World AIDS day is marked on the 1 December each year to remind people about the HIV and AIDS epidemic. Globally, an estimated 35 million people are living with HIV according to the latest United Nations Joint Programme on HIV/AIDS (UNAIDS) report (available at http://www.unaids.org/en/dataanalysis/knowyourresponse/globalaidsprogressre...). In the report, UNAIDS has launched its ‘Fast-Track’ strategy (details at http://www.unaids.org/en/resources/documents/2014/) with targets to end the world AIDS epidemic by 2030. The 90-90-90 approach by 2020 means we need to achieve: 90% of people living with HIV knowing their HIV status; 90% of people who know their HIV-positive status on treatment; and, 90% of people on treatment with suppressed viral loads. Other targets include zero discrimination and reducing the annual number of new infections among adults to 500,000 – a 75% reduction on the currently estimated 1.9 million per year. The focus is on the 30 countries which account for 89% of new infections.
The epidemic has slowed in recent years. There were an estimated 2.1 million people newly infected with HIV in 2013, the lowest number recorded since the late 1990s when approximately 3.5 million people were acquiring HIV each year. This is equivalent to 6000 per day, 700 of whom were among children aged under 15.
In 2013, there were 1.5 million deaths from AIDS-related illnesses; the increased scale up of HIV treatment access continues to save lives and maintains the downward trend in AIDS-related deaths since the peak in 2005 when 2.4 million died. There has been a remarkable scale up in access to HIV treatment in the past five years from 7.4 million in 2009 to 13.6 million to the end June 2014 and this may yet reach the target of 15 million on treatment by 2015. There are however, significant gaps with regards to treatment access for infected children. Early initiation of treatment will save more lives and the World Health Organisation (WHO), in June 2013, recommended initiating antiretroviral treatment (ART) in those with a CD4 cell count <= 500cells/mm3 (http://www.who.int/hiv/pub/guidelines/arv2013/download/en/index.html).
This HPS Weekly Report includes the latest quarterly update on HIV infection in Scotland. This shows that, to the end of September 2014, there were 267 new reports of HIV infection in individuals not previously known to be infected. Based on these data, it is anticipated that the annual total for 2014 will be similar to those reported in the preceding four years (averaging 356 reports). Unprotected sexual intercourse among men who have sex with men (MSM) still appears as the main route through which new HIV infections are acquired in Scotland.
At the end September 2014, there are an estimated 4800 individuals who have been diagnosed and are living with HIV in Scotland. However, a proportion of individuals, an estimated 24% in 2013 according to the latest UK report (available at https://www.gov.uk/government/statistics/hiv-in-the-united-kingdom), remain undiagnosed. The evidence suggests that most new infections are a result of transmission from individuals who are unaware of their status - earlier and more frequent testing is essential to reduce this.
Access to treatment and care in Scotland is good: in the past year (from 1 July 2013 to 30 June 2014), almost 4000 individuals attended specialist services for HIV treatment and care. Of those attending, 90% are receiving antiretroviral drugs. Therapy continues to be successful: 96% of patients undergoing treatment had evidence of viral suppression at their last attendance. Thus, continuing high levels of care and treatment are being provided for the increasing number of people living with HIV in Scotland. There is, however, evidence that individuals are being diagnosed at a late or very late stage of infection when treatment may be less effective on a weakened immune system. In 2013, half of those newly diagnosed, and not previously known to be positive in Scotland, were at a late stage of infection. This further highlights the importance of widening access to, and increasing the opportunities for, HIV testing and getting people into treatment and care as early as possible.
The Scottish Government’s Sexual Health and Blood Borne Virus Framework (August 2011, http://www.scotland.gov.uk/Publications/2011/08/24085708/0), aims to reduce the number of HIV transmissions taking place in Scotland through increased prevention, increasing early diagnosis and improving the treatment and care of those living with the virus. Based on multi-agency partnership working to address a number of recommendations and through the monitoring of high level outcomes, the framework supports improvements in sexual health and wellbeing and addresses the impact of bloodborne virus infections in Scotland.