the mid-1990s and has since declined by almost a third, according to the annual update on the pandemic for 2009, published yesterday by the Joint United Nations programme on HIV/Aids (UNAids) and the World Health Organisation.

It is the first time that UNAids and the WHO have confirmed that the pandemic is on a downward trend and represents a landmark in the history of the disease. In their 2008 report, they said suggestions the epidemic had peaked were "speculation" and that it was "difficult to predict the epidemic's future course".

That report warned: "The HIV epidemic has repeatedly defied predictions... HIV is likely to have additional surprises in store that the world must be prepared to address."

But the 2009 update throws scientific caution to the winds and instead states clearly that the pandemic has passed its zenith: "The latest epidemiological data indicate that globally the spread of HIV appears to have peaked in 1996 when 3.5 million new infections occurred. In 2008 the estimated number of new HIV infections was approximately 30 per cent lower than at the epidemic's peak 12 years earlier."

It says that, in sub-Saharan Africa – the worst-affected region – new infections in 2008 were "approximately 25 per cent lower than at the epidemic's peak in the region in 1995".

It adds: "Asia's epidemic peaked in the mid-1990s and annual HIV incidence has subsequently declined by more than half. Regionally, the epidemic has remained somewhat stable since 2000." The annual report from UNAids and the WHO is the official record of the progress of HIV/Aids, and confirmation that the worst disease of modern times is in decline will be widely welcomed. Two years ago the organisations admitted that they had overestimated the numbers affected and revised the total down from 40 million to 33 million.

Despite the fall in new infections, the number living with HIV increased last year to 33.4 million as people are surviving longer with the roll-out of antiretroviral drug treatment. Greater access to drugs has helped cut the death toll by 10 per cent over the past five years.

There are now 4 million people on the drugs worldwide, a 10-fold increase in five years. The report says 2.9 million lives have been saved since effective treatment became available in 1996 but less than half the patients who need them are currently getting them.

The reasons for the decline in new infections are disputed. UNAids said prevention programmes involving sex education, HIV awareness campaigns and distributing condoms had had an impact. Critics said the pandemic was already in decline before prevention programmes were widely implemented and the disease was burning itself out. Ties Boerma, a WHO statistics expert, said countries whose HIV prevalence declined dramatically, like Zimbabwe, were not always those that got the most HIV cash.

Experts at UNAids said new infections had fallen 17 per cent since 2001, when the UN Declaration of Commitment on HIV/Aids was signed, triggering a global push to deliver anti-retroviral drugs and prevention programmes to the hardest hit parts of the world. Michel Sidibe, executive director of UNAids, said: "We have evidence that the declines we are seeing are due, at least in part, to HIV prevention. However, the findings also show that prevention programming is often off the mark and that, if we do a better job of getting resources and programmes to where they will make most impact quicker, progress can be made and more lives saved."

But Philip Stevens of International Policy Network, the London-based think-tank, said with HIV declining it was time to rethink global spending priorities and switch funds currently being spent on HIV to other conditions that kill more people. Globally, HIV causes about 4 per cent of all deaths, but gets 23 pence in every pound spent on development aid for health ($21.7bn in 2007, or £13.1bn).

Mr Stevens said: "In most countries HIV is a relatively minor problem compared with other conditions such as malaria and diarrhoeal disease. The exception is sub-Saharan Africa. South Africa has a 23 per cent prevalence but in many other countries [in the region] it's 3 to 5 per cent. They have a problem but it is not the huge problem that UNAids is claiming. We shouldn't let this single disease continue to distort overall global funding, especially when bigger killers like pneumonia and diarrhoea in developing countries are far easier and cheaper to treat."

Mr Stevens said the "single issue advocacy" by UNAids, which existed solely to draw money to the disease, had distorted global health priorities. "Governments are now talking about placing a bigger emphasis on primary care and building up public health systems."

Dr Karen Stanecki, senior adviser to UNAids, said repeated studies in different parts of the world, comparing the reduction in new infections with what happened where there was no intervention, had demonstrated the effectiveness of prevention programmes.

"The decline was over and above the natural decline in the epidemic. They showed it could only have been explained by behavioural change."

She denied that too much was being spent fighting HIV/Aids. "We are facing a great many challenges. There are still 7,400 new infections a day. For every five people who become infected, two start on treatment. So we still have a long way to go."

