New report says response to HIV/AIDS epidemic at risk of ‘dangerous complacency’

A new report states that a “dangerous complacency” in the response to the global HIV pandemic is risking a resurgence of the disease.

Authors of a new Lancet Commission led by the International AIDS Society say that HIV rates persist in high risk, marginalised populations and they warn that a resurgence of the epidemic is likely as the largest generation of young people age into adolescence and adulthood.

Stalling of HIV funding in recent years endangers HIV control efforts and historic ‘exceptionalism’ of HIV treatment and care may no longer be sustainable; services will likely need to be part of wider healthcare supporting related diseases and conditions.

The authors call on HIV researchers, healthcare professionals and policymakers to collaborate and make common cause with their counterparts in global health.

The report combines the expertise of more than 40 international experts who make recommendations for how HIV and global health can work together to advance global health and improve the HIV response. The report also models the impact of combining HIV within other health services in five countries, and is being presented at the AIDS 2018 conference in Amsterdam.

HIV is the epidemic of our time, with up to 38.8 million people living with HIV worldwide in 2015-2016, and around two million new cases diagnosed in 2015. There were one million AIDS-related deaths in 2016, and overall more than 35 million people have died of AIDS-related causes since the start of the epidemic.

Worldwide, 44% of all new HIV infections occurred in people from marginalised groups (such as gay and bisexual men, people who inject drugs, sex workers, transgender people, and the sex partners of people in these groups), and health systems struggle to reach and engage these groups.

At the same time, care for HIV is also changing as the population of people with HIV is steadily growing older due to the effectiveness of antiretroviral therapy (ART). Between 2012 and 2016, the number of people older than 50 years living with HIV increased by 36% worldwide. As this group have an increased risk of many age-related diseases (such as cardiovascular disease, neurocognitive disorders, renal disease and some cancers), a focus on prevention and management of non-communicable diseases (NCDs) for people with HIV is needed, creating a crossover with global health and wider health services.

HIV funding has remained flat in recent years, at about US$19.1 billion, roughly US$7 billion short of the estimated amount needed to achieve the UNAIDS 90-90-90 targets. This is happening as a growing number of people are receiving ART and will require sustained access for decades to come – in June 2017 approximately 20.9 million people worldwide were receiving the drugs (57% of people with HIV), increasing from 680,000 people in 2000.