Feature story

UNAIDS in 2008: A year of progress, challenge, debate, and change

26 December 2008

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2008 has been a year of progress, challenge, debate, and change. In this year end review, UNAIDS provides a snapshot of key issues, events, and initiatives that shaped the global AIDS response in the past 12 months.

Progress
Investments in AIDS producing results

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Several milestones were reached in 2008: the goal of having at least three million people on antiretroviral treatment was achieved; at the end of 2008 around four million people were on treatment.

There were fewer new HIV infections in 2008 than in 2005, and the number of people dying due to AIDS has decreased.


Increased Leadership for the Global AIDS response

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Leadership commitment to HIV has been at high levels throughout 2008. At the High Level Meetings on AIDS and the Millennium Development Goals, countries reaffirmed their commitments to achieve global targets on AIDS.

A new initiative by the former President of Botswana, Mr Festus Mogae, brought together African leaders to unite on HIV prevention efforts. Two independent commissions on AIDS, one in Africa and one in Asia, reviewed the state of the AIDS epidemic in the two continents and called upon leaders to accelerate HIV prevention and treatment efforts.

Nearly US $10 billion was available for the AIDS response in low- and middle-income countries. Domestic spending on AIDS increased between 25% and 54%, and sub-Saharan countries spent six times more from their own resources. The United States of America committed a further US $48 billion from 2009 for five years for spending AIDS, Tuberculosis and Malaria.

 


Challenges
HIV prevention and treatment efforts lagging behind

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Significant challenges in the AIDS response remain: for every two people put on treatment, five others are newly infected. The total number of people living with HIV has increased to 33 million. Nearly 6 million people are in need of treatment today. Access to pediatric treatment for children is lagging behind, and men who have sex with men, people who inject drugs and sex workers are often ignored by HIV prevention and treatment programmes.


Global crises impact AIDS response

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Health systems are being stretched – and so are other sectors, for example education and labour. Rising food prices, along with shortages in food production, have placed additional burden on the ability of families to sustain their lives. Furthermore, the global financial crisis has lead to uncertainty about the potential impact on the AIDS response.


Human rights of people living with HIV and marginalized populations often violated

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Many countries are revising or adopting new laws, many to protect people living with HIV from discrimination. But in many countries, there is a worrying trend in criminalizing transmission of HIV as well as of sexual behaviour.


Debates
Is AIDS over?

The UNAIDS 2008 Report on the global AIDS epidemic clearly showed that AIDS is not over in any part of the world, even though the number of new HIV infections has fallen in several countries. The report cautioned that AIDS continues to be a leading cause of death in Africa. It also underlined that HIV incidence is increasing in countries with older epidemics such as the United States of America, Australia, Germany, and England. World leaders at various international forums, starting from the UN High Level Meeting on AIDS and the Mexico AIDS conference to ICASA in Dakar have resoundingly refuted the notion that ‘AIDS is over’.


Is AIDS weakening health systems?

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Weak health systems have impeded progress in accelerating access to HIV treatment services in many countries. At the same time, AIDS has also caused a strain on the already weak health systems in many countries.

Speaking at the International AIDS Conference in Mexico, the Director General of WHO Dr Margaret Chan said, “We should not blame disease-specific programmes for weakening the health system. The truth is that for decades, governments have underinvested in health infrastructure”. Dr Chan added that “further sustainable progress depends absolutely on improved service capacity. At this stage, we have an historical opportunity to align the agenda for responding to AIDS with the agenda for strengthening health systems.”

UNAIDS Executive Director Dr Peter Piot, Executive Director of UNAIDS, in an interview said, “There’s absolutely no evidence that AIDS undermines health services. If anything, it certainly strengthened certain services. Determined governments will make sure that disease specific funding is used to strengthen local capacity.”


Is there a single magic bullet for HIV prevention?

HIV prevention strategies and programmes have been at the centre of many debates. Various experts have approached it from different angles: the role of multiple sexual partners and concurrent relationships, HIV treatment as prevention, male circumcision, the role of condoms, and delaying sexual debut have been subjects of discussion.

UNAIDS has argued that the word “only” doesn’t work for AIDS—whether it is for treatment only, HIV prevention only, condoms only, abstinence only or male circumcision only. In reality all are needed—a truly comprehensive approach. For UNAIDS, the three pillars of a comprehensive and effective AIDS response, as we move towards universal access, are HIV prevention, treatment, and care and support.

UNAIDS advocates that countries implement HIV prevention programmes that will be truly effective in reducing new HIV infections. This requires a strategic combination of interventions that address populations that are at risk or vulnerable for HIV transmission and that utilize behavioral and social change methods that are appropriate and informed by the latest evidence.


Change at UNAIDS
Dr Peter Piot’s term as UNAIDS Executive Director comes to an end in 2008.

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At the end of 2008, Dr Peter Piot, the founding Executive Director of UNAIDS, will leave his post after leading the organization since its inception. In 2009, he will join Imperial College London as the first director of its new Institute for Global Health.


Mr Michel Sidibé appointed new UNAIDS Executive Director.

Michel Sidibe, the current Deputy Executive Director of Programmes for UNAIDS, was appointed the new Executive Director of UNAIDS on World AIDS Day. He assumes his new position in January 2009.


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