UNAIDS, Lancet: Take accelerated action on HIV treatment access, research and development, and address epidemic drivers, or risk rebound

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LancetUNAIDS . ” . . . the question is no longer whether the fight against AIDS can be won; the only questions are: will it be won — and when?”

An international commission of scientists and others involved in and affected by responses to the global HIV pandemic released findings from a two-year examination of what isn’t happening, but must, to end the worldwide public health threat of AIDS, with conclusions that a “massive and rapid expansion” of current efforts is needed.

In the meantime, their report says, HIV remains a major threat to public health, with too many people getting the virus, too many unaware of their infections, and too many people dying of AIDS-related causes, and, still in many places, more people getting the virus than beginning treatment for it, to sustain advances against the pandemic at the current rate. A continuation of just the present level of “already major efforts,” the report says, will see progress reversed, with more new infections and more AIDS-related deaths by 2020 accompanied by continuing rising costs to contain them.

At the same time, the report asserts, as recommendations previously released by UNAIDS have, that  with heightened focus and funding for programming and research, and increased attention to accountability, governance, human rights and social and economic conditions that still fuel the pandemic, HIV could cease by 2030 to be a public health threat.

The report Defeating AIDS, advancing global health, was published in the medical journal The Lancet today. The report comes as policy makers in the U.S., the world’s largest funder and leader of responses to the HIV pandemic, weigh funding priorities for global health responses in the year ahead. It also comes on a day that legislators weigh a proposal to cut funding for infectious diseases research, proposal inspired in part, as noted here, by perceptions that the global HIV pandemic has been “substantially addressed.”

Not yet, the report says, which presents models showing a more than 50 percent increase in HIV infections and HIV-related deaths over the next decade and a half at the current rate of investment and without new advances.

In addition to delineating barriers to realizing the benefits of existing proven treatment and prevention methods, the report calls for added investments in research towards social, programming, and biomedical solutions. It notes that new treatments will be needed as resistance to antiretroviral treatments can be expected to increase and that long-acting antiretroviral drugs will be important to access for increasing numbers of people receiving treatment.

The report calls for continued multiple approaches to vaccine development, to development of HIV prevention methods that can be used by women, and, while noting obstacles to the quest “seem insurmountable,” toward a cure for HIV.

The commission, and report was led by HIV research and programming leaders who include, respectively former and current UNAIDS heads Peter Piot, and Michel Sidibe, former leaders of the President’s Emergency Plan for AIDS Relief Eric Goosby and Mark Dybul — who now leads the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Salim Abdul Karim, who leads the South Africa-based CAPRISA HIV prevention research laboratory.

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