On December 1, people around the globe who come together to recognize World AIDS Day will have much to mourn and also much to celebrate. Worldwide, about 35 million lives have been lost to HIV/AIDS, but remarkable strides have also been made in halting the disease's progression.
World AIDS Day was first observed in 1988. The day was originally conceived by the World Health Organization to raise awareness and support. This year marks the 31st World AIDS Day, with the 2019 theme being Communities Make the Difference. That theme comes with two major objectives, according to the WHO: "highlighting the difference these communities are making to end HIV while drawing global attention to the need for broader engagement with them to strengthen primary health care."
The day is an opportunity to take stock of the epidemic's scope and the everyday impact of the virus–and what better way to do this than by reminding ourselves of the often alarming numbers involved?
The stories of individuals who have lived with HIV/AIDS, or who have lost a loved one to the illness, will always have a unique power. But the following statistics, gathered from government data and scientific research, bring home the vastness and complexity of the epidemic.
This figure works out to about 1 in every 200 people over the age of 13. What's more, 1 in 7 don't know they're infected because they haven't been tested for the virus.
Globally, an estimated 36.9 million people are living with HIV/AIDS—nearly 70% of them in Africa. While the rate in the United States may seem low by comparison, it still is one of the highest in the developed world, says Michael Horberg, MD, director of HIV/AIDS at Kaiser Permanente. (In the U.K., for instance, roughly 1 in 625 people are estimated to be HIV-positive.)
This statistic, from 2014 (the most recent year for which solid data is available), is heartbreaking yet also encouraging: It's about a quarter of the number of people who died of HIV/AIDS in 1995, when mortality reached an all-time high and dramatically less than the 21,601 estimated deaths from HIV/AIDS in 2009.
The sharp decrease is a testament to improved testing, diagnosis, and treatment. "This number, while still too high, shows that quality HIV care, and the potent medications we now have, [have] dramatically improved the lives of HIV-positive Americans and people worldwide," Dr. Horberg says.
In 2016, young people accounted for one in every five new infections in the United States, according to the Centers for Disease Control and Prevention (CDC). From 2010 to 2015, HIV infections among this age group fell 24%. In 2017, 8,164 teens and young adults between 13 and 24 were diagnosed, according to the CDC.
Unfortunately, only 10% of high school students and just 21% of male students who are sexually active with other males have been tested, according to the CDC.
This is a startling number, given that African-Americans make up just 12% of the U.S. population. The burden of disease is even more disproportionate among 13- to 24-year-olds, an age group in which African-Americans or blacks (government agencies tend to use the terms interchangeably) account for 54% of new infections.
"HIV is now a disease of minorities—black, Latino, gay men—and people who have been often medically disenfranchised in the past," says Dr. Horberg, who is also chair of the HIV Medicine Association, a professional association for doctors and health care providers who specialize in HIV/AIDS.
People can live with HIV for a decade (or longer) before they experience symptoms such as fever, fatigue, and joint pain—a fact that underscores the importance of testing and early detection.
Thanks to virus-fighting drugs (antiretrovirals), this asymptomatic period, known as the "chronic" or "latency" phase of the disease, can essentially be extended indefinitely. "If people are diagnosed early and given effective treatment, and if they stay on their treatment, they won't have any symptoms at all," Dr. Horberg says.
The number of people getting tested for HIV rose between 1997 and 2004 but has leveled off since then, according to the 2014 Kaiser Family Foundation survey results that produced the above statistic. Black and Latino survey respondents were much more likely than whites to report having been tested.
In the United States, National HIV Testing Day is observed on June 27, but World AIDS Day also features free testing and counseling events around the world.
The CDC recommends that everyone between these ages get tested for HIV at least once. People considered at higher risk for HIV should get tested more frequently, according to CDC guidelines.
Routine screening helps get more people into treatment sooner, Dr. Horberg says. "Not only does treatment help patients, but it will also greatly prevent others from getting infected."
The antiretroviral Truvada became the first drug approved by the Food and Drug Administration for preventing the sexual transmission of HIV in 2012. In one study of heterosexual African couples in which one partner was HIV-positive, the HIV-negative partners who took Truvada had a 75% lower risk of becoming infected compared with those taking placebo.
There are a number of caveats—most notably, people must diligently take the drug every day in order for it to be effective. But the study results do "show that there are many effective ways to prevent HIV infection," Dr. Horberg says. In 2017, 21.7 million people living with HIV were taking antiretroviral therapy, according to UNAIDS.
This decline is among the many bright spots in the World AIDS Day 2018 fact sheet from UNAIDS. In some regions hit hardest by the epidemic, the numbers are even more encouraging: From 2010 to 2016, new infections dropped by 29% in eastern and southern Africa.
This includes donations from governments, corporations, and individuals. Although the amount represents a huge increase from the $300 million spent in 1996, even more is needed: UNAIDS estimates $26.2 billion will be required to maintain these efforts in 2020.
Fighting HIV/AIDS is expensive. But in addition to saving lives, the investment will ultimately drive down worldwide health care costs, Dr. Horberg says. "There will be savings down the line, because you will have fewer newly infected people, people will be generally healthier, [and] they won't be hospitalized," he says.
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