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Bill & Melinda Gates Foundation

Reversing the HIV Epidemic: What’s Working and What’s Not?

July 26, 2012

At AIDS 2012 the Indian government is proudly presenting the outstanding achievements of its National AIDS Control Programme (NACP). India's story brings hope. It has recorded a 56 percent reduction in HIV prevalence in last decade. This has brought India’s HIV prevalence rate to 0.31 percent. In a country that has remained impacted with poverty, other serious health problems and a funds deficit this achievement is overwhelmingly positive.

But in some parts of the world, most notably North Africa and Eastern Europe, new HIV infection rates are beginning to rise. So what’s going right and what’s going wrong when it comes to reversing the HIV epidemic?

India: a successful HIV response

The Indian government attributes its success in curbing its HIV epidemic to these four important factors:

  • Increasing its own financial contributions to NACP, currently standing at 76 percent of overall money spent on HIV
  • Converging of a range of diverse health programmes
  • Policy reforms to focus on decriminalisation of people most at risk of HIV and availability of treatment
  • A strong political will and continued commitment to the response from those in authority

“We are looking at a new world with new resources, which changes the picture,” said Bernhard Schwartlander from UNAIDS at a plenary session on Tuesday. How right he is. In recent years, India and a number of other countries such as Brazil, Russia, China and South Africa have moved from low-income status to middle income status. And it is here in middle-income countries that HIV infection is concentrating and likely to do so in future.

Progress is uneven too, as Schwartlander explained. For example, Brazil and Russia are about the same in the terms of population and gross domestic product (GDP). They are also spending a similar amount on their HIV responses but there is a significant difference between the two when it comes to the state of the epidemic, with Brazil faring much better than Russia. This difference comes in a markedly different approach to policy reform and the role of civil society - both crucial factors in epidemic control.

In 2003, UNAIDS and the World Health Organisation launched the 3 by 5 initiative, with an ambitious target to provide antiretroviral therapy (ART) to three million people living with HIV by 2005. Since then, the progress has been beyond expectation. Over eight million currently receive ART in low- and middle-income countries, but another 7 million people need to be enrolled in treatment to meet the target of providing ART to 15 million people by 2015. Crucially, ART coverage needs to be more equally distributed, reaching in particular people who use drugs whom the epidemic is hitting the hardest.

India proves countries can up access to treatment and bring their epidemics under control. Exchanges like those going on at AIDS 2012, in which countries learn from one another, is how the path towards an AIDS free generation gets built.

The Key Correspondents team is a global network of community-based writers from around 50 countries across Asia, Africa, Latin America and the Caribbean supported by the International HIV/AIDS Alliance. A large number of KCs are people living with or affected by HIV. All are volunteers and include those working in advocacy, media, health and development. Follow the KC team on Twitter @thekcteam.

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