Joint United Nations Programme on HIV/AIDS

Article dated: 13 November 2014

There are 8 strategic objectives set by the United Nations in 2000 which aim to improve the global quality of life, health, education, economic development, and the environment by 2015.

Among the listed goals is a call to “halt and reverse” the spread of HIV, tuberculosis and malaria—particularly in areas of high prevalence such as Sub-Saharan Africa.

Problems faced are:

  • Inconsistency of funding due to global recession
  • Increasing numbers of new infections, including South Africa and Uganda

Here are the 4 goals relating directly to HIV/AIDS & TB:

Goal 1: Reduce sexual transmissions of HIV by 50%

  • From 2001 to 2011, the incidence of new HIV infections dropped by approximately 21% worldwide. However, from the perspective of sexual transmissions alone—particularly among individuals aged 15-24—the decreases are only half of what had been envisioned by UNAIDS.
  • More concerning still is the escalating number of new infections reported in Eastern Europe and Central Asia, which have literally doubled since 2001 (driven mainly by injection drug use). Similarly, the failure to stave HIV infections among men who have sex with men will merely contribute to an upward or stagnating trend in many developed and non-developed countries.
  • By contrast, impressive gains have been achieved in the Caribbean, where the new infection rate has plummeted by some 43% during the same period.

Goal 2: Place 15 million HIV-positive people on antiretroviral therapy

  • As of January 2014, approximately eight million people in developing countries had been placed on ART. Expanded treatment guidelines issued by the World Health Organization (WHO) in 2013—wherein therapy can now be initiated at 500 cells/mL or less— will only increase the potential for ART access.
  • By 2010 only 55% of the 14.4 million in need of ART actually received it.
  • Less than 28% of eligible children had access to ART.
  • Latin America and the Caribbean achieved the highest ART coverage of 68%
  • Eastern Europe and Central Asia had the weakest coverage of ART, 19%
  • By the end of 2015 it is estimated that a possible 15 million will be placed on ART
  • However, unless infection rates can be brought down by at least 50% by 2015, many question whether a global ART initiative can be sustained in the face of an ever-increasing HIV population.

Goal 3: Eliminate mother-to-child transmission of HIV and reduce AIDS-related maternal deaths by 50%

  • In June 2013, UNAIDS reported that seven African countries achieved a 50% reduction in new HIV infections among children since 2009. Much of the success is due to antiretroviral programs design to prevent mother to child transmission
  • In South Africa alone, MTCT rates have dropped to an astounding 5%, down from a high of 37% in 2000. Similarly, MTCT interventions in Botswana and Namibia are now well in excess of 90%, nearing what would be considered universal coverage in this key population.
  • In terms of child mortality, the MDGs called for a reduction in HIV-related maternal deaths to 38 deaths per 100,000 births. Most data suggests that these goals are attainable, with countries like South Africa reporting as few as 60 HIV-related deaths per 100,000 births as of 2014.
  • Still, there remain concerns as to the number of children receiving ART. While coverage increased by some 15% from 2009 to 2011, those numbers still lag behind those of adult men and women (21%).

Goal 4: Halve the number of tuberculosis deaths in people living with HIV

  • While TB remains the most common cause of death for this co-infected population, steady progress has been seen in a number of priority states, with 17 of 44 reporting greater than 50% reductions in death as of 2013.
  • Overall, there has been a 38% reduction in TB-related deaths, bolstered by intensified TB identification, greater infection control, and widespread use of prophylactic medications to prevent infection in vulnerable populations.
  • Increased access of ART has also contributed to the diminishing rate, particularly with the implementation of “directly observed therapy” (DOT) in many high-prevalence countries. The strategy, by which TB drugs are given daily by trained adherence monitors, has resulted in an impressive 85% cure rate in some of the hardest hit regions.
  • Despite this, there are a number of challenges that hinder progress. Today, more than a third of TB treatment centers do not offer DOT, while most cases of multi-drug resistant TB are neither diagnosed nor treated in accordance with prescribed WHO guidelines.
  • Far more concerning is the fact that, of the countries with high HIV/TB prevalence, only Kenya and Malawi are delivering ART to more than 50% of cases. Further progress needs to be made to ensure reduced TB-related mortality within these regions.