Ending AIDS

DOWNLOAD — Quarterly Update March 2013

DOWNLOAD — Quarterly Update November 2012

Hope stems from an accumulation of evidence on the potential impact of “combination prevention,” which includes voluntary medical male circumcision, the use of ART treatment in HIV-positive people to reduce infectiousness, prevention of pediatric infections, HIV testing and the full range of other effective HIV prevention interventions.

To begin to end the epidemic, we need to be strategic and ambitious in using what is available today. There is evidence on the impact some of these core strategies can have as stand-alone interventions. And there is modeling that shows that these strategies, taken to scale, with attention to key populations, will reduce deaths, new infections and the price tag for the AIDS epidemic over the long term.

There is agreement that the world can begin to end the epidemic. But there is an open and unspeakably urgent as to: how?

This report, An Action Agenda to End AIDS, lays out a plan for beginning to end HIV/AIDS. It includes clear time-bound outcome targets, as well as the responsibilities of different stakeholders to achieve these targets.

Download the report.

BEGINNING TO END THE AIDS EPIDEMIC
As the concept of combination prevention takes hold, there will inevitably be debates about which interventions to prioritize. Available evidence indicates that the following core interventions meet this test and deserve to serve as the backbone of efforts to end AIDS:

HIV Testing—to dramatically increase the number of HIV-positive and negative individuals who know their status and access needed services
HIV Treatment—to move to global implementation of ART guidelines that optimize treatment and prevention benefits
Voluntary Medical Male Circumcision—to achieve 80% coverage among adult males (ages 15-49) in 14 priority countries
Prevention of Mother-to-Child Transmission—to eliminate new infections in children by 2015
Focused, Evidence-Based Prevention Programs for Key Populations—to ensure that the full range of drivers of the epidemic are addressed, harm reduction, structural change aimed at gender equality and addressing domestic violence, economic empowerment, and rights-based health care for MSM, sex workers and other criminalized groups are essential.

To end the epidemic, we cannot do everything in every setting. Nor can we look to limited AIDS funding to address all the many ills that undermine health and development. Core interventions should be complemented, where indicated by local circumstances, by other strategies, such as condom promotion, harm reduction, behavior change strategies, demonstration projects for pre-exposure prophylaxis, and programs to address underlying determinants of HIV risk. There are multiple agendas focused on protecting human rights, addressing structural drivers, rights and health of injection drug users, gay men and other men who have sex with men, sex workers and other key populations, and advancing reproductive health rights and justice. These and many others that are not captured explicitly in this document. They underpin it nonetheless.

ENDING AIDS METHODOLOGY
The targets included in this report reflect best-case scenario calculations based on published modeling and epidemiological data, as well as analysis provided by experts in the field. Policy decisions included represent select, key decisions and are not intended as to be a complete historical account of all policy decisions.

Progress towards these targets as well as the accuracy of the targets themselves will be tracked on an ongoing basis with regular updates to the endingaids.org website.

Data was collected from a variety of sources. From 2000 to 2009 data sources for new HIV infections and deaths from AIDS-related causes include, UNAIDS Epidemic Updates and Annual Reports (2002 to 2010); sources for total people on ART, annual growth in the number of available treatment slots and ART coverage and vertical transmission figures include, WHO Global HIV/AIDS Response Progress Report (2011), WHO Towards Universal Access reports (2007, 2009) and WHO “3 by 5” Progress Report (2004); the source for spending figures is UNAIDS AIDS at 30: Nations at the crossroads (2011). Projected data from 2010 and beyond includes data from the UNAIDS Investment Framework (2011); sources for VMMC projections include a variety of peer-reviewed sources (Binagwaho et al., 2010; Curran et al., 2011; Dickson, KE et al., 2011; Mwandi et al., 2011; Njeuhmeli et al., 2011).

Data projections were cross-checked with leading modelers and epidemiologists working in the field who were able to provide additional confirmation based on their own calculations and (unpublished) work.

The “tipping point” is the time period in which the annual growth in the number of available treatment slots rises above the number of new HIV infections and the number of people living with HIV declines. The figures for the “tipping point” are averages from the years 2012 to 2014 in order to account for the variability that may occur in the exact timing of this point based on future projections.

BIBLIOGRAPHY
AVAC, National Empowerment Network of People Living With HIV/AIDA in Kenya, Sonke Gender Justice Network and Uganda Network of AIDS Service Organizations (2012). A Call to Action on Voluntary Medical Male Circumcision Implementing a Key Component of Combination HIV Prevention.

Binagwaho A et al. (2010). Male circumcision at different ages in Rwanda: A cost-effectiveness study. PLos Med 7:e1000211.

Curran K et al. (2011). Voluntary medical male circumcision: Strategies for meeting the human resource needs of scale-up in Southern and Eastern Africa. PLoS Med 8:e1001129.b

Dickson KE et al. (2011). Voluntary medical male circumcision: A framework analysis of policy and program implementation in Eastern and Southern Africa. PLoS Med 8:e1001133.

Mwandi Z et al. (2011). Voluntary medical male circumcision: Translating research into the rapid expansion of services in Kenya, 2008-2011. PLoS Med 8:e1001130.

Njeuhmeli E et al. (2011). Voluntary medical male circumcision: Modeling the impact and cost of expanding male circumcision for HIV prevention in Eastern and Southern Africa. PLoS Med 8:e1001132.

Schwartländer et al. (2011). Towards an improved investment approach for an effective response to HIV/AIDS. The Lancet 377:9782.

UNAIDS, (2002). Report on the Global HIV/AIDS Epidemic.

UNAIDS, (2004). Report on the Global AIDS Epidemic.

UNAIDS, (2006). Epidemic Update.

UNAIDS, (2007). Epidemic Update.

UNAIDS, (2009). AIDS Epidemic Update.

UNAIDS, (2010). Report on the Global AIDS Epidemic.