In most high HIV prevalence African countries, rates are currently flatlining or changing very slowly. The rate of new infections is high, the death rate is high and about one third of those needing treatment are receiving antiretroviral drugs.
Ideally, HIV programming should aim to reduce the number of new infections while treating as many people as possible. Unfortunately, prevention programmes have not been too successful. Therefore, the number of people living with HIV continues to increase and is only held down by a high death rate.
Continuing to treat those receiving drugs right now is becoming a problem because of funding shortfalls, so it is unlikely that the number of new recipients of treatment is going to increase in the foreseeable future. If people needing drugs are unable to get them, even temporarily, death rates will rapidly increase.
Ironically, this could result in the death rate exceeding the rate of new infections and HIV prevalence would then decrease. This may make it appear as if we are winning the fight against HIV because the prevalence figure tends to be used as a measure of epidemic severity.
Funding for HIV programming needs to increase because, in addition to getting as many people on treatment as possible, the rate of new infections also needs to be reduced. Otherwise the epidemic will continue to grow and, if treatment programming is not presently unsustainable, it soon will be.
Judging the state of a HIV epidemic using prevalence figures is futile because prevalence goes down when death rates exceed new infections; and prevalence goes up when those needing treatment are receiving it because more HIV positive people are living longer.
Instead of being blasted with prevalence rates all the time, we need some indication of the rate of new infections (incidence), death rates, treatment rates and possibly some other figures. Otherwise we have no way of judging the status of an epidemic. Sphere: Related Content
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