HIV-AIDS fact sheet from UN

The AIDS epidemic poses one of the most formidable challenges to the world at large. In 2008,
young people accounted for 40 percent of all new HIV infections in people aged 15 years and
older. Of the 33.4 million people living with HIV around the world, 4.9 million are between the
ages of 15 and 24.
Experience over the past decade has demonstrated how to address HIV among young people. In
countries with concentrated epidemics, programmes and resources must focus on youth who
engage in risky behaviours, including injecting drugs, selling sex and men having sex with men.
 

In countries with generalized epidemics, where the general population is at risk, all vulnerable
young people, particularly young women, need to be targeted. Evidence shows that sex education
helps in containing the spread of HIV by delaying the onset of sexual activity and encouraging
safer sexual behaviour.
 
The United Nations and the fight against HIV/AIDS
 
The importance of preventing HIV infections among young people has been a consistent
message in all HIV related commitments, especially those made by Member States at the 1994
International Conference on Population and Development, the 1995 World Conference on
Women and the 2001 United Nations General Assembly Special Session on HIV/AIDS.
 
The Declaration of Commitment on HIV/AIDS adopted by the Special Session is particularly
significant as it sets essential actions to significantly reduce HIV infections among young people.
In the most recent 2006 Political Declaration on HIV/AIDS, world leaders unanimously endorse
the goal of achieving universal access to HIV prevention, treatment, care and support for all,
including young people.
 
The Joint United Nations Programme on HIV/AIDS (UNAIDS) brings together the efforts and
resources of ten UN system organizations and the UNAIDS Secretariat to help prevent new HIV
infections, care for people living with HIV and mitigate the impact of the epidemic. Specialized
technical assistance on HIV to countries is provided through the UNAIDS Technical Division of
Labour.
 
The UNAIDS Secretariat focuses on strategic information, the Educational, Scientific and
Cultural Organization focuses on sex education in educational institutions , the UN Population
Fund coordinates issues surrounding out-of-school young people, UNICEF centers on adolescent
development and social protection, the International Labour Organization concentrates on labour
policies and workplace programmes and the World
 
Health Organization mainly focuses on health sector and its responses.
HIV prevention among young people is one of eleven “Essential Programmatic Actions for HIV
Prevention” in the UNAIDS policy position paper Intensifying HIV prevention.
 
As one of its ten priority areas, the UNAIDS Joint Action for Results: Outcome Framework 2009
– 2011 aims to empower young people to protect themselves from HIV, providing a road map
towards achieving the sixth Millennium Development Goal of reducing new HIV infections
among young people.
 
Progress
 
The commitments and actions by all stakeholders have facilitated progress in the HIV response
among young people. The rate of new infections among young people has decreased from 45 to
40 per cent from previous years. Additionally, sex education has led to a delayed onset of sexual
activity and increased the use of condoms in most of the sub-Saharan African countries that have
shown a decrease in HIV prevalence among young people (UNESCO 2009). Trend data from
2000 to 2007 confirms declines in HIV prevalence among young women attending antenatal
clinics in 14 of 17 selected African countries.
 
17 out of 45 countries with survey-based trend data, are starting to show a steady increase in HIV
prevention knowledge among young women. Several high prevalence countries are also showing
stabilization of their HIV epidemic with notable behavioural changes among young people in
terms of age at onset of sex, multiple partners, and condom use.
 
Many challenges still persist in translating lessons learned into practice. Linkages between HIV
and sexual and reproductive health services need to be strengthened. Programmes and financial
resources continue to target young people with low risk of HIV infection instead of focusing on
those most-at-risk.
 
Accurate and comprehensive knowledge about HIV is still not prevalent among young people
and investment in education is needed. Inadequate coordination between different national
stakeholders, such as Government ministries and civil society organizations, continue to hinder a
coordinated, comprehensive HIV programme for young people.
 
Furthermore, young people still need more opportunities for meaningful engagement in advocacy
and decision making.

The way forward

To be effective, youth-led organizations should be involved at all stages of development,
implementation and evaluation of policies and programmes at the national, regional and global
levels.
 
Representatives of youth organisations, especially from networks of young people living with
HIV, should participate at the Board of the Global Fund to Fight AIDS, Tuberculosis and
Malaria as well as the UNAIDS Programme Coordinating Board.
 
With adequate capacity building and the creation of institutional spaces for participation, young
people can make great contributions to the effectiveness of policies and programmes. With
support from regional and global networks, youth-led organizations and networks of young
people living with HIV can also mobilize youth movements to demand services.
 
Youth-led and youth-serving organizations should have a clear role in implementing national
HIV responses.
 
