Fight Against AIDS Shows Improvements

HIV AIDS treatment brings lower infections but greater needs

/ Author:  / Reviewed by: Joseph V. Madia, MD

More than 34 million people were living with HIV at the end of 2010, 30 years after the first AIDS case was reported - and nearly that many (around 30 million) have died from AIDS-related causes. Here in the United States, an estimated 1.1 million people are HIV-positive.

On June 3, 2011 the Joint United Nations Programme on HIV/AIDS (UNAIDS) released a report titled AIDS at 30: Nations at the Crossroads, which outlines statistics, prevention and treatment progress, resources and challenges surrounding the disease after three decades.

On the plus side, the rate of new HIV infections declined globally by nearly 25 percent between 2001 and 2009. Significant improvements have been made in preventing new HIV infection among children and through mother-infant transmission; the number of children newly infected with HIV in 2009 was 26 percent lower than in 2001.

The report also shows that some of the most important successes have been led by young people, who are increasingly adopting safe sex behaviors across the globe.

Treatment and Progress

About 6.6 million people in low to middle income countries were receiving antiretroviral therapy at the end of 2010, a nearly 22-fold increase since 2001. In 2010 alone, a record 1.4 million people started the lifesaving treatment - more than any other year before. At least 420,000 of them were children, an increase of more than 50 percent since 2008.

This is important, because recent trials show that if an HIV-positive person adheres to an effective antiretroviral regimen, the risk of transmitting the disease can be reduced by 96 percent.

“Access to treatment will transform the AIDS response in the next decade. We must invest in accelerating access and finding new treatment options,” said Michel Sidibé, UNAIDS Executive Director. “Antiretroviral therapy is a bigger game-changer than ever before—it not only stops people from dying, but also prevents transmission of HIV to women, men and children.”

While the rate of new HIV infections has gone down significantly, the total numbers still remain high - about 7,000 people per day become HIV-positive. There is also a huge gap in both infection and treatment rates geographically, with countries in sub-Saharan Africa, Southeast Asia and Eastern Europe reporting higher infection rates and far less access to treatment than North America and Western Europe. Nine million people worldwide who are eligible for treatment do not have access. And in all countries, certain populations are still at much higher risk: men who have sex with men, intravenous drug users, sex workers and transgender people.

The Gender and Race Gap

Gender inequalities remain a major barrier in the fight against AIDS. Young men are more likely to be informed about HIV prevention than young women. Recent UNAIDS Demographic Health Surveys found that an estimated 74 percent of young males know that condoms are effective in preventing HIV infection, compared to just 49 percent of young females.

Women account for more than one in four new HIV/AIDS cases in the U.S., and about two-thirds of those are African-American. HIV/AIDS is a leading cause of death for African-American women in many age groups, and is the leading cause of death worldwide for all women of reproductive age.

The Kaiser Family Foundation conducted a large-scale national survey of Americans at the thirtieth year milestone of HIV/AIDS. Key findings included that black Americans, particularly in young age groups, express much high higher levels of concern about HIV infection than whites. Black Americans have been disproportionately affected by HIV/AIDS since the epidemic’s beginning, and that disparity has deepened over time; while they represent only 12 percent of the U.S. population, they account for 46 percent of people living with HIV disease.

Declining Visibility

While the medical fight against HIV/AIDS is improving, a disturbing finding of the Kaiser survey was the reported declining sense of urgency and visibility in the U.S. Three-quarters of Americans could not name an individual who stands out as a national leader in the fight against HIV/AIDS, and perhaps most concerning is that HIV testing rates are flat since 1997, including among some high-risk groups.

To combat this problem worldwide, the World Health Organization (WHO) issued a new Global Health Strategy on HIV/AIDS in May 2011, outlining four strategic directions:

  • To optimize HIV prevention, diagnosis, treatment and care outcomes
  • To leverage broader health outcomes through HIV responses
  • To build strong and sustainable health systems
  • To address inequalities and advance human rights.

UNAIDS estimates that at least 4.2 million new HIV infections would be averted and 2 million lives could be saved, if WHO's recommendations were fully implemented in 2011-2015.


Investments into the HIV/AIDS response in the U.S. increased from $1.6 billion in 2001 to $15.9 billion in 2009. But UNAIDS says that at least $22 billion is needed in the U.S. by 2015. Financial resources in low to middle income countries also rose nearly ten-fold in the same time period, much of it coming from international donors.

“I am worried that international investments are falling at a time when the AIDS response is delivering results for people,” Sidibé said. “If we do not invest now, we will have to pay several times more in the future.”

With the recent resurgence of HIV infection among men who have sex with men, particularly in industrialized countries, WHO released the first-ever public health guidelines on HIV for this group and transgender people.

"We cannot imagine fully reversing the global spread of HIV without addressing the specific HIV needs of these key populations," said Dr. Gottfried Hirnschall, WHO's Director of HIV/AIDS Department. "We are issuing these guidelines to help countries and communities scale-up the services needed to reduce new infections and save lives."

Review Date: 
July 9, 2011