HIV epidemic will rebound dramatically without more funding, warn experts

The world could see the HIV epidemic rebound dramatically if countries fail to increase funding and expand access to drugs in the next five years, according to a major report.

The analysis, by the UNAids and Lancet Commission, highlights a “fragile window of opportunity” for maintaining progress on curbing deaths and infections and suggests that progress made during the past decade could easily be reversed.

“We must face hard truths – if the current rate of new HIV infections continues, merely sustaining the major efforts we already have in place will not be enough to stop deaths from Aids increasing within five years in many countries,” said Prof Peter Piot, director of the London School of Hygiene and Tropical Medicine, and lead author of the report.

Child mortality has fallen dramatically since the UN set a the goal of reducing under-fives deaths worldwide by two-thirds, and the spread of HIV infections has fallen by 44% in the last decade. However, the report highlights instances of complacency and even the reversal of progress in some countries.

In Indonesia, the incidence of HIV rose by 50% between 2005 and 2013, while in Uganda, new infections rose from 90,000 in 1999 to 170,000 in 2011 – a return to levels seen two decades previously.

Recent studies have also found clear evidence of resurgent HIV epidemics among men who have sex with men in western Europe, North America, and Asia, caused by risky sexual behaviour.

“Expanding sustainable access to treatment is essential, but we will not treat ourselves out of the Aids epidemic,” said Piot. “We must also reinvigorate HIV prevention efforts, particularly among populations at highest risk, while removing legal and societal discrimination.”

Elsewhere, the rate of new HIV infections is not falling fast enough and this, combined with rapid population growth in some of the most affected countries, is increasing the number of people living with HIV who will need antiretroviral therapy to stay alive.

“We have to act now. The next five years provide a fragile window of opportunity to fast-track the response and end the Aids epidemic by 2030,” said Michel Sidibé, executive director of UNAIDS. “If we don’t, the human and financial consequences will be catastrophic.”

Sustaining current HIV treatment and prevention efforts would require investments of up to 2% of GDP, and at least a third of total government health expenditure, in the most affected African countries to fund HIV programmes until 2030. The report calls for international funding to be urgently ramped up to support Aids efforts in low-income countries with a high rates of HIV.

“At present, the high level of efforts costs $19bn annually, whereas it will take $36bn annually to achieve the UN goal to end AIDS as a public health threat by 2030,” concludes the report, published in the Lancet.

Dr Eric Goosby, special envoy on malaria and former US global Aids coordinator, said: “If we do not continue to invest, three decades of remarkable progress in the fight against Aids will be in jeopardy. And that will have a resounding effect across the global health spectrum.”