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The near-elimination of HIV transmission in inner Sydney last year was a remarkable achievement, not least because there is no vaccine or cure, and the city was once one of the epicentres of the disease.
Experts say it resulted from the commitment of clinicians, activists and politicians to deploy the preventive tools that are currently available – and that it shows just how effective those tools can be. They comprise regular testing, education on safer sex, prophylactic drugs that block transmission, and giving treatment to people living with HIV because it prevents them passing the virus on and enables them to live long and healthy lives.
Some 39mn people worldwide are living with HIV and 1.3mn were infected last year. The virus disproportionately affects people in Sub-Saharan Africa and men who have sex with men.
The UN has set global targets for 2025 of 95 per cent of people with HIV knowing they have it, 95 per cent of that subset being on drug treatment, and 95 per cent of them achieving suppression of the virus to undetectable levels.
Some countries, particularly those with smaller populations and higher burdens of disease, have seen big falls in infections, and steady progress is being is being made at a global level.
Meg Doherty, head of the HIV programme at the World Health Organization, says “the secret sauce is political commitment”. While the numbers “can look relatively good in some places”, says Doherty, “as we start to look towards elimination [of HIV], we have to think about the entire population”, including those not identified or on effective treatment.
While it is a big achievement for about 70 per cent of people living with HIV to have suppressed the virus, that still leaves “30 per cent of people living with HIV walking around with the virus at some level that could contribute to new transmissions”.
The nations doing well against the targets have done so because of funding, leadership and collaboration between civic society and politicians, say experts.
“These are the countries that had high rates . . . of deaths in the 90s,” says Doherty. “There’s a feeling of ‘We’re not going to go back there, we need to do all that we can do not to go back there’.”
The reasons why countries do badly include lack of funding and repressive laws that discourage important sections of the population from engaging with health services. “We have pockets of great success, and we have pockets where HIV has been ignored,” says Doherty.
The fall in infections has been greatest in certain big cities that were early
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