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History of AIDS: 2011 Onwards

2011 History

David KatoMany themes from the previous year continued through 2011. The persecution of individuals who engage in same-sex relations was epitomised by the murder of Ugandan gay rights activist David Kato in January. Despite a lack of evidence that this was a homophobic act, his murder sparked a renewed outcry by international organisations for the rights of the LGBT community to be upheld. 1

Nevertheless, as the year progressed, animosity towards same-sex relations continued at both social and political levels across Africa. The tabling of the 2009 drafted anti-homosexuality bill by Uganda’s David Bahati (MP) was anxiously monitored by the international community. 2

A more positive development was announced in May. Hailed as a ground-breaking development for the field of HIV prevention, results from the HPTN 052 trial found that antiretroviral treatment could reduce the risk of transmission among discordant couples by 96 percent. Known as ' Treatment as Prevention', this prevention method involves the HIV-positive partner adhering to a regime of ARVs after diagnosis rather than waiting for their CD4 count to become low. 3

Travel restrictions for people living with HIV eased somewhat with the lifting of travel bans in Armenia and Fiji during July and August. However, 47 countries, territories and areas continue to uphold some sort of restriction on the travel and/or stay of people living with HIV. 4 5

In August, the Food and Drug Administration (FDA) approval of Complera, the second all-in-one fixed dose combination tablet, expanded treatment options for people living with HIV. The potential implications of patients being able to take one tablet instead of many, at different times of the day, are numerous. Patients may find it easier to adhere to treatment, the ability to take treatment discreetly will increase and an improvement in personal, work and social life may be achieved. 6

The failure of donor countries to honour their commitments to the Global Fund culminated in a critical decision by the Global Fund Board in November. It was announced that, due to reduced pledges and unmet or delayed contributions, the funding Round 11 would be effectively cancelled. To ensure continued funding for essential existing services the Global Fund introduced an emergency funding mechanism, with strict eligibility criteria. Amongst other consequences, the lack of money available to the Global Fund meant that the scale-up of services was put on hold. For example, Global Fund funding could only be used to maintain those people already on treatment, with none available to increase access to treatment. As a result, there were widespread concerns that the positive trends seen in the HIV epidemic in recent years would be reversed. 7

There were both set-backs and successes throughout 2011, and as the year came to a close the international HIV & AIDS community were aware, more than ever, of the need for continued effort in order to eliminate HIV infections and to improve the quality of life of people living with HIV.

2012 History

After the cancellation of the Global Fund’s Round 11 of funding, at the end of 2011, there was widespread concern over the amount of resources that would be available over the next couple of years. As a response to this, in January 2012, The Bill and Melinda Gates Foundation pledged US$750 million to support the Global Fund. 8

In April, UNAIDS released guidelines 9 recommending the use of ARV treatment as a form of HIV prevention among discordant couples. To reduce the chance of sexual transmission of HIV, it was recommended that the partner living with HIV should take HIV treatment (ART), regardless of whether they need ART for their own health or not. 10 Accessing HIV testing and counselling together as a couple was also strongly encouraged to improve status disclosure and safer sexual behaviours. UNAIDS Executive Director Michel Sidibé speaks at the launch of the UNAIDS Washington report at the Newseum in Washington, on July 18, 2012

In June, UN Women joined UNAIDS as a co-sponsor. This was an important and valuable move in the global effort to reduce new HIV infections. By making gender equality, women’s rights, female empowerment and reproductive rights part of the global focus, it was hoped that HIV would start to become less of a burden on women. 11

The Republic of Moldova lifted travel restrictions for people living with HIV; leaving 46 countries still imposing some form of travel restriction. 12

In July, it was reported that 6.2 million people in sub-Saharan Africa were receiving ART, raising the proportion of people who were in need of treatment and receiving it to 56 percent. This represented a 100 percent increase in less than a decade. 13

The US’ Food and Drug Administration (FDA) announced their approval of using an antiretroviral drug combination for pre-exposure prophylaxis (PrEP), to reduce the chances of the sexual transmission of HIV. Whilst mirroring the UNAIDS guidelines released in April, FDA advice went further by also recommending that HIV-negative people, with an increased risk of becoming infected with HIV – such as, people in serodiscordant relationships, or people classed as high risk for HIV infection, e.g. MSM - should begin taking HIV treatment for prevention. 14

The release of the UNAIDS’s ‘Together we will end AIDS’ report, at the 2012 International AIDS conference, revealed that: domestic investments for HIV and AIDS had increased by 50 percent in 81 low- and middle-income countries; US$8.6 billion was raised domestically, compared to US$8.2 billion internationally; and new infections amongst children were cut by 24 percent, since 2009, thanks to PMTCT interventions. 15

