Key facts: HIV/AIDS Programme Highlights 2008-09
HIV/AIDS in the world
HIV/AIDS is the world’s leading infectious killer, accounting for an estimated 2 million deaths in 2008 alone. It remains the leading cause of death among women of reproductive age. The epidemic continues to outpace international efforts to prevent the spread of the virus.
At the end of 2008, an estimated 33.4 million people worldwide were living with HIV. That same year, some 2.7 million people became newly infected.
New WHO report
More than 95% of HIV-positive people are in low- and middle-income countries. The epidemic continues to exact an especially heavy toll on sub-Saharan Africa, home to two thirds of people living with HIV, with more than 14 million children under the age of 15 losing one or both parents to AIDS.
In all regions, the epidemic is increasingly prevalent among key marginalized populations, such as sex workers, injecting drug users, men who have sex with men, transgender people, migrants, and prisoners. Depending on the social and legal situation in the country, these groups tend to face discrimination in accessing HIV services.
WHO's role: leading the way for a more effective HIV response and stronger heath systems
WHO has been a leader of the HIV response within the health sector, from its pioneering efforts in the 1980s to draw global attention to an unknown disease, to more recent contributions towards an unprecedented expansion of HIV treatment and key interventions.
As one of the six original Cosponsors of the Joint United Nations Programme on HIV/AIDS (UNAIDS), WHO collaborates with all UNAIDS Cosponsors and teams up with individual agencies on special themes--such as the United Nations Children's Fund (UNICEF) on prevention of mother-to-child transmission (PMTCT) and the United Nations Office on Drugs and Crime (UNODC) on prevention for people who inject drugs, and the UNAIDS Secretariat on surveillance.
WHO provides evidence-based guidance to help countries respond to the epidemic and strengthen their health systems. Between 2006-2008, WHO has prioritized the following five strategic areas:
- enabling individuals to know their HIV status;
- maximizing the health sector’s contribution to HIV prevention;
- accelerating the expansion of HIV treatment and care;
- strengthening and expanding health systems;
- investing in strategic information in an effort to better inform the HIV response.
WHO helps countries translate evidence into strategic action by convening experts to evaluate emerging data and develop policy recommendations. For example, in the wake of compelling evidence that male circumcision reduces the risk of female-to-male HIV transmission, WHO brought together a wide range of stakeholders to evaluate the role that male circumcision plays in HIV prevention. This resulted in the adoption of male circumcision as a new HIV prevention technology.
Many countries throughout the world depend on WHO guidelines to develop effective national policies and programmes. For example:
- all 46 countries in sub-Saharan Africa are using WHO-recommended antiretroviral treatment (ART) guidelines;
- all countries are also using WHO PMTCT guidelines for scale-up;
- twenty-three countries are using standardized WHO modules for Integrated Management of Adolescent and Adult Illnesses to guide clinical practice.
WHO technical experts, based in six Regional Offices and 140 Country Offices, provide tailored advice to Governments, civil society and other partners on the ground.
WHO actively involves key stakeholders, notably people living with HIV and broader civil society in technical consultations, guideline development, capacity building and other key initiatives at national, regional and global levels.
Success at last: impressive gains in saving lives
The past decade saw extraordinary achievements in the scale up of WHO-recommended priority interventions to prevent the spread of HIV/AIDS and improve the life-expectancy of people living with HIV.
WHO promotes the simultaneous, strategic use of multiple interventions for HIV prevention. These include correct and consistent condom use, HIV testing and counselling, male circumcision, and harm reduction. Prevention of mother-to-child transmission and 'prevention for positives', a core set of health-sector interventions to prevent opportunistic infections among HIV positive people, are vital entry points to stop the further spread of HIV from people with known HIV status.
WHO also advises countries on HIV prevention in health-care settings, through blood safety, injection safety, safe disposal of medical waste, and post-exposure prophylaxis. WHO continually updates its guidance and policy briefs for national policymakers on targeted interventions for HIV prevention in population groups with elevated HIV prevalence and transmission. The groups include people who inject drugs, men who have sex with men, transgender individuals, sex workers and prisoners.
WHO took swift action to promote provider-initiated testing and counselling of HIV and increased use of rapid testing technologies. As a result, the total reported number of HIV tests in 39 low- and middle-income countries more than doubled between 2007 and 2008. In 66 high-burden countries, the reported number of HIV testing and counselling sites increased by approximately 35% during this time.
