AIDS 2012: Reversing the epidemic - what’s working and what’s not?

As the discussions continue at AIDS 2012, the consensus is that much progress on fighting with HIV has been made. In the early 1980, testing positive for HIV brought a death sentence, now it means having a chronic but manageable disease. A global 20% reduction in prevalence rates since 2000 is a significant achievement.

But in some parts of the world, most notably North Africa and Eastern Europe, new HIV infection rates are beginning to rise. So what is going right and what is going wrong when it comes to reversing the HIV epidemic?

At AIDS 2012, the Indian government is proudly presenting the outstanding achievements of its National AIDS Control Programme (NACP). India’s story brings hope. It has recorded a 56% reduction in HIV prevalence in last decade. This has brought India’s HIV prevalence rate to 0.31%. In a country that has remained impacted with poverty, other serious health problems, and funds deficit this achievement is overwhelmingly positive.

The Indian government representatives give the credit to these four important factors:

• Increasing financial contributions to NACP from within the country, currently standing at some 76% of overall money spent on HIV
• The convergence of a range of health programmes, despite being a diverse country
• Policy level reforms with greater focuses on decriminalisation of key populations and availability of treatment
• A strong political will with a continued commitment

“We are looking at a new world with new resources though, which changes the picture,” says Bernhard Schwartlander from UNAIDS. A number of countries in recent years have moved from a low-income status to middle income status with Brazil, Russia, India, China and South Africa leading the way. It is also the middle-income countries where HIV infection is concentrating more and likely to do so in future.

In almost all parts of the world, an increase in domestic funding has been providing strength to national AIDS control programmes. A total of 81 countries have seen an increase of up to 56% on their domestic spending on AIDS. This is a positive sign, but in no way means that international assistance has a lesser role to play, especially on the research and treatment sides. An adequate balance between dependence, self-reliance and sustainability must be ensured.

Progress is uneven too, as UNAIDS explains. For example, Brazil and Russia are about the same in the terms of population, GDP and money spent on the HIV response but there is a significant difference between the two countries on the state of the epidemic, with Brazil faring much better than Russia. This difference comes in a differing approach to policy reform and the role of civil society - both crucial factors in epidemic control.

In 2000, an ambitious target of providing antiretroviral therapy (ART) to three million people living with HIV by 2010 was set. The progress has been beyond expectation. Over eight million currently receive ART. But the progress needs to be equally spread with more ART coverage and a special focus on people who use drugs where the epidemic is hitting the hardest.

When it comes to ending the epidemic there is more good news than bad. India proves it can be done. And exchanges like those going on at AIDS 2012, in which countries learn from one another, is how the path towards an AIDS free generation gets built.