The world is doing better than it was to combat AIDS but is still not doing enough, says the 2006 report on the global epidemic by UNAIDS, the joint United Nations project on HIV and AIDS.
The report comes 25 years after the disease, which UNAIDS describes as “among the greatest development challenges in human history,” was first recognised (MMWR Morb Mortal Wkly Rep 1981;30: 250-2).
It was presented at a press conference in New York on Tuesday, the day before the opening of the UNAIDS 2006 high level meeting on AIDS. Peter Piot, executive director of UNAIDS, Ann Veneman, executive director of Unicef, and Thoraya Obaid, executive director of the UN Population Fund, spoke at the press conference. They said that 126 countries had submitted full reports.
They said that progress had been made since 2001, when the UN General Assembly committed itself to achieving targets to deliver prevention programmes, treatment, care, and support for people with HIV to halt and then reverse the epidemic by 2015. Responses had been better in some countries and regions than others, they said.
The report said that financial resources for AIDS programmes, including spending by governments, have increased significantly since 2001, although global financing for AIDS may be only a third of what would be needed.
In future, the report says, responses must move from a crisis management approach to long term commitment and building capacity to deal with the epidemic. “Ending the AIDS epidemic will depend largely on changing the social norms, attitudes, and behaviours that contribute to its expansion,” it says. Responses must consider women's empowerment, homophobia, attitudes toward sex workers and injecting drug users, universal education, and social attitudes that contribute to the low status and powerlessness of women and girls.
About 65 million people have been infected with HIV, and AIDS has killed more than 25 million people. Most of the nearly 39 million currently infected with HIV do not know they are infected, the report said.
Each year there are about 4.1 million new HIV infections and about 2.8 million deaths from AIDS. The number of people living with HIV is rising, because of population growth and because drug treatment is prolonging life. Worldwide, about 1% of adults are infected with HIV.
The epidemic is worst in sub-Saharan Africa and is not declining there, although some countries have made progress. The Caribbean is the second most affected region in the world.
The epidemic is growing fastest in Eastern Europe and Central Asia—“a twenty-fold increase in less than a decade,” the report says. The countries most affected by the epidemic in the region are Ukraine and the Russian Federation, “which has the biggest AIDS epidemic in all of Europe.”
Resurgent epidemics are occurring in the United States, some European countries, and Australia among men who have sex with men, apparently as they stop using safe sex methods.
Worldwide, women make up about half of those infected with HIV, with the largest number in sub-Saharan Africa.
The good news, the report says, is that most countries have “a strong foundation... to build an effective HIV response, with increasing political commitment and partner coordination.”
The bad news is that prevention programmes are still not good enough at reaching people at greatest risk—such as young people and men who have sex with men—and at using antiretrovirals to prevent transmission from mothers to infants.
HIV treatment and prevention programmes are still not grounded in civil rights, the report says, so stigma and discrimination against people with HIV continue to interfere with people's access to prevention measures and treatment. Nor is there adequate care and support for the 15 million children orphaned by AIDS, it says.
The 2006 Report on the Global AIDS Epidemic is available at www.unaids.org.