An estimated 15.8 million people are now on HIV treatment, a doubling from five years ago, as countries adopt the UNAIDS Fast-Track Strategy using data to fine-tune delivery of HIV prevention and treatment services to reach people being left behind

GENEVA, 24 November 2015—Ahead of World AIDS Day 2015, UNAIDS has released a new report showing that countries are getting on the Fast-Track to end AIDS by 2030 as part of the Sustainable Development Goals. By adapting to a changing global environment and maximizing innovations, countries are seeing greater efficiencies and better results.

Progress in responding to HIV over the past 15 years has been extraordinary. By June 2015, UNAIDS estimates that 15.8 million people were accessing antiretroviral therapy, compared to 7.5 million people in 2010 and 2.2 million people in 2005. At the end of 2014, UNAIDS estimates that new HIV infections had fallen by 35% since the peak in 2000 and AIDS-related deaths have fallen by 42% since the 2004 peak.

“Every five years we have more than doubled the number of people on life-saving treatment,” said Michel Sidibé, Executive Director of UNAIDS. “We need to do it just one more time to break the AIDS epidemic and keep it from rebounding.”

The life-changing benefits of antiretroviral therapy mean that people living with HIV are living longer, healthier lives, which has contributed to an increase in the global number of people living with HIV. At the end of 2014, UNAIDS estimates that 36.9 million people were living with HIV. Once diagnosed, people need immediate access to antiretroviral therapy.

Countries are gearing up to double the number of people accessing HIV treatment by 2020. This Fast-Track approach will be instrumental in achieving the UNAIDS 90–90–90 treatment target of ensuring that 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are on treatment and 90% of people on treatment have suppressed viral loads.

“Today, we have more HIV prevention options than ever before. And with better data, we can become better matchmakers, finding the right prevention options for the right people,” said Mr Sidibé.

To end AIDS as a public health threat, an accelerated and more focused response is needed using better data to map and reach people in the places where the most new HIV infections occur. To support countries with this approach, UNAIDS has released a new report, Focus on location and population: on the Fast-Track to end AIDS by 2030, which gives examples of more than 50 communities, cities and countries that are using innovative approaches to reach more people with comprehensive HIV prevention and treatment services.

Through the responsible use of detailed national data sets, countries are able to focus at a more granular level, mapping where new HIV infections occur and where people need services most.  The report demonstrates how countries can redistribute resources to improve access to HIV prevention and treatment services. With the Fast-Track approach and front-loaded investments, gaps are closed faster and resources go further and from 2020 annual resource needs will begin to fall.

The report highlights how high-impact HIV prevention and treatment programmes, such as pre-exposure prophylaxis, voluntary medical male circumcision and sexual and reproductive health services, are being successfully implemented in various locations and for different populations, including adolescent girls and young women and their partners, pregnant women living with HIV, sex workers, transgender people, gay men and other men who have sex with men and people who inject drugs.

Examples of high-impact programmes are:

• A nationwide mapping in Kenya has helped to reach more female sex workers with a comprehensive package of HIV services and reduce the number new HIV infections among sex workers. Most dramatic has been the reduction in the incidence of sexually transmitted infections, from 27% among people screened in 2013 to just 3% in 2015.
• In Botswana, a policy change increased access to secondary school. Each additional year of secondary education was shown to reduce the cumulative risk of acquiring HIV by 8.1 percentage points.
• In the Islamic Republic of Iran in 2002–2003 only one prison provided methadone for just 100 prisoners dependent on opioids. By 2009, however, 142 prisons across all 30 provinces offered this vital harm reduction service, reaching 25 000 prisoners.
• A quarter of El Salvador’s transgender people live in the capital, San Salvador. In 2014, community centres were established in the country’s three largest cities to provide a comprehensive package of HIV prevention and health-care services tailored to the specific needs of this highly marginalized population. Within the first six months of 2015, these specialist services had reached a quarter of San Salvador’s transgender population.

These innovative programmes use national and subnational data and local knowledge from populations at higher risk of HIV to direct tailored HIV and related services to reach the people currently being left behind, resulting in greater impact at lower cost.

