Paper figures with red ribbons

It is more than 35 years since the discovery of the human immunodeficiency virus (HIV), which has now spread across the whole of the world. Today some 37.9 million people are estimated to be carrying the virus.

If those infected with HIV do not get medical treatment, following an initial symptom-free period the HI viruses destroy the infected personʼs immune system, causing life-threatening infections as well as tumours. This disease pattern is referred to as acquired immunodeficiency syndrome, or AIDS. There is currently no cure. However, a therapy consisting of a combination of various drugs which stop the HI viruses multiplying can delay the outbreak of AIDS for a very long time and may even prevent it altogether.

Very many of those who are HIV positive live in developing countries, particularly in countries in sub-Saharan Africa. Around 25.6 million people in the region were infected in 2018. The disease is not only a disaster in human terms, but also in social and economic terms, and it jeopardises sustainable development in the countries affected.

Groups particularly vulnerable to HIV and AIDS

Advice on contraception in a health station in Bujumbura, Burundi

In countries with high infection rates, HIV affects the whole of the population. Due to biological, economic, social and cultural factors, women and girls are at particularly high risk of contracting HIV. That is why it is important to take account of their special needs when it comes to HIV prevention. It is also they who are worst affected by the negative consequences of the epidemic, as they are the ones who tend to the sick and look after AIDS orphans.

For various reasons, lesbian, gay, bisexual, transgender, transsexual and intersexual people, migrants, injecting drug users and sex workers are at greater risk of HIV infection. These groups are often also the victims of discrimination, which makes it more difficult for them to access preventive measures and treatment.


Collection of a blood sample in a hospital in Burkina Faso

Containing HIV and AIDS is one of the biggest challenges currently facing development policy. However, international efforts have in recent years scored successes which are encouraging and show that it is possible to slow down the spread of the HIV epidemic.

The spread of the HI virus has slowed down. Since the height of the epidemic in 1997 the number of new HIV infections has dropped by more than 40 per cent. In 2018 some 1.7 million people became infected with HIV (compared to 2.9 million in 1997).

The trend when it comes to children under the age of 15 is particularly encouraging. In this age group the number of new HIV infections dropped by 43 per cent between 2010 and 2018 (from 280,000 to 160,000).

In the countries of eastern and southern Africa, which are badly affected by the epidemic, the number of deaths due to AIDS was reduced by 44 per cent between 2010 and 2018. At the same time, the level of care available to those who are HIV-infected or suffering from AIDS has markedly improved. In the period between 2010 and 2018 the number of HIV-positive individuals receiving a combination therapy worldwide has risen from 7.7 to 23.3 million.

Outlook: What does the future hold?

Blood samples in an examination laboratory

One of the goals which the international community set at the UN Millennium Summit in 2000 was to have halted, by 2015, and begun to reverse the spread of HIV/AIDS. This goal was not achieved – almost 4,700 people still contract HIV every day.

In 2015 the international communityʼs goal of ending the AIDS epidemic by 2030 was included in the 2030 Agenda for Sustainable Development (Target 3.3). The Joint United Nations Programme on HIV/AIDS (UNAIDS) included three targets in its 2016–2021 Strategy:

  • By 2030, 95 per cent of those living with HIV are to know their status, 95 per cent of those who know their status are to be receiving antiretroviral treatment and 95 per cent of those on treatment are to have suppressed their viral load. The interim goal for 2020 is 90 per cent in each case.
  • By 2030, the number of new HIV infections is to drop to 200,000 adults each year (to 500,000 by 2020).
  • Discrimination against those living with HIV and AIDS is to be completely eliminated.

Existing preventive and treatment programmes will need to be massively expanded if these targets are to be achieved. UNAIDS has warned that if current levels continue the result will be another strong increase in the number of infections and deaths.

In addition, it will only be possible to contain HIV and AIDS in the long term if the living conditions of those concerned can be significantly improved, especially in poorer countries. To that end, poverty needs to be alleviated, human rights strengthened, education improved and the efficiency of healthcare systems increased.

Overall strategy on prevention, treatment, and care and support

Sale of condoms at a kiosk in Burundi

As long as immunisation is not an option and as long as an HIV infection can only be treated but not cured, prevention will remain the most important instrument for halting the epidemic’s spread. Studies show that – as well as individuals protecting themselves against infection, for example by using condoms – treating those infected with HIV with medicines which slow down viral replication contains the number of new HIV infections.

All the relevant measures should be incorporated into an overall national strategy which should include preventive measures as well as care and support for AIDS patients. Germany cooperates closely with its international partners on implementing such strategies. It is particularly important to include those people and groups affected by HIV and AIDS in shaping and implementing these strategies.

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