HIV / AIDS

HIV/AIDS is no longer a death sentence. Advanced tools for prevention and treatment have led to a 33% decline in new cases since 2001 and a 30% reduction in AIDS deaths since 2005. We need to continue to scale up these interventions in a rapid and targeted manner in order to reverse the epidemic and set our sights on the beginning of the end of AIDS.

When the Millennium Development Goals were established, ending the AIDS epidemic seemed like an unattainable goal. Today, we have made great strides toward this goal, having developed the advanced tools for prevention and treatment necessary to end the AIDS epidemic within our lifetime. The UNAIDS 2013 Global Report on the AIDS epidemic calls for action in 10 areas that will drive progress towards a global vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.

The Special Envoy’s Office believes that these “zero” targets are achievable. We are committed to advocating for, and supporting, efforts to provide universal access to critical prevention and treatment interventions. Through Born Free, the Special Envoy’s Office will contribute to the virtual elimination of mother-to-child transmission of HIV by the December 31, 2025 MDG deadline.

Target

MDG6 calls for two targets related to HIV: halting and beginning to reverse the spread of HIV/AIDS and achieving universal access to treatment for HIV/AIDS for those who need it. To reach these goals, the Special Envoy's Office is focused on:

• Ensuring that everyone who tests positive has access to anti-retroviral treatment (ART). This begins with the 26 million people who currently qualify for treatment under the WHO guidelines and should ultimately include all 35 million people estimated to carry the AIDS virus
• Virtually eliminating new HIV infections in children to 10% of 2009 levels by the end of 2015 (down to roughly 40,000 new HIV infections in children per year globally)

Situation

The past ten years have seen unprecedented global effort, resource allocation and results in the fight against the HIV/AIDS epidemic. We have gone from no-one on treatment to more than 10 million people on treatment, we have seen more than a 3x increase in funding for HIV programs and, for the first time, we are seeing several countries reach a tipping point – more people on treatment than newly infected.

Despite these achievements, we remain far from the goal of providing universal access to HIV-related services and particularly far from insuring that all people living with HIV have the necessary treatment. In July 2013, WHO issued new HIV treatment guidelines expanding treatment eligibility to all adults with a CD4 count under 500, as well as HIV-positive children under five and HIV-positive pregnant women. Currently, there are an estimated 35 million persons infected with HIV, of whom 26 million have CD4 counts under 500 and are therefore newly eligible for treatment.

Today 15% of all new HIV infections are in children and the vast majority of those are the result of mother-to-child transmission. Without treatment, 50% of children living with HIV will die before they reach the age of two. The solution is well understood: if an HIV-positive mother takes just one pill a day during her pregnancy, she can reduce the risk of her child being infected by 98%. The world has seen more than a 50% reduction in new HIV infections among children since 2003, when transmission was at its peak, yet more than 700 children are still born with HIV each day. Pediatric treatment for children living with HIV remains a challenge, but the world is aiming for both elimination of mother-to-child transmission of HIV and increased pediatric treatment coverage on par with adults by December 31, 2015.

Approach

The Special Envoy's Office believes that our pathway to ending the epidemic is to achieve universal access to HIV prevention and treatment interventions as appropriate, and to smartly target the communities in most need. Today we have affordable, highly effective anti-retroviral treatment (ART), as well as increasingly affordable testing, counseling and prevention services, and we must build a coalition of leaders committed to deploying available resources in the most effective and efficient way possible.

Our roadmap forward begins with gaining consensus and alignment among key AIDS donors and stakeholders (including PEPFAR, Global Fund, UNICEF, UNAIDS, WHO and the Bill & Melinda Gates Foundation) and the leading countries in domestic spending (including South Africa, Brazil, India and China) to call for the reallocation of existing funding to prioritize testing and treatment as first dollar spend in the AIDS response. We will build on this consensus to call for revised country plans that place testing and treatment at the heart of the AIDS response, along with sustained commitment to prevention strategies.