The World AIDS Day 2012 ‘Results’ report, released at the end of the year, showed that the number of new HIV infections had more than halved across 25 low- and middle-income countries since 2001; more than 73 percent reduction was reported in Malawi, and 71 percent reduction in Botswana. For the first time a majority, 54 percent, of people in need of ART were receiving it. Young people between the ages of 15-24 accounted for 40 percent of all new adult HIV infections, and were highlighted as a vulnerable group in need of more targeted HIV prevention services. 16

2013 History

In January, Jacob Zuma, President of South Africa launched the “Protect the Goal” initiative at the opening ceremony of the Africa Cup of Nations in Johannesburg. The campaign aimed to raise awareness of HIV and mobilise young people to commit to HIV prevention. 17 The "Protect the Goal" campaign

Law reforms in Mongolia saw the removal of all travel restrictions and other discriminatory policies for people living with HIV. UNAIDS Executive Director, Michel Sidibé, hailed the country for “taking this bold step” and hoped this would “encourage other countries to follow their example and move the world towards zero HIV-related stigma and discrimination." 18

In February, UNAIDS welcomed the new collaboration between the Medicines Patent Pool and ViiV Healthcare to increase access to antiretroviral therapy for children. The new agreement represented a significant step forward in HIV treatment for children as there are few existing antiretroviral drugs developed specifically for paediatric use. In 2012, UNAIDS estimated that 72% of children living with HIV who were eligible for treatment did not have access to it. 19

In May, UNAIDS and leading medical journal The Lancet established a new commission of political and health leaders to explore the post-2015 agenda of AIDS and global health. The UNAIDS and Lancet Commission: From AIDS to Sustainable Health will deliberate on strategies to ensure that the vision of the AIDS movement - zero new HIV infections, zero discrimination and zero AIDS-related deaths - can be achieved in the coming decades. It will also closely examine the new criteria for better global health results including issues such as, empowering communities to demand better health services, social equality for marginalised populations and increasing access to affordable, quality medicines. 20

The Global Update on HIV Treatment 2013: Results, Impact and Opportunities report by UNAIDS, WHO and UNICEF showed an acceleration in the roll out and uptake of antiretroviral therapy since 2011. A record 9.7 million people living with HIV were accessing treatment in 2012 compared to 8.1 million in 2011. 21

An equally positive report by UNAIDS in September showed significant progress towards reaching 2015 global targets on HIV. New HIV infections among adults and children were estimated at 2.3 million in 2012, a 33 percent reduction since 2001. Among children, new HIV infections fell to 260,000 in 2012, a reduction of 52 percent since 2001. AIDS-related deaths also dropped by 30 percent since their peak in 2005, with access to antiretroviral treatment more widespread. 22

Moreover, amfAR, the Foundation for AIDS Research and AVAC announced that from July 2012, 13 countries with generalised epidemics showed growth in the number of people on ART was greater than the number of new infections. In addition, at least 4 high-prevalence countries appeared poised to reach this 'tipping point'. However, they emphasised that whilst reaching the tipping point represents a critical milestone, it is merely the first step towards the ultimate goal of ending AIDS. 23

In October, Uzbekistan lifted all restrictions on entry, stay and residence for people living with HIV in the country. 24

A UNICEF report in November showed significant progress towards preventing mother-to-child transmission of HIV with over 850,000 new childhood infections averted between 2005 and 2012 in low and middle-income countries. 25

However, the 2013 Stocktaking Report on Children and AIDS raised concerns about adolescents and the need to address HIV and AIDS among this vulnerable group. Indeed, AIDS-related deaths among adolescents between the ages of 10 and 19 increased by 50 percent between 2005 and 2012, rising from 71,000 to 110,000. In 2012, an estimated 2.1 million adolescents were living with HIV. 26

The 2013 UNAIDS Report on the Global AIDS Epidemic demanded a new focus on the issue of HIV and ageing, with the aim of improving HIV services for those aged over 50. 27

In December, UNAIDS welcomed a $12 billion commitment by international partners to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The new commitments represented a sharp increase in pledges made at the previous replenishment conference of $ 9.2 billion. Shared responsibility by countries also grew. Domestic spending on HIV increased, accounting for approximately of 53 percent of global HIV resources in 2012. The total global resources available for HIV in 2012 were an estimated $18.9 billion. 28

 “These pledges are a demonstration of global solidarity and trust to move towards ending the three diseases. Support for the Global Fund comes at a crucial point in many parts of the world we are entering into a ‘make or break’ point in progressing towards our goals.” - Michel Sidibé, Executive Director of UNAIDS 29

In Uganda, the Anti-Homosexuality Bill (or "Bahati Bill") was passed against a backdrop of international condemnation. 30


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