/ 14 July 2010

HIV rates fall in worst-affected countries

The United Nations hailed a breakthrough in the fight against Aids on Tuesday with the release of figures showing that the prevalence of HIV has dropped among young people in 15 of the worst-affected countries in the world.

The news was even better in 12 of the countries, where HIV levels have fallen by 25% among people aged 15-24, in response, UNAids believes, to dogged prevention campaigns, warning of the dangers of HIV/Aids and the need for people to change their sexual behaviour.

Michel Sidibé, head of UNAids which released the report before the International Aids conference in Vienna next week, said that young people were leading a badly needed prevention revolution, adding that authorities needed to change tack in the battle against HIV/Aids.

“I think for me what is very important is to say to the world that we are at the defining moment now, where we need to re-shape completely the Aids response,” he said. This redefinition must take place, he said, because of rising treatment costs for HIV and the global economic crisis.

“The world is demanding change. We cannot continue with the same response. It is not sustainable. It is very clear from public opinion region by region that Aids continues to be a top priority, but they are calling for a paradigm shift.”

The costs of antiretroviral drugs for the millions who need them was going through the roof, he said. Even countries such as Brazil, which successfully made cheap Aids drugs available to all, were now hitting financial problems because the first-line drugs were no longer effective enough — HIV becomes resistant over time. Third-line drugs in Brazil now cost $19  per person per year.

But drugs alone, even if they were affordable, would not be enough. “While we were trying to push the treatment, we were seeing that new infections were growing and growing and we were not convinced we were making progress with young people,” said Sidibé.

So the report that UNAids is now releasing offers rare hope for a new strategy which must have prevention at its heart, even while efforts to make simpler, cheaper treatment available continue. “Young people are taking the lead, which is progress,” said Sidibé. “For the first time there is a correlation between that [declining prevalenc] and behaviour, which for me is very important news in terms of dealing with the epidemic.”

The biggest drop was in Kenya, where HIV in 15-24-year-olds was down by 60% between 2000 and 2005. In urban areas it went down from 14,2% to 5,4%, while in rural areas it dropped from 9,2% to 3,6%. In Ethiopia, the report shows a 47% change among young pregnant women in urban areas and 29% in rural areas. In Malawi and Côte d’Ivoire, prevalence among young, pregnant, urban women fell by 56% and in Burundi and Haiti it dropped by nearly half. Reductions of more than a third took place in Namibia, Zimbabwe, Botswana, Rwanda and Lesotho.

Most of the figures come from antenatal clinics, where pregnant young women are tested. Mathematical modelling shows that they are a good indicator of trends across the whole age group. Population surveys are better, however, and were available in seven countries. In six of those countries, a drop in prevalence was seen among young women — but in only four out of the seven was there a drop in prevalence among young men.

UNAids believes the progress is down to the success of efforts to persuade young people to change their sexual behaviour. In 13 countries where research was carried out, young people were reported to be waiting longer before they first have sex. Usually this was young women rather than young men, but in Cameroon, Ethiopia, Malawi and Zambia, both young men and women were waiting longer.

The study also found that both young men and women were having fewer sexual partners and that condom use has increased among young women as well as among young men. – guardian.co.uk