According to international reporting site Foreign Policy, the Joint United Nations Programme on HIV/AIDS, or UNAIDS, estimates there are 36.7 million people living with HIV today, and more than half of them are on drugs that hold the virus at bay — preventing it from becoming full-blown AIDS as well as preventing the virus from spreading to sexual partners or through drug use.
“Thanks to that treatment, substantially paid for by U.S. taxpayers, death rates have plummeted from a 2005 annual high of nearly 2 million to about 1 million in 2016,” Laurie Garrett of Foreign Policy wrote.
While there are increasing numbers of people taking both preventative medication and post-infection treatments — and death tolls are decreasing — the number of yearly infections around the world have not slowed down, and there are roughly two million people infected with HIV each year.
If that rate stays the same, UNAIDS projects that there will be nearly 54 million people living with HIV by 2030 with death rates taken into account. All of them will be in need of daily medication, which is a daunting task due to stagnated funding and stronger, drug-resistant strains of HIV.
A World Health Organization survey estimates that almost 10 percent of the people who start antiretroviral therapy are found to have a virus that defies easy treatment, requiring them to move to more expensive and less successful second- and third-line treatment.
These numbers are pulled from new cases recorded in Argentina, Guatemala, Namibia, Nicaragua, Uganda and Zimbabwe. A 2015 survey in Mexico found that 14 percent of those infected were found to have drug-resistant viruses.
A London School of Hygiene and Tropical Medicine 2016 analysis of African patients found that a staggering 16 percent of new infections were multidrug-resistant, meaning patients immediately needed third-line therapy.
If these resistant strains continue, an additional $650 million will be needed just for second-line treatment, and even then the success rate will be far below that of antiretrovirals, increasing the death toll by 135,000 and increasing the infection rate by 105,000.
The threat of an impending HIV/AIDS outbreak lies in these new drug-resistant strains, as second- and third-line treatments are less reliable and difficult to administer to patients in poor countries, as these backup treatments are much more expensive than treatments such as tenofovir, one of the biggest first-line HIV treatments.
This not only presents a need to develop more effective medications, but shows the need for more funding in terms of research, development and medicine distribution.
In wealthy countries where anti-HIV drugs are free and fully available the rates are much lower and the threat of drug-resistant strains are less of a threat. Comparing African and European patients, researchers found a lifelong probability that 20 percent of Europeans will build resistance to tenofovir — but as much as 60 percent of Africans are estimated to build the same resistance.
Preventative treatment like PrEP seems to lessen the threat of infection and drug-resistant strains. In San Francisco, where preventative treatment is common in gay men, it was found that in the year 2015 new infection rates plummeted by 17 percent.
However, instead of extending drug availability in poor and middle-income countries, proposed funding is expected to decrease dramatically over the next few years, meaning that at-risk countries need to come up with their own funds.
According to UNAIDS, poor and middle-income countries will need to boost domestic spending on HIV by 450 and 530 percent respectively to offset the decrease in funds.
Medicins Sans Frontieres (MSF), an international humanitarian health organization calls this proposed increase “highly unrealistic,” stating that few of the HIV hardest-hit countries have health budgets capable of even making a dent in these epidemics.
Much of this issue lies in the necessity to continue funding for daily HIV treatment — as every HIV-positive case requires daily treatment, often funded by the government or care organizations. The need for daily medication results in large sums that continuously need to be allocated. A decrease in funding marks a loss of medication availability for many people in struggling countries.
There is always the hope of future HIV and AIDS treatments such as vaccines, curative treatments and better preventative medication. But these solutions require further funding and research, and the global research and development budget has been on the decline since 2012.
Foreign Policy reports that the proposed 2018 White House budget would slash funding for the National Institute of Allergy and Infectious Diseases, America’s primary funder of HIV research, by $838 million. The overall National Institutes of Health would take a loss of almost $6 billion with the proposed budget.
The International AIDS Society notes that the budget cuts would result in “catastrophe” and “lost lives.”
“Dependency on U.S. aid is a serious vulnerability for the entire future of worldwide control of HIV/AIDS,” Garret reported. “The United States contributed $4.9 billion in 2016, or 71 percent of global support. It was followed by the United Kingdom ($646 million), France ($242 million), and the Netherlands ($214 million). Even at the most optimistic levels, these other donor nations can’t make up the difference.”
Pre- and post-infection treatment have become more widely available all over the world, but as new drug-resistant strains of HIV arise in poor countries without access to second- and third-line treatment, infection rates will rise and HIV will continue to spread.
“If the world isn’t willing and able to not merely stay the course, but expand support for treatment and R&D, it is hard to imagine any way out of the grim pandemic scenario,” Garrett wrote. “For those of us who chronicled the first HIV pandemic and witnessed entire social groups and societies in the throes of AIDS, the prospect of a second wave is gut-wrenching and hideous beyond contemplation.”
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