UNAIDS

On International Women’s Day, UNAIDS calls for greater action to protect young women and adolescent girls

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Every day, 460 adolescent girls become infected with HIV and every week 350 adolescent girls die of AIDS-related illnesses

On International Women’s Day, UNAIDS is urging countries to step up and protect young women and adolescent girls from HIV.

AIDS-related illnesses remain the leading cause of death for women aged 15–49 years globally. In 2017, 66% of new HIV infections among 10–19-year-olds were among females globally—in eastern and southern Africa, 79% of new HIV infections among 10–19-year-olds were among females.

“There is a vicious cycle of gender inequities, gender-based violence and HIV infection in many parts of the world,” said Michel Sidibé, Executive Director of UNAIDS. “Oppression and power imbalances must be reversed and harmful masculinities addressed in order to ensure that women and girls have full control over their sexual health and rights.”

Much more needs to be done to reach young people with HIV prevention, treatment and care. Young women and adolescent girls are especially being left behind. Gender-based violence, sexual exploitation and drug use are among the many factors that can increase the vulnerability of young women and adolescent girls to HIV.

Efforts to end AIDS are undermined where the human rights of young women and adolescent girls—especially their sexual and reproductive health and rights—are not supported. Countries must therefore enact laws and policies that enable access to services, including health and social protection, by young women and adolescent girls, helping them to claim their right to health.

International law gives people, including young women and adolescent girls, the right to access services to protect their sexual and reproductive health. However, 45 countries worldwide still have laws that require people under the age of 18 years to obtain the consent of their parents in order to be tested for HIV.

Social protection, education—including comprehensive sexuality education—and HIV prevention services that are integrated with sexual and reproductive health services have been shown to improve the health of, and empower, young women and adolescent girls. A South African study showed that HIV prevalence among girls who had finished high school was about half that among girls who had not (8.6% versus 16.9%). Children who access universal primary education in Botswana, Malawi and Uganda have been shown to have similar outcomes.

Investing in education. Investing in HIV and other health services. Preventing and protecting women and girls from violence. Eradicating harmful practices such as early, forced and child marriage. Promoting women’s rights. Through these actions young women and adolescent girls can be protected from HIV and the world can build towards ending AIDS by 2030.

UNAIDS is greatly encouraged by news of a possible cure of an HIV-positive man

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UNAIDS is greatly encouraged by the news that an HIV-positive man has been functionally cured of HIV. The man was treated by specialists at University College London and Imperial College London for advanced Hodgkin’s lymphoma in 2016 using stem cell transplants from a donor who carried a rare genetic mutation. Researchers report that HIV has been undetectable in the man since he stopped taking antiretroviral medicine 18 months ago.

“To find a cure for HIV is the ultimate dream,” said Michel Sidibé, Executive Director of UNAIDS. “Although this breakthrough is complicated and much more work is needed, it gives us great hope for the future that we could potentially end AIDS with science, through a vaccine or a cure. However, it also shows how far away we are from that point and of the absolute importance of continuing to focus HIV prevention and treatment efforts.”

Stem cell transplants are highly complex, intensive and costly procedures with substantial side-effects and are not a viable way of treating large numbers of people living with HIV. However, the results do offer a greater insight for researchers working on HIV cure strategies and highlight the continuing importance of investing in scientific research and innovation.

The result, reported at the Conference on Retroviruses and Opportunistic Infections in Seattle, United States of America, is one of only two cases of reported functional cures for HIV. The first was the case of the Berlin patient, Timothy Ray Brown, who received similar treatment for cancer in 2007.

There is currently no cure for HIV. UNAIDS is working to ensure that all people living with and affected by HIV have access to life-saving HIV prevention, treatment, care and support services. In 2017, there were 36.9 million people living with HIV and 1.8 million people became newly infected with the virus. In the same year, almost 1 million people died of AIDS-related illnesses and 21.7 million people had access to treatment.

UNAIDS welcomes large-scale HIV prevention trial results showing a 30% decline in the rate of new HIV infections

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UNAIDS welcomes the results from the HPTN 071 (PopART) trial. The results showed a 30% decline in new HIV infections where HIV prevention, including home-based HIV counselling and testing, was provided, as well as referral to HIV care and treatment for people testing positive for HIV according to country guidelines. The study took place between 2013 and 2018 and included 21 urban communities in Zambia and South Africa, covering a total population of 1 million people, the largest study of its kind.

“UNAIDS congratulates the PopART team on this important study, which clearly demonstrates the critical impact of community-based HIV prevention, testing and linkage to treatment,” said Michel Sidibé, Executive Director of UNAIDS. “It reinforces UNAIDS’ call for more community health-care workers across Africa, the need for increased investment in HIV prevention and treatment, including new and better tools and systems to deliver them. It also shows the urgent need to reach men and young people.”

