From Despair to Hope

This Saturday, the world will commemorate World AIDS Day. I will be in Haiti, a country that has not forgotten its people living with HIV, as it rebuilds itself from the earthquake that devastated the nation two years ago. Within days of the earthquake, HIV treatment services were re-established and HIV prevention programs were integrated into the rehabilitation effort. Haiti serves as a model to remind us that we cannot fail the 34 million people living with HIV in the world -- no matter the circumstance -- natural disaster or economic crisis. New HIV infections in Haiti have dropped by 54 percent in the last decade and have reduced AIDS related-deaths by 46 percent in the last five years. More importantly, they have showed that we can move from despair to hope.

Last week UNAIDS released two reports -- its annual World AIDS Day report "Results" and the bi-annual "Global Report on the AIDS Epidemic." Both reports have one message -- the pace of progress is unprecedented. What used to take a decade is now being achieved in 24 months. We have to keep this momentum to reach the 2015 global AIDS targets and the millennium development goal (MDG) of halting and reversing the AIDS epidemic. Many countries are already achieving the MDGs.

We have excellent results -- but we have a long ways to go in the next 1,000 days.

In 25 countries, the number of people becoming newly infected with HIV fell by more than 50 percent between 2001 and 2011. Half of them are from sub-Saharan Africa. In Ethiopia, new HIV infections fell by 90 percent, in Botswana by 71 percent, In Cambodia by 88 percent. Two countries with large numbers of people living with HIV, South Africa and India, saw new infections rates down by 41 percent and 57 percent, respectively. These are impressive results.

Together with new HIV infections, the number of people dying from AIDS is rapidly falling too, as more than 8 million people are accessing HIV treatment. The number of people added onto HIV treatment increased by 65 percent in the last two years -- a record increase of 2.3 million people in sub-Saharan Africa. For the first time more than half of people eligible for antiretroviral therapy were receiving it. But there are nearly 7 million people waiting. Add to it the nearly 4 million discordant couples (where one partner is living with HIV and the other is not) who can benefit from access to treatment as prevention. Antiretroviral therapy has emerged as a powerful tool for saving lives -- and we must extend this benefit for everyone who wants it. We have to begin first of all by encouraging people to know their HIV status. Today only half of the people living with HIV know their status.

In 2009, I made a call for the elimination of new HIV infections among children. For the past year, together with Ambassador Eric Goosby, the United States Global AIDS Coordinator, we have met with world leaders, business leaders and community groups in many countries to push this goal. There is good news for babies, we are seeing success. More than half of all reductions in new HIV infections globally have been among infants. In the past two years the number has come down by a quarter -- this compared to the six years it took to achieve similar results in the past. We are making progress towards our target of zero new HIV infections among children.

So how can we get the same results for adults? There were an estimated 2.2 million new HIV infections among adults in 2011 -- considerably reduced from the nearly 3 million about a decade ago, but still a very high and unacceptable number. This is because HIV prevention programs for adults are failing to reach people most at risk -- notably sex workers, men who have sex with men, transgender people and people who inject drugs. HIV prevalence among these populations is much higher than the general population. We have to do more -- even in countries where HIV has spread widely among the general population. Take for example Kenya, 33 out of every 100 new HIV infections occur amongst these key populations. Yet global investments on men who have sex with men, people who inject drugs, sex workers and transgender people was a mere US$ 228 million compared to the annual need of nearly US$ 1.7 billion in 2015.

Another potential HIV prevention tool -- voluntary medical male circumcision -- has the potential to avert nearly one in five adult HIV infections in Eastern and Southern Africa, yet less than 2% of total expenditure goes to this option. Condoms, a longstanding prevention tool remain largely unavailable. One estimate shows that more than 2 billion condoms were procured in 2010, far short of the 13 billion estimated needed for HIV prevention in 2015.

HIV prevention continues to hold the key to the future of the AIDS epidemic and must be adequately addressed.

On the investment front -- as the world continues to emerge from a challenging economic crisis -- we have been able to narrow the resource needs gap in the AIDS response.

We've done this by promoting a new partnership of shared responsibility and global solidarity. Eighty-one countries have increased domestic investments by more than 50 percent. But many countries still and will continue to need international assistance. We are down to a 30 percent gap between what is available and what is needed annually by 2015. I hope the results achieved by the global AIDS response will provide the impetus of world leaders to invest more and bridge the final $7.2 billion dollar gap.

We have 1,000 days to go before we have to meet the world AIDS targets. What are the next steps? UNAIDS will focus on accelerating access to HIV testing and treatment. Now that we know rapid and massive scale-up is possible, we need to do more to reach the 6.8 million people waiting for treatment. And we will continue to focus on how to reach key populations with crucial HIV services.

In the past two years we have put an extra focus on scale up in high impact countries such as South Africa -- with stunning results. I see similar opportunities in other key African countries.

One of the big differences I've observed is that countries who have not yet seen the big leaps in progress know what needs to be done and they are doing it. I was just in Indonesia a short while ago and was extremely encouraged to see an important scale-up HIV testing and HIV prevention services for key populations.

The results we are achieving today could not have been obtained without partnership and leadership, particularly from Civil Society, the African Union, the United States PEPFAR programme, and the Global Fund. The next 1,000 days will be a test to our commitment and follow through. We will be counting on all partners globally, regionally and in countries to join together to accelerate results for people.