Oonagh O’Brien Institute for International Health

and Development Queen Margaret University

Winnie Sseremu

from Uganda

diagnosed 1988

aged 27. Today:

50

Jaime Tovar from

Colombia.

Diagnosed 1987

with HTLV 111 aged

24, today 48.

Since 1999 (the year the epidemic is thought to have peaked) new infections have fallen by 19%.

In 33 countries HIV incidence (number of new cases per year) has fallen by 25% between 2001 and 2009. 22 of these countries are in Sub Saharan Africa. The biggest African epidemics are stabilising or declining (UNAIDS 2010).

In seven countries, 5 in eastern Europe and central Asia, HIV incidence increased by 25% between 2001 and 2009.

Decrease not evenly

spread in population groups

Gains are fragile…

Reduction in new infections in young

people- delayed first sex, higher use of

condoms

Greatest reductions in HIV incidence

(new infections)are in the countries with the highest numbers of people living with

HIV

Reduction in transmission from

parent to child including during breast feeding.

Concerted programme based

on evidence

Huge increase of numbers of people on treatment and reduction in AIDS

diagnosis and deaths including a 19% less

deaths in children

Treatment as prevention-

adherence to treatment with

undetectable viral load over a sustained

period can lead to 96% reduction in transmission to

partner. May 2011

Successes

Still a huge gap in funding treatment- approximately 36% of those who need

treatment in poor countries have access

Health systems struggling with burden of treatment roll out in all sorts of

different ways

Stigma still in evidence and abuse of human

rights to men who have sex with men (MSM)

and drug users increased

Growing economic crisis- struggle to

maintain national and international funding

Women still highly vulnerable in multiple ways linked to HIV

Legacy of loss: orphans and vulnerable children, loss of

communities, material loss.

Challenges: Numbers still extremely high…..

Goal 6. Combat HIV/AIDS, malaria and

other diseases • Target 7. Have halted by 2015 and begun to

reverse the spread of HIV and AIDS

• Target 8. Have halted by 2015 and begun to

reverse the incidence of malaria and other major

diseases

Have we halted the rise of HIV?

November 2010 BBC report - UN claim HIV epidemic has halted.

Unexpected consequence- malaria reduces 75% over 4 years in patients on ART (Kasirye et al IAS abstracts 2009 )

In the report of the 2010 review of MDGS

the UN don’t use the word halted. It is

stated that cases are declining in some

areas of the world, but not all, and as well

as the success they highlight a number of

areas of concern: • The continuing high number of cases

• Lack of knowledge about how to protect oneself

• Lack of condom use especially in poor countries

• Have HRs been ignored in MDGs?

• Focus on targets too technical and too narrow?

Human Rights activists

• Are the Millennium Development Goals (MDGs) and human rights complementary or conflicting?

• Harvard and IDS March 2010

Symposium MDGs and HR

• MDGs do not call into question the benefits of liberalization of international trade and finance.

• Established at time of economic stability

Interventions rather than

questioning system

MDGs – loss of focus on wider impacts of gender inequality-

Too focussed on narrow goals and

outcomes- no focus on gender

rights (UN conferences of the

1990s)

No linking of issues- i.e.

reducing gender inequality should

be embedded into poverty

reduction

June 2011: United Nations General Assembly High Level Meeting on AIDS

Political Declaration on HIV/AIDS: Intensifying our Efforts to eliminate HIV/AIDS

Agreed new AIDS targets for 2015 including:

increase number of people on treatment to 15 million advance efforts towards reducing sexual transmission of HIV

and halving HIV infection among people who inject drugs by 2015.

push towards eliminating new HIV infections among children in the next five years.

reduce tuberculosis related deaths in people living with HIV by half in the same time period.

Some good news….

But world economic crisis- reduced

income and spending may lead to

upsurge in infections and mortality

What has been the importance of MDG 6

and where do we go with the target after

2015?

Implications for Scotland and Malawi