November 20, 2012
New H.I.V. Cases Falling in Some Poor Nations, but Treatment Still Lags
By Donald G. McNeil
New infections with H.I.V. have dropped by half in the
past decade in 25 poor and middle-income countries, many of them in
Africa, the continent hardest hit by AIDS, the United Nations said
The greatest success has been in preventing mothers from infecting
their babies, but focusing testing and treatment on high-risk groups
like gay men, prostitutes and drug addicts has also paid dividends, said
Michel Sidibé, the executive director of the agency U.N.AIDS.
“We are moving from despair to hope,” he said.
Despite the good news from those countries, the agency’s annual
report showed that globally, progress is steady but slow. By the usual
measure of whether the fight against AIDS is being won, it is still
being lost: 2.5 million people became infected last year, while only 1.4
million received lifesaving treatment for the first time.
“There has been tremendous progress over the last decade, but we’re
still not at the tipping point,” said Mitchell Warren, the executive
director of AVAC, an advocacy group for AIDS prevention. “And the big
issue, sadly, is money.”
Some regions, like Southern Africa and the Caribbean, are doing
particularly well, while others, like Eastern Europe, Central Asia and
the Middle East, are not. Globally, new infections are down 22 percent
from 2001, when there were 3.2 million. Among newborns, they fell 40
percent, to 330,000 from 550,000.
The two most important financial forces in the fight, the
multinational Global Fund for AIDS, Tuberculosis and Malaria and the
domestic President’s Emergency Plan for AIDS Relief, were both created
in the early 2000s and last year provided most of the $16.8 billion
spent on the disease. But the need will soon be $24 billion a year, the
“Where is that money going to come from?” Mr. Warren asked.
The number of people living with H.I.V. rose to a new high of 34
million in 2011, while the number of deaths from AIDS was 1.7 million,
down from a peak of 2.3 million in 2005. As more people get
life-sustaining antiretroviral treatment, the number of people living
with H.I.V. grows.
Globally, the number of people on antiretroviral drugs reached 8
million, up from 6.6 million in 2010. However, an additional 7 million
are sick enough to need them. The situation is worse for children; 72
percent of those needing pediatric antiretrovirals do not get them.
New infections fell most drastically since 2001 in Southern Africa —
by 71 percent in Botswana, 58 percent in Zambia and 41 percent in South
Africa, which has the world’s biggest epidemic.
But countries with drops greater than 50 percent were as geographically diverse as Barbados, Cambodia, the Dominican Republic,
Ethiopia, India and Papua New Guinea
. [...where circumcision is not prevalent.]
The most important factor, Mr. Sidibé said, was not nationwide
billboard campaigns to get people to use condoms or abstain from sex. Nor was it male circumcision
, a practice becoming more common in Africa.
Rather, it was focusing treatment on high-risk groups. While saving
babies is always politically popular, saving gay men, drug addicts and
prostitutes is not, so presidents and religious leaders often had to be
persuaded to help them. Much of Mr. Sidibé’s nearly four years in his
post has been spent doing just that.
Many leaders are now taking “a more targeted, pragmatic approach,”
he said, and are “not blocking people from services because of their
Fast-growing epidemics are often found in countries that criminalize
behavior. For example, homosexuality is illegal in many Muslim
countries in the Middle East and North Africa, so gay and bisexual men,
who get many of the new infections, cannot admit being at risk. The
epidemics in Eastern Europe and Central Asia are driven by heroin, and
in those countries, methadone treatment is sometimes illegal.
Getting people on antiretroviral drugs makes them 96 percent less likely
to infect others, studies have found, so treating growing numbers of people with AIDS has also helped prevent new infections.
Ethiopia’s recruitment of 35,000 community health workers, who teach
young people how to protect themselves, has also aided in prevention.
Mr. Warren’s organization said in a report on Tuesday that the
arsenal of prevention methods had expanded greatly since the days when
the choice was abstain from sex, be faithful or use condoms. Male
circumcision, which cuts infection risk by about 60 percent [They can never resist saying that, with ever increasing certainty, can they? Or failing to mention it is only from women to men?]
a daily prophylactic pill for the uninfected and vaginal microbicides
for women are in use or on the horizon, and countries need to use the
ones suited to their epidemics, the report concluded.