A report released in Geneva by UNAIDS revealed that HIV prevalence among young people has declined by more than 25 percent in 15 of the 25 countries most affected by AIDS. This is largely because of less risky sexual behavior among the youth in countries like Cameroon, Ethiopia, Ivory Coast, Kenya, Malawi, Namibia, Tanzania, Zambia and Zimbabwe.
"Young people are taking the lead," UNAIDS chief Michel Sidibe said. He named the new objectives in combating AIDS as "zero new HIV infection, zero discrimination, zero AIDS-related death," but said "current treatment strategy is not enough to reach our goals."
Denis Farrell, AP
The United Nations' AIDS agency says its new plan, called Treatment 2.0, could prevent 10 million AIDS-related deaths by 2025. Here, a woman walks past HIV+ written upside-down on a wall in Johannesburg on World AIDS Day 2009.
His agency laid out the new approach, Treatment 2.0, which Sidibe called a "game changer" consisting of five "pillars."
The first is to create a better pill and diagnostics. In today's treatment regimens, infected individuals have to take multiple pills every day to stop the virus from reproducing.
But the heavy dosages that need to be consumed cause severe side effects and often leave people unable to afford the second stage of treatment, which is necessary to keep the virus in check.
The U.N. wants to see multiple drugs consolidated into a single pill that would have fewer side effects and be less toxic. "A one-pill, once a day anti-retroviral therapy has been shown to improve both adherence and quality of life while maintaining the same efficacy," the report said, noting that such a pill would also remove the need for a second or third line of treatment.
The study also underlined the need to produce simpler and cheaper diagnostic tools that don't require complicated lab work and can yield results within a few hours.
The second pillar of the U.N. plan advocates "treatment as prevention," with a focus on stopping the transmission of the virus from mother to child and between couples. The report found that providing anti-retroviral treatment to everyone who needs it could reduce new HIV infections by as much as one-third annually. A recent study provided anti-retroviral drugs to the infected partner in each of 3,400 couples in sub-Saharan Africa, and found that such treatment reduced transmission rates by 92 percent.
"Treatment can become part of the prevention strategy. Optimizing treatment coverage will also result in other prevention benefits, including lower rates of tuberculosis," the study said.
Studies also show that anti-retroviral therapy reduces the incidence of pregnancy-related deaths among women. It is estimated that presently AIDS is responsible for 61,000 of the 350,000 annual deaths of women during childbirth worldwide, and that its harshest impact is in Africa.
The third objective, "Stop cost being an obstacle," seeks to address the costs of anti-retroviral therapy programs, especially the second line of treatment, which is far less affordable than the first round.
A 2008 survey found that 98 percent of adults and 97 percent of children in 43 high-burden countries were receiving the first line of treatment, but no more than 2 percent could get to the second-line regimens.
The U.N., however, pointed out that there have been large dips in the cost of the first line of anti-retroviral therapy. In low- and middle-income countries, the average annual cost of first-line drug treatments was $143 per person in 2008, down by 43 percent since 2004.
The study suggested targeting the non-drug-related expenses of providing treatment, such as hospitalization, monitoring and out-of-pocket expenses, which cost twice the price of the drugs themselves. And the simpler the drug regimen is, the fewer the number of interactions a patient needs to have with her physician.
The report also said UNAIDS will put more emphasis on encouraging people to start treatment at the right time instead of waiting until they get really sick, which will become possible with more efficient AIDS tests that allow people to start treatment before they feel sick.
Finally, Treatment 2.0 includes a push for more community mobilization to encourage women, and men who have sex with men, to seek medical help.
Some 5 million young people worldwide live with HIV, and they account for about 40 percent of new infections. But the report found that in 13 countries -- including Cameroon, Ethiopia and Malawi -- young people are waiting longer before becoming sexually active, have fewer multiple partners and are more apt than their elders to use condoms.
That wasn't the only good news, either. The U.N. found a 60 percent decline in HIV prevalence in Kenya between 2000 and 2005. And in neighboring Ethiopia in the same period, HIV prevalence among pregnant young women had been reduced by 47 percent in urban areas and 29 percent in rural areas.
But there is still an immense amount of work to be done. At the end of 2008, according to UNAIDS, 33.4 million people were living with HIV worldwide, and in that year there were nearly 2.7 million new HIV infections and 2 million AIDS-related deaths.
