South-East Asia Regional Conference on Epidemiology

Towards universal access to HIV prevention
and care
Charles Gilks
Globally, over 33 million people were estimated to be living with HIV at the end of 2008. HIV is a
preventable disease. It is also very easily treatable but is not yet a curable infection. The global estimates
of HIV cases are lower than those of any other infectious or chronic disease. The reasons for this are
twofold: first, there is an extremely accurate serological test which is low-cost, very simple, highly
sensitive and specific; and, second, many countries routinely survey antenatal women for HIV infection.
Moreover, many countries are doing good-quality household biological and behavioural surveys, which
is even a more sensitive way to derive population-based numbers of people living with HIV infection.
It was estimated in 2008 that about three million new cases of HIV infection had occurred in the
world. There is no accurate way to know the number of new infections; however, incident cases can be
relatively easily estimated from the prevalent adolescent cases. Two thirds of the global burden of the
disease is in sub-Saharan Africa. In <strong>Asia</strong>, it is about 10%, and, of these, India accounts for the majority
or about 50%. At one stage, HIV was reckoned to be an epidemic which was out of control in India,
but now there is no evidence of increase but actually it is on the decline. The number of HIV cases
has been declining from an estimated 2.5 million in 2002 to about 2.3 million now. Numerically, India
as a country has the third largest number of people living with HIV. It is a big country with a large
population but its prevalence rates are quite low. The decline in prevalence is a little bit faster because
one of the issues that have made the interpretation difficult is the dramatic increase in the population
size. There are some secular trends also which are driving down the prevalence, which is not all due
to successful HIV interventions.
HIV is an eminently preventable infection; however, one could say that the prevention programmes
are not doing particularly well even after 25 years of intense efforts and a significant evidence base
of what works and what does not. Over 7000 new infections occur every day and nearly 97% of
these infections are occurring in low- and middle-income countries. The rich countries are pushing
forward to achieve universal access to the prevention component of a comprehensive package. This
is most evidenced with vertical transmission: in North America, Europe and Australia, HIV infection
transmitted from pregnant mother to infant has almost entirely been eliminated. However, still 1200
new infections occur every day in children globally. There is a growing feminization of the epidemic.
Now there is gender parity in the number of new adult infections globally. Increasingly, infections are
being seen in young people, adolescents and young adults who are traditionally quite difficult targets
for effective public health interventions.
Untreated HIV infection is usually fatal but now highly effective antiretroviral therapy (ART)
is available and accessible. Despite this, about two million people die of HIV every year, with the
majority in sub-Saharan Africa. The large number of deaths is a big challenge for a comprehensive set
of packages for HIV at a national or regional level. However, because of better access to combination
ART, deaths are lower than it used to be a couple of years ago. Programmes are doing better in