Press Conference on Launch of 2011 UNAIDS World AIDS Day Report

 

This year had been a “game changer” as the world reached a critical turning point in the response to the global HIV epidemic, averting thousands of deaths, preventing thousands more infections and breaking long-standing political barriers, Bertil Lindblad, Director, New York Office of the Joint United Nations Programme on HIV/AIDS (UNAIDS), said at a Headquarters press conference today.

Launching the 2011 UNAIDS World AIDS Day report, he said:  “The good news is that there has been a lower number of new infections, 2.7 million.  However, we now have the largest number of people living with HIV around the world, 34 million.  The good news here again is that that’s very much due to the fact that we have seen remarkable increases in access to HIV treatment.”

A total of 6.6 million people, almost half of eligible patients, in low- and middle-income countries were receiving anti-retroviral treatment, he reported.  Increased access had already had an impact in that people were living longer with HIV and it would have a great impact on the epidemic in terms of the pool for new infections, he said.  Eleven of those low- and middle-income countries, including Botswana and Brazil, had already reached 80 per cent access to treatment.  As a result, an estimated 700,000 AIDS-related deaths had been averted in 2010 alone.

He said that properly targeted and sustained investments achieved results.  Pointing to the report, he said he hoped that the framework outlined by UNAIDS would be used by countries in times of financial crisis or austerity.  Such a framework would consist of essential activities, including focused interventions for key high-risk populations, particularly sex workers and their clients, men who had sex with men, and injecting drug users.  It would also include prevention of new HIV infections in children, behaviour change programmes, condom promotion and distribution, treatment, care and support for people living with HIV, as well as voluntary medical male circumcision in high HIV prevalence countries.

A new level of political commitment had been evident in 2011, he said.  A high‑level meeting in June had resulted in a political declaration and, for the first time ever, Member States had adopted concrete targets to halve infections and increase global funding to an annual $24 billion by 2015.  There was now a levelling of the epidemic, but turning it around required that that be sustained, he said.

Among the key findings, the report stated that Eastern Europe and Central Asia had seen an alarming 250 per cent increase in HIV infections since 2001, with 90 per cent of cases from the Russian Federation and Ukraine, he noted.  Drug use was cited as the main driving force, requiring specific targeted interventions financed in a targeted way, he said.

Joining Mr. Lindblad at the press conference was Kim Nichols, Co-Executive Director of the American non-profit organization African Services Committee.  She agreed that, despite some good news around new infections, now was not the time to reduce efforts, decrease financial resources to fight HIV, or to let intellectual property or trade barriers hobble universal access to HIV treatment.

Ms. Nichols was also a non-governmental organization Board Member of UNITAID, an international facility for the purchase of drugs against HIV/AIDS, malaria and tuberculosis, which worked to reduce prices and accelerate access to AIDS, tuberculosis and malaria drugs, diagnostics and prevention commodities.  She said “new infections are decreasing, but not rapidly enough to turn the tide of the epidemic”.

There were indeed fewer AIDS deaths, but with the number of people living with AIDS was increasing, and prevention still had to be the “mainstay” of the response, she said.  Conclusive evidence that treatment served as prevention among those who received it, however, meant that it was essential to achieve universal treatment coverage.  At that point, it should be possible to begin to drive the curve of new infections much more sharply downwards, she said.

In addition, she urged development of new strategies and targets for increased voluntary consensual and rights-based HIV testing with linkages to HIV services.  Efforts should also be strengthened to integrate HIV, tuberculosis and malaria responses into reproductive, maternal and child health initiatives, with matching financial commitments.  “It is essential that we focus on the quest for resources to expand and sustain the global response and to find innovative resources to treat at least 14 million living with HIV by 2015,” she said.

Country ownership was essential for sustaining prevention and treatment successes, she said.  Also imperative was the commitment of national Governments to adopting and absorbing the downstream costs of HIV investments, she said.  Innovative mechanisms should be maximized for increasing access to essential HIV medicines, such as the HIV medicines patent pool, and countries still facing patent barriers must utilize flexibility to produce generic drugs.  “We should break the upwards trajectory of costs on AIDS medicines, not by spending less, instead, by fostering the development of more affordable, quality drugs and durable formulations,” she suggested.

In addition, access to point-of-care diagnostics and clinical monitoring tools should be scaled up, she said.  It was also critical that bilateral free trade agreements not include essential HIV medicines.  Opportunities for innovative financing in the AIDS fight should be addressed, she said, pointing out that UNITAID’s emphasis on market impact investments in HIV, tuberculosis and malaria drugs was a proven way of bringing less expensive, better formulated products to market and maximizing the numbers of people who could access them.

Paediatric and adult second-line HIV drugs had come down so far in price in the last three years as to triple the number of patients treated with the same previous investment, she said.  Other potential innovative financing mechanisms included financial transaction tax and the solidarity tobacco levy, which together could raise billions of dollars.

