Tom Colborne looks at the latest UNAIDS epidemic update and reflects on good news and future challenges. Find out how you can help.
The UNAIDS epidemic update for 2009 has just been published, and the results are fascinating. Download the full report here or read the UNAIDS Sub-Saharan Africa Factsheet.
Infection rates in 33 countries worldwide have fallen by 25% or more. 22 of these countries are in Sub-Saharan Africa. This shows conclusively that interventions aimed at prevention, resulting in positive behaviour change, work. 
In 7 countries in Eastern Europe and Asia, new infection rates have risen by more than 25%. This shows the effect of stigma, discrimination, ignorance, lack of access to services and bad laws.
In many cases, as UNAIDS observe, the effects either way are profound.
What we are seeing in Africa now is an epidemic that is being tamed through the behaviour of young people. Suddenly it is Asia and Europe that need to learn lessons – both positive and negative – from Africa. There are signs that Africans, despite the huge political, economic, educational and humanitarian challenges inherent to many of their everyday lives, are beginning to win the war against perhaps the single greatest threat to African humanity.
The overall tone of the report is positive. There is talk of turning a corner: new infections are down, medication has decreased the number of AIDS-related deaths, the adult HIV prevalence in Sub-Saharan Africa is down, results from South Africa show that mother to child transmission can be all-but-eliminated under controlled medical conditions. But let’s put this into context.
There are as many people living with HIV in the 10 countries of Southern Africa as in Europe and Asia combined
1.3m Africans died of AIDS-related illnesses in 2009. That’s about one every 25 seconds for a year.
56% of Africans who need HIV medication still have no access to treatment
Each African man has – on average – access to 20 condoms per year
We are still talking about an epidemic that is off the scale of any natural disaster, terrorist threat, famine or even war since 1945. We are still talking about 1 in 20 African adults being infected with a contagious and fatal virus, and we are still talking about a continent starved of resources and reliant on discarded medicines from the Western world.
There are some other worrying things that strike me as I read this report.
Are HIV rates declining in Africa partly, largely or simply because there are less people less to infect? Have we reached an epidemiological saturation point, a wildfire plateau where the spread of the virus is reduced largely due to large swathes of the most-at-risk members of the population being already infected?
HIV will fight back. It plays the long game, and is without question the most cunning virus ever faced, replicating in the very biological structures that exist to repel it, spreading through the behaviours common to every human but so often shrouded in silence, and allying with some of mankind’s biggest historical enemies (TB, cancer, poverty, ignorance greed and fear) to widen its impact.
The retro-virus HIV will typically become resistant to treatment within a number of years at which point the infected person must move on to a second combination of drugs; there are people in America who are now on their 20th line of treatment. In Africa only first line treatment is widely available – largely Western hand-me-downs of drugs that their previous owners (or more correctly their previous owners’ viruses) have outgrown. What happens when African HIV learns to overcome this first-line treatment? Will the world’s banks, governments and pharmaceuticals step forward in a time of economic austerity to provide the highly expensive second and third line drug regimes to the 25 million infected Africans?
The Millenium Goals promised universal access to HIV treatment by 2010. But due to broken promises on funding we are only a little over half the way there. That means millions of Africans will continue to die needlessly of an infection that in the developed world is as manageable as diabetes.
Perhaps the tide is turning, and the winning of countless individual battles is beginning to win the war. We know that knowledge and behaviour change – allied with political will, funding and medical science – will save countless lives. But we also know funding will be even harder to secure, that huge new challenge, particularly around treatment, are just around the corner and that the sheer numbers of people at risk will never be reflected by the amount of public coverage and political attention.
Giving 90 minutes of your salary to TackleAfrica this World AIDS day is one small way in which you can help some of those most affected by HIV in Africa. With your support we can reach over 25,000 young people this year, giving them the knowledge and power to keep themselves and their loved ones safe.
One Game Saves Lives
Tom Colborne, 1st December 2010