 It is essential to ensure an HIV free new generation through successful implementation of the
following evidence- informed prevention strategies: youth-specific HIV and sexuality education;
mass media interventions; youth-friendly rights-based sexual and reproductive health services,
including use of condoms, and male circumcision. We must also reduce the risks of unsafe drug
use and provide drug dependence treatment for young injecting drug users.
 
The UNAIDS Outcome Framework priority area on young people aims to reduce new HIV
infections among young people by 30 per cent by 2015. It recommends three bold results that by
2011 must be achieved in at least 9 of the 17 countries that have largest number of young people
living with HIV:
·        Ensure at least 80% of young people in and out school have comprehensive knowledge of HIV.
·        Double young people’s use of condoms during their last sexual intercourse.
·        Double young people’s use of HIV testing and counselling services.

UNAIDS 2030

UNAIDS is leading the global effort to end AIDS as a public health threat by 2030 as
part of the Sustainable Development Goals.

Since the first cases of HIV were reported more than 35 years ago, 78 million people
have become infected with HIV and 35 million have died from AIDS-related illnesses.
Since it started operations in 1996, UNAIDS has led and inspired global, regional,
national and local leadership, innovation and partnership to ultimately consign HIV to
history.

UNAIDS is a problem-solver. It places people living with HIV and people affected by the
virus at the decision-making table and at the centre of designing, delivering and
monitoring the AIDS response. It charts paths for countries and communities to get on
the Fast-Track to ending AIDS and is a bold advocate for addressing the legal and
policy barriers to the AIDS response.

UNAIDS provides the strategic direction, advocacy, coordination and technical support
needed to catalyse and connect leadership from governments, the private sector and
communities to deliver life-saving HIV services. Without UNAIDS, there would be no
strategic vision for the AIDS response.

UNAIDS generates strategic information and analysis that increases the understanding
of the state of the AIDS epidemic and progress made at the local, national, regional and
global levels. It leads the world’s most extensive data collection on HIV epidemiology,
programme coverage and finance and publishes the most authoritative and up-to-date
information on the HIV epidemic—vital for an effective AIDS response. UNAIDS
produces data for impact—no major report, speech or policy initiative on HIV has been
launched or made without referring to data collected and released by UNAIDS.
UNAIDS is a model for United Nations reform and is the only cosponsored Joint
Programme in the United Nations system. It draws on the experience and expertise of
11 United Nations system Cosponsors and is the only United Nations entity with civil
society represented on its governing body.

UNAIDS has helped to position, shape and scale up the response to HIV like no other
organization, encouraging dialogue and bringing in communities that have been left out
of decision-making. Without UNAIDS, the human rights of people living with HIV would
have been held back and the voice of civil society would be heard far less often.

UNAIDS has transformed policy. UNAIDS has shaped public policy on HIV at the global,
regional and national levels. It has mobilized investment for sound national policy using
evidence, experience and political advocacy, built health and community systems,
established legal frameworks and shaped public opinion towards creating healthy and
resilient societies.

Human Rights

The UNAIDS Secretariat has offices in 70 countries, with 70% of its staff based in the
field, and has a budget of US$ 140 million for 2018. The budget for the Joint
Programme for 2018 is US$ 242 million.

A human rights-based approach is essential to ending AIDS as a public health threat.

Rights-based approaches create an enabling environment for successful HIV responses
and affirm the dignity of people living with, or vulnerable to, HIV.

With the adoption of the Sustainable Development Goals, United Nations Members
States committed to leave no one behind and to end the HIV, tuberculosis and malaria
epidemics by 2030. Leaving no one behind requires addressing stigma, discrimination,
and other legal, human rights, social and gender-related barriers that make people
vulnerable to HIV and hinder their access to HIV prevention, treatment, care and
support services.

The AIDS response has demonstrated the importance and feasibility of overcoming
legal, human rights and gender-related barriers to HIV services. Through advocacy and
litigation, civil society and people living with HIV have been instrumental to advancing
human rights in the response to the epidemic. In many countries across the world, their
demands have led governments, parliamentarians, donors and partners such as the
United Nations to support law reform, policy change and human rights programmes.

Yet these efforts and investments to advance human rights remain insufficient. Human
rights challenges, including stigma and discrimination, inequality and violence against
women and girls, denial of sexual and reproductive health and rights, misuse of criminal
law and punitive approaches and mandatory testing remain among the main barriers to
effective HIV responses. These challenges particularly affect people living with HIV and
key populations. 

UNAIDS ensures that global human rights standards and commitments translate into
action and programmes at the country level by supporting stakeholders to build
alliances within the Joint UNAIDS Programme and beyond and to respond effectively to
human rights challenges in the context of the AIDS response.

