The world is “losing the fight” against HIV, with a damning report from the United Nations warning 1.5 million new infections were reported last year – three times more than global targets.
The “faltering progress” has been driven by donors redirecting resources to Covid-19 and other crises, and by low- and middle-income countries cutting domestic funding for two consecutive years. Millions more lives are now at risk, UNAIDS said.
Eastern Europe and central Asia, Latin America, the Middle East and North Africa have all seen increases in annual HIV infections over several years, while cases have jumped for the first time in a decade in Asia and the Pacific – where Malaysia and the Philippines have seen “alarming” jumps in transmission.
“This new data confirms our worst fears – that the fallout from the global Covid-19 pandemic and the other crises slammed on the brakes in the fight against Aids,” said Tom Hart, president of campaign group The ONE Campaign. “Two decades of progress was halted in two years. And as with all viruses, if you are not making progress, you are losing the fight.”
According to UNAIDS, 650,000 people died from Aids in 2021 – equivalent to one fatality a minute – despite effective HIV treatment and tools to prevent, detect, and treat opportunistic infections.
The agency warned that Latin America, which was an early success story in the roll-out of treatment, has lost momentum, allowing epidemics among men who have sex with men and other key populations to rebound.
Meanwhile, only 51 per cent of HIV-positive people in eastern Europe and central Asia received treatment in 2021. This region also has few harm reduction services in place – such as providing free condoms and needles – and criminalises HIV transmission and exposure in all but two countries, deterring carriers from seeking treatment.
Children being left behind
The report, published on Wednesday, added that half of children living with HIV do not have access to lifesaving antiretrovirals (ARVs), compared to one quarter of all people living with HIV. Children account for four per cent of people living with HIV, but 15 per cent of Aids-related deaths.
“The lack of access to life-saving medicine for half of children with HIV is an outrage,” Winnie Byanyima, UNAIDS Executive Director, told The Telegraph.
ARVs stop HIV from multiplying and can suppress the virus to undetectable levels in blood – meaning it cannot be passed on. The treatment also allows a person’s immune system to recover, overcome infections and prevent the development of Aids.
In total, 10 million people do not have access to ARVs. Child coverage is especially low in western and central Africa, at 35 per cent, and eastern and southern Africa at 56 per cent.
This is mainly due to a failure to test all children who have been exposed to HIV and offer care for those infected, the UN said.
Approximately 160,000 children were newly infected with HIV in 2021. The report found that almost half of new infections in children were due to HIV-positive women not receiving ARVs.
The report comes as concerns that tens of thousands of people in India are at risk of an HIV rebound due to a nationwide shortage of the life-saving drugs.
India has provided free ARVs to its 2.3 million HIV positive citizens since 2004, a policy which has been credited with both extending the lives of those infected and also causing transmission rates to decline. The cost of ARVs on the private market is unaffordable for many across the developing country.
But that programme is now under threat after the government was unable to find a new supplier to replenish stocks in December. Now, many hospitals have used up the last of their stockpile and are regularly forced to turn away HIV positive patients, sparking small protests at the end of last week.
‘Global solidarity has stalled’
Internationally, resources available to fight the Aids pandemic are also waning. According to UNAIDS, funding was six per cent lower in 2021 compared to 2010, as high income countries cut back on aid spending.
Meanwhile, debt repayments for the world’s poorest countries reached 171 per cent of all spending on healthcare, education and social protection combined, choking countries’ capacities to respond to AIDS, the report said.
“When international support has been most needed, global solidarity has stalled. Leaders must not mistake the huge red warning light for a stop sign. This must become a moment for a surge of international support,” said Ms Byanyima.
There are bright spots, the UN said, including robust declines in annual HIV infections in the Caribbean and western and central Africa – the latter driven largely by improvements in Nigeria.
It was also reported on Wednesday that the fourth patient in the world – and the oldest – has gone into long-term remission of HIV without antiretroviral therapy, after receiving stem cells from a donor with a rare genetic mutation.
But there are concerns that some breakthrough drugs may not reach everyone who needs them. Last week dozens of high profile figures – including Sir Richard Branson, Stephen Fry and the former prime minister of New Zealand, Helen Clark – wrote to the British pharmaceutical company Viiv Healthcare, urging the firm to lower the price of a groundbreaking HIV drug.
Viiv has developed an injectable drug, cabotegravir, which only needs to be taken every few months, as opposed to a daily regimen of ARV pills. But there are concerns that the treatment will remain “out of reach” of the world’s poor due to cost.
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