Global killer: The history of HIV

1981 Aids is detected in California and New York. The first cases are among gay men, then drug users

1982 Aids is reported among haemophiliacs and Haitians in the US; cases in some European countries

1984 Scientists identify HIV as the cause of Aids

1985 An HIV test is licensed for screening blood supplies

1987 AZT is the first drug approved for treating Aids

1990 Around 8 million people are living with HIV worldwide.

1996 Combination anti-retroviral treatment is shown to be highly effective against HIV

1997 Aids deaths begin to decline in developed countries, due to the new drugs

2001 At a UN special session, world leaders set long-term targets on HIV/Aids

2002 The Global Fund is established to boost the response to Aids, TB and malaria

2003 The WHO launches the "three by five" campaign, to get three million people on drug treatment by 2005

2004 After much hesitancy, South Africa begins to provide free antiretroviral treatment

2007 Around 33 million people are estimated to be living with HIV

2009 UNAids and WHO confirm Aids pandemic is in decline

Life and Style
ebookNow available in paperback
ebooks
ebookA delicious collection of 50 meaty main courses
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Recruitment Genius: Business Development Manager / Sales - OTE £45,000

    £35000 - £45000 per annum: Recruitment Genius: This company is a solutions / s...

    Recruitment Genius: Sales Executive - OTE £45,000

    £18000 - £45000 per annum: Recruitment Genius: A Sales Executive is required t...

    Recruitment Genius: Test Development Engineer

    £35000 - £40000 per annum: Recruitment Genius: Are you inspired to bring new a...

    Recruitment Genius: Trainee Motor Engineer

    £14000 - £18000 per annum: Recruitment Genius: This is an exciting opportunity...

    Day In a Page

    Sepp Blatter resignation: The beginning of Fifa's long road to reform?

    Does Blatter's departure mean Fifa will automatically clean up its act?

    Don't bet on it, says Tom Peck
    Charles Kennedy: The baby of the House who grew into a Lib Dem giant

    The baby of the House who grew into a Lib Dem giant

    Charles Kennedy was consistently a man of the centre-left, dedicated to social justice, but was also a champion of liberty and an opponent of the nanny-state, says Baroness Williams
    Syria civil war: The harrowing testament of a five-year-old victim of this endless conflict

    The harrowing testament of a five-year-old victim of Syria's endless civil war

    Sahar Qanbar lost her mother and brother as civilians and government soldiers fought side by side after being surrounded by brutal Islamist fighters. Robert Fisk visited her
    The future of songwriting: How streaming is changing everything we know about making music

    The future of songwriting

    How streaming is changing everything we know about making music
    William Shemin and Henry Johnson: Jewish and black soldiers receive World War I Medal of Honor amid claims of discrimination

    Recognition at last

    Jewish and black soldiers who fought in WWI finally receive medals after claims of discrimination
    Beating obesity: The new pacemaker which helps over-eaters

    Beating obesity

    The new pacemaker which helps over-eaters
    9 best women's festival waterproofs

    Ready for rain: 9 best women's festival waterproofs

    These are the macs to keep your denim dry and your hair frizz-free(ish)
    Cycling World Hour Record: Nervous Sir Bradley Wiggins ready for pain as he prepares to go distance

    Wiggins worried

    Nervous Sir Bradley ready for pain as he prepares to attempt cycling's World Hour Record
    On your feet! Spending at least two hours a day standing reduces the risk of heart attacks, cancer and diabetes, according to new research

    On your feet!

    Spending half the day standing 'reduces risk of heart attacks and cancer'
    Liverpool close in on Milner signing

    Liverpool close in on Milner signing

    Reds baulk at Christian Benteke £32.5m release clause
    With scores of surgeries closing, what hope is there for the David Cameron's promise of 5,000 more GPs and a 24/7 NHS?

    The big NHS question

    Why are there so few new GPs when so many want to study medicine?
    Big knickers are back: Thongs ain't what they used to be

    Thongs ain't what they used to be

    Big knickers are back
    Thurston Moore interview

    Thurston Moore interview

    On living in London, Sonic Youth and musical memoirs
    In full bloom

    In full bloom

    Floral print womenswear
    From leading man to Elephant Man, Bradley Cooper is terrific

    From leading man to Elephant Man

    Bradley Cooper is terrific