HIV pandemic officially in decline, say health agencies

The HIV pandemic which started 28 years ago is officially in decline, two of the world's leading health organisations say.

The number of new HIV infections peaked in the mid-1990s and has since declined by almost a third, according to the annual update on the pandemic for 2009, published yesterday by the Joint United Nations programme on HIV/Aids (UNAids) and the World Health Organisation.

It is the first time that UNAids and the WHO have confirmed that the pandemic is on a downward trend and represents a landmark in the history of the disease. In their 2008 report, they said suggestions the epidemic had peaked were "speculation" and that it was "difficult to predict the epidemic's future course".

That report warned: "The HIV epidemic has repeatedly defied predictions ... HIV is likely to have additional surprises in store that the world must be prepared to address."

But the 2009 update throws scientific caution to the winds and instead states clearly that the pandemic has passed its zenith: "The latest epidemiological data indicate that globally the spread of HIV appears to have peaked in 1996 when 3.5 million new infections occurred. In 2008 the estimated number of new HIV infections was approximately 30 per cent lower than at the epidemic's peak 12 years earlier."

It says that, in sub-Saharan Africa - the worst-affected region - new infections in 2008 were "approximately 25 per cent lower than at the epidemic's peak in the region in 1995".

It adds: "Asia's epidemic peaked in the mid-1990s and annual HIV incidence has subsequently declined by more than half. Regionally, the epidemic has remained somewhat stable since 2000."

The annual report from UNAids and the WHO is the official record of the progress of HIV/Aids, and confirmation that the worst disease of modern times is in decline will be widely welcomed. Two years ago the organisations admitted they had overestimated the numbers affected and revised the total down from 40 million to 33 million.

Despite the fall in new infections, the number living with HIV increased last year to 33.4 million as people are surviving longer with the roll-out of antiretroviral drug treatment. Greater access to drugs has helped cut the death toll by 10 per cent over the past five years.

There are now 4 million people on the drugs worldwide, a 10-fold increase in five years.

The report says 2.9 million lives have been saved since effective treatment became available in 1996 but less than half the patients who need them are currently getting them.

The reasons for the decline in new infections are disputed. UNAids said prevention programmes involving sex education, HIV awareness campaigns and distributing condoms had had an impact. Critics said the pandemic was already in decline before prevention programmes were widely implemented and the disease was burning itself out.

Experts at UNAids said new infections had fallen 17 per cent since 2001, when the United Nations Declaration of Commitment on HIV/Aids was signed, triggering a global push to deliver anti-retroviral drugs and prevention programmes to the hardest-hit parts of the world.

Dr Karen Stanecki, senior adviser to UNAids, said repeated studies in different parts of the world, comparing the reduction in new infections with what happened where there was no intervention, had demonstrated the effectiveness of prevention programmes.

- INDEPENDENT