Determined to end the Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) by 2030, the World Health Organization (WHO) will today at the International AIDS Conference in Durban, South Africa, adopt a four-pronged approach.
The Organization will at the conference which ends on July 22, highlight the need to renew attention to HIV prevention, whilst maintaining momentum on scaling up access to HIV treatment. It is also signalling the growing emergence of antiretroviral (ARV) drug resistance and the need for sustainable financing of the global response.
Director-General, WHO, Dr. Margaret Chan, in a statement, yesterday, said: “The enormous progress on HIV, particularly on treatment, is one of the big public health success stories of the century.
“But this is no time for complacency. If the world is to achieve its goal of ending AIDS by 2030, it must rapidly expand and intensify its efforts.”
Worried that its last report on HIV-related drug resistance (2004-2008) showed that five per cent of people on Anti Retro Viral (ART) were resistant to at least one antiretroviral drug, the WHO is monitoring the trends and noted worrisome indications that drug resistance is emerging as a more significant threat in some countries and populations.
WHO, therefore, said that it is launching a report on “Early Warning Indicators of HIV drug resistance” in Durban this week to help countries monitor factors that may contribute to the problem. These programme factors include adherence to treatment and retention in the services, interruptions in the supply of antiretroviral drugs through stock-outs, and poor quality of treatment services.
The report outlined actions countries need to take in order to identify problems early and to act quickly to avert drug resistance. As treatment continues to expand, countries will need to be vigilant to ensure that the quality of treatment services is assured to minimize the emergence of drug resistance.
To address this threat, WHO is developing a Global Action Plan on HIV drug resistance – calling on countries to continue surveillance to ensure rapid action.
WHO noted that better prevention will happen if countries invest strategically in approaches with the greatest impact, for example by exploiting new interventions, such as pre-exposure prophylaxis (PrEP) – where antiretroviral drugs are used to protect people at high risk of becoming infected with HIV.
WHO also highlighted the importance of revitalizing long-established and proven approaches, such as the promotion of condoms, and to maintain momentum on voluntary medical male circumcision in the 14 most-affected countries of eastern and southern African countries, where 11.7 million voluntary medical male circumcisions were performed in 2015.
At the same time, countries need to deliver these services more efficiently to reach more people at lower cost, including through the integration of HIV prevention into sexual and reproductive health services.
Since 2015, WHO has recommended that all people diagnosed with HIV start antiretroviral therapy (ART) as soon as possible to prevent illness and death. The uptake of WHO’s Treat All policy has been rapid.
Implementation has been facilitated by recent dramatic improvements in ART being used – with 1 tablet a day, which is safe and well tolerated.
According to the WHO, AIDS-related deaths have fallen 45 per cent since their peak in 2005 and 26 per cent since 2010. Expanding HIV treatment also helps reduce transmission: as the level of the virus drops in a person, so does the risk of transmission.
But many challenges remain. More than 40 per cent of people living with HIV still do not know they are infected, highlighting the need for ready access to simple and affordable testing services. Self-testing provides an opportunity for more people to be tested, particularly those who are reluctant to use health services.
The WHO noted that there is also a need to tailor treatment programmes to reach people who may be reluctant to come forward, and to ensure that these people are supported by a full range of community services, as well as strengthening health systems more generally so people can receive the full range of health services they need, beyond HIV.
The WHO noted that the ever-expanding development agenda, changing donor priorities and continuing threats to the global economy all pose challenges to financing efforts to end AIDS. It will be important to ensure full replenishment of the Global Fund to fight AIDS, TB and Malaria in September.