The nature and location of the HIV pandemic has changed in recent years with the number of new infections in sub-Saharan Africa falling by around 25 per cent since 2001 and regions, such as the Caribbean, seeing a dramatic decline, thanks to increased access to antiretroviral treatments and interventions.
Latest figures show that 2.5 million people were newly infected with HIV in 2011 – down from 3.2 million in 2001. However, while globally the number of people newly infected may be decreasing, in Eastern Europe and Central Asia it continues to rise at an alarming rate.
In this region new infections have increased by 250 per cent over the past decade, with more than 90 per cent of cases occurring in Russia and Ukraine. Aids-related deaths have increased 21 per cent since 2005 compared with a 24 per cent reduction globally.
So, while the challenges of addressing the HIV situation in sub-Saharan Africa remain, there is growing concern over low and middle-income countries outside Africa, where more than 19 million people are now living with HIV.
It appears that new infections are rising in Eastern Europe and Central Asia because harm-reduction services for people who inject drugs and services for other key populations are not being implemented. Only 11 per cent of all investment in HIV prevention is focused on key populations at higher risk.
There are concerns about a rise in new HIV infections in Western Europe, which may be partly due to the impact of the financial crisis
“Politically unpopular groups, like men who have sex with men, sex workers, people who inject drugs and transgender populations are disproportionately affected by HIV because of stigma, discrimination and criminalization,” says Christine Stegling, associate director of International HIV/Aids Alliance.
In Eastern Europe and Central Asia access to life-saving antiretroviral therapy (ART) is among the poorest in the world. “Only 25 per cent of adults in need were receiving ART in 2011. In fact, even though the majority of people living with HIV in Eastern Europe and Central Asia are those who inject drugs, this group accounted for less than 25 per cent of people receiving ART,” says Martin Donoghoe, programme manager HIV/Aids, at the World Health Organization’s Regional Office for Europe.
There is good news, however. Latest figures released by UNAids[c1] show that today an estimated eight million people worldwide are now receiving the ART they need. That means worldwide, 54 per cent of the 14.8 million people eligible receive the treatment.
“Globally there has been an important scaling up of access to antiretroviral treatments generally and better services for pregnant women to prevent transmission to their children,” says UNAids’ chief of data for action Peter Ghys.
Sub-Saharan Africa remains the area most heavily affected by the HIV epidemic, accounting for 69 per cent of people living with HIV. However, the number of people dying from Aids-related causes in sub-Saharan Africa has declined by 32 per cent since 2005. In Botswana, where treatment coverage is 80 per cent, Aids-related deaths have fallen by more than 50 per cent and the number of children newly orphaned is also declining as more parents are living longer.
HIV prevalence in West and Central Africa remains comparatively low, estimated at around 2 per cent. There are pockets of higher areas, such as Cameroon at 5.3 per cent, Central African Republic 4.7 per cent, Côte d’Ivoire 3.4 per cent, Gabon 5.2 per cent and Nigeria 3.6 per cent.
Mr Ghys warned of emerging epidemics in the Philippines, Pakistan and Bangladesh. “In the Caribbean, the picture is more varied with prevalence exceptionally low in Cuba, contrasting with 3.1 per cent adult HIV prevalence in the Bahamas, Haiti and the Dominican Republic,” he adds.
In Latin America, around one-third of people living with HIV are in densely populated Brazil, where prevention and treatment projects have contained the epidemic.
According to available evidence, the number of new HIV infections in the Middle East and North Africa increased from 27,000 in 2001 to 37,000 in 2011, bringing the number of people living with HIV in the region to an estimated 300,000 at the end of 2011.
There are concerns about a rise in new HIV infections in Western Europe, which may be partly due to the impact of the financial crisis. “In Greece, where they did not invest sufficiently in services for people who inject drugs, they have seen an horrendous outbreak of HIV,” says Mr Donoghoe.
“Lack of investment in prevention and treatment of HIV is incredibly short-sighted, particularly in times of financial crisis. Countries already struggling could be devastated by HIV outbreaks,” he says.
While data from 20 Western European countries shows that the numbers of reported HIV cases have been relatively stable since 2004, and the number of heterosexual and drug- injector cases has declined, there is strong evidence of resurgent epidemics among men who have sex with men, with an 18 per cent increase in the number of such cases since 2004.
