Imagine a world where discriminatory laws and policies standing between health services and men who have sex with men, people who inject drugs, sex workers, prisoners, people living with HIV, and others now pushed to the margins of their societies were replaced with laws and policies protecting human rights and ensuring equal access to services. Imagine if 90 percent of all people living with HIV were aware of their infection, 90 percent of all people diagnosed with HIV had reliable, ongoing antiretroviral treatment, and 90 percent of those people were treated successfully enough to not become sick, and not transmit the virus to other people. Imagine if instead of the 2.1 million new HIV infections estimated to have occurred last year, that number dropped to half a million.
UNAIDS global health modellers did, and in the program’s latest report, released in advance of World AIDS Day 2014, they argue in words, graphs, charts and maps that if all of those were to happen in the next five years, the AIDS epidemic as we know it would end, nearly half a century after it was recognized, by 2030. The report, Fast-Track: Ending the AIDS epidemic by 2030, shows what that, in turn, would mean, with 95 percent of people living with HIV aware of it, 95 percent of those on treatment, and the virus so successfully suppressed in 95 percent of those people, as to pose little risk of transmission. If you do the math, that would mean that by 2030, about 85 percent of people living with HIV would be healthy and unlikely to pass the virus to anyone else. HIV would still exist, and, among those remaining 15 percent, untreated or less successfully treated, AIDS would too. The virus that leads to AIDS still would take a toll, and require attention, but it would be controlled.
UNAIDS calls the goal visionary and the pace of progress it will require “rapid.” Compared to the present pace, which in recent years, in some respects, the report notes, has been greatly accelerated, it makes strong case that the action it calls for is both speedy and ambitious. It also makes a case that the pace of present efforts, if continued, will allow AIDS to not only outpace efforts to control it, but rebound.
At the same time the action the report calls for, if missing now, is basic. The report notes, for example, that “many members of key populations report having no contact with HIV prevention programmes in the past 12 months.” Defining key populations as those “at higher risk of acquiring HIV,” the report notes that “only about three fifths of countries have risk reduction programmes for sex workers,” that “most countries fail to provide opioid substitution therapy or access to sterile needles and syringes for people who inject drugs,” and that in countries where national targets for reaching men who have sex with men fall well below global targets, “the perception that few members of these groups exist in these countries” is one of the reasons. And while noting that “the world is on track to deliver HIV treatment to at least 15 million people by 2015,” it also notes that treatment delivery for the most vulnerable and powerless of those people is far behind, with just 24 percent of children needing antiretroviral treatment getting it.
The report notes that just 30 countries account for 89 percent of all new HIV infections. They include countries with HIV responses supported by the United States President’s Emergency Plan for AIDS Relief, and the Global Fund to Fight AIDS Tuberculosis and Malaria, as well as the U.S. itself, where an estimated 50,000 new infections occur yearly. The report also contains a “scorecard” of countries’ AIDS responses, looking at rates of antiretroviral treatment for adults, children, provision of HIV and TB services, prevention of mother to child transmission, condom use among sex workers and men, and travel restrictions based on HIV status.