More than 1.2 million people began taking anti- HIV therapy in 2009, a 30% increase that brings the worldwide total to 5.2 million, UNAIDS said Monday in its annual report, but that still leaves 10 million people in the developing world in need of access to the lifesaving drugs.
Since the pandemic peaked in 1999, new infections have fallen by 19% — in some key countries by 25% or more. Expanding access to treatment has yielded a 19% decline in deaths since 2004.
"That clearly demonstrates that with confidence and conviction we have broken the trajectory of the AIDS epidemic," Dr. Paul De Lay, deputy executive director of the UNAIDS program branch, said at a news conference Monday. "Fewer are infected, fewer are dying."
But those gains are at risk because of the economy, Bernhard Schwartlander, chief epidemiologist at UNAIDS, said at the news conference. "In 2009, for the first time, the funds available for fighting the epidemic were less than in the previous year."
In 2008, international funding was $7.7 billion. The next year, it dropped to $7.6 billion. The United Nations estimates that achieving its goal of universal access to AIDS drugs will require at least $15 billion a year.
Eric Goosby, U.S. global AIDS coordinator, said in a statement that this country has been stretching its funding through a variety of approaches, including switching from air transportation for medications to ocean and land transport and increasing the use of generic drugs.
In a report last week in the British Medical Journal, Dr. Eran Bendavid of Stanford University Medical School and his colleagues said it has been possible to continue expanding treatment programs amid slow funding growth because of substantial declines in drug prices brought about by the use of generics: a drop from $1,177 per year per patient in 2003 to $96 in 2008. But they said those price drops are unlikely to continue and that further expansion will require new infusions of funds.
Schwartlander called on low-income countries to carry a bigger share of the burden, noting that "90% of AIDS spending in low-income countries now comes from international sources. That creates a dependency we must overcome."
But A. Cornelius Baker, an AIDS expert on the Presidential Advisory Council on HIV/AIDS, cautioned that it was important to continue to provide support for people in the poorest countries. "People should not have to spend themselves into poverty to stay alive," he said.
"Even when drugs are made available much more cheaply than in the United States, when they are living on $2 a day," it is simply not feasible for them to pay for the drugs, he said.
Some of the most impressive gains noted in the new report have been in sub-Saharan Africa, which has borne the brunt of the AIDS pandemic. In 22 countries in the region, the incidence of HIV infections fell by at least 22% from 2001 to 2009 as a result of education and prevention programs. Nearly 37% of adults and children in the region who were eligible for antiretroviral therapy in 2009 received it, compared with just 2% seven years earlier.
Not all the news is good. In Eastern Europe and Central Asia, the number of people living with HIV almost tripled from 2000 to 2009, climbing to 1.4 million people. Russia and Ukraine are particular problem areas, accounting for nearly 90% of all new infections in the region.
The epidemic there is concentrated primarily among drug abusers, sex workers and, to a lesser extent, gay males.
Authorities are also seeing a resurgence in HIV infections among gay males in the United States and Europe, according to the report. The total number of people living with HIV in the two regions grew from 1.8 million in 2001 to 2.3 million in 2009, with about 35,000 deaths in 2009, compared with 37,000 in 2001.