The Global Fund must not falter, she said, as it could not fail to deliver through effective, proven grass-roots organizations in low- and middle-income countries.  It was time for sustaining and increasing the response, she said.  There had been a somewhat fragile trajectory, until recently, to achieve global funding levels to reach universal access targets by 2015.  The target of $24 billion per year by 2015 must be secured for the achievable “win” of universal access, she urged.

Mr. Lindblad concluded that sustainable response, or “shared responsibility”, had been a key feature in discussions leading up to June’s political declaration.  That meant that countries, according to what they could manage in the case of low- and middle-income nations, with the international community’s support should together reach universal access.

Asked about the cause of the sharp increase in HIV infections in Eastern Europe and Central Asia and about male circumcision as a recommended prevention tool, Mr. Lindblad said he had functioned as a regional director for UNAIDS in the Eastern Europe and Central Asia region until three years ago and noted that the phenomenon was very particular, with injecting drug use being the main driver in practically all the countries of that region.

However, several problems existed, he said.  While the resources to fight AIDS had increased quite dramatically in the Russian Federation, the funds were not targeted clearly.  For example, an injecting drug user in those countries lived on the margins of society and faced a huge stigma and discrimination.  In that region, the use of methadone and needle exchange programmes — part of a comprehensive package to reduce HIV levels — were politically controversial.  Thus, there were serious problems in making the case that results would be achieved through targeted resources.  In other countries as well, there was probably a larger than recognized incidence of HIV among men who had sex with men, which was linked to homophobia and legal barriers in terms of same sex relations.

In high-prevalence settings where male circumcision had proven to be an effective infection prevention tool, he noted its use in the context of heterosexual transmissions.  There was no evidence that it would be a solution, for example, in men to men sex.  Circumcision was effective, he said, and much progress had been made in South Africa and other sub-Saharan African countries, where campaigns for voluntary male circumcision based on World Health Organization (WHO) guidelines had borne fruit.

Asked how politics had contributed to the increased HIV infections in Eastern European and Central Asia, Mr. Lindblad said HIV was indeed a political issue requiring political commitment at the highest level.  That had been a message from UNAIDS since 2001.  In several Eastern European countries, there was a political “block” that was resistant for a variety of reasons to, among others, a comprehensive treatment, prevention and support package for injecting drug users.  A root cause of increased HIV infections in that region was the swell in the number of injecting drug users, following the fall of the Soviet Union.

He added that traditional and cultural factors, such as perceptions about homosexuality, were among the more difficult aspects of the HIV response.  However, he maintained, human sexual behaviour and social phenomena, such as drug use, or commercial sex were important factors that needed to be examined.

Asked whether male circumcision was recommended in high prevalent areas, such as Kenya, Mr. Lindblad said male circumcision was recommended as one of several prevention tools in high-prevalence countries, including in sub-Saharan Africa.  It would not make sense to call for voluntary male circumcision in France or the United Kingdom or the United States, even though in the latter, it had been a common practice for other reasons.

To a question concerning the degree to which a cure should be involved in the discussions, Mr. Lindblad said “there is no cure for HIV infection and there is no vaccine”.

Ms. Nichols added that discussions were ongoing about curing the epidemic by addressing treatment and prevention via universal access, which would begin to drive down the numbers in the epidemic.  At the same time, research and a cure were needed.  There were a few research groups working exclusively on a cure.  “But we are still a ways away,” she said.  The “Berlin man” case, where a man was cured of viral infection through a bone marrow transplant several years ago, had spawned new research, however, the world was still years away from a cure, she said.

Asked about coherence in the United Nations system, notably, the position of  the United Nations Office on Drugs and Crime (UNODC) on harm reduction, Mr. Lindblad said UNAIDS was a joint programme that included UNODC.  There was also a joint policy adopted by the World Health Organization (WHO), UNODC and UNAIDS that advocated that broad treatment, prevention and support package.

Misunderstandings occurred when people focused only on the needles or methadone, since a whole battery of programmes were involved, alongside addressing the other root causes for rampant injecting drug use, he added.

Ms. Nichols said that challenges existed in introducing agreed language on the subject of harm reduction.  Even in the most recent political declaration, the term “harm reduction” was not included, she noted.

Mr. Lindblad agreed.  Regarding politics and HIV, he was pleased that the June declaration for the first time had managed to mention the three vulnerable populations by name.  There were enormous difficulties in 2001 and 2006, when there was “absolutely no way” to get those groups included in writing.  “At least we’ve come that far, and between the lines you can interpret that you need certain interventions to target these groups,” he said.  “It’s still a challenge.”

Correspondents were informed that copies of the latest UNAIDS report was available online at www.unaids.org.

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For information media • not an official record