Treatment access masks wider barriers to 2020 targets

25 November 2016

Treatment access gains are to be applauded – but we will get nowhere if we don’t prevent more new infections and reach out to key affected populations

People who inject heroin relax in their ward at the government-run Jangalak rehabilitation centre in Kabul, Afghanistan.

Significant gains have been made in expanding access to vital antiretroviral treatment to millions of people living with HIV globally. As of June 2016, there were an estimated 18.2 million people with access to HIV treatment, up from 17 million at the end of 2015 and 15 million people in 2014.

If these efforts are increased, reaching the target of 30 million people on treatment by 2020 should be possible, according to the UNAIDS report, Get on the Fast-Track: the life-cycle approach to HIV, launched this week (21 November).

But treatment wins are overshadowed by a lack of progress elsewhere. Since 2008, there has been no change in the number of new HIV infections among adults – remaining at 1.9 million each year since then. And while the total number of new HIV infections (adults and children) has decreased from 3.2 million in 2000 to 2.1 million in 2016, we’re still a long way off meeting the target of less than 500,000 new infections by 2020.

The report also notes that the number of people dying from an AIDS-related cause is still unacceptably high. There were 1.1 million AIDS-related deaths in 2015 – of which 400,000 were people dying from tuberculosis (TB) co-infection, an entirely curable disease.  

In all regions of the world – apart from Eastern and Southern Africa and Western and Central Africa – key affected populations such as men who have sex with men, sex workers and people who inject drugs account for the majority of new HIV infections.

In central Asia, Europe, North America, the Middle East and North Africa – 90% of all new HIV infections were among these groups and their sexual networks in 2014. Globally, 45% of all new infections were among key populations and their networks.

Alarmingly, among these groups HIV infection rates are stagnating at best. In the case of men who have sex with men, the number of new HIV infections among this population is rising globally.

What is becoming clear is that HIV prevention efforts are not reaching these groups. In many parts of the world, these key affected populations live on the fringes of society, highly marginalised both politically and culturally. This type of stigma, discrimination and often criminalisation, makes them highly unlikely to access healthcare.

“What matters is the lack of inclusion and widespread discrimination," said Luiz Loures, the Deputy Executive Director of UNAIDS. "It is clear that we cannot end the AIDS epidemic without taking care of the needs of key populations."

The report also highlighted the need to reach adolescent girls and young women – reported on earlier this week.

Photo credit:
Jordi Bernabeu Farrús/ CC-BY

Written by Caitlin Mahon

Content Specialist - HIV & Sexual Health