New HIV infections, AIDS-related mortality rising in Pakistan: UNAIDS report

Islamabad: The latest UNAIDS report on the global AIDS epidemic mentions Pakistan as a country reporting sharp increases in new HIV infections and rising AIDS-related mortality.

Titled ‘Seizing the Moment,’ the 2020 report highlights the scale of the HIV epidemic and how it runs along the fault lines of inequalities. It draws attention to remarkable but highly unequal progress, notably in expanding access to antiretroviral therapy, and highlights how urgent it is for countries to and act with greater urgency to reach the millions still left behind.

“HIV infections in Asia and the Pacific have declined slightly, with reductions in Cambodia, Myanmar, Thailand and Viet Nam offset by sharp increases in Pakistan and the Philippines,” the report states.

According to the report, only 14 countries have achieved the 90–90–90 HIV treatment targets (90% of people living with HIV know their HIV status, of whom 90% are on antiretroviral treatment and of whom 90% are virally suppressed). “AIDS-related mortality rates are rising in Afghanistan, Pakistan and the Philippines. Late diagnosis and poor adherence to treatment are missed opportunities to prevent onward transmission and AIDS-related deaths. About half of key populations living with HIV are not aware of their HIV status, but assisted testing and self-testing could increase the rates of HIV diagnosis,” the report points out.

The report states that the 2020 targets of reducing AIDS-related deaths to fewer than 500,000 and new HIV infections to fewer than 500,000 will not be met because the achievements have not been shared equally within and between countries, and because Covid-19 risks have blown HIV progress way off-course. Missed targets have resulted in 3.5 million more HIV infections and 820,000 more AIDS-related deaths since 2015 than if the world was on track to meet the 2020 targets. In addition, the response could be set back further, by 10 years or more, if the Covid-19 pandemic results in severe disruptions to HIV services.

Presenting a profile of Asia and the Pacific, the report informs that key populations and their partners accounted for an estimated 98% of new HIV infections, and more than one quarter of new HIV infections were among young people (aged 15 to 24 years). Rising numbers of new infections among gay men and other men who have sex with men are a major concern.

An overall slowing in reductions in new HIV infections coincides with a decline in political and programmatic commitment, alongside punitive laws and policies and rising stigma and discrimination that block effective AIDS responses.

Key populations are insufficiently served by HIV prevention programmes. Some progress has been made in introducing innovative prevention tools, such as pre-exposure prophylaxis (PrEP). A small minority of countries have both high coverage of needle–syringe programmes and moderate coverage of opioid substitution therapy.

Evidence indicates increased use of methamphetamine drugs linked to HIV transmission, and there is a need for innovative harm reduction services that respond to changing patterns in drug use. Civil society organizations are widely involved in HIV prevention programmes, but these community-led services are not available at sufficient scale, the report flags.

Of the 38 million people living with HIV, 25.4 million people are now on treatment. That means 12.6 million people are still waiting. New HIV infections have been reduced by 23% since 2010, thanks in large part to a substantial decrease of 38% in eastern and southern Africa. But HIV infections have increased by 72% in eastern Europe and central Asia, by 22% in the Middle East and North Africa and by 21% in Latin America.

UNAIDS estimates that $26.2 billion will be required for the AIDS response in 2020. At the end of 2019, $18.6 billion was available for the AIDS response in low- and middle-income countries, almost $1.3 billion less than in 2017. Around 57% of the total resources for HIV in low- and middle-income countries in 2019 were from domestic sources.