Since 2007, WHO has led efforts to assist countries in rolling out adult male circumcision for HIV prevention, which reduces the risk of female-to-male transmission of HIV by 60%. With financial support from the Bill & Melinda Gates Foundation and PEPFAR, WHO has developed policy recommendations and toolkits to guide and accelerate male circumcision programme implementation in 13 priority countries in sub-Saharan Africa.
Efforts to prevent mother-to-child transmission has averted at least 200 000 paediatric infections since 2001. In 2008, 45% of HIV-positive pregnant women in low- and middle-income countries received antiretroviral drugs to prevent mother-to-child transmission, compared to 35% in 2007. In 2009, WHO has developed a new PMTCT strategic vision, calling for accelerated support to PMTCT in 20 high-burden countries and the virtual elimination of paediatric HIV by 2015.
Notable progress was made in preventing HIV transmission in key populations at risk of HIV. In collaboration with UNODC and UNAIDS, WHO produced a technical guide in 2009 to help countries set ambitious targets for expanding HIV prevention and treatment services that support injecting drug users. Efforts to establish and scale-up opioid substitution programmes in Ukraine, Indonesia, Malaysia and Viet Nam were successful.
WHO and UNAIDS leadership in the "3 by 5" initiative for ART was an important step in a longer-term global effort to achieve the Millennium Development Goals (MDGs). By the end of 2008, more than 4 million people in low- and middle-income countries worldwide were receiving ART – a 36% increase over 2007 and a 10-fold increase in five years.
Nearly all patients (98%) taking ART in high-burden countries are receiving first-line treatment, in accordance with WHO guidelines. On the basis of a thorough review of emerging evidence, and in consultation with leading scientists and partners, WHO updated its recommendations for ART in 2009. WHO will continue to provide leadership and coordination to revise and update the guidelines in order deliver safer and more effective treatment.
Tuberculosis (TB) is a leading cause of death among people living with HIV. WHO has published HIV/TB guidelines in 2009, in partnership with PEPFAR and UNAIDS. Globally, 1.4 million TB patients were tested for HIV in 2008, up from 1.2 million in 2007.
The increased attention to health issues generated by the HIV response has helped drive a broader increase in health spending. As HIV scale-up accelerated in the first half of this decade, overall development assistance for health grew from US$6 billion in 2000 to US$22 billion in 2007.
WHO has played an important role in supporting 50 countries develop funding proposals to the Global Fund, with an increasing success rate.
WHO is partnering with countries to increase the capacity of the health workforce to deliver HIV services through 'task-shifting', whereby specific tasks associated with health care delivery are delegated from highly qualified health workers to other health and community workers. In 2008, more than half of 93 reporting countries had developed policies to address human resource shortages through task-shifting strategies.
WHO takes the lead in monitoring and evaluating the health-sector response to HIV. In collaboration with partners, WHO helps countries generate quality data, monitor progress against relevant indicators, and use data to improve their health-sector response to HIV.
Each year, WHO collaborates with UNAIDS and UNICEF to publish "Towards Universal Access", the definitive global and regional reference for the health sector response to HIV, measuring progress in the availability, coverage and impact of priority HIV interventions. In 2009, 158 of 193 UN Member States reported national data to WHO, including 139 low- and middle-income countries.
Beyond 2010: time to protect and advance HIV gains
HIV/AIDS is far from over. For every two individuals who start ART each year, five people are newly infected, and young people under 25 represent half of the new cases.
As the rate of new infections continues to outstrip the expansion of treatment access, the long-term queue for HIV treatment lengthens, underscoring the urgent need to further intensify both prevention and treatment efforts.
2010 is the deadline to achieve universal access to treatment under the MDG 6 target B, with the aim of scaling up HIV prevention, treatment, care and support services and halt the spread of HIV/AIDS by 2015.
Much work remains: only 42% of people in low- and middle-income countries who needed treatment were receiving it in 2008. The international community is falling short of reaching the 2010 target, but it has acquired valuable know-how in the process. Universal access will be reached only if the international community sustains its investment in the HIV response.
WHO leads the health sector’s contribution to the HIV response. At least 55% of all resources required to mount an effective global response to the epidemic need to be directed towards the health sector. And WHO's contributions are vitally needed to protect the gains achieved over the past decade and to reach the MDGs.
In order to maintain its current level of support to HIV/AIDS responses in countries, WHO needs between US$40-60 million per year, in addition to its regular organizational and UN funding for HIV/AIDS.