The tale of two global HIV responses continues to unfold this week, in data released by UNAIDS in the run-up to the 22nd International AIDS Conference in Amsterdam.
One response, driven by antiretroviral treatment and pre-exposure prophylaxis, by unhindered access to health services and education, by the decriminalization of drug use and sex work, along with other established and emerging proven measures, shows rates of preventable deaths, illnesses and new infections dropping sharply. It is the reason the report offers some numbers tantalizingly close to those projected by UNAIDS as critical to reach by 2020 if HIV is to be ended as a global public health threat in the foreseeable future. The beneficiaries of that response tend to live in high-income countries, and among some demographics of so-called “innovation incubators” in East and Southern African countries according to UNAIDS.
The other response, stalled by stagnant funding and bound by restrictive laws and policies (to which lately has been added the U.S. expanded global gag rule), sees unrealized possibilities in static, and even increased rates of new infections, illness and deaths. The populations — there are no beneficiaries — affected by that constrained response live in low- and middle-income countries in areas affected by vast inequities of wealth, and among populations whose rights have been derailed for reasons of circumstance or identity. The goals of at least 90 percent of all people living with the virus being aware of it, at least 90 percent of those receiving the antiretroviral treatment they need to stay alive, and for treatment in 90 percent of those to be consistent and effective enough to prevent illness and transmission remain out of reach in that response, according to the data. It is the reason that the dream could be deferred, even as inequities that fuel, and are fueled by disease, as well as a fast-growing population of new adolescents and young adults multiply the risks of the pandemic gaining ground.
The first response shows what can be done with the gains science and practice have made in the last several years alone, UNAIDS says. The second response shows why those gains must be shared better. The report is here.
Science Speaks will cover more data, more breakthroughs, and more challenges at AIDS 2018 live from Amsterdam, July 19 – 27.