90-90-90: AN AMBITIOUS TREATMENT TARGET TO HELP END

THE AIDS EPIDEMIC

Ending the AIDS epidemic is more than a historic obligation to the 39 million people who
have died of the disease. It also represents a momentous opportunity to lay the
foundation for a healthier, more just and equitable world for future generations. Ending
the AIDS epidemic will inspire broader global health and development efforts,
demonstrating what can be achieved through global solidarity, evidence-based action
and multisectoral partnerships.

Although many strategies will be needed to close the book on the AIDS epidemic, one
thing is certain. It will be impossible to end the epidemic without bringing HIV treatment
to all who need it.

As the world contemplates the way forward following the 2015 deadline for the targets
and commitments in the 2011 Political Declaration on HIV and AIDS, a final target is
needed to drive progress towards the concluding chapter of the AIDS epidemic,
promote accountability and unite diverse stakeholders in a common effort. Whereas
previous AIDS targets sought to achieve incremental progress in the response, the aim
in the post-2015 era is nothing less than the end of the AIDS epidemic by 2030.

In December 2013, the UNAIDS Programme Coordinating Board called on UNAIDS to

support country- and region-led efforts to establish new targets for HIV treatment scale-
up beyond 2015. In response, stakeholder consultations on new targets have been held
in all regions of the world. At the global level, stakeholders assembled in a variety of
thematic consultations focused on civil society, laboratory medicine, paediatric HIV
treatment, adolescents and other key issues.

Powerful momentum is now building towards a new narrative on HIV treatment and a
new, final, ambitious, but achievable target:

 By 2020, 90% of all people living with HIV will know their HIV status.
 By 2020, 90% of all people with diagnosed HIV infection will receive
sustained antiretroviral therapy.
  By 2020, 90% of all people receiving antiretroviral therapy will have viral
suppression. 
 There are 38 million people living with HIV
 81% know they are HIV positive; The rest DO NOT
 Two out of three people living with HIV are on antiretroviral therapy
 Only 59% of people living with HIV have undetectable levels of the virus

HIV PREVENTION

No single prevention method or approach can stop the HIV epidemic on its own.
Several methods and interventions have proved highly effective in reducing the risk of,
and protecting against, HIV infection, including male and female condoms, the use of
antiretroviral medicines as pre-exposure prophylaxis (PrEP), voluntary male medical
circumcision (VMMC), behaviour change interventions to reduce the number of sexual
partners, the use of clean needles and syringes, opiate substitution therapy (e.g.
methadone) and the treatment of people living with HIV to reduce viral load and prevent
onward transmission.

Despite the availability of this widening array of effective HIV prevention tools and
methods and a massive scale-up of HIV treatment in recent years, new infections
among adults globally have not decreased sufficiently. The 2016 United Nations
Political Declaration on Ending AIDS target is to reduce new HIV infections to fewer
than 500 000 by 2020, from more than 1.8 million in 2016.  

Three interconnected reasons seem to underpin the failure to implement effective

programmes at scale: lack of political commitment and, as a result, inadequate
investments; reluctance to address sensitive issues related to young people’s sexual
and reproductive needs and rights, and to key populations and harm reduction; and a
lack of systematic prevention implementation, even where policy environments permit it.

UNAIDS seeks to boost global and national HIV prevention leadership and
accountability and Fast-Track the implementation of effective HIV prevention
programmes at the country level by providing guidance on effective approaches to
achieve the prevention targets of the 2016 Political Declaration, which include ensuring
access to combination prevention options, including condoms, PrEP, harm reduction
and VMMC to at least 90% of people at risk by 2020, especially young women and girls
in high-prevalence countries and key populations, reaching 3 million people at high risk
with PrEP, reaching 25 million men with VMMC and making 20 billion condoms
available in low- and middle-income countries. 

The UNAIDS Executive Director has called for the establishment of a new global
prevention coalition and a 2020 road map. The objectives of the coalition are: to create
a platform of HIV prevention policy-makers, programme managers and civil society to
strengthen political commitment; define critical steps and milestones to ensure effective
prevention programme scale-up in a global prevention road map; and strengthen the
accountability of all stakeholders as well as technical support for HIV prevention
programmes, towards achieving the 2016 Political Declaration prevention targets and
commitments.

HIV Treatment

Since the discovery of AIDS in 1981 and its cause, the HIV retrovirus, in 1983, dozens
of new antiretroviral medicines to treat HIV have been developed. Different classes of
antiretroviral medicines work against HIV in different ways and when combined are
much more effective at controlling the virus and less likely to promote drug-resistance
than when given singly. Combination treatment with at least three different antiretroviral
medicines is now standard treatment for all people newly diagnosed with HIV.
Combination antiretroviral therapy stops HIV from multiplying and can suppress HIV to
undetectable levels in blood. This allows a person’s immune system to recover,
overcome infections and prevent the development of AIDS and other long-term effects
of HIV infection.

