Morenike Oluwatoyin Folayan
New HIV Vaccine and Microbicide Advocacy Society
25th August 2019
A new study published by the Global Burden of Disease 2017 HIV Collaborators on the 19th of August 2019 in the Lancet HIV journal (https://www.ncbi.nlm.nih.gov/pubmed/31439534) reported that despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality.
The study used a modelling strategy for each country to assess the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980-2017 and forecast these estimates to 2030 for 195 countries and territories.
The study authors found that global HIV mortality peaked in 2006 with 1·95 million deaths and decreased to 0·95 million deaths in 2017.
Also, new cases of HIV globally peaked in 1999 (3·16 million) and since then have gradually decreased to 1·94 million in 2017. Between 2007 and 2017, the global age standardised annualised rate of change in HIV incidence decreased by 3·0%.
The confluence of these trends produces a steady increase in the total number of people living with HIV. Prevalence has increased from 8·74 million (7·90–9·68) people living with HIV in 1990 to 36·8 million (34·8–39·2) in 2017, of whom 40·5% (37·8–43·7) were not on ART.
The decrease in HIV related mortality, new HIV infections and ART scale-up globally, resulted in a steady increased in the HIV prevalence, from 8·74 million people living with HIV in 1990 to 36·8 million people living with HIV in 2017. Of the total number of people living with HIV in 2017, 40·5% were not on ART.
The estimates highlight differences in HIV burden between males and females and between different age groups. Females aged 30–34 years had the highest percentage of HIV deaths of all female age groups while males aged 35–39 years had the highest percentage of HIV deaths of all male age groups.
New infections among women were mostly among younger adults, with 20·8% of new infections occurring among females aged 20–24 years in 2017, relatively unchanged from the incidence in 2007 (20·9%, 19·8–22·1). In 2017, males aged 25–29 years had the highest incidence of all male age groups, accounting for 18·6% of new infections that year, which is a substantial change from 2007.
Although HIV infections in children have decreased substantially with the scale-up interventions for prevention of mother-to-child transmission, in 2017, 139 555 new infections were in children younger than 1 year, and 122 254 HIV deaths were in children younger than 15 years.
Most HIV deaths in people younger than 15 years are in children younger than 5 years, but this proportion has decreased from 82·1% in 2007 to 63·4% in 2017, showing the increase in lifespan for children who are HIV positive.
Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini.
In Nigeria 128 000 females and 88 800 males were newly infected with HIV in 2017. Also, 87 500 females and 81 600 males died of HIV related deaths in Nigeria. The age standardised annualized rate of change in HIV new infections between 2000 and 2017 was –5·1% while that age standardized annualized rate of change in HIV related deaths was –5·2%.
The study concluded that although great progress has been made in reducing HIV related incidence and mortality since their peaks earlier in the epidemic, only 54 countries are on track to meet the 2020 target of 81% ART coverage (90% started, 90% retained), only 12 countries are expected to meet the 2030 target of 90% ART coverage (95% started, 95% retained). Also, fewer than ten countries will meet the mortality or incidence targets in 2020 and 2030.
The authors noted that although treatment access and prevention mechanisms exist and can be widely implemented, inadequate ART coverage and adherence could perpetuate the AIDS epidemic.
They also note that that decreases in mortality have out-paced decreases in incidence, therefore much needs to be done to prevent new cases of HIV. To truly end the HIV epidemic, the pace of progress needs to increase. Strides in this direction can be made by continuing to expand universal access to ART and increasing investments in proven HIV prevention initiatives that can scale to have population-level effects.
A prior study conducted by the Global Burden of Disease Health Financing Collaborative Network published on May 5 2018 in the Lancet (https://www.ncbi.nlm.nih.gov/pubmed/29678342), had identified that though the total health spending per country had increased worldwide from 1995 to 2015, there had been a decline in development assistance for health continue, including for HIV/AIDS. The authors also warned that additional cuts to development assistance could risk slowing progress towards global and national health goals including those related to HIV control.
Bibliography
1. Global Burden of Disease Health Financing Collaborator Network. Spending on health and HIV/AIDS: domestic health spending and development assistance in 188 countries, 1995-2015.Lancet. 2018 May 5;391(10132):1799-1829
2. GBD 2017 HIV collaborators. Global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. Lancet HIV. 2019 Aug 19. pii: S2352-3018(19)30196-1.
