ABSTRACT
Although the HIV/AIDS epidemic has been around for more than a quarter of a century, it is still evolving differently across regions and countries. During this period, tens of millions of people worldwide have been infected with HIV and over 25 million have died from AIDS-related illnesses, but at the same time there have been significant developments and changes in the surveillance and response to the epidemic. Most significant is the emergence of antiretroviral (ARV) therapy, which transformed the response to the epidemic by introducing the possibility of life extension for AIDS sufferers. Until then, being infected with HIV was considered to be a “death sentence” sooner rather than later, in contrast with the situation today wherein the latest generation of ARV drugs can offer an almost normal lifespan. Initially, treatment was not affordable in resource-poor developing countries because of prohibitively high costs of ARV drugs, but progressive and substantial reductions in cost over time and increased donor funding have made treatment accessible to some of the millions of AIDS sufferers in the developing regions, and particularly in sub-Saharan Africa, which has some of the poorest countries with the highest HIV prevalence rates in the world. Despite advancement in tracking and treating HIV/AIDS worldwide, indications today are that the spread of the epidemic is far from being brought under control. Access to treatment and the implementation of effective prevention programs remain limited in the regions and countries most affected by the disease, for various reasons ranging from resource constraints to social, cultural, and political factors which undermine efforts to respond effectively. The rapid spread and deadly impact of HIV/AIDS worldwide, and
the realization that the epidemic is a long-wave event with longer-term development implications, have led to an extraordinary mobilization of human and financial resources and the establishment of exceptional global partnerships and programs in response, such as UNAIDS; the
Global Fund to Fight AIDS, Tuberculosis and Malaria; the Global Business Coalition on HIV/AIDS; and the International AIDS Society. Billions of dollars have been raised from various sources to support the fight against HIV/AIDS at global, national, and community levels. The diversity of the global HIV/AIDS epidemic and its transitional
and multidimensional characteristics have produced different approaches and mixed experiences in the context of the global response. At the same time, the variety of experiences and lessons from the global response have also brought into focus critical and unresolved issues, as well as new and emerging challenges. HIV/AIDS has continued to spread globally and, more worryingly, to large and populous countries in Asia such as China, India, and the former Soviet Central Asian countries, with potential strategic economic and political implications. In sub-Saharan Africa, where AIDS is now the leading cause of death, some progress has been made in slowing down the spread of the epidemic in the region, but the epidemic appears to be outpacing both physical and human resources in the worst affected countries. Inadequate healthcare facilities and ignorance have meant that only about a third of infected pregnant women in Africa receive ARV drugs for prevention of mother-to-child transmission, something which has been entirely avoidable for years. HIV/AIDS has maintained strong causative links with poverty in low-and middle-income countries, and stigma and discrimination and other social problems, including gender inequality, remain powerful barriers to prevention and treatment programs in those and many other countries worldwide. Two decades of efforts by the scientific community involving hundreds of millions of dollars in research and experimental trials have so far failed to produce a successful vaccine against HIV infection, let alone a cure for the disease. The emerging threat of TB-HIV and other HIV-linked coinfections does not seem to be getting sufficient attention in the response to HIV/AIDS at global and national levels. This chapter summarizes these critical and unresolved issues, as well
as emerging challenges which must be addressed in the context of further efforts to control and reverse the spread of HIV infection worldwide and to mitigate its impact on the millions who are already infected, their families, and communities. The summary takes into account that HIV/ AIDS is now facing stiff competition from new and emerging global concerns, such as climate change, energy security, food shortages, water access, terrorism, and the financial crisis, to remain a priority issue on the international agenda. It notes that while some of these competing global concerns are significant to the current state of the world, they also have important links with and implications for HIV/AIDS.1