There were three arms in the study. Arms A and B delivered the PopART package of HIV prevention, which includes annual household-based HIV counselling and testing, linkage to care at the local health centre for people living with HIV, follow-up visits to people living with HIV to ensure that they were linked to care and to support adherence to treatment, promotion of voluntary medical male circumcision for men who tested HIV-negative, services to prevent mother-to-child transmission of HIV, referral for treatment of sexually transmitted infections, provisions of condoms in the community and screening and referral for tuberculosis.

Arm A offered immediate initiation of antiretroviral therapy to people testing positive for HIV irrespective of CD4 count. Arm B offered antiretroviral therapy only to people who were eligible in accordance with the country guidelines—this was a CD4 count of 350 at the beginning of the trial, which moved to 500 and in 2016 treatment was offered to all people living with HIV, as in arm A. Arm C had no household intervention, but people did have access to HIV testing and treatment services in accordance with the country guidelines.

Both arms A and B reached the 90–90–90* targets overall. In arm B, HIV incidence declined by 30% compared to the basic standard of care offered by the countries involved in the study. In arm A incidence declined by just 7%, which, although not statistically significant, is surprising; ongoing transmission was also at a considerable rate (1.5%) in arm A. Further analysis is under way to help explain why the decline in incidence was not higher in arm A despite high viral suppression (viral suppression was 72% in arm A, 68% in arm B and 60% in arm C).

Subgroup analysis also showed that in both arm A and arm B antiretroviral therapy coverage was high in women older than 25 years and in men older than 40 years, but men and younger people had a much lower coverage. It also showed that men and younger people were much less likely to be virally suppressed. This emphasizes the importance of ensuring that 90–90–90 is reached at the country level but also that each population group reaches 90–90–90.

The impact of community-based access to testing, treatment and primary prevention in the trial is evident and supports UNAIDS’ focus on strengthening community platforms. UNAIDS promotes this work through the 90–90–90 initiative, the Fast-Track cities initiative and the Global HIV Prevention Coalition, a coalition convened by UNAIDS and the United Nations Population Fund to accelerate access to combination HIV prevention in settings with high HIV incidence. The work of the coalition includes a particular focus on young women and their male partners—groups that were found to require better access to services in the PopART trial.

UNAIDS underscores that there is still no single HIV prevention method that is fully protective against HIV. To end the AIDS epidemic, UNAIDS strongly recommends a combination of HIV prevention options. These include ensuring that all people living with HIV have immediate access to antiretroviral therapy, the correct and consistent use of male or female condoms, starting having sex at an older age, having fewer partners, voluntary medical male circumcision, and the use of pre-exposure prophylaxis for people at higher risk of HIV infection.

The results of the PopART trial were presented at the Conference on Retroviruses and Opportunistic Infections, taking place in Seattle, United States of America from 4-7 March 2019.

* By 2020, 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads.

‘Dramatic’ drop in global HIV infections

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The number of HIV infections and Aids-related deaths has fallen dramatically, according to a UN report.

Death rates fell from 2.3 million during its peak in 2005 to 1.6 million last year, says UNAIDS.

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The number of new HIV infections fell by a third since 2001 to 2.3 million.

Among children, the drop was even steeper. In 2001 there were more than half a million new infections. By 2012 the figure had halved to just over a quarter of a million.

The authors put the fall in deaths and infection rates in children down to better access to antiretroviral drugs which help suppress the virus.

Without treatment, people with HIV can go on to develop Aids which makes simple infections deadly.

By the end of 2012 almost 10m people in low and middle income countries, including South Africa, Uganda and India, were accessing antiretroviral therapy, according to the report.

The improved access is being attributed to drugs being more affordable and available in communities, as well as more people coming forward for help.

Way to go

According to UNAIDS, the world is “closing in” on its Millennium Development Goals to stop and reverse the Aids epidemic by 2015.

But it says the world can go beyond its target of getting 15m people on HIV treatment by 2015. The World Health Organization has now revised its guidelines making even more people eligible for treatment.

The report also found that progress has been slow in providing HIV services to people who are most at risk of infection, like those who inject drugs.

And it highlights the need to do more to deal with sexual violence against women and girls. They make up a key group of people vulnerable to infection.

Bev Collins, Health Policy Advisor at Doctors without Borders said: “Huge leaps forward have been made to make sure that millions of people – especially in the developing world – can access lifesaving HIV treatment at an affordable price.

“But this is no time for complacency. We need to keep on rolling out access to better treatment strategies, expanding access to accurate, cost-effective testing, and to care”