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Deaths from AIDS continued to decline last year as the number of people on HIV drugs worldwide surged 21 percent from 2010, according to a report that found poor and middle income countries spent more on treatment.
Deaths dropped 5.6 percent to 1.7 million in 2011 from the previous year as 8 million people in developing regions gained access to medicines that fight the infection, according to a report today from UNAIDS, the United Nations’ program to treat and prevent the illness. In Sub-Sahara Africa, where 69 percent of people with HIV live, the number on therapy jumped to 6.2 million from 100,000 in 2003.
“There is still a huge gap from where we should be, but the world is doing better,” said Mitchell Warren, executive director of AVAC: Global Advocacy for HIV Prevention, in a telephone interview. “The big story is no longer about the science; it is about the money and politics. The two biggest questions now are where is the money coming from and where is it going to go.”
About 7 million people infected with HIV in low income countries still need drugs and don’t get them, the report said. Global health experts are now talking about getting millions more people on medications based on recent data showing that early treatment can prevent transmission of the AIDS virus. One concern is how to pay for it as the U.S. and some European nations tighten foreign aid.
More than 20,000 AIDS researchers and activists will meet in Washington next week at the International AIDS Conference, the first time the gathering has been held in the U.S. in 22 years. Much of the focus of the weeklong conference will be on how to get more people on treatment and prevent new infections, which occurred in 2.5 million people last year, down from 3.2 million in 2001. The total number of people living with HIV is 34.2 million, the report said.
“It is definitely going in the right direction,” said Gottfried Hirnschall, director of the department of HIV/AIDS at the World Health Organization, in a telephone interview. “We have a very decisive moment in front of us to say we need to do more.”
AIDS deaths peaked in 2005 and 2006 at 2.3 million and have been going down since then, according to the report.
Last year, governments and non-profits spent $16.8 billion on HIV treatment and prevention, an 11 percent increase from 2010. Still, that’s at least $5 billion short of the $22 billion to $24 billion needed to reach the United Nations’ goal of getting treatment to all 15 million people who need it. The recommendations call for treatment once infection-fighting cells decline below a particular level.
It will cost billions of dollars more to expand treatment to a broader swath of patients with earlier stage disease in order to prevent transmission of the AIDS virus. Last May, a study of 1,763 couples in which one partner was infected found that starting drug treatment right away in the infected person greatly slashed the odds that the unaffected partner would get the virus. The findings were the first proof that treating a person with HIV can reduce the chance they will infect others.
In that study, a single infection occurred among 886 couples where treatment began immediately with a mix of drugs from companies including Gilead Sciences Inc. (GILD) and Bristol-Myers Squibb (BMY) Co. Twenty-seven other infections occurred among 877 couples where treatment was delayed.
Treating all such couples with AIDS drugs would expand the treatment pool by another 5 million people, said Hirnschall. Treating pregnant woman living with the HIV virus and certain other high-risk groups would add another 3 million people, he said.
“The major challenge we face is to make paying for treatment sustainable over the long term,” Michel Sidibe, executive director of UNAIDS, said in the report.
While total funding from big Western aid donors has been largely flat since 2008, countries in Africa and Asia that are most affected by AIDS are spending more, the report said. Spending on AIDS by affected low and middle income countries increased 15 percent to $8.6 billion last year.
Some countries in Africa, including Rwanda and Uganda, are taxing mobile phone calls to help pay for AIDS treatment, the report said, while South Africa has increased its AIDS funding five-fold over the last five years.
“Countries that have been hit hard are doing more to address their own epidemic and that is critical,” said Chris Collins, director of public policy at amfAR, The Foundation for AIDS Research, in a telephone interview. “It is a good sign.”
Big international funders for HIV treatment include the United States, various European countries, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Since 2004, the U.S. government has almost tripled its funding of global AIDS treatment and prevention to $6.64 billion through the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR. That program provides drugs to 3.9 million people.
At the same time, the price of treatment has fallen to $100 a year per person from $10,000 in 2000 for the least expensive regimens in the poorest countries, the report said. Gilead, the world’s biggest maker of AIDS drugs, sells its drugs for no profit in the poorest countries and has given permission to Indian generic-drug makers to sell copies of some of its medicines.
President Obama’s fiscal 2013 budget would cut AIDS funding from the U.S. by $220 million, a 3 percent reduction from 2012 and a 7 percent cut from 2010 levels.
“This conference is about the huge potential we have to begin to end the aids epidemic,” said Collins. “It would be a tragedy if rich country donors failed to seize this opportunity.”
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