Eight million people now being treated for HIV

MARIO RITTER: And I’m Mario Ritter. The 19th International AIDS Conference took place last month in Washington, DC. More than 20,000 people attended the six-day event. Today, we tell about some of the latest developments in the fight against AIDS and HIV, the virus that causes the disease.

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BARBARA KLEIN: More than eight million people around the world are now receiving antiretroviral drug therapy. That is a twenty percent increase over the past year. All those receiving the treatment have the human immunodeficiency virus, known as HIV.

The Joint United Nations Program on HIV/AIDS released a report before the AIDS conference. The report is called “Together We Will End AIDS.” It says almost one point four million people were added to the number of people receiving treatment in last year alone.

More than thirty-four million people are now living with HIV. The report says that is the largest number ever, because of the greater availability of life-saving drugs. But about two-point-five million people were newly-infected with the virus last year.

MARIO RITTER: Michel Sidibe is the head of the Joint United Nations Program on HIV/AIDS, also called UNAIDS.

MICHEL SIDIBE: “I personally believe that it is a new era -- new era for treatment, new era for prevention. But it is also from my personal reading a beginning of a journey to getting to zero.”

Michel Sidibe says the world is now in a time of shared responsibility, mutual accountability and global solidarity. He says those issues will influence the discussion about HIV/AIDS in the coming years.

International spending for the fight against HIV reached almost seventeen billion dollars last year. Mr. Sidibe says the money was spent effectively.

MICHEL SIDIBE: “We are talking more and more of cost- effectiveness, efficiency, reducing unit costs of producing any results. We are trying to make sure that the framework, investment framework, we are using with the countries becomes smarter.”

BARBARA KLEIN: Many countries have greatly increased their own investment in fighting the disease. Spending by individual countries is now greater than international spending for the first time. For example, South Africa spent two billion dollars last year in the fight against HIV/AIDS.

Much of the international aid for treatment, research and prevention comes from PEPFAR -- the President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Eric Goosby is the United States’ Global AIDS Coordinator. He also leads PEPFAR.

ERIC GOOSBY: “Our resource allocation and prioritization -- shifts that over the last three years we have aggressively tried to institute in our PEPFAR programs -- have begun to show the fruit of that labor. Moving to high risk populations - targeting key populations -- to ensure that they are identified in a safe setting, in a safe space, to allow them to be entered and retained in care over time.”

PEPFAR works with national governments to create programs for their people.

ERIC GOOSBY: “I think that the numbers that UNAIDS is presenting to the world reassure me that we are positioned to know, monitor and understand the data as it comes in. And we have moved I think over the last few years to be much more nimble in our ability to reposition our programming.”

MARIO RITTER: But there is still much work to be done. UNAIDS says billions of dollars more will be needed for the fight against HIV/AIDS. The UN group says one point seven million people died from AIDS-related causes last year. That is 24% fewer deaths than in 2005, when the number of deaths was at its highest.

Tuberculosis -- or TB -- is the number one cause of death among people living with HIV. People suffering from HIV/AIDS have weakened natural defenses for fighting disease. That increases their likelihood of getting TB.

BARBARA KLEIN: People between the ages of fifteen and twenty-four are responsible for forty percent of all new adult HIV infections. Most of those infections are among young women. Studies have shown that many young people do not know how to prevent HIV infection.

Many of those infected in parts of Asia and Eastern Europe do not have access to treatment. And infections are increasing among sex workers, men who have sex with men and users of intravenous drugs.

But UNAIDS says efforts are continuing to have fifteen million people on treatment by twenty-fifteen. We have placed a link to the UN report on our website, voaspecialenglish.com.

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MARIO RITTER: The World Health Organization says developing countries need a full plan of action for treating HIV. WHO officials say some groups of people are still unable to get the treatments they need.

Studies have shown that antiretroviral drugs extend the lives of people infected with HIV. The drugs can also prevent infection. This means countries may be able to slow the spread of AIDS. But some of those most in need of HIV treatment and prevention are unable to get them because of their social standing.

Gottfried Hirnschall is the director of the World Health Organization’s HIV/AIDS Department.

GOTTFRIED HIRNSCHALL: “We’ve seen in many countries that there remains stigma against certain population groups. And in some countries these behaviors of these groups are criminalized. Being a sex worker in many African countries is criminal behavior. Being an MSN in some countries is criminalized and obviously injection drug use is.”

The expression MSN means men who have sex with men. These men are one of the groups most at risk of infection.

GOTTFRIED HIRNSCHALL: “We see barriers for these individuals to access services. And we obviously see that as a consequence in many places these groups have higher infection rates. They have higher mortality, etcetera.”

BARBARA KLEIN: Another part of the fight against HIV/AIDS is the question of when to start treatment. In the early days of antiretrovirals, the drugs were usually given to people when the body’s defenses against disease had collapsed. A person’s health is measured by the CD4 count. That is the number of immune system cells a person has.

Dr. Hirnschall says, in recent years, doctors have suggested that people start on treatment much earlier.

GOTTFRIED HIRNSCHALL: “If you start as soon as possible -- and that’s what’s happening now in the US with the policy change that just took place -- you may have a benefit to the patient. WHO now recommends initiation of treatment below a CD4 cell count of 350, which means that the immune system has already some signs of weakening, but that the patient is still not very sick yet.”

The WHO official says many infections could be avoided by giving treatment earlier.

MARIO RITTER: Two recent studies have confirmed the effectiveness of what is being called the “treatment as prevention” plan. One study involved what researchers call discordant couples, where one person has HIV and the other does not. The study found that drugs were 96% effective in preventing the spread of the virus.

The second study showed the effectiveness of giving drugs to people who were not infected.

GOTTFRIED HIRNSCHALL: “Even if you give drugs prior to exposure - in other words to HIV-negative persons -- referred to as pre-exposure prophylaxis -- you may also protect this person from becoming infected. So the whole field of the use of anti-retrovirals has become more and more exciting, but at the same time more complex.”

Dr. Hirnschall says it would cost more in the short-term to put more people on anti-retrovirals sooner -- probably billions more. But he says, in the long-term, the cost will drop and lives will be saved.

GOTTFRIED HIRNSCHALL: “You will have quite impressive reductions of both mortality and new infections. So we estimate over a period until twenty-twenty more than twelve million new infections could be averted and seven point four million deaths could be also averted. So in other words, yes, you need to invest. You need to frontload the resources, but you’re buying something for it.”

Dr. Hirnschall says the World Health Organization is writing rules to help developing countries care for and treat those most at risk of infection.

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BARBARA KLEIN: Two other studies found that anti-AIDS drugs may protect HIV-negative individuals against the deadly virus. The studies involved couples in Kenya and Uganda. One partner was infected with HIV and the other was not.

The testing lasted from 2008 to 2010. The study showed a 67% to 75% reduced risk of infection in the non-infected partner. That was in comparison to those who took a placebo or harmless substance.

However, a third study showed no difference in protection. Those tests involved women in Kenya, South Africa and Tanzania. The results were published in the New England Journal of Medicine.

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MARIO RITTER: This SCIENCE IN THE NEWS was written by VOA reporter Joe De Capua. It was adapted into Special English and produced by Christopher Cruise. I’m Mario Ritter.

BARBARA KLEIN: And I’m Barbara Klein. Join us again next week for more news about science in Special English on the Voice of America.