Spain, Cambodia bring results for an AIDS-free generation

December 2, 2013


Yesterday was the 25th anniversary of World AIDS Day.  This year’s theme, “Shared Responsibility: Strengthening Results for an AIDS-Free Generation,” reminds us of the event’s original mission in 1988: uniting people, from Argentina to Zimbabwe, to fight the lethal virus and to honor individuals who have died trying.

For me this year, the concept of “strengthening results for an AIDS-free generation” takes on a new – or at least a different – meaning as I’ve recently started working at IHME. Researchers here are focused on understanding the world’s burden of diseases, and rigorously evaluating what is and isn’t working to improve the health of populations worldwide. For HIV/AIDS specifically, researchers aim to provide the best understanding of how each country’s HIV/AIDS burden is changing over time. Armed with these results, researchers hope that countries can strengthen the programs and package of interventions they use to further reduce and prevent HIV/AIDS transmission.

So what are the results telling us – and how can we use them to support an AIDS-free generation?

(1) What the data say today:

Since beginning of the HIV/AIDS epidemic, the World Health Organization (WHO) reports that 70 million people have been infected with HIV worldwide. According a recently published paper documenting HIV/AIDS trends, just over 25 million people died from HIV/AIDS between 1980 and 2010. Globally, the epidemic peak in HIV/AIDS deaths took place in 2006, with the total number of people dying from HIV/AIDS falling 15% by 2010.

Fewer people are dying from HIV/AIDS today than at the global epidemic’s peak, but the number of people living with HIV continues to rise worldwide. This seemingly contradictory result is influenced by two factors, one emerging from success and one arising from a daunting challenge. The good news: the scale-up of HIV/AIDS treatment has allowed more people with HIV/AIDS to remain alive – and healthier – for longer periods of time rather than dying soon after they are infected with HIV. The bad news: new cases of HIV are rising in places where the burden of HIV/AIDS has relatively lower (such as in Asia and the Pacific).

(2) How to use these results for an AIDS-free generation

There are many ways to gauge progress in the fight against HIV/AIDS: reduction in mortality rates, declines in new cases in many countries, increases in the number of HIV cases treated, and so on. At the population level, HIV/AIDS research specialists, such as IHME’s Katrina Ortblad, recommend looking at the decrease in HIV/AIDS deaths from a county’s epidemic “peak to present” (or 2010 in this case, as that’s the most recent data point available). This percent reduction can reflect how well a country has responded to its own HIV/AIDS burden, especially in terms of reducing untimely death from the disease.

So which countries have shown some of the most notable progress? In an earlier post, a map of “bright spots” highlighted a number of places where HIV/AIDS deaths have dropped dramatically between the country’s epidemic peak and 2010. Here’s a deeper dive into two standouts:

Cambodia: a global leader in reducing HIV deaths

In 1998, Cambodia had one of the highest HIV prevalence rates in Asia; twelve years later, the country led the world in reducing HIV/AIDS deaths by 86% from its epidemic peak in 2003 to 2010. According to a 2008 interview with Dr. Mean Chhivun, the director of Cambodia’s national HIV/AIDS program, a likely game-changer was the implementation of Cambodia’s Continuum of Care HIV program in 2003. Prior to 2002, Dr. Vun explained, very few HIV-positive individuals received any treatment in Cambodia. In 2001, only 71 patients received antiretroviral therapy (ART) in the entire country. The Continuum of Care program brought together a comprehensive treatment model, ranging from pediatric services to community support, and was quickly scaled up throughout Cambodia (from 20 sites in 2003 to 230 by 2008).

Spain: a model of how to target high-risk populations for HIV and succeed

In the early 1990s, Spain had one of the largest HIV/AIDS disease burdens in Europe. Between the country’s epidemic peak in 1995 and 2010, Spain recorded an impressive 85% reduction in deaths from HIV/AIDS (ranking third, in terms of progress, only behind Cambodia and New Zealand). Prior to Spain’s epidemic peak, it was recognized that a large proportion of new HIV cases was occurring among injection drug users. In response, the country enacted policies to legalize the use of methadone to treat heroin dependence, widely distribute sterile injection equipment to users, and improve access to HIV/AIDS treatment. According to the Bulletin of the World Health Organization, these actions “led to a turnaround in the country’s HIV epidemic.”

As demonstrated by Cambodia and Spain, concerted action – and shared responsibility – can help lower deaths from HIV/AIDS.

As mentioned in this blog post, we’ve partnered with the Institute for Health Metrics and Evaluation to share instances of positive deviance in the Global Burden of Disease data. Every week, we’re highlighting a new statistic, which we hope journalists can use as inspiration for stories. You can see the full series by clicking on the “Positive Deviants (GBD)” category on the right of the page.


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