1 December 2018 marks the 30th anniversary of World AIDS Day – a day created to raise awareness about HIV and the resulting AIDS epidemics. Since the beginning of the epidemic, more than 70 million people have acquired the infection, and about 35 million people have died. Today, around 37 million worldwide live with HIV, of whom 22 million are on treatment. This December is the 30th anniversary of World AIDS Day, with the theme: “Know Your Status”.
When World AIDS Day was first established in 1988, the world looked very different to how it is today. Now, we have easily accessible testing, treatment, a range of prevention options, including pre-exposure prophylaxis, and services that can reach vulnerable communities.
The effort to develop effective treatment for HIV is remarkable in its speed and success. Clinical trials of antiretrovirals (ARVs) began in 1985 – the same year that the first HIV test was approved – and the first ARV was approved for use in 1987. However, a single drug was found to have only short-term benefits. By 1995, ARVs were being prescribed in various combinations. A breakthrough in the HIV response was announced to the world at the 11th International AIDS Conference in Vancouver when the success of as “highly active antiretroviral treatment” (HAART) – a combination of three ARVs reported to reduce AIDS-related deaths by between 60% and 80%.
Because of the high cost of ARVs, most low- and middle-income countries could not afford to provide treatment through their public programmes. World Health Organisation (WHO) announced the ‘3 by 5‘ initiative with the aim of providing HIV treatment to 3 million people in low- and middle-income countries by 2005. The '3 by 5' initiative was the most ambitious public health programme ever launched, which would increase 15-fold the number of people receiving life-saving treatment in some of the poorest countries of the world, in just three years. In 2015, WHO recommended the use of ARVs to prevent HIV acquisition – pre-exposure prophylaxis or PrEP – for people who do not have HIV but are at substantial risk.
HIV is not an easy virus to defeat. Nearly a million people still die every year from the virus because they do not know they have HIV and are not on treatment, or they start treatment late. This is despite WHO guidelines in 2015 recommending that all people living with HIV should receive antiretroviral treatment, regardless of their immune status and stage of infection, and as soon as possible after their diagnosis.
One of the biggest challenges in the HIV response has remained unchanged for 30 years: HIV disproportionally affects people in vulnerable populations that are often highly marginalised and stigmatised. Thus, most new HIV infections and deaths are seen in places where certain higher-risk groups remain unaware, underserved or neglected.
The theme of this World AIDS Day – Know Your Status – is important. One in four people with HIV do not know that they have HIV. To bridge some critical gaps in the availability of HIV tests, WHO recommends the use of self-tests for HIV. WHO first recommended HIV self-testing in 2016, and now more than 50 countries have developed policies on self-testing. This World AIDS Day, WHO and the International Labour Organisation also announced new guidance to support companies and organisations to offer HIV self-tests in workplace.
Source: World Health Organisation