While the world has a long way to go before it can be Aids free, it has learnt to handle the epidemic better than before. This is the picture one gets from the 2012 edition of UNAIDS Global Report, which was released recently and which shows that HIV infections have dropped by more than half in 25 low-income and middle-income countries. And the recorded number of new infections, 2,498,754, in 2011, was a figure 20 per cent lower than in 2001!

Still, some 34 million people worldwide were living with the incurable human immunodeficiency virus (HIV) at the end of 2011, according to UNAIDS, the lead UN agency dealing with global AIDS response. Globally, efforts to face and handle the serious health challenges presented by HIV/AIDS have led to a fall in the number of people dying as a result of AIDS and a stabilisation of the number of people infected with HIV. But ‘getting to zero’ is an idea that is too farfetched and probably only suitable for a slogan, which it is. From 2011 to 2015, ‘Getting to zero’ is the slogan for World AIDS Day, falling each year on December 1, a day devoted to raising awareness of HIV/AIDS and strengthening support for HIV-positive people and those who are affected by AIDS.

Behind this slogan is the aim to achieve one of the anti-poverty targets (or what we refer to as the Millennium Development Goals, with 2015 as its deadline for achieving them) of halting and beginning to reverse the spread of HIV/AIDS. This may seem somewhat implausible in the context of Pakistan where the most prominent face of HIV epidemic are people who inject drugs (PWID), whose numbers are steadily on the rise, and who, despite awareness programmes and free syringe exchange offer, continue to share syringes. UNAIDS Global Report 2012 shows Pakistan with the highest ratio between PWID and overall adult prevalence rates — 27.2 per cent of PWIDs in Pakistan have HIV, compared to just 0.1 per cent of the wider population!

Injecting drugs is a major driver of HIV in not only Pakistan but also in other countries, particularly in other Asian nations and about 16 per cent of people who inject drugs in Asia are living with HIV. According to a report by Sindh Government’s Enhanced HIV/AIDS Control Programme, national surveillance shows “HIV prevalence among IDUs in Karachi and Hyderabad has increased to 42 per cent and the infection has gained epidemic proportions among male sex workers and transgenders...” The overlapping of sex work and injecting drug use compounds the problem and spreads the infection to the rest of the population.

There are an estimated 106,000 HIV cases in Pakistan, with 5,256 people living with HIV (PLHIV) registered in 17 antiretroviral therapy centres by the end of 2011, including 189 children, 1,018 and 4,049 adult females and males, respectively. On average, in 2011, there were around 40-45 new PLHIV starting on antiretroviral therapy per month, according to UNAIDS’ Country Progress Report 2012. In recent years, repatriated migrant labour has been found to constitute another high-risk group. As a result, unsuspecting spouses become infested with HIV, and eventually children born to such couples are in danger of facing the same fate.

A ray of hope

Thanks to new ways of preventing transmission, HIV positive mothers now have higher hopes for healthy babies. And the greatest progress has been made in reducing new HIV infections in children, with half of the global reductions in new HIV infections in the last two years being among newborn children. The method of prevention of the transmission from the HIV-positive mother to the unborn child involves a long course of AIDS drug treatment, known as antiretroviral therapy, and the avoidance of breastfeeding, which reduces the risk to below two per cent. According to the World Health Organisation, since 1995, when prevention of mother to child transmission (PMCT) was introduced, hundreds of thousands of children around the globe have avoided contracting HIV infection because of antiretroviral prophylaxis. Antiretroviral therapy is also one of the factors behind reducing the number of people becoming HIV infected and dying from AIDS. According to UNAIDS, some eight million people were being treated with AIDS drugs by the end of 2011 and the UN has set a target to raise the figure to 15 million people by 2015.

Among the other factors that have led to positive global statistics for HIV/AIDS are scaled up response and investment by most governments to treat and stop the spread of the infection. The UNAIDS report also shows that 81 countries have increased domestic investments by some 50 per cent between 2001 and 2011. This is also true in the case of Pakistan. The World Bank had provided financing to approved and committed HIV/AIDS prevention activities in the country but withdrew the financial support at the end of 2009. However, the established programmes and services in the public sector, which include diagnostic and treatment services, are continuing.

It is apparent that efforts to tackle this infection are working, and research, particularly for an AIDS vaccine, is making progress. Awareness, precautions, and timely testing and treatment are what it will take to get anywhere near ‘zero’.