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Why Isn't the Global Rate of HIV Infection Declining?

Fewer people are dying, but the HIV infection rate has stayed the same since 2005.

Michael Byrne

Michael Byrne

Image: Leonie Pauw/Shutterstock

The rate of new HIV infections peaked globally in 1997 with 3.3 million cases. From there, a steady decrease was seen until 2005, when the average number of new infections had decreased to 2.6 million per year. This rate has remained more or less constant since then, according to a new study published in the Lancet HIV, with the result being a steady growth of total HIV cases to approximately 38.8 million in 2015.

These are discouraging results; one should expect that, given increasing public awareness, infections would consistently continue to decline.

The same study notes, however, that HIV mortality is falling globally. In 2005, 1.8 million people died from the illness, while that number fell to 1.2 million in 2015. The decrease here can be primarily attributed to two things: The scale-up of antiretroviral therapy (ART), which can keep the virus at bay almost indefinitely in infected patients, and prevention of mother-to-child transmission.

Image: GBD 2015 HIV Collaborators

But still, why such difficulty in reducing infection in the first place? As it turns out, the infection rate is even increasing in some places (which is offset by decreasing rates in others, leaving the global stagnation). While the wildfire HIV epidemics of sub-Saharan Africa have somewhat been quelled, infection rates in previously quieter locales such as Indonesia and the Philippines have boomed.

"The need for HIV programmes, particularly ART programmes, continues to grow because of both the sustained high incidence of infections and the success of ART in extending the lifespan of people living with HIV," the study notes. "However, since 2010, development assistance for HIV has remained nearly constant. This absence of additional funding is by stark contrast with the $36 billion needed annually to achieve the UN goal to end AIDS by 2030."

A study published in April of this year projected no significant increase in HIV/AIDS funding in the hardest-hit regions, at least from outside sources. Middle-income countries may be able to fill the gap, but in southern sub-Saharan African nations where HIV rates are highest, not so much. Based on epidemiological and financial trends, sustaining ART programs—and meeting the UN's goal—may not be possible.

As for what exactly it will take to reverse these trends, the new study offers some ideas: "Meeting the needs of people living with HIV will require a combination of concentrating development assistance for HIV on these low-income countries, improving the efficiency of HIV programmes, increasing domestic financing, lowering the cost of treatment (including prices of ART drugs), and reducing future incidence through more concerted efforts," the authors write.

They add that, "Development assistance efforts will also need to be scaled up if the free flow of low-cost generic drugs is hampered. Additionally, public and private sectors need to be incentivised to continue research and development of new and better prevention and treatment strategies to combat the epidemic in the long term."

As far as pathogens go, HIV is almost supernaturally adroit. And the development of medicines and prevention strategies that can effectively neutralize it are among the crowning achievements of modern medicine. Just putting the global war against HIV on cruise control, as recent trends suggest, should be unthinkable.