Worldwide, around 15 per cent of people currently infected with the virus don't know their HIV status. In West and Central Africa, one in five people living with HIV didn't know their HIV-positive status at the end of 2020. Once someone is diagnosed with the disease, viral load monitoring - measuring the levels of HIV virus in the blood - is essential to measure whether treatment is working. While annual viral load tests are standard in wealthy countries, access in developing countries still lags far behind.
Confronting a deadly pandemic
Over 38 million people were living with the human immunodeficiency virus (HIV) at the end of 2021, the majority of them in sub-Saharan Africa. While there is no cure for HIV, a combination of drugs known as antiretrovirals (ARVs) enables people to live longer, healthier lives if taken regularly. The cost of first-line drugs is now cheaper than ever, but efforts are still needed to ensure everyone who is living with HIV receives treatment.
Globally, 28.7 million people living with HIV were receiving ARVs in 2021. This equates to a global ARV coverage rate of 75 per cent. However, only 52 per cent of children were receiving ARV treatment at the end of 2021. (All figures: UNAIDS)
There is no cure for HIV, although life-long treatment using combinations of drugs known as antiretrovirals (ARVs) helps manage the virus and enables people to live longer, healthier lives if taken regularly. While nearly 10 million more people are on treatment today than in 2016, deadly treatment gaps exist, especially among children in the Middle East and North Africa; in the latter, only half of the people living with HIV receive ARVs.
While most people living with HIV can stay healthy on first-line antiretrovirals - which cost around US$63 per person per year – some people develop resistance to this regimen and have to switch to second-line regimens. But the price of doing so is high - literally. Second- and third-line regimens are over four times the price of first-line regimens.
Low HIV prevalence rates - ranging from two to 10 per cent across West and Central African countries and one per cent across the Middle East and North Africa - have left these regions in a blind spot in the global HIV response. These regions continue to lag behind in attention and investment in tackling the epidemic, resulting in low access to testing and treatment. In West and Central Africa, children and pregnant women have dismally low rates of treatment coverage. It is unacceptable to witness people dying of AIDS within hours of being admitted to our hospitals in the Democratic Republic of Congo (DRC), Guinea, Kenya and Malawi.
In conflict settings and when people are displaced, ensuring the continuity of care for people with HIV - including a long-term supply of drugs - can be difficult. Logistical and security issues are barriers for both our teams and patients in ensuring that people living with HIV can access the care and treatment they need to stay healthy. In Yemen, providing uninterrupted treatment during years of war has proved logistically challenging - and dangerous to our staff and patients.
So-called ‘key populations’, or groups of people, include people disproportionately affected by HIV, including sex workers, people who inject drugs, men who have sex with men, and prisoners. Despite their higher risk of acquiring HIV, these key groups are often excluded from accessing HIV treatment and prevention as well as comprehensive health services. Stigma, discrimination, social exclusion, violence and criminalisation are part of their daily struggles. In Mozambique, MSF provides packages of HIV and sexual and reproductive healthcare services for sex workers and men who have sex with men in key sites.
HIV lowers the body's immune response and, without effective treatment, leaves people living with the disease much more vulnerable to deadly opportunistic infections like tuberculosis (TB). TB is the single biggest killer of people living with HIV, accounting for around 30 per cent of AIDS-related deaths; However, according to UNAIDS, only under half of the people living with HIV and TB had their TB diagnosed and notified in 2021.