Civil society activists, working closely with researchers and national regulatory
authorities, promoted unprecedented investment in AIDS research and accelerated
access to new medicines. This enabled new medicines and combinations to get to
patients faster than ever before. Pressure from the global AIDS movement also ensured
that the prices of new medicines were rapidly brought down to make them affordable to
almost every country in the world.

Currently, there are 23.3 million people globally on HIV treatment. A person living with
HIV who starts antiretroviral therapy today will have the same life expectancy as an
HIV-negative person of the same age. Antiretroviral therapy results in better outcomes
when started early after HIV infection rather than delaying treatment until symptoms
develop. Antiretroviral therapy prevents HIV-related illness and disability and saves
lives. AIDS-related deaths have globally declined by 43% since 2003. Antiretroviral
therapy also has a prevention benefit. The risk of HIV transmission to an HIV-negative
sexual partner is reduced by 96% if the partner living with HIV is taking antiretroviral
therapy.

Safer and more effective antiretroviral medicines and combinations are increasingly
available and affordable for low- and middle-income countries. Current World Health
Organization recommended standard first-line antiretroviral therapy for adults and
adolescents consists of two nucleoside reverse-transcriptase inhibitors (NRTIs) plus a
nonnucleoside reverse transcriptase inhibitor or an integrase inhibitor. Fixed-dose
combinations and once-daily regimens are preferred. Second-line antiretroviral therapy
in adults consist of two NRTIs plus a ritonavir-boosted protease inhibitor.

The effectiveness of HIV treatment is best monitored by measuring the amount of HIV in
a person’s blood. If the virus cannot be detected they are said to have viral-load
suppression—indicating that their HIV infection is unlikely to progress and they are at
very low risk of transmitting the virus to their partner. Viral-load testing is recommended
six months after starting antiretroviral therapy and annually thereafter to ensure that
treatment is being taken and that drug-resistance has not developed.

HIV treatment works best when taken as prescribed. Missing doses and stopping and
re-starting treatment can lead to drug resistance, which can allow HIV to multiply and
progress to disease. People living with HIV on treatment need to be provided with the
support that they need to overcome the challenges to taking treatment regularly and
robust systems to monitor drug resistance must be in place.

WHAT IS WORLD AIDS DAY?

Each year, on 1 December, the world commemorates World AIDS Day. People around
the world unite to show support for people living with HIV and to remember those who
have died from AIDS-related illnesses.

Each World AIDS Day focuses on a specific theme, which this year will be Global
solidarity, shared responsibility. This year’s theme joins a growing list of challenges that
World AIDS Day has alerted people to globally.

Founded in 1988, World AIDS Day was the first ever international day for global health.
Every year, United Nations agencies, governments and civil society join together to
campaign around specific themes related to HIV.

 Awareness-raising activities take place around the globe.

 Many people wear a red ribbon, the universal symbol of awareness of, support for
and solidarity with people living with HIV. 
 People living with HIV make their voice heard on issues important in their lives.
 Groups of people living with HIV and other civil society organizations involved in
the AIDS response mobilize in support of the communities they serve and to raise
funds.
 Events highlight the current state of the epidemic.
World AIDS Day remains as relevant today as it’s always been, reminding people and
governments that HIV has not gone away. There is still a critical need for increased
funding for the AIDS response, to increase awareness of the impact of HIV on people’s
lives, to end stigma and discrimination and to improve the quality of life of people living
with HIV.
Themes

2020    Global solidarity, shared responsibility

2019    Communities make the difference

2018    Know your status

2017    My health, my right

2016    Hands up for HIV prevention

2015    On the Fast-Track to end AIDS

2014    Close the gap

2013    Zero discrimination

2012    Together we will end AIDS

2011    Getting to zero

2010    Universal access and human rights

2009    Universal access and human rights

2008    Stop AIDS. Keep the promise—lead, empower, deliver

2007    Stop AIDS. Keep the promise—leadership

2006    Stop AIDS. Keep the promise—accountability

2005    Stop AIDS. Keep the promise

2004    Women, girls, HIV and AIDS

2003    Stigma and discrimination

2002    Stigma and discrimination

2001    I care, do you?

2000    AIDS: men make a difference

1999    Listen, learn, live! World AIDS campaign with children and young people

1998    Force for change—world AIDS campaign with young people

1997    Children living in a world of AIDS

1996    One world, one hope

1995    Shared rights, shared responsibilities

1994    AIDS and the family

1993    Time to act

1992    AIDS—a community commitment

1991    Sharing the challenge

1990    Women and AIDS

1989    Our lives, our world—let’s take care of each other

1988    A world united against AIDS