Access to antiretroviral therapy for HIV has risen dramatically worldwide over the past two decades, and nearly 21 million people are now receiving lifesaving treatment, according to a new UNAIDS report released in advance of World AIDS Day on December 1.
UNAIDS Executive Director Michel Sidib� released the "Right to Health" report Monday, November 20 in the Khayelitsha Township near Cape Town in South Africa, a country with one of the highest HIV prevalence rates in the world.
"Many people do not remember that in 2000 there were only 90 people in South Africa on treatment," Sidib� said. "Today, South Africa has the biggest life-saving treatment program in the world, with more than 4 million people on treatment. This is the kind of acceleration we need to encourage, sustain and replicate."
According to the report, an estimated 36.7 million people were living with HIV worldwide in 2016. Of these, 20.9 million were on antiretroviral treatment through June 2017, up from 685,000 in the year 2000. South Africa has been one of the global leaders in scaling up treatment.
"In 2001, the first person in Khayelitsha started HIV treatment," said South African Minister of Health Aaron Motsoaledi. "Today there are almost 42,000 people on treatment here. The success of Khayelitsha's treatment program is a microcosm of the massive success of South Africa's HIV program."
Despite this progress, an estimated 1 million people worldwide died of HIV-related illnesses in 2016, which can happen when people do not take antiretroviral medications or start treatment too late.
The report also says that 1.8 million people were newly infected with HIV in 2016. This represents a 39 percent decrease from the 3 million people who were infected each year at the height of the epidemic in the late 1990s, according to the report. New infections among infants and children fell by about 50 percent between 2010 and 2016.
But countries vary widely in their success at stemming the epidemic. The reports says that while new infections have fallen by 48 percent since 2000 in sub-Saharan Africa, they have risen by 60 percent since 2010 in Eastern Europe and Central Asia, where the epidemic is largely driven by sharing needles for injection drug use.
Effective treatment that suppresses viral load to an undetectable level prevents HIV transmission, as does PrEP using the Truvada (tenofovir/emtricitabine) pill taken daily or before and after sex.
The World Health Organization now recommends that all people diagnosed with HIV should be treated as soon as possible, and that all people at substantial risk should be offered PrEP. San Francisco was the first jurisdiction to push for universal early treatment in 2010, and the city has also been a pioneer in PrEP implementation.
UNAIDS has set a goal that by 2020, 90 percent of all people living with HIV will know their HIV status, 90 percent of those diagnosed with HIV will be on antiretroviral therapy, and 90 percent of those on treatment will have achieved viral suppression.
Some countries are on track to reach these targets, but others are falling behind. The report emphasizes that more funding is needed to close the gaps. Funding for the global AIDS response has reached nearly $20 billion annually, but experts predict a $6 billion shortfall for HIV programs in 2020, according to the report.
The report emphasizes that health care, including HIV care, is a human right, and one that cannot be denied to marginalized groups who bear the brunt of the epidemic, including transgender people, gay and bisexual men, sex workers, and people who use drugs. The report also highlights the importance of reaching adolescents and young adults, who have among the highest rates of new HIV infection in many countries.
"Transgender people have been shut out many times before," Phylesha Brown-Acton of the Asia-Pacific Transgender Network says in the report, "We have been strategic about getting into the meeting rooms, but there is still a lot of work to be done. We must be heard in those meeting rooms, not silenced or ignored."
For gay men, discrimination and criminalization are often barriers to HIV prevention and treatment.
"The main reason standing in the way of gay men and other men who have sex with men and their right to health is the criminalization of individuals and their behaviors and wide discrimination against vulnerable populations," according to Elie Ballan, executive director of the M-Coalition, an organization focused on health care for gay men in the Arab world. "The right to health is not a plan to be completed within certain dates - it is a mission, a vision and a way of life to ensure the health of current and future generations."