It is estimated that there are 36.7 million people living with HIV globally with 1.8 million new infections in 2016 alone (1). This number represents an 11% drop in the number of new infections from 2010 . Some might consider this an achievement or a testament to the impact of strategic national and global policies aimed at tackling the epidemic. But in reality, these numbers mask the discrepant pace in the effort to tackle transmission and AIDS-related deaths in countries across the globe. UNAIDS recently reported a steep decline in new infections in sub-Saharan Africa against an alarming increase in the number of new infections in eastern Europe and central Asia in the same period (2). In the UK where the HIV burden is considerably lower, the number of new infections has been steadily falling (3). The reasons for these differences are complex and certain socio-economic factors have the potential to undermine the global effort to tackle transmission.
Across the globe people living with HIV still experience considerable levels of stigma that impede access to timely treatment and care. Much of the stigma stems from false beliefs that infection automatically results in death, that it occurs as a result of behaviour that is frowned upon, or from false information about the risk of transmission from an infected individual. Stigmatisation inevitably results in isolation and marginalisation of the very groups that require prompt access to treatment and care.
According to Professor Robin Shattock from the Department of Medicine at Imperial College London, there has been some progress towards ending stigmatisation of people living with HIV in the UK even though it has not completely gone away. Dr Roger Tatoud, Senior Director at the International AIDS Vaccine Initiative (IAVI) states that although there has been some progress in the UK with respect to increased willingness within the UK MSM community to get tested or to disclose their status, stigma still persists and is felt on a regular basis within that community. The global situation is perhaps not as encouraging because cultural norms in certain countries place a constraint on the willingness of individuals to agree to get tested or to disclose their status for fear of being isolated.
In line with the WHO 2015 guidelines on the need to address stigma and discrimination as a barrier to accessing HIV treatment (4) it is important for all countries to confront stigma in all its forms and ensure that the rights of those affected by HIV or at risk are protected.
Mind the funding gap
For the first time since the HIV epidemic began in the 80s, more than half of all people living with HIV are now on treatment (2). This significant development is in line with the 90-90-90 targets launched by the UNAIDS in 2014 which targets transmission by emphasising viral suppression among people living with HIV (6). Considerable contributions from international organisations around the world have funded research into vaccines to tackle HIV infection. Such funds have also enabled the establishment of community-led HIV services across the world to increase access to rapid diagnosis, counselling and treatment. Given the impact of these activities on the global disease burden it is imperative that the effort is sustained particularly as the UK considers the terms for an exit from the European Union. A number of large HIV vaccine research projects that have been recently funded by the European Union are currently being co-ordinated by research scientists from Imperial College London and other institutions across the UK. One of such projects (EAVI 2020) (5) brings together leading HIV researchers from public organisations and biotech companies from across Europe, Australia, Canada and the USA in a focused effort to develop protective and therapeutic HIV vaccines. It is unclear how an exit from the union will affect future funding of such work. Professor Shattock thinks that it may be impossible for UK scientists to play a leadership role on such projects in the future if the right terms for an exit from the Union are not agreed upon.
Continuous bipartisan led funding of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) over the years has had a significant positive impact on controlling the HIV epidemic in countries with a huge disease burden (6). This is why according to Dr Tatoud, any reduction in such funding is likely to have a detrimental effect on access to treatment in affected countries and consequently hamper efforts aimed at reducing the disease burden.