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"We have reached a crossroads"

23.07.2018 - Article

From July 23 to 27, scientists, people infected with HIV and their families are meeting in Amsterdam at this year's International AIDS Conference. Our German expert Dr Kai Gesing explains the current danger posed by the human immunodeficiency virus (HIV).

The fight against HIV is expensive. People affected need medication, prevention campaigns have to be financed.
The fight against HIV is expensive. People affected need medication, prevention campaigns have to be financed.© KfW
Never before have there been so many people infected with HIV receiving treatment as there are today. And that's good news!

Dr. Kai Giesing: That is very good news! On the one hand, for the people affected because they can live longer, healthier lives, even though the drugs can have considerable side effects. On the other hand, it has been shown that the number of viruses in the body fluids is greatly reduced by treatment if the people affected take the medication correctly and have not developed resistance to it. This also reduces the likelihood that the virus will be further transmitted.

This lowers the number of new cases. The UN organisation UNAIDS reported in 2017 that the number of people infected per year had fallen by 1.8 million. In 1997, this figure was 3.5 million, or almost twice as high. But the organisation is still not happy with this development. Why?

Because it's not happening fast enough. The United Nations has set itself the target of fewer than 200,000 new infections worldwide by 2030. While the downward trend is visible, and the rate continues to fall in many countries, the curve is levelling off. In a few regions the numbers of new infections are even on the rise. There is therefore reason to fear that this target cannot be reached.

HIV Red Ribbon
HIV Red Ribbon© KfW
Now a disproportionately higher number of people are affected in developing countries than in the industrialised nations. 60 percent of those affected worldwide live in Sub-Saharan Africa alone. Are these countries even in a position to fight the virus?

The people there need our support. At the United Nation's Millennium Summit in September 2000, the participating countries thus stated, among other things, their intention to intensify efforts to fight infectious diseases together. The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) was formed to achieve this goal. Many countries and private companies pay into this fund. Germany is one of the most important donors. The funds are used to finance all possible approaches to combating malaria, tuberculosis and AIDS.

Does that mean handing out condoms?

Not only. Of course, sexual transmission is the most important. But it is not enough to just distribute condoms. We also need to raise awareness and create incentives to change behaviour. The range of preventative medical tools has also broadened in recent years. One example is pre-exposure prophylaxis. Partners of people infected with HIV take HIV drugs to keep from becoming infected. This is an effective measure.

Condoms are an effective means of protection against HIV infection. This fact has to be widely spread, which is the only way to win the fight against the virus.
Condoms are an effective means of protection against HIV infection. This fact has to be widely spread, which is the only way to win the fight against the Virus.© KfW
Can you provide a few other examples?

Yes, we have found that the social environment in risk areas also plays a significant role. In South Africa, we work with young women who are economically dependent on "sugar daddies" who are infected with HIV. These men, who are usually older, persuade the women to engage in unprotected sexual contact with small gifts. We try to empower the women so that they are not forced to get involved with these men. In addition to sexual contact, the virus can also be transmitted when drug addicts share needles, through mother-to-child transmission and blood transfusions. In these areas, the German development bank KfW has invested in various countries, for example, by strengthening blood banks and ensuring that blood reserves are pure, i.e. free of HIV.

New statistics for the southern and eastern parts of Africa give reason to hope: the incidence of new infections there has fallen by almost 30 percent since 2010, in children by as much as 55 percent. How can this positive development be explained?

The successes in Sub-Saharan Africa firstly have to do with the realisation that HIV is a major problem that needs to be combated and requires massive investment. Secondly, since 2000, the available funds have risen every year and are now at a very high level. This level either needs to be maintained or further increased if we want to successfully end HIV in Africa.

At the same time, there are reports from the Middle East, North Africa and from Eastern Europe to Central Asia that the number of new infections there has risen by 60 percent since 2010. How can this be?

Every country has specific particular characteristics that affect the transmission of HIV. In Central Asia and Eastern Europe, the primary cause of the epidemic is that drug addicts share dirty needles and become infected. In addition, addicts have poor access to care and diagnosis and often have to finance their drug consumption through prostitution. Especially in the Middle East, another problem is that HIV is a taboo subject and not acknowledged as a threat.

What measures can help contain the epidemic there?

The prevention campaigns there must be specifically adapted to meet local factors. In some regions, it is not possible to just encourage the use of condoms. Studies have shown that, in Central Asia for example, infection is most widespread among drug addicts. As a consequence, specific programmes focus their efforts on this target group. It is primarily a question of preventing drug addicts from sharing needles. Or some work to get people away from needles altogether by handing out methadone in tablet form.

© KfW

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