• Since July 2014 the community organization Colectivo Amigos contra el SIDA (CAS) has provided comprehensive HIV services in Guatemala City that are promoted on popular social networking websites and gay dating apps. The services are then provided through outreach activities in popular meeting places, such as parks, pedestrian walkways, saunas and nightclubs. These efforts have increased the reach of HIV prevention services by 61%, and the number of people tested increased by 32%. However, the map shows that coverage of services is still very low in many parts of the city.
• In the Blantyre district of Malawi, self-test kits were provided to 16 000 residents. Some 76% of residents self-tested and shared their results with a volunteer counsellor within one year.
• In 2012 and 2013, health facilities in Guangxi, China, began offering immediate initiation of antiretroviral therapy following diagnosis of HIV. As a result, the average time between diagnosis of HIV and initiation of treatment plummeted from 53 days to five days. Mortality also fell by approximately two thirds, from 27% to 10% during that same time period.
• Rwanda has integrated programmes to prevent mother-to-child transmission of HIV into maternal, neonatal and child health services and by 2014 had reduced new HIV infections among children by 88% compared to 2009.   

In the report UNAIDS identifies 35 Fast-Track countries that account for 90% of new HIV infections. Focusing on location and population and programmes that deliver the greatest impact will reap huge benefits by 2030: 21 million AIDS-related deaths averted; 28 million new HIV infections averted; and 5.9 million new infections among children averted.

“Everyone has the right to a long and healthy life,” said Mr Sidibé. “We must take HIV services to the people who are most affected, and ensure that these services are delivered in a safe, respectful environment with dignity and free from discrimination.”

The report shows that areas with fewer numbers of people living with HIV and lower HIV prevalence are more likely to have discriminatory attitudes than areas that have more cases of HIV. This seemingly contradictory result is explained by education and understanding about HIV usually being higher in countries where HIV is more prevalent and where more people are receiving treatment. However, these discriminatory attitudes make it more difficult for people in low-prevalence areas to come forward to seek HIV services for fear of stigma and reprisals.   

Adopting the UNAIDS Fast-Track approach through strong leadership and investment within the communities, cities and countries most affected, the AIDS epidemic can be ended by 2030 as part of the Sustainable Development Goals. 

Read the publication on ISSUU

• Part 1 (Foreword - Conclusions)
• Part 2a (Where services are needed - Lesotho)
• Part 2b (Malawi - References)

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

The ambitious HIV treatment target set for 2020 greatly influenced governments and partners in their approach to the AIDS response, said senior officials of Luxembourg and UNAIDS at a briefing for diplomatic missions in Geneva, Switzerland, on 9 November.

Efforts to scale up treatment in the next five years are crucial to ending the AIDS epidemic. The 90–90–90 treatment target for 2020 calls for 90% of people living with HIV to know their HIV status, 90% of people who know their HIV-positive status to access antiretroviral treatment and 90% of people on treatment to have suppressed viral loads.

Unlike earlier treatment targets, which focused solely on the number of people starting HIV treatment, 90–90–90 focuses on the ultimate aim of HIV treatment—viral suppression, which significantly reduces both the risk of HIV-related illness and death and the risk of HIV transmission.

At the briefing, speakers from UNAIDS and Luxembourg outlined priority areas to implement 90–90–90. They reiterated that the political will and the scientific tools exist to end the AIDS epidemic. Success has been achieved in different areas and regions of the world, but more needs to be done to ensure that no one is left behind and to close the treatment gap for children.

Luxembourg, a longstanding supporter of UNAIDS, became a strategic partner this year in the push to end the AIDS epidemic as a public health threat by 2030. The alliance between UNAIDS and Luxembourg aims to leverage the therapeutic and preventive benefits of antiretroviral therapy.

At the briefing, Marc Angel of Luxembourg was appointed as a UNAIDS champion for the 90–90–90 treatment target. He has been an AIDS advocate for more than 25 years.

As a member of the Chamber of Deputies of Luxembourg since 2004, Mr Angel serves as the Chairman of the Committee for Foreign and European Affairs, for Defence, for Cooperation and Development and for Immigration of the Luxembourg Parliament.

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GENEVA, 6 October 2015—New Global Standards for quality health-care services for adolescents developed by the World Health Organization (WHO) and UNAIDS aim to help countries improve the quality of adolescent health care.

Existing health services often fail the world’s adolescents (10-19-year-olds). Many adolescents who suffer from mental health disorders, substance use, poor nutrition, intentional injuries and chronic illness do not have access to critical prevention and care services. Meanwhile, many behaviours that have a lifelong impact on health begin in adolescence.

“These standards provide simple yet powerful steps that countries – both rich and poor – can immediately take to improve the health and wellbeing of their adolescents, reflecting the stronger focus on adolescents in the new Global Strategy for Women’s, Children’s and Adolescents’ Health that was launched in New York in September,” says Dr Anthony Costello, Director of Maternal, Children’s and Adolescents’ Health at WHO.

