[afro-nets] Highlights of annual UNAIDS/WHO 2006 AIDS Epidemic Update

["Amadou MOREAU" <amoreau@pcdakar.org>]

Highlights of annual UNAIDS/WHO 2006 AIDS Epidemic Update
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Cross-posted from: AIDS@ccih.org

The annual UNAIDS/WHO 2006 AIDS Epidemic Update, released November 21, summarizes the global AIDS situation as follows:

“An estimated 39.5 million people are living with HIV. There were 4.3 million new infections in 2006 with 2.8 million (65%) of these occurring in sub-Saharan Africa and important increases in Eastern Europe and Central Asia, where there are some indications that infection rates have risen by more than 50% since 2004. In 2006, 2.9 million people died of AIDS-related illnesses.” The report observes that “declines in infection rates are also being observed in some countries, as well as positive trends in young people's sexual behaviours.”

Some countries' AIDS efforts have remained stagnant or even gone backwards; however the report also states that, “Positive trends in young people's sexual behaviours—increased use of condoms, delay of sexual debut, and fewer sexual partners—have taken place over the past decade in many countries with generalized epidemics. Declines in HIV prevalence among young people between 2000 and 2005 are evident in Botswana, Burundi, Côte d’Ivoire, Kenya, Malawi, Rwanda, Tanzania and Zimbabwe.

The complete report is accessible online at
http://www.unaids.org/en/HIV_data/2006GlobalReport/default.asp.  Data by region can be downloaded at http://www.unaids.org/en/HIV%5Fdata/epi2006/

Some highlights that may be of interest to CCIH listserv readers, including a section on faith-based organizations, are copied below from the chapters on HIV prevention and on the role of civil society.

COMPREHENSIVE HIV PREVENTION

The steady growth of the AIDS epidemic stems not from the deficiencies of available prevention strategies but rather from the world’s failure to use the highly effective tools at its disposal to slow the spread of HIV. Some 25 years after the epidemic was first recognized, most people at high risk of HIV infection have yet to be reached by HIV prevention, as many policy-makers refrain from implementing approaches that have been shown to work.

If anything has been learnt from the past 25 years of the epidemic, it is that HIV prevention works.  The early successes of Brazil, Thailand and Uganda in reversing their national AIDS epidemics through courageous political leadership and starting strong prevention efforts early have been well documented. More recent evidence suggests that prevention efforts are now also contributing to reductions in HIV prevalence in Cambodia and Zimbabwe, and in parts of Burkina Faso, Haiti, Kenya and the United Republic of Tanzania (UNAIDS, 2005a).

While funding for HIV programmes has increased in recent years, many countries are failing to direct financial resources towards activities that address the prevention needs of the populations at highest risk, opting instead to prioritize more general prevention efforts that are less cost effective and less likely to have an impact on the epidemic (see ‘Financing’ chapter).

Scaling up available prevention strategies in 125 low- and middle-income countries would avert an estimated 28 million new HIV infections between 2005 and 2015—more than half of those that are projected to occur during this period—and would save US$ 24 billion in associated treatment costs.

Effective prevention of sexual transmission of HIV requires a combination of programmatic interventions and policy actions that promote safer behaviours, reduce biological and social vulnerability to transmission, encourage use of key prevention technologies, and promote social norms that favour risk reduction, as stated in the UNAIDS’ policy position paper Intensifying HIV Prevention.

Analysis of prevention interventions to change behaviour has consistently found that such programmes reduce the frequency of sexual risk behaviours. Behavioural aims for HIV prevention include: abstinence and delayed sexual debut for young people; monogamy within relationships; reduction in the number of partners; and correct and consistent condom use.

Especially in settings with high HIV prevalence, effective HIV prevention often requires changes to deep-seated traditions and social norms regarding human sexuality. Given the important role of concurrent unprotected sexual partnerships in the spread of HIV in sub-Saharan Africa (Halperin and Epstein, 2004), persuading sexually active individuals to accept partner reduction and monogamy as valued norms may be critical to the long-term success of HIV prevention efforts. Countries that have lowered HIV incidence have benefited from the emergence of new sexual behaviour patterns—fewer commercial sex transactions in Cambodia and Thailand, delayed sexual debut in Zimbabwe, increasing emphasis on monogamy in Uganda, and an increase in condom use.

In the long run,effective HIV prevention for women will require policy reforms that empower women and promote gender equality.

Young people’s risk of HIV infection is closely correlated with age of sexual debut (Pettifor et al., 2004). Accordingly, abstinence from sexual intercourse and delayed initiation of sexual behaviour are among the central aims of HIV prevention efforts for young people (Santelli et al., 2006).

To be effective, HIV prevention services for young people should be widely accessible, evidence-based, grounded in human rights, age-specific and gender responsive, and should help build life skills to enable young people to reduce their vulnerability. Such services should also involve young people living with HIV, and support balanced and comprehensive prevention strategies that promote abstinence, faithfulness, women’s equality and empowerment, reduction in the number of partners, and consistent condom use (UNICEF, 2005).

Contrary to common fears or stereotypes, extensive research has detected little evidence that sex education leads to an increase in sexual activity.

In recent years, programmes that promote abstinence as the sole HIV prevention strategy for young people have attracted considerable attention from researchers, programme implementers, policy-makers, advocates and commentators. On the basis of extensive experience in low- and middle income countries as well as in high income countries, experts in adolescent health broadly agree that comprehensive HIV prevention programmes—which simultaneously promote condom use and delayed initiation of sex for those who are sexually active—represent the most effective approach to HIV prevention for young people.

A study of a youth-oriented media campaign in Zambia called the Helping Each Other Act Responsibly Together (HEART) campaign found that young people who saw the campaign were 60% more likely than those who had not to report being abstinent and more than twice as likely to have ever used a condom (Underwood et al., 2006).

At the same time, optimism about the treatment or misperceptions about the effects of antiretroviral drugs may also cause some people to increase their risk behaviour. Concern about this potential effect is not without foundation. In a study of 1168 HIV-positive women in the United States, initiation of antiretroviral therapy was associated with an increased likelihood of engaging in unprotected sex (Wilson et al., 2004).

To mount a comprehensive, sustained HIV prevention effort with the appropriate coverage and intensity, financing for such efforts must significantly increase. UNAIDS and its research partners estimate that US$ 11.4 billion in financing for HIV prevention activities will be needed by 2008 to ensure that the world is on track to achieve the Millennium Development Goal of halting and beginning to reverse the global AIDS epidemic by 2015. Were the world to mount such a comprehensive, evidence-based response in all regions, HIV prevention would account for 52% of all HIV and AIDS spending worldwide in 2008 (UNAIDS, 2005c).

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