Gentle reminder: AIDS activists hold placards as they attend a march called Keep The Promise 2016 through the streets of Durban, South Africa, on the sidelines of the International AIDS Conference (AIDS 2016) in mid-July. (JP/Rita Widiadana)

Thirty years ago, there was very little hope for people affected by HIV or AIDS, the most advanced stage of HIV, with many considering it a death sentence.

Not anymore. HIV is now a manageable disease and people living with it can expect to live long if they have access to treatment.

However, despite scientific progress and multilateral funding mobilization, the epidemic continues to be a major global public health issue.

This year’s International AIDS Conference (AIDS 2016), with the theme “Access Equity Rights Now”, held in Durban, South Africa, in mid-July, aimed to answer this challenge and renew global commitments to ending the AIDS epidemic.

“This conference comes at another crucial time in the HIV epidemic. AIDS 2016 focuses on the actions needed to write the last chapter in the long struggle against AIDS,” said Chris Beyrer, AIDS 2016 international chair and the outgoing president of the International AIDS Society (IAS).

The five-day conference, attended by 18,000 global leaders, scientists, advocates and front-line health workers, focused on significant scientific achievements in finding an HIV cure and vaccine as well as challenges in many fields that have been hampering efforts to tackling the epidemic.

UNAIDS executive director Michel Sidibé was also optimistic that this year would be a pivotal year in the global attempt to end the AIDS epidemic.

“AIDS 2016 must mark the commitment to finish what we started and fast-track the end of AIDS,” Sidibé said.

UNAIDS has set fast-track targets, which include cutting new HIV infections to fewer than 500,000 by 2020 and fewer than 200,000 by 2030; AIDS-related deaths to fewer than 500,000 by 2020 and fewer than 200,000 by 2030.

The fast-track targets aim for 90 percent of people living with HIV knowing their HIV status, 90 percent of people diagnosed with HIV receiving antiretroviral therapy, and 90 percent of people receiving antiretroviral therapy experiencing viral suppression by 2020.

UNAIDS estimates the price tag for fast-tracking the AIDS response will be US$26 billion by 2020.

The latest UNAIDS data said around 17 million people were accessing antiretroviral therapy out of 36.7 million people globally living with HIV in 2015.

The data also says 2.1 million people are newly infected with HIV and 1.1 million people die from AIDS-related illnesses.

Around 78 million people have become infected with HIV since the start of the epidemic in the early 1980s and 35 million people have died from AIDS-related illnesses.

Having an estimated 690,000 people living with HIV, the Indonesian government has been quick to consider how to adopt the ambitious global fast-track.

“The Indonesian Health Ministry has been at the forefront of adopting the fast-track agenda and both national and city-based planning has commenced,” explained David Bridger, UNAIDS country director.

“But, there are clearly still many challenges to be faced but both government and community groups understand the need to accelerate the response in Indonesia,” added Bridger.

The enormous progress in the fight against HIV, particularly in terms of treatment, is one of the big public health success stories of the century.

However, director general of the WHO, Margaret Chan, said her institution had flagged four key challenges in ending AIDS by 2030 including in the fields of prevention of HIV infection, scaling up treatment, the growing emergence of antiretroviral (ARV) drug resistance and the need for sustainable financing in the global response to AIDS.

 Meanwhile, a study from the Global Burden of Disease collaborative network found that 74 countries saw increases in new infections between 2005 and 2015, including in Egypt, Pakistan, Kenya, the Philippines, Cambodia, Mexico and Russia.

 The research, launched during AIDS 2016, found that not only the global number of new cases continued to decline, the pace also greatly slowed. New infections of HIV fell by an average of only 0.7percent per year between 2005 and 2015, compared to the 2.7 percent drop per year between 1997 and 2005 around the world.

The study is based on findings from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) coordinated by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle, US.