Adolescents form a unique group, rapidly developing both physically and emotionally but are often dependent on their parents or guardians.  WHO and UNAIDS Global Standards for quality health-care services for adolescents recommend making services more “adolescent friendly”, providing free or low-cost consultations, and making medically accurate age-appropriate health information available. They also highlight the need for adolescents to be able to access services without necessarily having to make an appointment or requiring parental consent, safe in the knowledge that any consultation remains confidential, and certain that they will not experience discrimination.

“If we want to keep adolescents healthy, we have to treat them with respect,” says Dr Costello. “Adolescents are particularly vulnerable to certain health issues. The top three causes of death among adolescents are road traffic injuries, AIDS-related illnesses and suicide.

“AIDS is the leading cause of death among adolescents in Africa and the second primary cause of death among adolescents globally,” says Dr Mariângela Simão, Director of Rights, Gender, Prevention and Community Mobilization at UNAIDS. “All adolescents, including key populations, have a right to the information and services that will empower them to protect themselves from HIV.”   

Not only is adolescence a period of life when people are particularly vulnerable to certain health issues, it is also a time when critical behaviours are shaped that will affect health in the future.   

“So many behaviours – healthy or unhealthy – that impact the rest of our lives begin in adolescence,” adds Dr Costello. “The health sector cannot stand there and tell people they are sick because of the ways they use tobacco and alcohol, and their attitudes to diet and exercise, if it does not do a better job of helping people develop healthy habits as adolescents.”

Training health workers is critical.

Dr Valentina Baltag, adolescent health expert at WHO, says: “There are countries where every fifth citizen is an adolescent. Yet most students in medical and nursing schools graduate with no understanding of the specific needs of adolescents in accessing healthcare. This is unacceptable.”

The Global Standards for quality health-care services for adolescents call for an inclusive package of information, counselling, diagnostic, treatment and care services that go beyond the traditional focus on sexual and reproductive health.

Adolescents should be meaningfully involved in planning, monitoring and providing feedback on health services and in decisions regarding their own care.

More than 25 low- and middle-income countries have already adopted national standards for improving adolescent health services.

The global standards from WHO and UNAIDS are built on research from these countries, as well as feedback from health providers and more than 1000 adolescents worldwide. They are accompanied by an implementation and evaluation guide that outlines concrete steps that countries can take to improve health care for adolescents.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Twelve United Nations (UN) entities have released a joint statement calling for an end to violence and discrimination against lesbian, gay, bisexual, transgender and intersex (LGBTI) people. The joint statement highlights the UN’s inter-agency commitment on working with Member States to protect, respect and fulfil the right of LGBTI people to live free from violence, persecution, discrimination and stigma. It also calls on countries to repeal discriminatory laws.

LGBTI people face a wide range of human rights violations. The UN and others have documented widespread physical and psychological violence against LGBTI people in all regions, including murder, assault, kidnapping, rape and sexual violence, as well as torture and ill-treatment in institutional and other settings.

In many countries, the response to these violations is inadequate; in others, human rights defenders challenging these violations are frequently persecuted and face restrictions on their activities. The legislative framework can exacerbate the situation, with 76 countries criminalizing consensual same-sex relationships between adults. These laws expose individuals to the risk of arbitrary arrest, prosecution, imprisonment and even the death penalty in at least five countries.

Punitive environments that marginalize LGBTI people also create significant challenges in responding to HIV. Gay men and other men who have sex with men are 19 times more likely to be living with HIV than the general population, and HIV prevalence among gay men and other men who have sex with men is rising in certain regions, including Asia and the Pacific and Latin America. Transgender women are 49 times more likely to be living with HIV.

In addition to violating the fundamental human rights of LGBTI people, punitive laws severely restrict the ability of LGBTI people to access critical HIV and other health services. Service providers are often forced to stop working, owing to harassment or fear of prosecution.

The UN Secretary-General, Ban Ki-moon, re-affirmed his support for LGBTI rights with a message delivered during last year’s UN General Assembly. “The fight for human rights—and the fight against discrimination—lies at the core of the mission of the United Nations. The fight for equal rights demands global engagement. That is why the United Nations actively works to tackle homophobia and transphobia around the world,” he said.

The UN entities that have signed the joint statement on ending violence and discrimination against LGBTI people are: the International Labour Organization (ILO); the Office of the High Commissioner for Human Rights (OHCHR); the United Nations Development Programme (UNDP); the United Nations Educational, Scientific and Cultural Organization (UNESCO); the United Nations Population Fund (UNFPA); the Office of the United Nations High Commissioner for Refugees (UNHCR); the United Nations Children’s Fund (UNICEF); the United Nations Office on Drugs and Crime (UNODC); the United Nations Entity for Gender Equality and the Empowerment of Women (UN Women); the World Food Programme (WFP); the World Health Organization (WHO); and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

Read the joint statement