UNAIDS calls for urgent action to close ‘prevention gap’
UNAIDS has raised the alarm on new HIV infections among adults and the need to step up prevention efforts. The Prevention gap report highlights that new adult infections have not decreased in the last five years and in some regions are on the increase, with 1.9 million adults becoming infected with HIV globally each year since 2010.
In contrast, new infections among children have seen a decline of more than 70% since 2001. This is proof that significant improvements in prevention of mother-to-child services and initiatives to scale up the number of positive pregnant women on treatment are having an impact.
While some regions have seen a minimal decline in annual new adult HIV infections in the last five years, such as East and Southern Africa (4%) and Asia and the Pacific (3%), they are bucking the trend. Increases in new infections during the same period have been registered in Eastern Europe and Central Asia (57%), the Caribbean (9%), the Middle East and North Africa (4%) and Latin America (2%).
UNAIDS is calling for an increase in HIV prevention efforts to stay on the Fast-Track to ending AIDS by 2030 and close what it is calling the ‘prevention gap’.
Michel Sidibé, Executive Director of UNAIDS, commented: “The power of prevention is not being realised. If there is a resurgence in new HIV infections now, the epidemic will become impossible to control. The world needs to take urgent and immediate action to close the prevention gap.”
Why is prevention falling behind?
Key population groups, namely men who have sex with men, sex workers and their clients, transgender people, people who inject drugs and prisoners, accounted for 35% of all new infections globally in 2014, according to the report. So stigma and structural barriers need to be addressed as a priority to ensure key populations have access to a full range of HIV prevention options.
The role of treatment as prevention also needs to be further capitalised to increase levels of viral suppression. 57% of people now know their status, 47% of people living with HIV have access to treatment and 38% of people living with HIV have viral suppression – but greater focus on the UNAIDS 90-90-90 targets is needed to make treatment as effective as possible.
Funding for HIV is in decline – donor funding has dropped to the lowest level since 2010 – and just 20% of global HIV resources are spent on prevention. UNAIDS recommends that for funding to have the biggest impact it needs to provide people at higher risk of HIV with combination prevention options where they live and work.
This location and population focus presents a strong argument to know your epidemic and tailor investments and prevention efforts where they are needed most. For example, in East and Southern Africa three quarters of new infections among adolescents aged 10-19 are among girls, with gender inequality and a lack of age-appropriate HIV services fuelling this.
What should be the focus of prevention efforts?
There are now more HIV prevention options available than ever before, but people need to be able to access them. In its report UNAIDS proposes five key prevention pillars that should be provided ‘comprehensively and in combination’ to reach as many vulnerable people as possible:
- programmes for young women and adolescent girls and their male partners in high-prevalence locations
- key population services in all countries
- strengthened national condom programmes
- voluntary medical male circumcision in priority countries
- PrEP for population groups at higher risk of HIV infection.
The HIV response also needs to invest in new ideas – capitalising on science, innovation and research to create a forward-looking approach to HIV prevention.