“If this trend of stubbornly high new infections continues, there will be significant challenges in meeting the UN’s Sustainable Development Goal [SDGs] for the world to witness the end of AIDS in less than 15 years,” said IHME director Christopher Murray.

 “Everyone in population health — researchers, policymakers, practitioners, pharmaceutical companies, advocates and others — needs to understand that even if more people are living with HIV, we cannot end AIDS without stopping new infections,” Murray said.

Echoing Murray, Peter Piot, professor and director of the London School of Hygiene and Tropical Medicine and the founding executive director of UNAIDS also reminded the public of the threats of the AIDS epidemic that remained.

 “The continuing high rate of over 2 million new HIV infections represents a collective failure that must be addressed through intensified prevention efforts and continued investment in HIV vaccine research,” he said.

 “This study shows that the AIDS epidemic is not over by any means and that HIV/AIDS remains one of the biggest public health threats of our time,” he added.

 * This article was written with support from the International AIDS Society and UNAIDS.

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Express yourself: Two girls write down their opinions at one of booths at the International AIDS Conference (AIDS 2016). This year’s conference aimed to renew global commitments to end the AIDS epidemic. (JP/Rita Widiadana)

Facts about HIV/AIDS:

Causes: Acquired immune deficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV), which infects cells of the immune system, destroying or impairing their functions. Infection with the virus results in progressive deterioration of the immune system, leading to immune deficiency, which increases susceptibility to a wide range of infections and diseases that people with healthy immune systems can fight off.

AIDS: The most advanced stage of HIV infection is AIDS, which can take from two to 15 years to develop depending on the individual.

Transmission: HIV can be transmitted through unprotected sexual intercourse (vaginal or anal) and oral sex with an infected person; transfusion of contaminated blood; and the sharing of contaminated needles, syringes or other sharp instruments. It may also be transmitted between a mother and her infant during pregnancy, childbirth and breastfeeding.

Risk factors: Factors that put individuals at greater risk of contracting HIV include: unprotected anal or vaginal sex, sexually transmitted infections (STIs), sharing contaminated needles, syringes, blood transfusions or medical procedures.

Prevention and treatment:

● Male and female condom use (80 percent protection from STIs)

● Testing and counseling for HIV and STIs

● Voluntary medical male circumcision, which reduces female-male sexual transmission of HIV infection by 60 percent

● Antiretroviral (ART) use for prevention — a 2011 trial confirmed that if an HIV positive person adheres to an effective ART regimen, the risk of transmitting the virus to their uninfected sexual partner can be reduced by 96 percent

● Oral pre-exposure prophylaxis (PrEP) for a HIV-negative partner is the daily use of ARV drugs by people who do not have HIV to block the acquisition of the virus

● Post-exposure prophylaxis for HIV (PEP) is the use of ARV drugs within 72 hours of exposure to HIV in order to prevent infection

Progress from 2000-2015:

● Pills needed to treat HIV down from eight a day in 2000 to only one a day in 2015. Target to reach only one injection (pill) per three months by 2020.

● Cost of ART medicines per person per year was US$10,000 in 2000, down to only $100 in 2015 for first line regimens.

● Investment for the AIDS response was $5 billion in 2000, rising to $19 billion in 2015. It aims to each $26 billion by 2020.

Groundbreaking research from AIDS 2016 (among others):

● Triple ART therapy ANRS Quartor, research led by Dr. Pierre de Truchis from Hôpital Raymond Poincaré, which allows a patient to take ART just four days a week, instead of daily. This simplification of treatment is designed to reduce side effects and treatment costs.

● HVTN 100: Studies of vaccine to prevent HIV infection led by Glenda Gray, professor and president of the South African Medical Research Council, Scott Hammer, professor of epidemiology at Columbia’s Mailman School of Public Health, and Larry Corey, emeritus director of the Fred Hutchinson Cancer Research Center in Seattle.

Sources: International AIDS Society (IAS), UNAIDS and World Health Organization (WHO)

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