Confronting the HIV/AIDS deadly pandemic
Nearly 38 million people were living with the human immunodeficiency virus (HIV) at the end of 2020, the majority of them in sub-Saharan Africa. While there is no cure for HIV, a combination of drugs, known as antiretrovirals (ARVs), enable people to live longer, healthier lives if taken regularly. The cost of first-line drugs is now cheaper than ever, but efforts are still needed to ensure everyone who is living with HIV receives treatment.
Globally, 27.5 million people living with HIV were receiving ARVs in 2020. This equates to a global ARV coverage rate of 73 per cent. However, only 54 per cent of children were receiving ARV treatment at the end of 2020.
Worldwide, nearly one in five people currently infected with the virus don't know their HIV status. In West and Central Africa, nearly one-third of people living with HIV didn't know their HIV-positive status in 2019. Once someone is diagnosed with the disease, viral load monitoring - measuring the levels of HIV virus in the blood - is essential to measure whether treatment is working. While annual viral load tests are standard in wealthy countries, access in developing countries still lags far behind.
There is no cure for HIV, although life-long treatment using combinations of drugs known as antiretrovirals (ARVs) helps manage the virus and enables people to live longer, healthier lives if taken regularly. While 10 million more people are on treatment today than in 2014, deadly treatment gaps exist, especially in West and Central Africa, and the Middle East and North Africa, the latter where just over a third of people living with HIV receive ARVs.
While most people living with HIV can stay healthy on first-line drugs - which cost around US$65 per person per year - a significant number develop resistance to this regimen and have to switch to second-line regimens. But the price of doing so is high - literally. Second-line regimens are nearly four times the price of first-line regimens. To switch from second- to third-line regimens is up to eight times more expensive, as much as $2,200 per person per year. This is in large part because pharmaceutical corporations maintain monopolies that block price-lowering generic competition. On top of overcoming pricing barriers, adequate medical follow up must ensure a timely identification of resistance and a switch of regimens when needed.
Low HIV prevalence rates - ranging from two to 10 per cent across West and Central African countries, and less than one per cent across the Middle East and North Africa - have left these regions in a blind spot in the global HIV response. These regions continue to lag behind in attention and investment in tackling the epidemic, resulting in low access to testing and treatment. In West and Central Africa, just 58 per cent of people living with HIV are on treatment. It is unacceptable to witness people dying of AIDS within hours of being admitted to our hospitals in Democratic Republic of Congo (DRC), Guinea, Kenya and Malawi.
In conflict settings and when people are displaced, ensuring the continuity of care for people with HIV - including long-term supply of drugs - can be difficult. Logistical and security issues are barriers for both our teams and patients in ensuring that people living with HIV can access the care and treatment they need to stay healthy. In Yemen, providing uninterrupted treatment during more than five years of war has proved logistically challenging - and dangerous to patients and staff.
So called ‘key populations’ include vulnerable people who are disproportionately affected by HIV, including sex workers, people who use drugs, men who have sex with men, and prisoners. Despite their higher risk of acquiring HIV, key populations are often excluded from accessing HIV treatment and prevention as well as comprehensive health services. Stigma, discrimination, social exclusion, violence and criminalisation are part of their daily struggles. In Mozambique and Malawi, MSF provides packages of HIV and sexual and reproductive healthcare services for sex workers and men who have sex with men in key sites along main transport routes.
HIV lowers the body's immune response, and without effective treatment, leaves people living with the disease much more vulnerable to deadly opportunistic infections like tuberculosis (TB). TB is the single biggest killer of people living with HIV, and in 2019 accounted for 30 per cent AIDS-related deaths. However, according to UNAIDS, only 44 per cent of people living with HIV and TB in 2019 had access to care.
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Research & Publications
Burden sharing or burden shifting? How the HIV/TB response is being derailed
Treatment scale-down ahead?
Stopping Senseless Deaths: Overcoming access barriers to affordable, lifesaving diagnostics and treatments for HIV and opportunistic infections
Towards Peer-Led HIV and SRH Services for Sex Workers and Men Having Sex with Men
Left behind by the HIV response - Kinshasa
MSF at IAS 2017
MSF publishes study on the accuracy of HIV rapid diagnostic tests
Untangling the Web of Antiretroviral Price Reductions 18th Edition
Fight against HIV doomed to fail without urgent focus on West and Central Africa
HIV: Antiretroviral drugs fail to consistently reach patients in countries most affected by HIV/AIDS
MSF HIV/AIDS Researchfieldresearch.msf.org
We produce important research based on our field experience. So far, we have published articles in over 100 peer-reviewed journals. These articles have often changed clinical practice and have been used for humanitarian advocacy. Read all our HIV/AIDS-related articles on our dedicated Field Research website.